Rope-a-dope and cancer – don’t punch yourself out.

 

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Boxing was a big deal when I was growing up, and the brilliance of Muhammad Ali’s boxing strategies stand out: ‘crazy man’ against Sonny Liston; and, ‘rope-a-dope’ against George Foreman are my favorites.  Getting into the heads of his formidable opponents gained Ali an edge, and the wins, but it also highlighted something important, effort is not everything, knowing when to give it all is.  If you want to win a marathon you don’t run the first mile as fast as you can, measured patience is valuable, thinking things through is important.

I think many cancer patients can learn from Ali’s strategies.  It’s often heard, and it may be the only frame of reference that newly diagnosed cancer patients have going into their first treatments, ‘I’m fighting hard against cancer’, and Jim Valvano’s ‘Don’t give up, don’t ever give up’.  Worthy mantras for sure, attitude is important.  However, Ali exploited a similar mindset in 1974 when fighting George Foreman for the heavyweight champion of the world in the famous Rumble in the Jungle in Kinshasa, Zaire.

Ali let Foreman punch him round after round, absorbing the blows while leaning back against the ropes, guarding his body and face with his arms and gloves.  The undefeated Foreman eventually grew tired, punched out, and Ali then came off the ropes and knocked  Foreman out in the eight round.  Ali strategized NOT to stand toe to toe and match brute punch with brute punch.  Instead, Ali exploited Foreman’s aggressiveness to his own advantage, until George was tired and vulnerable, then Ali was able to quickly finish him off for the heavyweight title.  As the fight was developing Ali was being criticized and questions for how he was, or was not, fighting, but he knew exactly what he was doing, and it worked perfectly.  Ali went against conventional thought and won.

Can cancer patients learn from this?  Perhaps.  Cancer patients can beat cancer but lose the battle to an infection due to their weakened physical condition.  Can exercise help, probably.  Can considering how to fight help as well?  I say yes.  I have an example from one of my own treatment experiences.

I had heard about bone pain associated with Neulasta (Pegfilgrastim), a common drug given to chemotherapy patients to boost their white blood cell counts and to help prevent infection.  After receiving my first injection of Neulasta I waited for the bone pain to start.  After a few days I didn’t have any pain, I felt lucky.  However, on the third day, while driving to complete some errands, I started having pulsing pain in my pelvis.  I thought, pelvis, a large flat bone that produces blood cells, this makes sense.  The pain would pulse stronger with each heart beat, for about 8 beats, then it would subside for about another 8 beats, giving me welcome relief from the pain before repeating this cycle.  It must have frightened other drivers to see me gripping my steering wheel with white knuckles, grimacing hard, and shouting out.  I wasn’t working on Ali’s ‘crazy man’ strategy either.  Good thing they couldn’t hear me in the car!

When I got home I called the oncology clinic to tell them about the pain and to find out what I should do.  I was told to use some Tylenol, which blunted the pain, although I could still feel the pulsing going on.  Ok, this is part of dealing with cancer and cancer treatments.  Tough it out, I’m fighting cancer I thought.  That night the pain moved from my pelvis to my sternum, another flat bone, makes sense.  I thought my femur (the head of long bones produce blood cells too) might be next.  However, the experience of the sternum pain was different.  Although the pain was blunted, I started feeling my blood pressure drop and I got some mild chills and shakes.  This concerned me since I was already laying down, and the direction my blood pressure was headed, lower, wasn’t a good direction.  I didn’t tell my wife, something common between cancer survivors and their caregivers, since she had just fallen asleep, but I was concerned about whether I would wake up if I fell asleep.

The next morning, a day ahead of schedule, I went to see my oncologist.  He listened to me give all the details about how I was doing, then he started backing to the door signaling that our session was over.  He had just put his hand on the door handle when I mentioned the chills and shakes from the night before.  “That was the most important thing you’ve said, I think you have a bone infection.”  He started me on an antibiotic infusion, and half an hour into the three-hour infusion I felt completely better.  I had been walking around with a bone infection and I had thought it was just part of the pain from the Neulasta shot.  What might have happened had he left the appointment not hearing about the chills and shakes?  The Tylenol was masking the pain and I accepted the pulsing in my bones  as part of fighting cancer.  I was rope-a-doping myself – fighting with maximal effort, being tough, accepting the pain, when I may have been on the verge of being knocked out, maybe even for good.

