February 2024 – Frantic Shanti

“Moving Through Cancer”: A Short Film from ACSM

(Title image: Photo by guille pozzi on Unsplash)

I’ve been coming across a lot of interesting–and hopefully useful– videos. The one I’m posting here is presented by the nonprofit Fund for Sustainable Tomorrows and the American College of Sports Medicine, the latter being the organization through which I received my personal trainer certification almost 16 years ago.

This is a 20-minute film with a hopeful message!

The film, narrated by former Olympic figure skater and cancer survivor Scott Hamilton, showcases the stories of how survivors are using exercise to make themselves feel better and increase their chances for survival. It also shows how our knowledge about physical activity’s benefits during cancer treatment has increased, and the programs that have been created to help cancer patients become and stay active.

It’s amazing to see how within a decade or two the attitude about cancer and exercise has changed. Whereas individuals undergoing cancer treatment used to be told to rest as much as possible, now it’s understood that exercising through your treatment is one of the best ways to not only minimize associated side effects but also decrease the chances of cancer recurrence.

For me, exercising during my treatment was a way to feel normal when everything else felt out of control.

The current recommendation is aerobic activity for 150-300 minutes per week along with twice weekly resistance training sessions. And it’s best to do both types of exercise for a well-rounded program, if you can manage it.

But the most important thing to remember is that no matter what you do, doing something is better that doing nothing. Research has discovered the existence of myokines, hormones that are produced in the tissue of skeletal muscles. They are released during muscular contractions and seem to have anti-cancer properties, slowing cancer growth and spread. That is very exciting news!

Of course, exercise is not a cure, and there is no guarantee that if you are an avid exerciser you won’t get cancer or won’t have it recur. However, there’s a very good chance that physical activity will make you feel better and help you continue with life-saving treatments.

As E. Ronald Hale, MD, MPH, Medical Director of Radiation Oncology at Kettering Health states (from the video), “The best cancer treatment in the world is useless if you can’t get through the cancer treatment.” The side effects from cancer therapies can be debilitating, but getting out and moving will improve your quality of life and help you finish your treatment.

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It’s worth mentioning that the number of exercise professionals who have had additional training in working with cancer patients is growing, which means that cancer-informed trainers and yoga teachers are becoming easier to find. Now it’s the insurance companies that need to get on board.

yoga4cancer: Bringing the Benefits of Yoga to Cancer Patients and Survivors [VIDEOS]

(Title image: Photo by Zoltan Tasi on Unsplash)

In February 2022, I started a yoga teacher training program with a singular goal: to eventually teach yoga to cancer patients and survivors.

With its mix of physical postures (asanas), breathwork (pranayama) and meditation, yoga is ideal for someone going through the traumatic experience that cancer can be. Yoga can provide enough physical exertion to count as moderate exercise and the ability to help the practioner calm their mind, things that are so important for improving cancer treatment outcomes. However, classes must be designed carefully and taught thoughtfully.

Yoga4Cancer Q&A for Cancer Patients and Survivors (Yoga Alliance on YouTube)

Keep in mind, yoga teachers were yoga practitioners first. Many of them got really good at the practice, developed great flexibility and balance and gained respect for the tradition of yoga. But that doesn’t automatically make them appropriate yoga teachers for cancer patients, who need an instructor that understands the nuances of what cancer is and how treatment affects us.

A yoga teacher and breast cancer survivor by the name of Tari Prinster addressed that need by creating yoga4cancer (y4c), “an evidence-informed Oncology Yoga method tailored to address the specific physical and emotional needs left by the cancer and cancer treatments. The approach matches breath and movement to stimulate the immune system, improve flexibility & strength, reduce anxiety and boost overall well-being” (from the y4c website).

I’m planning to begin the y4c advanced 75-hour certification program (see informational video here) either later this year or early next. I’ve been so impressed by y4c’s emphasis on understanding the unique situation that cancer patients and survivors are in–it’s not just your garden variety beginner yoga class with “also for cancer patients” dressing. The program is well-thought out and comprehensive, and I’m so excited to embark on this next leg of moving closer to my teaching goal.

In the meantime, here is a selection of videos created by Tari and her instructors that are specifically geared for the mental and physical needs of cancer patients and survivors:

Yoga4Cancer Oncology Yoga for Cancer Related Fatigue (Yoga Alliance on YouTube)

Yoga4Cancer Yoga for Bone Loss (Yoga Alliance on YouTube)

Yoga4Cancer Yoga for Range of Motion (Yoga Alliance on YouTube)

Yoga4Cancer.com Yoga for Anxiety (Yoga Alliance on YouTube

yoga4cancer.com Yoga for Lymphedema (Yoga Alliance on YouTube)

yoga4cancer.com Yoga for Constipation (Yoga Alliance on YouTube)

Enjoy!

Effects of Diet and Exercise on Chemotherapy Tolerance and Efficacy: Research

(Title image: Photo by Hermes Rivera on Unsplash)

Many cancer patients complain of feelings of helplessness after their diagnosis, and I can certainly relate to that. As a result, I’m particularly interested in research that explores whether patients can gain control over the success of their treatments.

The most recent study I’ve come across includes breast cancer patients undergoing treatment at Yale and Dana Farber Cancer Centers.

