Exercizing to Reduce Falls

04/22/13  Portland, Ore.

By Lee Lewis-Husk

Women who survive cancer often face new risks from the therapy itself. One well documented risk is fall-related fractures.

Why they are at risk is still unknown. To find answers, researchers at the OHSU School of Nursing are testing the idea that exercise may be able to reduce falls in older female cancer survivors.

“We don’t know whether they’re falling because they’re aging faster than other adults or whether they have some unique treatment-related risk for falling,” says Kerri Winters-Stone, Ph.D., principal investigator of a five-year, $2.8 million study funded by the National Cancer Institute.research study

Winters-Stone, an associate professor at the nursing school who earned her Ph.D. in human performance and exercise physiology, has conducted ground-breaking work showing that cancer survivors can reverse treatment-related side effects and symptoms with exercise.

In 2002 cancer survivor, Haralee Weintraub, learned she had invasive breast cancer. “(During treatment) I felt left out of the process,” she recalls. “The cancer was being treated first, and I was just the person bringing it along. When I saw my oncologist, I asked him what I could do to feel like I was the boss again of my own destiny, to get some power back.”

He suggested clinical trials and put her in touch with Winters-Stone. “I had terrible fatigue, no energy and trouble taking the garbage can 20 feet to the curb,” she says. “I’d gained 40 pounds, and when I met Kerri, she said it was from inactivity.” Weintraub enrolled in one of Winters-Stone’s early studies on exercise and bone health in women with cancers. “When I first started, I couldn’t do a single push-up. After exercising, I was able to do 10.”

Now 60, Weintraub is enrolled in the GET FIT (Group Exercise Training for Functional Improvement after Treatment) trial that will compare tai chi training to strength training in female cancer survivors 50 to 70 years old. She has been randomized to the tai chi group. Tai chi (TIE-CHEE) is an ancient Chinese martial art that involves slow, controlled movement, while moving the body outside its center of gravity. The researchers hope that tai chi may make women more stable and less likely to fall in their day-to-day activities. The specific aims of the study are to determine whether tai chi or strength training is better at reducing falls in this population and also the mechanism by which either form of exercise reduces falling. Another goal is to find out whether the benefits of either intervention last after structured training ends. A control group will receive seated stretching exercise.

A large study, the research goal is to enroll 430 women over the next two and a half years. Participants will attend group exercise class twice weekly for six months and will complete physical function tests and health surveys four times over a year. Winters-Stone says they’ll recruit about 50 new participants every three months, initiating a cycle of enrollment, testing and exercise training. “Once we get one group started, we’ll start to look for the next 50,” she explains. The study ends in 2017.

All GET FIT participants will exercise in classes around the Portland area and then go to an OHSU lab for assessment of muscle strength, gait, stability and other tests of physical performance.

“Your doctor wants to recommend something helpful to get your strength back but they’re not going to unless they have studies to prove it,” says Weintraub. “Kerri and her colleagues are supplying the proof, showing that you will regain your strength and overcome what your cancer treatments have taken away from you. “

GET FIT benefits extend beyond research

Researcher Winters-Stone and survivor Weintraub alike extol the non-scientific, emotional and psychosocial side effects of the study.

“I strongly believe that physical exercise has multiple benefits,” says Winters-Stone, adding that they’re trying to develop the right exercise programs for these women so they can reduce their risk of additional health problems and have a higher quality of life after cancer. “We believe in the power of physical activity and want to pass that value on and show women they can be successful exercisers and have control over their health. Seeing women transform is a really rewarding thing.”

Weintraub, owner of Haralee.com, a company that makes moisture-wicking sleepwear for women having night sweats, says that patients often feel a void when cancer treatment ends. “During treatment, people are concerned about your health, checking you out. But when it’s over, you’re not seeing your oncologist regularly, and you can feel almost afraid. In the study, there’s a shared understanding and camaraderie that’s almost as helpful as the exercise.”