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So, for all you tough, stubborn, cancer fighters out there, keep it up, but also be willing to sometimes consider backing off and redirecting your efforts.  And for those of you who have been putting off getting that lump or mole checked out, or if you have not had a physical exam in years, get in there!  Don’t rope-a-dope yourself before any fighting even begins, and set aside time each week to improve your fitness, if you have to fight, it’s better to be physically ready for it.  It is no fun getting a prostate exam or colonoscopy, but dropping your drawers, bending over, and taking it up the backside can be a winning strategy.

 

Time to consider ditching the chemo recliner?

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A cancer study published earlier this year found some very interesting results regarding the blood flow of tumors at rest versus during exercise.  For some of you, it may be a surprise to learn that this had not yet been studied in animals or in humans.  For me, I have been waiting for something like this for the past 2 1/2 years, since I began looking into exercise and cancer survivor research.  In spite of all the cancer fundraising events where people exercise to raise money for cancer research, little is know about what all that exercise may be doing to tumors.

The study (only in rats) examined prostate tumor tissue at rest and during low to moderate intensity exercise.  At rest, the blood flow to prostate tumor tissue was less than that of the surrounding prostate tissue and less than that of the control animals’ prostate tissue.  However, during exercise, the prostate tumor tissue blood flow increased 200%, significantly above that of the surrounding prostate tissue or that of the control animals’ prostate tissue, both of which remained the same as at rest.

If you’ve ever had chemotherapy or accompanied someone who has, you may remember those nice, comfortable, recliners for resting in while the drugs pump into the veins.  Well, if we could extrapolate the results of this study, resting in recliners would seem to limit blood flow into tumors at the very time that we want it to be at its maximum – while the drugs are flowing in.  Now, before you get too concerned about infusion nurses yelling at chemotherapy patients to ‘push it’ for 30 more seconds on the treadmill, remember, the study used low to moderate intensity, and as I wrote previously, intensity is relative to each cancer patient’s fitness level.  For many patients, I would not be surprised if strolling around the infusion ward was low to moderate intensity exercise, and for some, maybe even near maximal intensity.  Currently, one of the best parts of chemo infusions could actually be the walking out of the infusion ward when it’s over, plus, any ‘exercise’ (shopping, walking, work/household duties) done afterwards until the chemotherapy drugs are metabolized or eliminated.

They let us walk into and out of the chemotherapy infusion wards, why not walk during infusion?  Some concerns may be over balance due to any sedatives administered as a part of the infusion process.  True, but some sedative doses can be decreased.  When I had to drive myself home after a series of infusions, they cut my Benadryl in half so that I wouldn’t be woozy for the drive home.  There must be other sedatives as well that could be similarly adjusted.

An editorial that accompanied the cancer study I cited above, mentioned how emerging evidence is ‘beginning to challenge the current perception of exercise as a “soft” intervention that “cannot hurt.” ‘  This is similar to what cardiology went through decades ago.  Then, patients were sent home to bed rest for weeks after a heart attack.  Once more research started coming in, showing that patients did better if they started exercising soon after their heart attack, cardiology started getting patients moving.  This may be where we are with cancer treatments and exercise – leaving the ‘soft’ intervention realm and moving into the “A Team’ of evidence that shows improvements in existing cancer treatments.   But we need human studies first, this is why I started WorkOut Cancer.

I hope you’ll help us to move evidence like this along into human studies.  This is not rocket science but basic physiology, much of which has been overlooked in favor of billion dollar drug development.  Fair enough, there are many effective cancer drugs, I’m not opposed to them, but can we improve the delivery of those drugs with something as simple as switching from recliners to strolling the infusion ward halls?  Furthermore, what else might we discover about these physiological mechanisms that might improve cancer treatments?  We will never know unless we do more research like this.  Please donate.

Thank you!

 

References:

Modulation of Blood Flow, Hypoxia, and Vascular Function in Orthotopic Prostate Tumors During Exercise.  McCullough, D.J.,  et al.  J Natl Cancer Inst 2014 Mar 13. [Epub ahead of print]

Therapeutic Properties of Aerobic Training After a Cancer Diagnosis: More Than a One-Trick Pony?  Lee W. Jones, Mark W. Dewhirst.   JNCI J Natl Cancer Inst (2014)dju042doi: 10.1093/jnci/dju042First published online: March 13, 2014

Chemo man brain … it ain’t pretty!

