37 Exercise and Cancer.mp3: Audio automatically transcribed by Sonix
37 Exercise and Cancer.mp3: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.
Speaker1:
Hi and welcome to the Cancer Secrets podcast. I am your host and guide, Dr. Jonathan Stegall. Cancer is like a thief who has come to steal, kill and destroy. I have personally seen it wreak havoc on patients, friends and even my own family. But I am on a mission to change the cancer paradigm. Who? The practice of integrative oncology cancer treatment that integrates the best of conventional medicine with the best of alternative therapies backed by science and personalized to each patient. You need a positive voice you can trust. This podcast will share valuable information to give you practical hope for a better outcome. So I invite you to join me on this journey as we seek to change the cancer paradigm together. Hello and welcome back to the Cancer Secrets podcast. I'm your host, Doctor Jonathan Stegall. This is season three and episode number 37. In today's episode, I'm going to discuss a very important topic exercise. Exercise isn't just for overall health and fitness, as you'll see. It's a very important tool in our anti-cancer arsenal. As I've said before, if exercise were a drug which could be patented, it would be worth billions. As always, we encourage you to listen with a loved one or friend. Learning and enjoying the show with a community will be more impactful than doing so alone. Today's show is going to be a great one as we dive into the topic of exercise.
Speaker1:
Not surprisingly, most oncologists, as well as others working in the cancer field, are unprepared to discuss exercise as it relates to cancer. As is the case with nutrition, exercise is not a significant portion of education or clinical training when it comes to cancer. This is partly due to the fact that most of the research on the topic is relatively new. In 2008, the American College of Sports Medicine held the first Exercise and Cancer Roundtable. The aim of this was to discuss the role of exercise and cancer survivorship. At that time, just over a decade ago. Only limited evidence existed regarding the relationship between physical activity and cancer prevention. Thankfully, over the past decade, a significant amount of research has been done indicating that the level of physical activity or lack thereof is closely related to the development of multiple types of cancer. For example, in 2008, strong evidence for exercise and its role in cancer prevention only existed for two types of cancer breast and colorectal. However, by 2018, research uncovered strong evidence for physical activity, lowering the risk of seven different cancer types, including colon, breast, uterine kidney, bladder, stomach and esophageal. Research also found that physical activity reduces risk of developing lung, pancreatic, prostate, ovarian leukemias, lymphomas and head and neck cancers. It's very likely that exercise reduces risk for developing other cancer types as well. In this episode, we will dive into the details regarding the role of exercise in preventing cancer, how it can be used as a cancer treatment for those currently battling cancer, and also how it should be a part of every cancer survivors treatment plan.
Speaker1:
As we know, the transformation of normal, healthy cells into cancer cells is a complex one consisting of many steps. Exercise is thought to affect this process in several ways. First, exercise promotes a healthy weight. As we know, obesity is a significant risk factor for developing cancer, an imbalance of hormones such as an increase in estrogen levels in overweight and obese women, coupled with elevated growth hormone levels also present in this patient population, has been shown to increase risk of multiple types of cancer. In addition, people battling obesity also tend to have more insulin resistance, meaning that they are unable to utilize sugar in the diet as well as non-obese patients. They also tend to have greater levels of inflammation, which we know promotes a formation in progression of cancer. As we can see, exercise promotes a healthy weight, hormonal balance, improved blood sugar control and reduced inflammation, all of which serve to reduce the risk of developing cancer. The benefits don't end there, though. Animal studies have shown a significant impact of exercise on tumor growth. Studies have shown reduction in tumor growth ranging from 31% up to nearly 70%, which is very impressive. Further inquiries into the cancer mechanism of exercise have revealed a few additional pearls.
Speaker1:
First exercise appears to reduce cancer cell proliferation, or, in other words, the rate at which cancer cells grow. This appears to be due to the activation of tumor suppressor genes, which have the ability to slow down cancer growth as well as the stimulation of apoptosis, which is programmed cell death. Long time listeners of this podcast will recall that apoptosis is a mechanism by which healthy cells die once they reach the end of their lifespan. However, cancer overrides this mechanism of apoptosis and does not die unless we kill it. Another benefit of exercise lies in its effect on angiogenesis. Angiogenesis is the formation of new blood vessels which cancer encourages in order to better nourish itself. Research has shown that exercise normalizes tumor blood vessels altering circulation in these areas. This partially explains why chemotherapy seems to work better in test subjects who exercise regularly compared with test subjects who do not exercise. The theory is that exercise allows chemotherapy to better reach its target. Finally, we know that exercise has an effect on immune system function. More specifically, exercise increases what is known as Interleukin six, which is released from contracting skeletal muscle and increases natural killer cell activity and subsequent infiltration of immune cells into tumors. Now that we have a better understanding of how exercise can prevent cancer, let's discuss the role of exercise in cancer treatment. First, it's interesting to note that multiple studies have shown that people who exercised regularly prior to their cancer diagnosis had better treatment outcomes.
