BEATING CANCER: THE HEALING POWER OF EXERCISE

Strength To Beat Cancer: New Research Shows The Healing Power Of Exercise

The Record, Bergen County, NJ

May 18, 2008

The standard weapons in the fight against cancer surgery, chemotherapy and radiation may soon be joined by something far simpler: exercise.

New research shows that regular physical activity helps reduce the risk of recurrence of breast cancer and slows the advance of prostate cancer.

In a few years, exercise will probably be prescribed regularly for cancer rehabilitation, said Melinda Irwin, an expert on cancer and exercise at Yale University School of Medicine. Personal trainers may join oncologists, surgeons and radiologists as members of the cancer-treatment team.

Exercise will become a “targeted therapy, similar to chemotherapy or hormonal therapy,” Irwin said

Any regular physical activity the equivalent of a 30-minute walk, five times a week will do.

“Don’t think you have to work up a sweat or train for a marathon to benefit,” Irwin said.

Exercise offers many other advantages: It fights the fatigue caused by cancer treatment, calms anxiety and helps survivors feel better about themselves and their bodies.

Some personal trainers now specialize in working with cancer patients and more will soon be certified through a program of the American College of Sports Medicine. The Ridgewood YMCA offers a 12- week strength-training and fitness program for cancer patients and survivors.

About a month after breast-cancer surgery, I jumped back into the pool and a sport I’ve enjoyed for years.

I eased slowly into the full-length extension of freestyle as I tested how strongly I could pull myself through the water. Thankfully, I didn’t lose much range of motion. And just being in the pool with the early-morning regulars lifted my spirits: I was getting back to normal. Now, a few months later, I’m as fast and strong as ever moving through the water.

There are 10 million cancer survivors in the United States, 22 percent of them women who have had breast cancer, 17 percent of them men who’ve had prostate cancer. Exercise makes sense for most of them to live longer, avoid other health problems, and just feel better

Heart attack patients are now routinely put on exercise plans. But workouts for cancer patients are neither prescribed by doctors nor covered by health insurance.

“We’re where cardiac rehab was 20 years ago,” Irwin said. Once exercise was shown through research to prevent fatal heart attacks, 12 weeks of rehabilitation became the standard of care for most heart patients. In fact, many hospitals opened cardiac rehab centers.

One day, that will probably happen with cancer patients.

In the meantime, as a cancer survivor, I can’t see a downside to starting now. It needn’t cost anything walking is free and you can work out at home. The hardest part is getting started and making time.

But what stronger motivation can there be than avoiding another go-round with cancer?

Besides, I feel so much better when I exercise. Lately, during a high-anxiety round of follow-up tests, my early-morning swim and gym sessions have kept me grounded. Even when I’m bruised from biopsies, a walk always restores me especially when I have the company of my husband or a friend.

Even with a low level of exercise, people benefit psychologically, said Rita Musanti, an oncology nurse-practitioner at the Cancer Institute of New Jersey who earned her doctorate studying exercise and cancer recovery. With so many cancer survivors in the community, she’d like to see informal networks created to encourage recovering cancer patients.

I certainly cherished the encouragement from swimmers or gym members I’d known only by face who quietly introduced themselves and revealed their own stories of cancer recovery. There are a lot of us out there. We draw inspiration from each other.

‘Out of that slump’

Beth Wajts of Hillsdale joined the Ridgewood YMCA’s free “Living Healthy, Living Strong” class in January after her second surgery for breast cancer, followed by chemotherapy and radiation.

“I cannot believe the way I walked in, and the way I walked out,” she said.

“I never believed I would get out of that slump,” Wajts said. “Now I feel incredible.”

One of her classmates, Joyce Murray of Hawthorne, had three surgeries in an eight-week period last summer, then chemotherapy with many complications. No amount of sleep could cure her fatigue, she said.

After she started the twice-weekly program of resistance training and cardiac fitness, “I was surprised at the quick rebound,” she said. “I really feel better.”

Recovering from cancer was her “job for the last year,” she said, but at the program’s conclusion, she was looking forward to getting back to work as a school nurse.

Angelo Chiusano, 81, joined after 43 radiation treatments for prostate cancer and surgery for an aortic aneurysm. Thanks to the camaraderie in the weight room, “I’ve gained a new family,” the Oakland resident said. “It’s made such a difference in my feelings.”

After doing the weight-resistance circuit in the gym each session, he swam. “Then, when I go home, I walk a mile,” he said. He’s continued his workouts even though the program has ended.