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The male brain is odd enough (I heard those amens ladies!), apply some chemotherapy to it and the results can be, well, let’s just be kind and say … interesting.  A typical generalization is that men are driven to solve problems while women are motivated by emotion.  Us guys try to fix things, that’s what we’re wired to do.  Note the word ‘try’, because we’ve been known to make things worse (I know ladies, I know).

One of my favorite stories is from the book  And In Health by Dan Shapiro, PhD.  On pages 143-144 Dan tells the story of a couple talking, then laughing, about how lucky they were when the chemo brain affected husband nearly burned down their house after forgetting he was cooking something on the stove.  The lucky part was that the overflow from the bath he forgot he was running upstairs crashed though the ceiling and put out the fire.  I laughed until I cried at that story.  Check that off the bucket list.

My story is not nearly as dramatic but is probably not uncommon for the types of distorted plans men can come up with under the influences of chemo brain.  As patients, we are given time between chemo cycles so our bodies can repair before the next toxic assault.  Well, tumors are a part of the body and they can regrow and repair between chemo cycles too, some drugs may even contribute to that process.  I wasn’t about to let that happen without the potentially ‘normalizing’ affects of exercise, which I hypothesized would influence, in my favor, any regrowth or repair that my lymphoma tumors might be trying to do.

After my chemo cycles I often had low blood pressure, which caused me to become dizzy from standing up.  A cancer specialist physical therapist told me a technique of pumping my legs before standing up to raise my blood pressure.  This helped.  However, that first day home, I was concerned that my plans for walking on the treadmill might be dismantled by my low blood pressure, so I fired up the chemo man brain for a solution.

I decided I would text my wife ‘ok’ every 5 minutes while walking on the treadmill.  If she didn’t get a text then she should call the EMTs.  Great plan I thought, some of you guys are agreeing while others are already improving on the man plan – you should have done ‘face time’ or done such and such.  The other brains, women’s, are rolling their eyes, just like my wife did at work while she and her colleagues agreed that my plan was the dumbest they had ever heard of.

The walk went well.  I actually felt better since my blood pressure increased due to the physical exertion.  Afterwards I continued to feel better than before the ‘workout’ (1.36 miles on treadmill at a max of 2.7 mph & 0% grade for 30 minutes – slowest of my life).  When my wife came home that evening she reiterated the stupidity of my plan.  “I had the front door unlocked for the paramedics” I told her.  “Well you forgot to tell me that” she replied, as if it even mattered.  “Why didn’t you just wait until I came home from work?” she asked.  “I didn’t think of that” I replied.  D’oh!  Chemo man brain.

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If you have a chemo man brain story I’d love to read it.  Post a reply!  Thanks!

References:

Therapy-Induced Acute Recruitment of Circulating Endothelial Progenitor Cells to Tumors.  Shaked, Y., et al.  Science 313, 1785 (2006): DOI10.1126/science.1127592 http://www.sciencemag.org/content/313/5794/1785.full.pdf

NORMALIZATION OF THE VASCULATURE FOR TREATMENT OF CANCER AND OTHER DISEASES.  Goel S., et al.  Physiol Rev 91: 1071–1121, 2011 doi:10.1152/physrev.00038.2010  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3258432/pdf/nihms348021.pdf

Physical activity and tumor vessel morphology among men with prostate cancer.  Van Blarigan, E., et al.    http://mb.cision.com/Public/3069/9520261/82b38a3d9391d0bb.pdf

Exercise modulation of the host-tumor interaction in an orthotopic model of murine prostate cancer.  Jones, L.W., et al.  J Appl Physiol 113: 263–272, 2012.

And in health A Guide for Couples Facing Cancer Together.  Dan Shapiro, PhD.,  First Edition, Trumpeter Boston & London 2013,  ISBN 978-1-61180-017-3 (pbk.)

You can find out more about Ken’s treatments and training here.

‘Bro-marrow’ lesson #1: Don’t kill the donor!

