- Posted by jdavis on June 14, 2011
Exercise is muscling into its way into disease prevention and treatment plans.
By Julie Deardorff, Chicago Tribune
Cindy Gerstner, 42, strapped her feet into a rowing machine and began gliding back and forth with all the energy she could muster. This wasn’t just a workout for Gerstner, whose stage IV breast cancer has spread to her brain, lungs, bones and liver. It was a 40-minute dose of medicine.
“It’s part of my treatment plan,” said Gerstner, a member of Recovery on Water or ROW, a crew team made up of breast cancer patients and survivors who believe exercise is a powerful tool to help keep cancer at bay. “It’s almost as important as chemotherapy in helping me stay on this earth as long as possible.”
Once relegated to health clubs, exercise is muscling into its way into a wide variety of disease prevention and treatment plans. Physical fitness programs are already a staple of cardiac care. But though research is still in the early stages, there’s encouraging evidence that consistent workouts can help with everything from cancer, autoimmune disorders and Parkinson’s disease to alcoholism. University of Illinois scientists recently received funding for a study that looks at whether riding a stationary bicycle during treatment can help dialysis patients.
The burgeoning “exercise is medicine” movement is championed by dozens of organizations, including the American College of Sports Medicine, the Chicago Park District and cancer support groups. New national cancer guidelines urge both patients and survivors to exercise during and after treatment for 150 minutes per week, the same advice given to the general public.
Some big questions remain unanswered, such as what type and how much exercise is needed for what illnesses. In many cases, working out appears to relieve symptoms, but its impact on the natural course of the disease isn’t known. And many physicians are cautious about prescribing something that can stress the body, especially for patients in the throes of a life-threatening illness.
“There’s still a prevailing attitude out there that patients shouldn’t push themselves during treatment,” said Kathryn Schmitz, an associate professor of epidemiology and biostatistics at the Abramson Cancer Center at the University of Pennsylvania School of Medicine and lead author of the new guidelines.
Schmitz acknowledges that exercise is a stressor on the body but said resting too much also can have adverse effects. “Our message — avoid inactivity — is essential,” she said.
If exercise isn’t already a habit, of course, it can be intimidating. It’s harder to do when you don’t feel good. And “some people would truly rather take a pill,” said Dr. Holly Benjamin, an associate professor and pediatric sports medicine specialist at the University of Chicago.
“But once they do it, so many people feel so much better.”
In the past, breast cancer patients who had undergone surgery were told not to lift more than 15 pounds for the rest of their lives. Doctors also encouraged rest and limited exercise, fearing that strenuous effort would slow treatment or exacerbate conditions such as lymphedema, a painful swelling of the arms.
But Schmitz’s groundbreaking work, published last year in the New England Journal of Medicine, reversed decades of cautionary advice by finding that slow, progressive weight lifting wasn’t just safe; it could prevent lymphedema flare-ups.
Exercise can help people being treated for cancer cope with the side effects of chemotherapy, surgery and radiation, including fatigue and the loss of muscle mass. “It helps them get through treatment in better form,” said David Nieman, director of the Human Performance Labs at Appalachian State University and the author of several textbooks on exercise as medicine.
A handful of observational studies, meanwhile, have suggested that exercise could result in a 40 to 50 percent reduction in the risk for recurrence of breast cancer, said Schmitz, though randomized controlled trials would be needed to prove a benefit.
For a few conditions, including Parkinson’s disease, there’s hope that exercise can affect the illness itself. In animal studies, exercise improved symptoms and increased the level of brain-derived neurotropic factor, a chemical that protects cells.
“Exercise may modify disease by slowing the primary process of cell loss associated with Parkinson’s disease,” said Dr. Cynthia Comella, a neurologist at Rush University Medical Center, who is currently investigating the effects on Parkinson’s of regular exercise with a personal trainer.
For treatment of pediatric rheumatic diseases, “exercise has been overlooked,” said Dr. Bruno Gualano of the University of São Paulo in Brazil.
Exercise’s greatest strength may be that it can work on both physical and emotional levels.
Gerstner, an associate professor on leave from Columbia College, was diagnosed with Stage 1 cancer in 2007 but said exercise was not discussed as a way to prevent recurrence. Now she’s rowing as a way to keep her body strong so she can endure more of the treatment.
“I may be exhausted when I arrive (at practice) but I feel energized when I leave,” said Gerstner, who has a 4-year-old daughter with her husband, Alfredo. “It also helps me feel “normal” — that my body hasn’t totally abandoned me via cancer, but that I can still exercise and push myself.”
If some health advocates had their way, exercise would be the most widely prescribed “drug” in the country.
In Chicago, for example, any resident with an exercise prescription from a doctor for an obesity-related disease — including diabetes, high blood pressure and asthma — can receive a free three-month membership to Chicago Park District fitness centers.
And for the past several years, the Erie Family Health Center, which provides care in Chicago’s medically underserved communities, has encouraged providers to prescribe physical activity.
But research on whether the prescriptions are effective is limited and mixed. A study of Australian women between the ages of 40 to 74 found that exercise prescriptions increased physical activity and quality of life over two years, though falls and injuries also increased.
Other work has found that exercise-referral schemes had a small effect in increasing physical activity in sedentary people and that patients referred by cardiac nurses and physicians tend to comply more than those referred by general practitioners.
Choosing specific goals — such as reducing blood sugar by 20 points or improving blood pressure — or setting someone up with a personal trainer was also found to be more effective than just telling someone to go exercise.
“People who aren’t regular exercisers need a lot of guidance,” said Dr. Holly Benjamin, an associate professor and pediatric sports medicine specialist at the University of Chicago.
“You have to empower the patient, give them concrete benchmarks and provide follow-up and feedback,” Benjamin said. “When it fails, it’s a lack of knowledge or interest on the part of the physician who is the coach or captain of the ship.”
Despite a burgeoning “exercise is medicine” movement, physicians remain more likely to refer someone to a specialist than to a health club, in part because they may be unfamiliar with fitness and not sure how receptive patients will be, said Indiana University physical activity expert Nicole Keith.
“Unless physicians themselves are athletes they’re not always well educated in this, and it’s a big barrier to effectiveness,” Benjamin said.