If you're shopping at Wal Mart this month, pick up a copy of the July issue of All You magazine. I'm featured in a series on women fighting cancer. I, along with two other terrific ladies, tell our stories of fighting and learning.
When people talk about the benefits of exercise for cancer survivors, they often talk about quality of life issues: greater feeling of control, easing side effects of treatment, improved self image. But there are plenty of data showing benefits for overall outcomes - reducing the risk of relapse and death - for several cancers.
The best evidence, so far, for the benefits of exercise comes from studies of breast cancer patients.
So, what do we know?
In 2005, results were released from the Nurses' Study and published in the Journal of the American Medical Association which found that regular, moderate exercise (3-5 hours of walking or equivalent of moderate exercise) reduced the risk of breast cancer recurrence by about 50%. The study followed nearly 3,000 nurses who were diagnosed with stage I, II, or III breast cancer between 1984 and 1998.
In another study, Dr. Melinda Irwin, PhD, MPH, associate professor of epidemiology and public health at the Yale School of Medicine, and colleagues found that moderate physical activity reduced the risk for death by all causes by 67% in women with breast cancer who remained active 2 years after diagnosis. The Health, Eating, Activity and Lifestyle (HEAL) study was published in 2008 in the Journal of Clinical Oncology.
A study by Dr. Christine Friendenreich and colleagues, of the Alberta Health Services-Alberta Cancer Board in Calgary, Canada, followed 1,231 women for 8.3 years. The women who exercised at least 4 hours per week over their lifetime had a 44% lower risk of breast cancer death. In addition, similar levels of exercise reduced the risk for women already diagnosed with breast cancer of recurrence, progression, or new primary breast cancer by 34%.
There have been other studies with slightly different variables (looking at only post or pre-menopausal women, or different exercise intensities) that have had somewhat different results. However, all show improvement in breast cancer outcomes with exercise. Depending on the exact measurements, exercise reduces the risk of breast cancer death by anywhere from 40 - 55%, which is as much as standard treatment.
I often tell people that I love to exercise, but even if I hated it, with numbers like that I'm out there walking!
We also know that exercise reduces the risk of developing breast cancer in the first place. That's why it's important for all of us to encourage our friends, daughters, nieces, and sisters to be active.
Of course, there are variables we can't control. I was very active and healthy, and I developed breast cancer at an early age. I will never know why. But there is much we can do to improve our chances.
So go out for a walk, ride a bike, go dancing. And better yet, take along someone you care about - improve her chances, too.
In the Happy Days blog of the New York Times earlier this week, Leonard Mlodinow wrote about the limits of control. We all know of too many examples of the negative effects of control: "control freaks" who strive to control every little thing, making themselves and those around them miserable; or make bad decisions based on faulty assumptions that they can control outcomes.
On the other hand, humans need to feel some sense of control to be happy. Without control, people suffer the effects of depressions and stress, even disease. Mlodinow writes about the psychologist Bruno Bettelheim's conclusions that survival in Nazi concentration camps depended on the ability to keep some areas of "independent action" - of control.
The empowerment of control is one of the benefits I always stress when I talk about exercise and cancer. All of the well-documented physical benefits are important (improved quality of life, fewer side effects of treatment, improved immune function and treatment adherence, and lower risk of recurrence for some cancers). But equal to all of those benefits is the sense of control.
There is so much we can't control in our disease and our fight. But no matter how out of control we may feel, there are things we can control.
I was young and very healthy when I was diagnosed. I was in my 30s, ate well, didn't smoke, exercised, and had almost no history of cancer in my family. And yet I developed breast cancer. I had no control over that. I had no control over what my cells were doing. I didn't control them as the cancer cells were multiplying. I didn't control whether they were being killed by chemotherapy drugs or radiation. I was not in control of that! But I could control if I went outside for a walk. I could control my bicep muscle. In the face of the tsunami that is cancer, that may seem like a very small point, but at the time, it was huge - it was everything!
We have many opportunities for control. We have choices. We can choose something positive and empowering, or choose to abdicate.
Fitness is one area in which we do have some control. We can choose to take the stairs or lift the milk five times before putting it away. We can choose to go for a walk. If even getting out of a chair is difficult, we can choose to do some leg lifts to strengthen our legs, or struggle to get out of the chair, then sit back down and get up again.
These, and a hundred other examples, are our choices. We have control. And in that moment of choice, choosing the positive, the healthful, is powerful! Use that power; savor and enjoy it!
New research showing decreased effectiveness of the drug Tamoxifen when combined with some common antidepressants was presented at the recent annual meeting of the American Society of Clinical Oncology (ASCO). However, as is often the case, the new information raises many questions and the answer is not always clear. A second study presented at the meeting showed no decline in tamoxifen's cancer-fighting abilities when combined with antidepressants.
The first study found that women taking both Tamoxifen and an SSRI antidepressant (most commonly Prozac or Paxil) had a 13.9% chance of their breast cancer returning over 2 years. That compared with only 7.5% recurrence for women taking Tamoxifen alone.
The second study, conducted at Leiden University Medical Center in the Netherlands, found no increased risk of recurrence for women taking both drugs. However, the number of women taking both drugs was small, only 215.
Many breast cancer survivors take Tamoxifen to reduce their risk of recurrence. But often one of the side effects of Tamoxifen is hot flashes, which are frequently controlled by antidepressants.