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The text from the transplant coordinator read  ‘Congratulations, your brother is a match!’  Oddly, this puzzled me, which probably reflects the altered mental state a cancer diagnosis can put you in, and I ever so briefly entertained the thought that she might be joking.  Then it dawned on me, this was real, and this was great news!  Next I thought of how relieved my stressed-out wife would be and of how the coordinator must welcome sending a message like that.

My older brother was the first potential donor that we tested for my stem cell transplant.  I felt lucky, the chances of curing my complex lymphomas just went up.  Even though we are different in many ways, other than a twin, he was an excellent match.

Two weeks before the scheduled transplant he flew out to stay with us.  The flight was another source of altered mental state concern.  If he catches something from another passenger will the transplant be delayed?  Should he wear a mask?  Tell him to take hand sanitizer with him. What if the plane crashes?  Should we drive him out?  Which is safer, driving or flying?  That close to a cure, stressing the little things became a hobby if not a necessity.  However, upon his arrival I had a different plan of action, physical action.

I had just read some research finding that donors that exercised improved the stress resistance of their stem cells, and that increased the survival of the recipient by three fold.  Even though the study was in mice, my brother was going to start exercising, I’d put him on a treadmill and feed him cheese if necessary.

Luckily for him I had a Garmin GPS watch with a heart rate monitor that he could wear.  As if giving his stem cells wasn’t enough, each day he uploaded his ‘training’ into my Garmin online account, which I could access via my iPad from my hospital room on the transplant isolation ward where I was for eight days while they wiped out my bone marrow.

My altered mental state kicked into high gear a few days before transplant when my wife called saying that she was headed out to search for my brother.  He had called asking her to come get him from his walk and he seemed disoriented.  Oh no, had all the walking given him a heart attack?  What was wrong?  Was he ok?  Was he going to make it?  His stem cells, was the transplant in jeopardy?  My marrow was already being wiped out, was there a contingency plan?

Fortunately, his disorientation was only geographically related and not a medical issue.  He had started his walk late in the day and it had gotten dark which hid the landmarks that he’d recently become accustom to.  Scare over but lesson learned.  From the Garmin online data I saw that just strolling around our town’s neighborhoods for an hour a day was in his heart rate training zone.  So I asked him to just keep his walks leisurely, to enjoy himself, and to walk in the mornings!  He ended up walking 12 of the 14 days prior to donating his stem cells, more than 6 miles on one of those days.

For a brief time I’d thought that my zeal to improve the chances of a successful transplant may have killed my brother, but he was doing it all to save me.

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References:

Exercise and Hematopoietic Stem and Progenitor Cells: Protection, Quantity, and Function.  Michael De Lisio and Gianni Parise. Exerc. Sport Sci. Rev., Vol. 41, No. 2, pp. 116-122, 2013.  http://journals.lww.com/acsm-essr/Fulltext/2013/04000/Exercise_and_Hematopoietic_Stem_and_Progenitor.8.aspx

a unique record of my donor’s exercise prior to harvesting his stem cells  http://workoutcancer.org/uploads/Donor.pdf

Cancer and me: a bike and the psychiatric ward.

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Almost a year ago, after being diagnosed with my third cancer in as many years, I was admitted to hospital to start chemotherapy.  This new cancer, Diffuse Large B Cell Lymphoma (DLBCL), was aggressive and required an aggressive treatment protocol that consisted of being hooked up to a chemotherapy infusion pump 24 hours a day for nearly 7 days straight.

An IV line was put into my arm (PICC line) near the crook of my elbow and it ran through the vein up to a larger vein at the top of my chest.  Besides being painful, this concerned me since I wanted to maintain the exercise routine that I had established in anticipation of needing chemotherapy.  But this turned out to not be my real problem, finding a stationary bike was.

I asked my nurse if there was a stationary bike that I could use.  I was surprised to hear that they had none on the oncology ward, and I was equally surprised to hear that in her 5 years of working there that no one had ever asked to exercise on a stationary bike.  This was an MD Anderson affiliated hospital, and MD Anderson is the #1 ranked cancer hospital in the US, I was disappointed to realize how little exercise was being used as a part of cancer treatments.

