Connections is a quarterly newsletter for primary care providers covering the latest developments and advances in medicine at OHSU. Learn about the many clinical, education and outreach resources available to you and your patients.
From the OHSU Knight Cancer Institute
Kerri Winters-Stone, Ph.D.
Dr. Winters-Stone is a co-leader of the OHSU Knight Cancer Institute Cancer Prevention and Control Program and the Elnora Thomson Distinguished Professor in the OHSU School of Nursing. Her research focuses on exercise, health and longevity in cancer patients and survivors.
If you advise patients to exercise, you're not alone. Providers often cite the U.S. Department of Health & Human Services guidelines for 150 minutes of moderate exercise or 75 minutes of vigorous exercise per week, though patients do not always follow them.
Until recently, however, not all oncologists have advised patients to exercise. Now, OHSU Knight Cancer Institute research is showing strong benefits to exercise tailored for cancer patients and survivors. In a group of 90 women who were receiving or completed breast cancer treatment, those who got a recommendation to exercise plus a free DVD of yoga exercises—with three levels of difficulty for varying abilities—reported less overall fatigue than those receiving a recommendation alone.
Guidelines recommend exercise
In 2010, the American College of Sports Medicine published guidelines for cancer patients and survivors to exercise at the same levels as the public and stay as active as possible. Previously, clinicians often discouraged exercise during treatment for fear patients would be fatigued and have difficulty completing therapy. Survivors might be advised to be active but given little or no direction.
Since 2010, the literature on exercise's benefits for treatment-related symptoms has burgeoned. Investigators are now studying whether and how exercise can improve survival. This spring, OHSU researchers will be part of developing new ACSM guidelines, to include exercise for various cancer types and specific outcomes, such as symptom management and recurrence reduction.
Reducing the inflammation marker C-reactive protein with exercise
OHSU researchers found that breast cancer survivors who participated in one strength training program reduced their blood levels of C-reactive protein by 4 percent, compared to a 57 percent increase in women in control groups who did a placebo program of seated stretching and relaxation. The data also showed that women in the exercise group that gained significant amounts of strength and/or who lost weight experienced even greater drops in CRP.
Why strength training stands out
Many patients are advised to walk for exercise. Strength training yields similar benefits, plus additional functional improvements such as more easily climbing stairs and rising from chairs. It can also slow bone loss and reduce joint pain. Strength training programs at OHSU utilize everyday moves such as standing up from a chair while wearing a weighted vest. The aim is to make such daily activities easier to accomplish.
Removing barriers to exercise
Before recommending exercise, primary care providers and oncologists should address physical impairments related to cancer treatment. Patients may need physical therapy or pain management to be mobile enough to exercise. Removing barriers is important because OHSU exercise specialists still see patients who struggle with exercise readiness – breast cancer survivors with shoulder pain and limited arm mobility, ovarian cancer survivors with pelvic pain and survivors with incontinence that inhibits their exercise capacity.
Finding community resources
Community exercise resources for patients and survivors may include:
- Nearby major cancer centers
- Community cancer centers
- Better Bones and Balance – a program from Oregon State University that is available on DVD and is often offered in community fitness centers.
- The YMCA's Livestrong program for cancer survivors
- Cancer exercise trainers certified by the American College of Sports Medicine
Why cancer-specific training?
Cancer patients and survivors may need or want lower-intensity exercise than is offered in community gyms and health clubs or need modifications. Survivors have said they feel more comfortable in classes with those who share the cancer experience. Routines can also be tailored to specific needs, such as mitigating fall risk for survivors with peripheral neuropathy or reducing bone loss and muscle weakness in men taking androgen deprivation therapy.
OHSU researchers have also studied the effects of exercise on married couples affected by cancer. One study paired patients and spouses (who are frequently also caregivers), as training partners. Couples were counting repetitions, providing encouragement, spotting each other during lifts, and doing some tandem exercises. Successfully piloted in couples where the man had prostate cancer, couples exercise will now be studied in couples who have experienced prostate, breast or colon cancer in the past two years.
Researchers are finding that exercising as a couple leads to better retention and adherence to exercise. Involving spouses may be a key to helping patients become and stay active. In another project, couples train together three days a week while the man receives radiation therapy for prostate cancer. Adherence is high, men are showing improvements in strength and mobility despite undergoing radiation therapy, and women are also showing physical improvement. These studies highlight the importance of exercise to caregiver health and to keep couples active and connected.
OHSU Knight Cancer Institute specialists are always available to consult with you. If you have questions about exercise and cancer, you may email Kerri Winters-Stone.
If you have questions or would like to refer a patient for evaluation, please call the OHSU Physician Advice and Referral Service at 503-494-4567.