Actively fighting cancer
Although it may seem cruel to ask people in the throes of cancer treatment to hop on a treadmill or lift weights, Julie Main has long believed that exercise can play an important role in helping patients to heal.
“Surgery cured my cancer, but exercise got me through the whole process,” said Main, who is general manager of the Santa Barbara Athletic Club.
Now scientific research is supporting her view. Physical activity, scientists are finding, can offset some of the debilitating effects of cancer treatment, including fatigue, weight gain, anxiety and depression.
“Patients who exercise report less fatigue, more energy and a better feeling of general well-being,” said Dr. Anne McTiernan, director of the Prevention Center for the Fred Hutchinson Cancer Research Center in Seattle.
In a study published in Cancer Practice in 2001, researchers at Johns Hopkins University in Baltimore found that breast cancer patients who exercised three or more days a week for a total of at least 90 minutes reported significantly less fatigue and emotional distress, as well as a higher quality of life, than women who did no purposeful exercise.
Such findings are holding true for patients undergoing treatment for other forms of cancer too.
Dr. Fred Kass, medical oncologist and director of research for the Cancer Center of Santa Barbara, now recommends exercise for all his patients.
“I don’t wear a sweatshirt and a whistle, but I do everything I can to get my patients to exercise during treatment,” he said. “Doctors don’t do patients any favors by promoting bed rest. It is absolutely clear that the more exercise patients get, the better they do.”
He adds that although exercise doesn’t erase all the side effects of cancer therapy, it makes them more manageable.
Main is the first to agree. Diagnosed at age 36 with Stage 2 breast cancer, meaning the cancer had spread but was not yet considered advanced, Main had a mastectomy, reconstruction and six months of chemotherapy.
Though fit when she was diagnosed, she was by no means an athlete. But during her chemotherapy, she exercised three to four days a week, taking group step classes at the gym, walking on the treadmill and doing weight training. “I never missed a day of work and continued to care for my two young children,” she said, crediting her fitness regimen with giving her energy and stamina. Eleven years later, she’s still cancer free.
After Main and her doctor observed that exercise seemed to improve her quality of life when compared with that of other cancer patients, Main co-founded the Cancer WellFit Program with business partner Paula Lilly to help other cancer patients feel better too.
The program, sponsored jointly by the Santa Barbara Athletic Club and the Cancer Center of Santa Barbara, offers cancer patients a free 10-week membership to the health club and the opportunity to work out with other cancer patients under the guidance of certified personal trainers. The program enrolls up to 200 new patients a year.
Trainers encourage clients to do 30 minutes of cardio several times a week on their own, then lift weights with guidance at the club. The aerobics improves clients’ conditioning, but the focus on building lean body mass is crucial.
Adjuvant cancer therapy -- including chemotherapy and the hormone therapy prescribed for prostate cancer patients -- zaps lean body mass and changes body composition, said Wendy Demark, associate professor of surgery at Duke University in Durham, N.C.
Staying on the couch makes matters worse, she adds. Losing lean body mass, or muscle, leads to greater weakness and fatigue. That coupled with the emotional blow of cancer can lead to depression.
“The only way to offset the bodily changes is through exercise,” said Demark.
As women age, they naturally tend to lose lean body mass and add fat, but research has shown that the bodies of women undergoing chemotherapy lose more lean muscle and add fat at a rate 10 times faster than women who are not undergoing cancer treatment. (Men also undergo a similar body composition shift as they age, Demark said.)
A study published in the Journal of Clinical Oncology in 2001, for example, tracked 53 women being treated for breast cancer. The group’s average body fat at the beginning of the study was 33.6%. One year later it was 35.8%.
Researchers aren’t sure why women undergoing chemotherapy add fat and lose muscle so rapidly.
“One theory,” said Demark, “is that chemotherapy is designed to attack fast-growing cells. Muscle cells grow faster than fat cells, so may be more of a target. Another potential reason is that chemotherapy shuts down ovaries and throws women into accelerated menopause.”
Weight training is particularly helpful to cancer patients, Main said. It builds muscle, which increases strength, burns more calories per pound than fat, promotes a feeling of well-being and reverses the deconditioning that occurs among idle cancer patients.
Preliminary studies are also showing that exercise reduces the rate of cancer recurrence.
In a report presented at the American Assn. of Cancer Research in March, researchers from Brigham and Women’s Hospital in Boston and Harvard University studied 2,296 women with breast cancer, all of them participants in the Nurses’ Health Study. Researchers looked at the exercise levels of these women starting at two years after their diagnosis, and tracked them from 1986 to 2002.
“The relative risk of death from breast cancer was decreased with every level of physical activity compared to being sedentary,” said Dr. Michelle Holmes, lead investigator for the study.
Recurrence rates dropped 19% among women who did the equivalent of walking one to three hours a week, and 54% less among those who exercised three to five hours a week.
“We already knew that exercise improves quality of life after a breast cancer diagnosis. [But] we were able to show that even moderate physical activity improves the odds of surviving breast cancer,” Holmes said.
McTiernan, author of “Breast Fitness: An Optimal Exercise and Health Plan for Reducing Your Risk of Breast Cancer” (St. Martin’s Press, 2000), said that one possible reason for the improvement in the odds was that exercise reduces the levels of insulin and estrogen in the body.
“Both those hormones have been shown to boost the rate of cancer cell growth,” she said. “Exercise also boosts immune function, which can help keep cancer in check.” (Because being overweight increases the chance of cancer recurrence, keeping weight off through exercise helps too.)
Doctors acknowledge that not every cancer patient feels up to exercising. Certainly, right after surgery, patients need to take it easy and start exercising only with a doctor’s approval. But once patients get the green light, Kass encourages them to push their limits. “If all they can do is walk around the house once a day, I ask them to try twice.”
For cancer patients who can’t fathom a brisk walk outdoors, experts advise them to do what they can. “If you need to hunker down and stay inside, then put on a yoga video,” said McTiernan, “but do something. It’s productive to do a little more than you feel like.”
Main recalls that when she took her step classes during her treatment, “every step felt like torture. But I would feel so much better afterward. I just kept telling myself when I felt miserable that the exercise was for my future.”
She also liked the feeling of control exercising gave her. “After you get a cancer diagnosis, you have few choices about what’s going to be done to your body. Exercise lets you take back some control.”
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Where to find an exercise program
To find an exercise program for cancer patients, try these resources:
The American Cancer Society can refer you to support and exercise groups by region. Call (800) ACS-2345 or go to www.cancer.org.
The Well-fit Program, in Santa Barbara, can direct you to other similar programs in your area. Call (805) 966-6147 or go to www.cancerwellfit.com.
The Leukemia and Lymphoma Society sponsors Team in Training, an endurance training program for people who want to raise money to find a cure for these cancers. Call (800) 955-4572 or go to www.teamintraining.org.
Team Survivor is a health and fitness resource for women affected by cancer. The organization has chapters across the country. In Los Angeles, call (310) 829-7849 or go to www.teamsurvivor.org.
The Wellness Community is a national nonprofit support group for cancer patients, with locations throughout Southern California. To find exercise programs in your area, call (888) 793-WELL or go to www.thewellnesscommunity.org.