There were some bikes in the cardiology unit (exercise is a part of rehab after a heart attack) but I wasn’t able to use them because cardiology was in another building and that would require me to go outside to get there – not allowed.  A patient coordinator then set about trying to locate a bike for me and her initial search found one in the basement of the psychiatric ward.

In order to get to the bike I had to navigate some stairwells, so they reluctantly disconnected me from the infusion pump and gave me one hour to complete my exercise and to shower afterwards.  I also had to be escorted and accompanied by a nurse (not the shower though), so off we went.

Arriving at the psychiatric ward was a bit surreal.  In the small lobby there were two locked doors, one of them had an unsettling notice on it ‘extreme escape risk’.  I wondered about the patients behind the doors, each going through something different from me but also sharing something similar – the need to get healthy again.  This was a sobering reminder that there were other debilitating things besides cancer, and that my health issues, although somewhat complicated and rare, in the grand scheme of things, were nothing special.  I felt fortunate, I was beginning my recovery with a clear action plan, literally too, and with an understanding of what I needed to do and why.

After buzzing for assistance we were given the okay to go to the basement where the bike was.  Down more stairs we came to an old, small, gym.  It was odd, with ceramic tile walls and bars on the windows, and most of the equipment had been abused and was in need of repair.  The only decently functioning piece of equipment was an air-dyne bike, this is the type with big fan blades on the front wheel, which makes cycling at higher RPMs difficult, if not impossible.

Another problem was that the bike’s handlebars were connected to the pedals, this made the handlebars move backwards and forwards with each pedal revolution.  I was not going to be able to use the handlebars that way because I was still sore from the PICC line in my right arm.  Plus, my left arm was also sore from the recent biopsy surgery done in order to confirm my cancer diagnosis.  A final problem was that there were no toe clips on the bike.  For support, I held on with my left hand to a broken display console that was mounted between the handlebars.  With no toe clips and a fan for a front wheel, this was going to be one interesting, if not difficult, ride.

For a moment I thought about the situation, me: chock full of tumors, in a psychiatric ward basement, chemotherapy drugs still coursing through my veins, and wanting to ride a dysfunctional exercise bike.  I chuckled nervously to myself, maybe I belong here.  Then I started pedaling.

As a runner, I broken 4 minutes for the mile, ran under 2 hours and 10 minutes for the marathon, and won numerous races around the world, but I never accomplished anything more uplifting than turning the pedals on that derelict bike.  I rode that thing for 30 minutes while trying to control my emotions so that I could finish the workout and still have time to shower before being hooked up again to the infusion pump.  The nurse was nearby texting on his cell phone, unaware of my riding predicament or of my emotions.

Prior to being admitted for chemotherapy I had been researching exercise and cancer treatments, and I had come across only one study, done on a small group of breast cancer patients, where someone had exercised during chemotherapy infusion.  I had advocated that there be more studies on whether this could improve a patient’s response to chemotherapy – could exercise during infusion enhance chemotherapy and increase survival rates?  I already knew that exercise was good for my quality of life, but now it was my turn as guinea pig.  This added a different perspective to a study of this type, and it increased my respect and appreciation for patients who volunteer for research studies or clinical trials, they are heroes to me.

In the basement of that psychiatric ward, while riding a rickety old exercise bike, and with chemo drugs doing their thing inside me, I was alone with the enormity of that moment … and I was elated.  Somehow this all seemed to fit for me – a bike, science, and faith, versus cancer, and I liked my chances.

 

NOTE:  The hospital’s patient coordinator was able to locate a better bike in a storage room and they kindly brought it to my room for the remainder of my first chemo cycle.  I was then able to exercise without being disconnected from the chemotherapy infusion pump.  They also had the bike waiting for me when I started my 2nd chemo cycle (no pun intended) two weeks later.

References/links:

A summary of my exercise intentions regarding cancer treatments (with scientific references at the end)

http://workoutcancer.org/Treatment___exercise.html

US News and World Report, Hospital, specialty – cancer

http://health.usnews.com/best-hospitals/area/tx/university-of-texas-md-anderson-cancer-center-6741945/cancer

A pilot study of aerobic exercise performed in breast cancer patients during chemotherapy infusion.

http://meeting.ascopubs.org/cgi/content/abstract/28/15_suppl/e19527

Cycling through cancer

http://www.indystar.com/article/20130331/LIFE02/303310045/

What is exercise for cancer patients? It’s all relative.