Speaker1:
For example, people who exercised regularly prior to receiving a diagnosis of colorectal cancer had a 23% lower risk of death from their cancer. For breast cancer, those who exercise regularly prior to diagnosis had an 18% lower risk of death. These are significant findings. Now let's assume that someone has cancer and did not exercise prior to diagnosis. Research shows that starting an exercise regimen after a cancer diagnosis still results in a significantly decreased risk of dying from cancer. Studies found a reduction in risk, ranging from 25% up to nearly 70%. These results were especially strong for breast, colorectal and prostate cancers, and I believe that's simply due to the fact that these cancers are among the most common and therefore test subjects with these types of cancer are easier to find than those who have rare types of cancer. It's important to note that this does not mean that exercise doesn't help patients with other types of cancer, because I suspect that it does. Additional benefits of exercise in the setting of cancer include a significant reduction in anxiety and depression, both of which are extremely common in cancer patients. Patients who exercise more also report less fatigue in general, better sleep quality, and also an improved quality of life. In 2019, the American College of Sports Medicine released their recommendations regarding physical activity for cancer survivors.
Speaker1:
Research has shown that only a minority of cancer patients and cancer survivors exercise regularly. So what does a healthy and appropriate exercise prescription look like? Well, before embarking on an exercise regimen, it's important that you discuss your desire for more physical activity with your oncologist and the rest of your care team. I can't possibly give you specific advice here, as every patient is different and every situation is different. I encourage you to take great care in starting an exercise regimen and obtain advice and help from medical and health professionals who know you best. This is especially important if you are very conditioned, extremely fatigued from treatment. Have balance or mobility problems. Or have cancer in your bones as each of these situations can make exercise a potentially dangerous endeavor. Ultimately, the goal is for you to engage in exercise that is safe for your current condition with specific goals for the short, medium and long term in mind. Acknowledging the fact that oncology professionals are ill equipped to address exercise with cancer patients, the American Cancer Society published an article in October 2019 to help guide clinicians in assessing patients and their candidacy for exercise. I'm going to read those recommendations to you now. The Oncology Clinicians Guide to Referring Patients to Exercise. Step one Assess. This involves asking three questions. Question number one How many days during the past week have you performed physical activity where your heart beats faster and your breathing is harder than normal for 30 minutes or more? Question two How many days during the past week have you performed physical activity to increase muscle strength, such as lifting weights? Question number three Would this patient be safe exercising without medical supervision? For example, walking, hiking, cycling, weightlifting.
Speaker1:
So the answer to question number three is split up into two possible answers, yes or no. If the patient answers yes and the patient is able to to move about, we call this being ambulatory and their performance score for daily functioning is is relatively high. Then they would be a good candidate for an exercise prescription, meaning they should be able to conduct exercise consisting of moderate intensity aerobic exercise for up to 30 minutes three times per week, and also resistance exercise for 20 to 30 minutes twice a week. Research has shown that a combination of both aerobic activity as well as resistance exercise is the best combination. Now, these don't have to be done at the same time, but typically speaking, we would say out of a seven day week, if three of those days, if they if three of those days consist of aerobic activity and two of those days consist of resistance exercise, then that's a really good combination and a really well rounded program designed to allow for the most benefit. And this article goes on to recommend that the oncologist or oncology professional then refer the patient to the best available community program.
