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Published on January 28, 2020

Doing this after cancer helps recovery

Cancer Exercise

Most cancer patients undergoing treatment face fatigue, anxiety, the risk of becoming frail and possible damage to other parts of the body, such as the heart. With all that in mind, exercise may be the last thing on their list of priorities. But new research is showing that exercise can dramatically improve outcomes.

In a report released in November 2019, in the journal Medicine & Science in Sports & Exercise, the American Cancer Society, the American College of Sports Medicine and 15 other international organizations published new guidelines for exercise for cancer patients. The overall message was: “Get moving and keep moving.”

That advice is exactly what Kristine Whaples, a registered clinical exercise physiologist, has been giving her patients for years. Whaples started a cancer wellness pilot program called Living Fit for You! at Falmouth Hospital in 2013. That program was so well received that she started a second program at Cape Cod Hospital in 2018.

“It became an incredibly successful program,” said Peter Hopewood, MD, of Cape Cod Surgeons in Falmouth, and an active member of the Cancer Committee at Falmouth Hospital. “It’s our biggest support group.

“I think Kristine deserves a lot of credit because the way she does it is perfect. She meets with patients, works on nutrition and some lifestyle changes and then there is the physical therapy exercise program for conditioning.”

As of January 2020, the Living Fit for You! (LFFY!) program is officially registered with the Moving Through Cancer registry. The registry is new and was developed by Dr. Kate Schmitz and the American Council on Sports Medicine. The Cape program is the second in the state to be registered.

The programs are free to anyone with cancer before, during or after their treatment. Patients can have 12 visits that each last an hour and a half, Whaples said. The first 30 minutes is pure aerobic exercise. Then the group lifts weights together. Finally, there is an educational component where participants learn lifestyle tips like how to incorporate stress reduction or better nutrition into their routine.

In addition to keeping people conditioned, the international roundtable that resulted in the report on exercise and cancer concluded the following benefits:

  • Significant reduction in cancer-related fatigue
  • Significant reduction in anxiety
  • Significant reduction in depression
  • Significant improvement in self-reported physical function

Their recommendations were that people undergoing cancer treatment should exercise at least three times a week at moderate intensity, like a brisk walk for at least 30 minutes and lift weights twice a week if possible. The report noted that those who participated in supervised exercise programs like Living Fit for You! do better than those who exercise independently.

The Cape Cod LFFY! programs occur in Hyannis at the CCHC Cardiovascular Center on Main Street, and at Falmouth Hospital.

In the past, most of the patients Whaples worked with came in after treatment. But now, thanks to the new guidelines, that will change.

“The new guidelines recommend that oncologists send people to an exercise physiologist or a program like this while they are doing treatment,” she said. “Typically, in the past, people were told to take care of themselves and relax, but now they want you to move.”

Why During Treatment?

There is a multitude of reasons why the changes make sense. Once a person has undergone treatment, they are often fatigued and deconditioned – even if they exercised before their cancer diagnosis. Whaples explained that people have the most muscle mass they will ever have at the age of 20. Every year after that, people lose 1 percent of muscle mass a year.

By the time they are 50, they have lost 30 percent of their muscle mass. That means they also have lost 30 percent of their ability to burn calories because muscle burns calories. Cancer treatment dramatically accelerates this aging process.

“Breast cancer patients typically will lose 10 to 15 percent of their muscle mass during treatment,” she said. “That’s huge. If you look at it in years, it took 30 years to lose 30 percent and then just nine months to lose 15 percent.”

One of the side effects of cancer treatment is the risk of frailty. Frailty is a worrisome health concern, according to Dr. Hopewood.

“If people become frail, they are not going to be able to sustain any illness at all,” he said. “We look at frailty as another way to measure health. Frailty is measured by how fast you can walk down the hall and get out of a chair. If you look at some people, you know they would get blown over by a stiff breeze. It’s not going to take much to push them over the edge. Mortality risks go way up.”

A formal program can give cancer patients the encouragement and discipline they need to stick with their exercise regime, Whaples said.

“It takes effort to move when you are not feeling well, and supervision can really help,” she said. “It’s nice to have someone to bounce things off of to help with the program because sometimes you are so fatigued you can’t get out of your own way.

“I’ve had people who were triathletes or marathon runners who just don’t know how to get started again. Our goal is to get them back to being independent again with their own exercise routine. Or, if they’ve never done one, to maybe start walking on most days.”

Whaples keeps data on the impact her program has on patients. She has observed a 43 percent reduction in fatigue in those with cancer in general and a 62 percent reduction in those with breast cancer.

Anyone who is interested in the program can ask their oncologist for a referral. Or they can contact Whaples directly at 508-495-7685 or by email at kwhaples@capecodhealth.org. If you contract her directly, she will be in touch with your oncologist to request clearance to join. The program is open to anyone who currently has cancer or who is a cancer survivor, even if treatment was several years ago.