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In the US most adults do not get the recommended 150 minutes of moderate intensity or 90 minutes of vigorous intensity physical activity per week.  Nothing new about this, however, maybe it doesn’t accurately describe what is physical activity for cancer patients, particularly those in the midst of treatment.  I argue that many cancer patients may be meeting the recommended guidelines but they just don’t know it.

There is a measure in exercise physiology called maximum aerobic capacity, which is recorded as maximum oxygen uptake, or VO2max for short (maximum volume of oxygen).  Elite endurance athletes have values above 80 (it’s recorded as millilitres of oxygen per kilogram of body weight per minute: [ml/kg/min]).  However, in many of the exercise and cancer studies I read, I often see average maximum oxygen uptake for cancer patients below 20.  What does this mean and how does it relate to cancer patients meeting the physical activity guidelines?

Bear with me as I first translate VO2max into something easier to understand.  I noticed one study where the cancer subjects had an average VO2max of 17.5 ml of oxygen/kg/min, this is a convenient number that converts into something we can relate to.  An intermediate conversion is needed to something called a *MET, 1 ‘standard MET’ equals 3.5 ml of oxygen/kg/min, so a 17.5 VO2max = 5 METS.  A 5 MET activity is walking at 4mph, one mile in 15 minutes (4 laps around a high school track).

So there we have it, our cancer subjects have a maximum aerobic capacity to walk 4mph.  However, this doesn’t mean that they can actually walk the entire mile in 15 minutes, none the less, they should not feel inferior about it because an elite endurance athlete can’t go 15 minutes at their maximum aerobic capacity either.  What?  You see, maximum oxygen capacity can only be maintained for about 3-5 minutes regardless of who you are – cancer patient or elite endurance athlete.

For our cancer subjects, just one of those laps around that high school track at a speed of 4mph will take 3 minutes and 45 seconds.  It is an interesting comparison then that the track & field world record for one mile is 3 minutes and 43 seconds (all four laps around that high school track).  However, I guarantee you that the guy who set that world record could not have done another lap at his record pace – he was at his maximal oxygen capacity (actually a little above it as he sprinted the last part of the race, but he didn’t use any more oxygen to do that extra effort).  So it would be no surprise if our cancer subjects also became exhausted after 3:45 of walking only one lap at their maximal oxygen capacity.  This is just like the world record holder who is exhausted after running for 3:43 at his maximum oxygen capacity.  What then can cancer patients do to get 150 or 90 minutes of exercise in a week?  They can slow down.

If our 5 MET capacity cancer subjects slow down to 60% of their maximum, which is considered to be moderate intensity, they will be at 3 METs, and this intensity they will be able to sustain for longer than 5 minutes.  The relative part of all this is that they can achieved 3 METs by walking a dog!  Yep, according to the 2011 Compendium of Physical Activities, if our cancer subjects do this they are doing moderate intensity physical activity.  Below are some other 3 MET activities from the Compendium:

  • walking 2.5mph (a mile in 24 minutes rather than in 15 minutes), if our subjects were to walk 5 laps around that high school track 5 days a week then they would meet the physical activity guidelines.  Or if you are an in-patient, walk the oncology ward halls before breakfast, before lunch, and before dinner – break it up into three 10 minute segments.
  • home activities – implied walking, putting away household items
  • child care, standing (e.g., dressing, bathing, grooming, feeding, etc.)
  • home repair/maintenance
  • some lawn and garden activities
  • some occupations, work tasks, and work walking
  • bowling (an often maligned recreational activity)
  • mini golf, driving range
  • horseshoes
  • shuffleboard
  • Pilates, tai chi, Qi gong
  • How many more activities become moderate intensity if an ‘adjusted’ or ‘measured MET’ is used rather than a ‘standard MET’?

Considering household and caregiving activities, some cancer patients may be getting close to meeting the physical activity guidelines just by maintaining a near normal work schedule or by puttering around their home while recovering between cycles of chemotherapy.  There was a recent study that was critical of counting household activities as physical activity.  This may be true for healthy adults, however, for cancer patients, some adjustments have to be taken into account.