Speaker1:
And there are a wide variety of different programs in communities across the country as well as throughout the world that are designed with cancer patients and cancer survivors in mind. And we're going to talk more about that in a little bit. However, getting back to question number three, would this patient be safe exercising without medical supervision? If the answer to that question is no or if if the oncologist does not feel that they have enough information to properly evaluate that patient, either because they don't know the patient well enough or because the patient is so conditioned to the point that that their their fitness level can't be properly evaluated, then the next step is to advise the patient to follow up with an outpatient rehabilitation facility or a physical therapist for more specific evaluation and guidance. And of course, the referral would then follow that recommendation so that the patient could get the care and input that they need, because that level of assessment and help is really outside the scope of what an oncologist or any kind of oncology practice is really capable of undertaking. So the above guidelines are really designed to give oncologists and nurse practitioners and physician assistance in the oncology realm just a good starting point to help patients. Rather than just saying you need to exercise more, it really gives patients a framework for where they can get started.
Speaker1:
Because I think that's really the hardest part is especially for patients. It's, it's, it's, it's having the confidence to start, you know, having the blessing of their oncologists in starting an exercise regimen and then knowing where to go from there. In other words, what are the specifics of that exercise regimen? What does that look like? So we're going to talk a little bit more about that. As I mentioned earlier, the the best exercise prescription for patients who are able to exercise includes a combination of aerobic activity as well as resistance training. So we're talking about aerobic activity that's typically separated into light, moderate and vigorous. Light aerobic activity would be a very casual walk or a stroll. It's not really getting your heart rate up much. It's not going so fast that you're breaking a sweat or having heavy breathing, but it is getting your heart rate up a little bit above normal. A moderate level of intensity would be more like a brisk walk where you're moving quickly, you're still able to carry on a conversation, but you're definitely getting your heart rate up. You're maybe breaking a light sweat, and then vigorous intensity would be something like jogging, where you're definitely moving a little bit faster, a little bit higher impact exercise, but still, you know, still within the realm of being able to to hopefully carry on a conversation, even if you're breathing heavier and your heart rate's faster.
Speaker1:
So the goal with with intensity is to is to really start with where you're most comfortable, where your current fitness level is and what it allows for. And then build up to about 30 minutes each session and again shooting for ideally at least three days a week of aerobic activity. 30 minutes per session is really the best way to go. And and, of course, it can be more than just walking or jogging. It can it could include biking, you know, riding a bicycle, swimming, water aerobics. There are a lot of different options in the recommendation is really to do something you enjoy. If you hate it and you dread it, then you're not likely to stick with it. So pick something that you enjoy. Realizing that you're going to be pushing yourself on some level, that it should be something you look forward to as much as possible. Hi, this is Dr. Stegall. Thanks again for being a loyal listener. If you love the Cancer Secrets podcast, I know you're going to love my Cancer Secrets book as well. In the book, I take a comprehensive look at cancer and its history while also digging into the treatment protocol. I wholeheartedly believe in integrative oncology. Integrative oncology uses the best of modern medicine with alternative therapies backed by science and personalized to each patient. I not only focus on common cancer treatments such as chemotherapy, but also on more outside the box treatments such as intravenous vitamin C, mistletoe, nutrition supplementation exercised and repurposed medications.
Speaker1:
I explain which tests you should have but probably aren't getting. I address the power of mind, body medicine and the importance of our thoughts and our words. I also take a look at common myths about cancer. Some of these will surprise you. I will teach you to be an open minded skeptic and give you the hope you need to fight cancer. Grab your copy today on Amazon in paperback or Kindle format. So if you're already exercising regularly and you're already regularly participating in vigorous activity, it is okay to push yourself a little bit more to the point where you may have trouble carrying on a conversation and you may be out of breath. But that would really only be reserved for people who are already at a pretty high activity level and are able to to tolerate that already for everyone else. If you're engaging in a light or moderate intensity level, you know, the the rule of thumb is conducted at a level where you can talk, but not where you can sing. So if you're if you're undertaking brisk walking, riding a bicycle at a moderate pace, doing water aerobics, doing a dancing class, you know, again, make sure that it's something that you're pushing yourself to the point where you can't sing a song, but you could have a have a conversation.
Speaker1:
And again, the recommendation is to build up to at least three days a week of aerobic activity, 30 minutes per session. But again, that's just a guideline. If you're if you're not able to do that yet, start start with what's comfortable for you. Even if it's just a few minutes here and there, maybe you can only do 3 to 5 minutes at a time or 10 minutes at a time. Start there, start there and then gradually build up. You don't have to build up over a week or two. You can build up over weeks and months, whatever is best for you. Kind of learn your body, know what your best suited for, you know, even if it's ten or 15 minutes a day, that's great. That's more than you were doing before, probably. So start with where you are and gradually work yourself up to the ideal, which would be 30 minutes per session, about three days a week. And then the resistance training is the other component here. A lot of people are intimidated by resistance training. They feel like they have to have a lot of experience with it. They're envisioning, you know, these bulky weightlifters and bodybuilders at the gym who are lifting all this weight. But you really don't need to be lifting heavy weight to benefit from resistance training. You don't even have to go to a gym.
