Cancer and Exercise

[Guest guest]

The below may be of interest.

Said the Doctor to the Cancer Patient: Hit the Gym

August 14, 2008

By ANAHAD O'CONNOR

http://www.nytimes.com/2008/08/14/health/nutrition/14fitness.html?

_r=1 & ref=health & oref=slogin

AS the group of women trickled into the aerobics studio at the

Bendheim Integrative Medicine Center in Manhattan on a recent

Thursday morning, there were subtle signs that this was no ordinary

fitness class.

One woman told the instructor that she had missed a string of

previous classes because she was grappling with fatigue, a side

effect of her new cancer medication. Others wore colorful wraps on

their arms, containment sleeves meant to protect against lymphedema,

a painful swelling of the arm stemming from breast cancer surgery.

Sponsored by Memorial Sloan-Kettering Cancer Center, this class for

cancer patients has been around for some time, mostly in a league by

itself. But in recent years, following studies that found exercise to

be beneficial in combating the effects of cancer, the class has

gained some company.

Gyms and fitness centers have begun stepping in to meet a small but

growing demand for programs designed to not only hasten recovery but

to address the fatigue of chemotherapy, the swelling of lymphedema

and the loss of muscle tone.

There have always been athletically inclined patients who stayed

active, even competitive, in the wake of a diagnosis. A recent high-

profile example is Shanteau, an American Olympic swimmer who

decided to put off testicular-cancer surgery until he had competed in

Beijing.

But most of the roughly 10 million cancer survivors in the United

States are not amateur Lance Armstrongs. Many, though, are inspired

by celebrities like Mr. Armstrong, seeing them as models for how to

come out on the other side of often-debilitating treatment regimens.

A new program from the Y.M.C.A., in partnership with the Lance

Armstrong Foundation, offers cancer fitness classes at more than a

dozen Y's in 10 states. At the women's gym Curves International,

researchers from Fox Chase Cancer Center in Philadelphia are looking

at whether overweight breast-cancer patients can keep to a five-day-a-

week Curves routine for six months. And survivors are organizing

their own classes.

" There used to be this understanding that if you're getting treatment

you're supposed to be in your bed, " said Pam Whitehead, an architect

and survivor of uterine cancer who started the Triumph Fitness

Program at gyms in Modesto and West Sacramento, Calif.

In some cases, oncologists are prescribing exercise, gently prodding

patients to tackle whatever activity they can manage: light walking,

simple stretches, exercise with resistance bands.

" I started in 1992 and that was really a time when not as many

patients were exercising, " said Dr. andra Heerdt, a breast

surgeon at Sloan-Kettering who is conducting a pilot program

involving exercise. " If a patient came to me back then and asked

about exercise, I would have said there wasn't really any

information. "

But now, she added, " they have a lot of options. "

Rahn, 46, an associate professor of political science at the

University of Minnesota, knows this well. After a double mastectomy,

her shoulders hurt so much that she was often hunched in pain. Then,

while researching her illness, she discovered a 2005 study on cancer

and exercise.

" The effects — what we call effect sizes in statistical research —

were enormous, " she said, " and I was like `How come no one is talking

about this?' " She had given up exercise a decade earlier, but the

study inspired her to go back to the gym.

" I started feeling so much better, " she said. " And it struck me that

if I'm feeling this good, then every cancer survivor should. "

So she founded a nonprofit group called Survivors' Training, and in

January opened a fitness studio in White Bear Lake, Minn., offering

yoga, strength training, Pilates and Nia, which combines dance and

martial arts. " I like to think of it as a support group that moves, "

she said.

Cancer experts say the shift in thinking began in the mid-1980s,

coinciding with a greater awareness of health and fitness.

Oncologists were faced with questions about exercise that they had

never heard before: how much was allowable and when?

Scientists also took notice of studies showing that those who were

physically active and eating well were less likely to develop cancer.

They then asked what impact exercise and diet would have on those

with the disease, said Dr. Fuchs, an oncologist at the Dana-

Farber Cancer Institute in Boston who studies cancer and exercise.

In the last eight years, a dearth of research has become a flood of

studies. Among them is one sponsored by the National Cancer Institute

in 2006 that looked at the effects of moderate exercise on groups of

breast and prostate cancer patients undergoing radiation therapy for

six weeks.

Those assigned to a daily program — taking walks of increasing

distance and doing exercises with a resistance band — had less

fatigue, greater strength and better aerobic capacity than those who

were not instructed to exercise. This finding, and similar ones, has

been replicated many times.

Other studies indicate that moderate exercise has additional benefits

like strengthened immune function and lower rates of recurrence.

Studies at Dana-Farber found that nonmetastatic colon cancer patients

who routinely exercised had a 50 percent lower mortality rate during

the study period than their inactive peers, regardless of how active

they were before the diagnoses.

Dr. Fuchs, a study author, said it influenced his advice. " I am

counseling all of my patients to increase their activity, " he

said, " or if they were regularly exercising before their diagnosis,

to continue. "

But every recommendation has its caveats. There will be days during

treatment when meaningful activity is not possible, oncologists say,

and that's fine. The American Cancer Society promotes moderate

exercise but encourages patients to discuss their exercise plans with

their oncologists, and lists on its Web site 13 precautions

(cancer .org/docroot/MIT/MIT_0.asp).

In the biweekly Focused Fitness class at the Bendheim Integrative

Medicine Center in New York, the instructor, Donna , seeks to

ease her charges back into exercise after, and often during,

physically draining treatments.

Arm extensions and other range-of-motion exercises that can help

relieve lymphedema were first on the agenda on a recent morning,

followed by heart-pumping lunges and core exercises. A woman who had

breast cancer slogged through a set of isometric exercises. " It looks

easy, " she said, " but try keeping your arms up all the time when your

nerves have been cut. "

Ms. , a registered nurse, encouraged the woman to keep pushing.

Then she looked at the class and turned to a visitor. " They're

amazingly strong, " she said.

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Carruthers

Wakefield, UK