This study appeared in the Journal of Clinical Oncology (Sanft et al., 2023). Researchers examined the effect of diet and exercise on “relative dose intensity” (RDI), which is the relationship between the amount of chemotherapy delivered to the patient compared to the standard amount prescribed. Low RDI means that there was a reduction in the chemotherapy the patient received and is generally associated with a poorer outcome. Dose reductions result from the patient’s difficulty in tolerating the drug.

The researchers also looked for “pathologic complete response” (pCR), which is “the lack of all signs of cancer in tissue samples removed during surgery or biopsy after treatment with radiation or chemotherapy” (definition from cancer.gov). This was for women receiving neoadjuvant chemotherapy, which is chemotherapy administered prior to surgery.

Yep, once again we come back to diet and exercise, even during chemo.
(Photo by Yulissa Tagle on Unsplash)

The subjects of this study were women recently diagnosed with stage I-III breast cancer, who either received the “usual care” or a diet and exercise intervention. Those in the intervention group received nutritional counseling with a focus on a plant-based diet. The physical activity included counseling and support for maintaining a home-based exercise program that included strength training (2x/week) and brisk walking (150 min/week of moderate intensity or 75 min/week of vigorous intensity).

What the research confirmed first was that the subjects in the intervention group were able to increase their exercise and diet quality, which showed that it was feasible to make lifestyle improvements even in the midst of chemotherapy.

However, in this study, the RDI for both groups (“usual care” and diet & exercise intervention) ended up being similar, but also quite high, which meant that women in both groups completed most of their treatment. The researchers noted that the study should be re-run with patients who were at greater risk of not being able to complete all their chemo to see how much of an effect improved diet and exercise would have, especially since exercise has been shown in other studies to have a positive effect on patient outcomes.

But a striking difference was seen for women receiving neoadjuvant (prior to surgery) chemotherapy in that the rates of pCR (disappearance of cancer in the tissues) were 53% for women in the intervention group versus 28% for women receiving usual care. That suggests that the intervention enabled the chemotherapy to be more effective.

There are many physical activities you can choose from–clifftop not required.
(Photo by Sigmund on Unsplash)

The researchers stated the following in summarizing their study: “Given that pCR is an accepted predictor of recurrence and mortality, our findings could provide oncologists with a supportive care intervention that affects the ability to potentially improve survival outcomes” (Sanft et al., 2023, J Clin Oncol). And this is very good news indeed.

The take-home message here is not surprising, and it’s good advice for life in general: no matter what your current lifestyle, prioritizing a healthier diet (emphasis on whole foods, plant-based, less processing, etc.) and engaging in regular cardiovascular and strength training exercise will improve your quality of life. It is always worth the effort.

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REFERENCE:
Sanft et al. (2023) Randomized Trial of Exercise and Nutrition on Chemotherapy Completion and Pathologic Complete Response in Women With Breast Cancer: The Lifestyle, Exercise, and Nutrition Early After Diagnosis Study. J Clin Oncol, 41: 5285–5295. https://doi.org/10.1200%2FJCO.23.00871. [This paper is Open Access and can also be found in PubMed Central: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10691793/]

February: A Great Month for a Diagnosis Reenactment

(Title image: Photo by Aaron Burden on Unsplash)

It’s February and that means it’s the start of “diagnosis season” for me. At this point in cancer survivorship, I don’t get as affected by everything that happened “on this date X years ago“. However, I have an oncologist appointment and my yearly 3D mammogram around this time, so I can’t forget what this month means.

You would think that since 2024 marks seven (!) years since my initial diagnosis, I’d feel pretty good about having made it this far past my treatment…and you would be right.

Seven years down and still going strong!
(Photo by Frankie Lopez on Unsplash)

I’m now living the feeling that I so desperately wished for seven years ago when everything felt devastating and out of control. My outcome, even with the many pesky moguls that I’ve had to clear, is something I’m so thankful for.

But of course, even as mellow and relatively unconcerned as I am now, there are little reminders of the rough and tumble past that unsettle me.

Like that point in my mammogram when the tech finishes up and leaves the room to consult with the radiologist, and all of a sudden I don’t feel great anymore. It’s maybe 5-10 minutes or so of sitting in a quiet room all by myself, wrapped up in that bathrobe-y gown made out of fabric that seems like it should be less scratchy, trying to focus really hard on the tropical ocean video that they have playing on the tv screen on the wall.

No matter how warm the room is, there is a cold spot in the pit of my stomach. The hospital does its best making the surroundings seem inviting. Really they try. But it’s kind of hard to mellow out the echo of an impending sense of doom.

Same goes for every time my oncologist says something like, “Hmmm, should we do another chest MRI?” No, no we should not. That’s about 45 minutes of being stretched out like superman on a surface that’s clearly meant for a woman much shorter than me, while getting my ears blasted.

In case you’ve never taken a ride in the tube, this is what it’s like. Don’t forget your earplugs. Bonus for chest MRIs: you’re lying on your belly with your arms stretched past your head for almost an hour, giving you plenty of time to reconsider your life choices.

My husband says the MRI sounds like a broken dot matrix printer. I think if your printer is making sounds like that, it’s time to evacuate the building.

Ah the memories. But again, I am talking about this from the vantage point of seven years away. It is nicer being up here above the fray. It also gives me a great view of the potential rollercoaster disaster that this season could become, if my scans go south.

But seven years into this, I’m betting it probably won’t. So far, so good.