Speaker1:
I mean, if you have access to a gym, that's great. You know, weight lifting equipment, you know, Nautilus machines, meat machines. There's different different manufacturers of resistance machines. Those are often a good place to start. I certainly encourage you to have a session or two with a trainer to show you how to use those machines. If you're not familiar with them, those are a good place to start because the the the movement is is locked in to a to a given range of motion. So you're less likely to injure yourself. But certainly if you're familiar with free weights, dumbbells and barbells and things, those can be great as well. I personally recommend working toward some sort of free weight training if you can, simply because you're going to incorporate your stabilizer muscles as well. So let's say, for example, like a bench press, if you're using a bench press machine, you're going to kind of be locked in to that range of motion, not really having to use any of your stabilizing muscles like your shoulders and your triceps as much. But if you're using, let's say, a barbell or dumbbells, then you are having to use those stabilizer muscles, which is going to call more of your body into play with that movement. So regardless, whatever you use, do something. If you have access to a gym, that's great. If you don't, you can certainly use weights at home.
Speaker1:
You know, they make the elastic bands now, which are great. You can use those at home, you can use those when you're traveling or even bodyweight exercises. They can be extremely beneficial. These are things like push ups and sit ups and pull ups if you can do them, things like that. I mean, you can do push ups on your kitchen counter. You can stand up from a chair and sit back down in the chair. I mean, again, find what works for you and your current fitness level. Even doing housework can be considered strength training depending on what you're doing. Certainly try to focus on your whole body as much as you can. You want to strengthen, certainly your legs, your back, your arms, your chest and your shoulders. So a good place to start so that you're avoiding the really heavy weights is to do whatever activity or exercise you're choosing, try to do between ten and 15 repetitions. And this is going to be a fairly light effort at first. You're not trying to to strain and lift too heavy, but but do 10 to 15 repetitions do them whatever the the activity is. Let's say you're doing bicep curls, try to do it such that those last few reps are challenging to you, but but not to the point where you're straining to make sure you're feeling it in your biceps. By that 50th repetition, make sure you're you're breathing well in and out.
Speaker1:
One word of advice is to exhale on the on the flexing portion. So if you're doing bicep curls, you're you're exhaling as you're curling the weight up and you're inhaling as you let the weight down. You're doing this in a in a in a controlled. Old Manor. Don't, don't, don't go too fast with your repetitions. You can do a few seconds up on the on the lifting portion and a few seconds down when you're letting the weight down. And then over time, you can build up to a little bit harder effort, a little bit more intensity where you're doing between eight and 12 repetitions per exercise. And even if you're just doing one set, which would be one one round of, of, of repetitions, that's okay. Over time, you can build up to doing several sets. So you do the 10 to 15 repetitions. You'd, you'd rest for a minute or so, do another set of ten or 15 repetitions, rest and then do another set, and you can do two, three or four sets. That way you can do the same thing if you're in that 8 to 12 repetition range, and you can do this 2 to 3 days a week. So you could actually do a full body program. And that can be as little as three or four exercises can really hit all of those body parts. Do that every day, each time you do it 2 to 3 days per week, ideally giving yourself a day, at least one day of rest in between each strength training session.
Speaker1:
And and you have an outstanding exercise program. That way you're hitting your cardiovascular system with the aerobic activity. You're working on your musculoskeletal system when you're doing the resistance training. And of course, there's some overlap there. You're working your cardiovascular system with strength training and you're also working your musculoskeletal system with aerobic activity. But, but, but they each have their own goal. And, and you're going to really do a lot of good for yourself. So not only will you be helping your body fight cancer if you're going through cancer or help you prevent cancer if you're a survivor, but you're also going to be having a lot of other benefits you're going to see, like we mentioned earlier, you're going to have improved mood. You're going to have a a lower risk of anxiety and depression. And certainly if you're battling anxiety, depression, you're going to see your symptoms improve from having a good exercise regimen on board. You're going to probably find that you have a generally improved quality of life. You're probably going to sleep better if you're dealing with aches and pains, you may find that those are better. So we have a whole host of benefits from this kind of exercise regimen. And I do also just want to mention, if you are a cancer survivor, you should know about the Livestrong program at the YMCA.