These two studies leave open a lot of questions, and no doubt will prompt further research. In the mean time, if you are taking both Tamoxifen and an antidepressant, talk with your doctor and explore your alternatives. There may be other types of drugs that could be affective in controlling hot flashes.
And some women are taking antidepressants for actual depression. (As I write that, I think - Duh!! Yes, some people going through cancer treatments also are depressed - but most of the press about these studies only mention antidepressants for controlling hot flashes.) So, if you are taking antidepressants for depression, you and your doctor must weigh the risks of staying on or going off your antidepressant. Let's face it, if you are seriously depressed, going off your antidepressant may pose more of a risk for you than your risk of recurrence. These are tricky questions that you must decide with your doctor.
There are also many non-drug options to help control hot flashes and mild depression. Alternative therapies like acupuncture, Reiki, or meditation can be quite effective for many women. Nutritional changes may also help. Figuring out if you have food triggers for hot flashes is a good start. Talk to a nutritionist.
And exercise! (you had to know I'd get to that) Exercise is well documented as a tool for fighting depression. A recent study, which I wrote about last week, showed that exercise improved mood for much longer than previously thought - up to 12 hours. And regular exercise can also help with hot flashes. Exercise alone may not put an end to your hot flashes or blues, but it can help.
The most important thing is to talk with your doctor. Weigh the severity of your symptoms with your risk. And I encourage you to explore all alternatives. Let the doctors sort out the drugs. You take control of the things you can - you control what you eat, if you go for a walk, or go to the gym. Maybe you can figure out the right combination of activities/foods that will work for you.
(You can read more about these two studies at Medlineplus.gov, one of the websites of the National Institutes of Health and a great resource for information.)
The observational study looked at 49 women attending a doctor-directed fitness clinic for cancer survivors. Researchers compiled data including demographic information, physical activity levels, and cancer treatment type, duration and time since treatment. The women's fitness levels were assessed by using a 3-minute step test.
The results showed that test completion and heart rate recovery were not affected by treatment.
This is really important information. "We know physical activity is a critical component of cancer survivorship, both during and after cancer treatment,” says Jennifer LeMoine, PhD, a post-doctoral research fellow with training in exercise physiology at GUMC’s Lombardi Comprehensive Cancer Center. “In order to prescribe an exercise program, it’s critical that we understand our patient’s fitness level and whether or not treatment has had an impact on their cardiovascular health.”
There is no denying that cancer treatments can cause fatigue, which sometimes is extreme. Many survivors feel that they are too weak and tired to exercise. However, this is objective data that show that their perceptions of their own capabilities may be very different from what cancer survivors are physically able to do.
Survivors sometimes do have physical limitations from treatment, but it is still possible to maintain and improve their fitness. In my work with Life-Cise and my private fitness training, I encourage people to do as much as they can. And we often find that they can actually do much more than they imagined.
Today I invited a guest to the blog. In full disclosure (as you will see), Carol is my client, but also my friend. In the months I've known her she has made real progress, and it's been fun for me to watch how much effect exercise can have in someone else's life. I know what it's meant for my life, but it's been interesting to watch the process unfold for someone else. I thank Carol for her kind words for me, and hope you will enjoy her story - and maybe find some inspiration.
Julie My name is Carol, and in early 2006 I was diagnosed with breast cancer and spent the "better" part of that year undergoing the gamut of treatments.
The family story goes that when I was born, the doctor looked me over and told my parents that they have an athlete here. Well ... I have never really considered myself to be an athlete. I've just enjoyed some recreational sports, have gone through periods of being more active and have had my couch potato moments as well.
Through my treatments, though, I found it very helpful to go out for walks on the days that I felt well enough to do so. And I believe that those walks had a great deal to do with me having more of those days, than not, where I felt well both physically and mentally. It was good to get outdoors and to feel that I still had some strength and stamina left in my body. And at a time when my whole world felt completely out of control, the exercise gave me a sense of having some control both over my ability to handle the treatments and even to positively affect my outcome. Walking also became time for me, a sort of walking meditation, which I looked forward to and which allowed me the opportunity to sort out into manageable bits the enormity of what I was going though. Keeping active, to the extent that I was able, became an indispensable part of my healing.
Now three (thankfully) healthy years have gone by and I've kept up my walking. But in this often surprisingly wonderful journey that is cancer recovery, I stay open and aware for more that I can learn and do to keep moving forward. I noticed that a fitness specialist, who herself was a breast cancer survivor, was giving a workshop at my local American Cancer Society and I was interested and even changed my schedule that evening so that I could attend. And that's where I first met Julie.
I've since had several sessions with her over these past months and under Julie's guidance my fitness level has been improving measurably. I know this not only because I feel it but also because Julie uses techniques to actually measure this progress. I am still walking and recently have begun running, which feels great. With the aid of Julie's expertise and encouragement I feel like I just might discover that athlete that the doctor saw in me all those years ago.
I continue to heal and re-build my life and, at mid-life, I've enrolled in college again and am working toward a second career. And as everything in one's life is interrelated, getting in better physical condition and becoming stronger and more focused makes me feel up to and better equipped to meet this new challenge as well.
An exercise program doesn't have to make one strive to be an athlete, or be a spiritual or life-changing experience. But it can be. There are many benefits to be gained at any level of improving one’s fitness. The important thing is to just begin moving because you never know where it may take you.