Cancer Rx: Move?
Exercise May Have Role in Treatment

By Lindy Washburn
The Record (Hackensack, N.J.)
Tuesday, June 17, 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.

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.

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.

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

Beth Wajts of Hillsdale, N.J., joined a 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, N.J., 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."

Angelo Chiusano, 81, joined the Y's program 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," he 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 has 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 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.

· 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 to 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. But studies have shown exercise also 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 underway.

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 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, N.J., 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 have had mastectomies and underarm incisions restore their 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.