Speaker1:
This is a program that consists of 290 minute small group exercise sessions per week for about 12 weeks, and these are led by YMCA exercise instructors who have completed specific training before working in the program. And this program is free to cancer survivors for at least 12 weeks, although I've heard that some YMCA is allow repeated participation without costs. So it's a great option for people who who live near a YMCA and who are members of the YMCA, the Livestrong program. My understanding is that most YMCA have this kind of program. So if you're a cancer survivor, then I would certainly inquire about that. And just so you know, the instructors, the instructors who are doing these programs, these classes, they do have certain certifications they have to have, and then they have to maintain that certification with qualified continuing education credits. So I feel like it's a really good program if you're a cancer survivor. But like I said, if you're if you're going to engage in an exercise regimen, whether you're a cancer patient or a cancer survivor, or even if you are interested in cancer prevention, definitely make sure that you have been cleared by your physician. If you're a cancer patient, certainly speak with your oncologist about this. If you have an integrative oncologist, then he or she should be very familiar with exercise already and how important that can be.
Speaker1:
I talk with my patients regularly about exercise. It's so important and I found that most patients really just don't know where to start. So the first step is getting clearance, so to speak, to engage in exercise. And if you're interested in cancer prevention and you don't have an oncologist, obviously have this conversation with your primary care provider, your internist, your family doctor, and just make sure that that you're clear to start an exercise regimen. Certainly, if you have a complicated history of high blood pressure or cardiovascular disease or diabetes, your needs may be slightly different. So just make sure that that you've been approved to undertake an exercise regimen and then stick with the guidelines we discussed earlier. Again, that's typically for about three days a week, aerobic activity where you're exercising at a comfortable pace. Certainly at first make sure that you're just getting used to the to to exerting yourself. And then you can certainly increase the intensity as well as the duration of exercise as you improve your fitness level. But but striving for about 30 minutes, three times a week on aerobic activity and then at least two days a week of resistance training where you're exercising the various muscles in your body, hitting the main muscle. Your legs, your abdominals, your back, your chest and shoulders, those are going to really contribute to your fitness if you're if you're using those kind of exercises.
Speaker1:
And again, start out with maybe 12 to 15 repetitions per exercise, you know, one set of each with that last repetition or two being challenging for you, but not overly straining, not to the point where you're your form is breaking down, and then over time you can add sets and you can even decrease the number of repetitions a bit, which would allow you to increase your weight. If you're getting that 8 to 12 repetition range and you're going to be in a good a good spot, not only increasing your muscle tone, but also actually tapping into your cardiovascular system as well. So that's really what we recommend. That's what the research recommends. So again, I want you to know that exercise is a very powerful tool. Please do not underestimate it simply because it's not a drug or a surgery or some kind of procedure. Exercise is extremely important and it's something that you can do regularly on your own. And so I encourage you to definitely incorporate exercise regularly if you're not and ask your your care team about this, because if they don't know, then they should be able to put you in touch with someone who can help you, whether that's an exercise physiologist or a physical therapist or someone who who does have training in this, that can really help you. So I hope you found this information today to be helpful.
Speaker1:
Again, if exercise is something you haven't been doing, start small, work your way up. And as a research shows, even a small amount of exercise can be beneficial. Consistency is key and engaging in exercise regularly while challenging yourself in a healthy way is really what matters. And just as another reminder, you don't have to be a professional athlete for exercise to be beneficial. Start with where you are. Don't feel the pressure to be a top level athlete. Don't worry about what other people might think. If you're out of shape, if you feel like you're just not very fit, that's okay. Most people aren't. If you have a gym membership, please don't avoid going to the gym simply because you're worried about what people might think. They're not looking at you, I promise. Everyone's at a different spot, and the important thing is that you get started and you do something. So again, I hope this has been helpful for you and it's always I encourage you to subscribe to the Cancer Secrets podcast to be notified when new episodes are released. If you're enjoying these podcasts, please take a minute and provide a review on iTunes or wherever you listen to podcasts. And finally, please share this podcast with your family and friends. All previous episodes are available for free on our website at Cancer Secrets dot com. We have more great episodes coming your way. I look forward to next time.
Speaker2:
Bye bye. Oh.
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