Therapy Across the Cancer Care Continuum: Interpretation and Insights from Dr. Mark Bettag!

Dr. Bettag recently shared an article titled “Exercise Therapy Across the Cancer Care Continuum” that appeared in the September issue of The ASCO Report. The article pointed to the many benefits of exercise and activity for cancer patients/survivors: Before Surgery, During Therapy, After Therapy, and with Advanced (Metastatic) Disease that summarized, “In totality, meta-analyses and systemic reviews conclude that exercise training improves patient-reported outcomes and physical functioning in a broad array of patients with cancer before, during, and after treatment. In addition to having beneficial effects of symptomatology, emerging data suggests that exercise training during these phases may lower the risk of death from cancer, although confirmatory data from adequately powered randomized trials are not yet available.”

The full article can be read here: https://ascopost.com/issues/september-25-2022/exercise-therapy-across-the-cancer-care-continuum/

That all sounds great! But I suspect many of you, much like me, would rather hear Dr. Bettag’s interpretation of this article along with his personal insights on the role of exercise and activity for cancer patients and survivors. I invited him to sit down and chat with me on the topic and, not surprisingly, he graciously and enthusiastically agreed!

Here are some excerpts from our chat:

What the Studies Say:

Exercise has been shown to be beneficial for healthy individuals. But when it comes to cancer, multiple studies that have been done on women with breast cancer suggest that exercise before and even during treatment results in greater strength, stamina, and endurance at the conclusion of chemotherapy compared to those who are more sedentary.

They’ve even done studies with 90-year-olds in nursing homes and found that simply lifting 1 to 2-pound weights will increase both strength and stamina. If it’s beneficial for even the elderly who are institutionalized there certainly is an even bigger and better benefit for the rest of us.

If you look at people before they have an operation for cancer, those that have exercised experience less post-op pneumonias and tend to recover better and quicker. And even those who have completed cancer treatment have a slightly decreased mortality. That’s mutli-focal because when you exercise, your risk for cardio-vascular disease goes down, reducing your risk for death from heart attack and stroke as well.

There is some evidence that exercise causes hormone changes in those with breast cancer and their risk of death for breast cancer may decrease through exercise. Some of those studies have not been done with other cancers, but evidence shows exercise will make you feel better, have more energy, and just have a better quality of life!

My Advice to Cancer Patients/Survivors:

I tell my patients, you don’t have to be training for a triathlon, or run marathons. And, of course, it depends on the situation. For example, it someone is dramatically decondition or morbidly overweight I wouldn’t expect them to go for a jog. That would not be healthy and would cause too much stress on the body. Start out by walking to the mailbox and working up to a walk around the block or maybe riding a stationary bike for five minutes the first week and increase that slowly every week. For those with aches, pains, and issues with their joints – consider swimming or water aerobics. I have older, more frail patients who do laps in their living rooms, some with walkers.

I think it is good to do some cardiovascular exercise because it will get your heart rate up which will improve your strength, stamina, and endurance. Isometric exercises that maintain or build strength – like lifting one or two-pound weights, or soup cans – is also very helpful. Exercise can be many things and it need not be one thing all of the time. It’s great to have variety so it doesn’t get old and stale.

Some of the chemotherapy regimens we give have specific side effects and if people are on steroids that can cause weakness in the shoulder or leg flexors which can make it more difficult to simply get up off a chair. Exercises specific to those muscles can lessen or eliminate those weaknesses.

It's More Than Physical:

They did a study at the Mayo Clinic years ago, looking at older people who were retired and were active. They compared those that played tennis, soccer, and I think it was volleyball with those that ran, swam, and biked to try and determine which were the most healthy activities. They found those who were involved in team sports were better off because of the social and supportive aspects of working out with others versus working out alone. We’re social creatures and we need to be with others!

What I Do:

I try to go for a jog three times a week and I try to go for a bike ride when I can. When the weather is nice I like to hike and I have been rock climbing since 1989 with a buddy from medical school. I also enjoy rock climbing with my kids.

How do I find time to exercise? Well, a big part of it is that I actually don’t watch TV! I haven’t watched much more than an occasional movie or a program with my family in about twenty years.

What I am seeing, for my own generation and even moreso for the younger generations, because we have become so computerized; and not just computers but cell phones and all of the digital technologies; there is so much opportunity to sit. Of course, it is important that we use technology to get things done, but I also think it’s okay to fast from these technologies. Take a day off from your computer, or your cell phone, or the TV. I think people will be amazed at how much time they can get back.

These technologies that supposedly help connect us are actually isolating us from the people around us, even the people in our how homes. If we get rid of some of the distractions in life, I think we will all experience more opportunities to enjoy the most wonderful blessings and the simple things in life – like the relationships you have, and spending time with others.

Thank you Dr. Bettag! And if you ever care to chat and share your thoughts with us again... I think I speak for all of our readers when I tell you that we are looking forward to it!

And, if you are an area cancer patient/survivor looking for ways to increase your activity and your connectedness with others... please keep reading!