Researchers are working to understand how physical activity helps fight cancer. Their findings so far suggest that exercise:

* Reduces blood levels of insulin, a substance in the body that causes cells to divide and grow more quickly. Women with high levels of insulin have a slightly higher risk of breast cancer and a much higher rate of recurrence and death.

* Helps repair infection-fighting T-cells, restoring the immune system after it has been damaged by chemotherapy.

* Reduces levels of circulating estrogen and testosterone, two hormones linked with breast, endometrial and prostate cancers. Even with medication to suppress estrogen production, some estrogen is stored in fat cells. Exercise may help by converting fat to muscle.

* Prevents weight gain and promotes weight loss, important because obesity is associated with lower rates of survival for many forms of cancer. For women with breast cancer, obesity at the time of diagnosis, and weight gain afterwards, are associated with worse outcomes. The heavier and less active a person is, the more likely her cancer will return.

Most of the scientific work so far has focused on women with breast cancer, simply because there are so many of us. But studies have also shown exercise has positive effects for survivors of colorectal and prostate cancers. Among men older than 65, three hours of vigorous activity a week was associated with a decline in death from prostate cancer.

Exercise is now considered so beneficial that cancer experts are even encouraging patients to begin or resume exercise while treatment is under way. Workouts might need to be scaled back in intensity and pace, but “evidence strongly suggests that exercise is not only safe and feasible during cancer treatment, but that it can also improve physical functioning and some aspects of quality of life,” according to the American Cancer Society.

Lockey Maissoneuve, a 41-year-old personal trainer, went through two mastectomies and chemotherapy two years ago. She is now is training for a triathlon.

“If you’re in treatment, the first week or two you try to do anything, you need to take a nap,” she said. “If there’s a day you want to exercise, do it.”

Wearing a wig was uncomfortably hot in the gym, so she switched to a kerchief. With her immunity reduced by chemo, she wiped down the equipment before she used it. She is now certified to work with cancer patients.

“The trainer is almost like your bodyguard,” said Julie Percy, of Parisi Sports Club in Midland Park, who also specializes in work with cancer patients. “We maneuver you to the right equipment, give you a sense of security.”

When scar tissue forms after surgery, it limits flexibility. Percy helps women who’ve had mastectomies and underarm incisions restore the range of motion.

Trainers have to be particularly attentive when someone has had surgery to remove lymph nodes. If the tiny valves in the vessels that transport lymph around the body fail, that can lead to lymphedema, a dreaded side effect of cancer surgery. The arm, for breast patients, or the leg, for prostate patients, becomes permanently swollen.

“We watch the amount of weights they use,” Percy said. She starts light and increases gradually. Women who have lymphedema, or a heightened risk of it, wear a compression sleeve.

Extra energy

Rita Scoccola, 43, of Wyckoff resumed exercising a year after she had a double mastectomy in 2000. She works out weekly with Percy and is in the best shape of her life.

“There’s always an awareness” of the ways her body has changed as a result of the surgery and reconstruction, Scoccola said, but her workouts, combined with healthful eating, have given her lots of energy.

The path back from a cancer diagnosis varies for each person: We start at different levels of fitness, and go through treatments of varying severity.

Feeling comfortable in my own body again, after the invasion of a terrible disease and then the medical procedures, restored much of my sense of health. It also helped me feel I could help myself, at least a little.

Becoming active again, said Maissoneuve, helped her “realize that cancer is not a jail sentence. It’s a big bump in the road. But you can find your new normal, and have a great life.”

What exercise can do

Exercise is considered an important preventive measure for all types of cancer. It also benefits cancer patients and survivors. Many studies have focused on the benefit of exercise for breast cancer survivors. They found:

* Physical activity after diagnosis may reduce the risk of death from the disease. The greatest benefit occurred in women who did the equivalent of walking three to five hours a week at an average pace.

* Exercise can help repair immune systems damaged by chemotherapy.

* During and after cancer treatment, physical activity improves cardiac fitness and energy levels.

* It helps to control weight. Being overweight or obese is associated with a worse prognosis.

* It improves self-esteem and lessens depression, anxiety and fatigue.

Studies of exercise and prostate cancer found that, among men over 65, three hours of vigorous physical activity a week was associated with a reduced risk of dying from the disease or being diagnosed with it at an advanced stage.

For information, see “Nutrition and Physical Activity During and After Cancer Treatment: An American Cancer Society Guide for Informed Choices.” It is online atcaonline.amcancersoc.org/cgi/ content/full/56/6/323.

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