One important consideration is that some chemotherapies can cause anemia.  Other things too can affect our cancer subjects, some of them are mentioned in a previous blog: Mt. Everest and Cancer.  So, during treatment, rather than our subjects having a maximum aerobic capacity of 5 METS, it may be lower than that.  This means that if they want to sustain their physical activity beyond 5 minutes, their normal 60% intensity will now be at a slower pace, and this brings in  even more Compendium activities.  If they don’t slow down, they will find their normal pace is now more fatiguing and that they have to rest a little longer between activities.  Unfortunately, and mistakenly, this causes many cancer patients to think they are too tired to ‘exercise’, so they nap a lot.  Their old 60% pace is now a 70% or 80% intensity (vigorous), which is ok to do but they will need to walk for shorter periods of time and to rest a little longer.

I recently read an online post by a cancer patient who mentioned becoming fatigued from just walking across a room.  I hope we can now understand that this could actually be viewed as part of a ‘workout’.  The key may be for that patient to start treating a walk across the room as exercise and to mentally incorporate it into a modified ‘workout’ routine.  This is not unlike how that world record miler might workout – he may do an effort at a specific intensity, recover, then repeat this pattern a number of times on a training day.  For our subjects, walking across a room, up some stairs, down a hall, getting tired, resting for a bit, and then repeating this pattern, could be considered a type of workout called interval training.  It may not be at the same pace as the world record miler but the relative intensity can be the same, cancer patients and clinicians just might not realize that it is.

Keep moving!

 

*MET    Metabolic equivalent: one size does not fit all. Byrne, N.M., et al. J Appl Physiol 99: 1112–1119, 2005.  Examining Variations of Resting Metabolic Rate of Adults: A Public Health Perspective. McMurray, R.G., et al. Med. Sci. Sports Exerc., Vol. 46, No. 7, pp. 1352–1358, 2014.  The standard oxygen consumption value equivalent to one metabolic equivalent (3.5 ml/min/kg) is not appropriate for elderly people. M. Kwan, J. Woo and T. Kwok. International Journal of Food Sciences and Nutrition, Volume 55, Number 3 (May 2004) 179 /182.  Activity-Related Energy Expenditure in Older Adults:A Call for More Research. Hall, K.S., et al. Med Sci Sports Exerc. 2014 Dec;46(12):2335-40.  Errors in MET Estimates of Physical Activities Using 3.5 ml·kg–1·min–1 as the Baseline Oxygen Consumption. Kozey, S., et al. Journal of Physical Activity and Health, 2010, 7, 508-516.

 

References:

Scientists Explore Effect of Exercise on Prostate Cancer Patients

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Scientists Explore Effect of Exercise on Prostate Cancer Patients

From the article:

‘In this study, researchers looked at 572 prostate cancer patients and found that those who walked at a faster pace before their diagnosis had more regularly shaped blood vessels in their prostate tumors than those who walked slowly.’

This is initial evidence of a hypothesis that I’ve been advocating, that exercise ‘normalizes’ tumor blood vessels, and that this is a good thing, particularly before chemotherapy or radiation which both work better with more oxygen.  This is contrary to the anti-angiogenic (choke off the blood supply of tumors) dogma that is dominant in oncology.  Although, some anti-angiogenic drugs do temporarily ‘normalize’ tumor blood flow, I think exercise will be found to do it better and also with less side effects, which many of the anti-angiogenic drugs cause.

Rakesh Jain at the Harvard Medical School is a pioneer in this vascular normalization area but with drug interventions.  Therefore, it is encouraging to read the results from this human study that suggest that exercise may be doing the same thing.  There have been some animal studies showing this but to my knowledge, this is the first one from tumors in humans.

For what it is worth, my advice, and what I applied to my own treatments (including exercising during chemotherapy infusion), is to exercise before first cancer treatment (as soon as you are diagnosed, or symptomatic if experiencing a recurrence) in order to improve tumor blood flow, which in theory should improve drug perfusion or the response to radiation.  This should improve treatment response rates, which I hope this study will spur many investigations on.

Keep moving, even if feeling fatigued on some days.  Do not let tumors gain any more advantage than they already have, influence their dysfunctional vasculature growth by normalizing it with exercise!

References

Rakesh Jain:

Animal studies: