Treatment – Frantic Shanti

Fighting Depression with Exercise

If you’ve hung around this blog for a while, you know that I am a firm believer that exercise will make just about anything better.

That was certainly the experience I had with cancer, as maintaining my fitness was critical to lifting my spirits. A nice workout was the best way for me to shake off the remaining side effects of a chemo infusion.

That’s why I’m not completely surprised that a group of researchers (Heissel et al., 2023, Br J Sports Med) are suggesting, based on a meta-analysis of 41 studies comprised of a total of 2264 participants, that exercise be used as a primary treatment for depression. That means they feel the results of their research demonstrated exercise to be just as effective as psychotherapy and medication.

The study authors conclude boldy, “Exercise is efficacious in treating depression and depressive symptoms and should be offered as an evidence-based treatment option focusing on supervised and group exercise with moderate intensity and aerobic exercise regimes.” [Emphasis mine]

However, while no one is arguing against the importance of exercise in helping individuals treat their depression, an article appearing in The Washington Post cites other researchers who feel that it may be premature to use exercise as a primary treatment for people suffering from clinical depression and suggest that additional studies should be conducted.

More research needs to be done to determine the specifics of how to use exercise to lift depression.

In particular, as a meta-analysis, although the total number of research participants was large (2,264), the individual studies on which the analysis was based tended to have smaller participant sizes, due in no small part to the fact that running studies like this can be costly.

There are still a number of questions that need to be addressed, such as exercise type, frequency, intensity and amount. Depression is different for everyone both in scope and origin, and an “exercise prescription” should be personalized for the individual. Still, no one is disupting that any form or length of exercise is far better than doing nothing.

In light of these results, what should you do?

Do the type of exercise you enjoy. The best results in this particular meta-analysis were obtained from moderate intensity exercise, although intense exercise was still beneficial, and benefits were also gained from even light exercise. Avoiding sedentary behavior was key.

If you’re just starting out, find a simple exercise that you’ll enjoy doing and will look forward to.

My personal suggestion for anyone who is not currently exercising would be to try to maintain consistency with a simple exercise like brisk walking. If you are able to get outside into nature, perfect! If you’re deadset on bingewatching the latest season of your favorite show and decide to march in place, swinging your arms while you watch, that is great too! It still beats the pants off of crashing out on the couch as the show plays on.

There are many ways to incorporate more movement into your life and also ways to make it pleasant so that you look forward to it. At the least, find a simple exercise that you don’t dread…and then keep doing it. In the meantime, we will await future studies that can offer more insights into the psychological benefits of exercise.

REFERENCES

The Study, a Meta-analysis
Heissel A, et al. (2023) Exercise as medicine for depressive symptoms? A systematic review and meta-analysis with meta-regression. Br J Sports Med. http://dx.doi.org/10.1136/bjsports-2022-106282.

A Reader-friendly Synopsis
Reynolds G (March 15, 2023) The best treatment for depression? It could be exercise. The Washington Post. https://www.washingtonpost.com/wellness/2023/03/15/exercise-depression-benefits/

There Goes Another Cancer Milestone…Big Deal

On October 23, 2017, I finished radiation therapy for my stage 1, triple-positive breast cancer. That was three years ago. At that point, I imagined myself being through all the “tough stuff”. I’d already had surgery that March, spent the summer enduring chemo infusions, and then six weeks of radiation in autumn.

October 23rd seemed like a “marker” day. I rang the gong in the radiology waiting room, with all the staff present and smiling. It was a day that I knew I’d remember.

Except that it didn’t end up being a very important milestone. At that point, I didn’t fully realize that the treatment doesn’t really end. I can only say that it’s been three years since I finished chemo and radiation. But the truth is that a few weeks after that I started tamoxifen (surprise!), which came with its own worries. And I still had more than half of my infusions of Herceptin (trastuzumab, a monoclonal antibody) left, which stretched into April of 2018.

I guess next April, I’ll mark THAT as another milestone.

This coming December I can mark a full year of taking letrozole (aromatase inhibitor), which came after two years on tamoxifen. But I’m still supposed to be on that stuff for “a few more” years – it’s funny that my oncologist has not been specific about that. And I’m not very interested in asking, unusual for me.

I really thought I’d have said “goodbye” to all things cancer by now, but its spectre still seems to follow me around.

What once seemed like a very clear treatment plan, a definite path through the cancer jungle, now seems fuzzy and gray. In one of my first posts here, I talked about being able to put everything behind me, with the more time that passed after “finishing” chemo and radiation. Who was I kidding?

When mammogram time comes up, there’s that familiar rush of anxiety, knowing that I’ll be sitting in that comfy robe in the quiet waiting room, pretending to enjoy a cup of tea, but my tummy will be floating and I’ll try to not to think of much. That’s the work of cancer.

When I wake up in the middle of the night with my hand aching and fingers painfully stiff, medication side effects that are deemed, by the medical community, to be “worth it”. That’s the work of cancer.

When I wonder whether my 18-year-old daughter should be doing breast self-exams now. And whether she’s be hurt by whatever “mistake” my body made in not cleaning up some tumorigenic genetic defect. That’s the work of cancer.

So it makes all those “milestones” a little less fun and exciting.

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But I have to be honest — I still note the time that’s passed by. For my breast cancer, the two-year mark is most important, followed by the five-year mark and then the 10-year one. Each year cancer-free makes me more cocky. But the truth is, one “bad” scan, and I’m back to square one: cancer patient. And then I’ll regret not having appreciated those milestones more.

What Do We Really Know About Cancer?

Some of the recurring themes in my conversations with my oncologist have been that there’s so much we still don’t know about cancer and that the truth will likely be much more complex than we realize.

The recommendations offered as ways to reduce the risk of cancer should not be misconstrued as sure ways of preventing the disease. Thinking we can prevent something gives us a sense of security, which is what we crave. With cancer, we don’t yet have a clear view of how the processes that initiate a DNA mutation translate into our everyday world behaviors or environmental influences, if they even do. What we know is mostly correlational, which means that there seems to be a connection between two things, that they occur together. But that does not mean that one causes the other.

Consider this example: the growth of grass that comes in spring is correlated with the appearance of robins searching for worms. But it would be incorrect to say that the appearance of robins causes the grass to grow. That’s confusing correlation with causation.

In the case of cancer, we don’t have significant causal information when it comes to providing guidelines to humans about what to do and what not to do to prevent the disease. We can offer suggestions, although as in the case of the robins, we can be way off in terms of the way that one thing might affect the other.

Perhaps most unsettling is that as humans, we’re used to being the top predator. What we don’t have as protection inherently (claws, fur, huge teeth), we can use our big brains to manufacture. Cancer, however, still exerts its dominance over us.

We are trying, of course, and learning more all the time. Witness how far we’ve come with treatments, and how we’ve affected the survival rates. That’s a significant and positive step – as a breast cancer survivor, I can attest to that.

But not being able to effectively address the cause means that the treatments, as effective as they may be, take a huge toll on the patient both physically and psychologically. Many of us struggle in recovering from treatments that are considered highly effective, while others succumb to either the disease or the treatment itself.

So as the Breast Cancer Awareness Month of October comes to a close, it’s a good time to celebrate all the positives associated with our medical advances, but also keep an open heart for those who continue to suffer from any type of cancer.

And many of those do not have the benefit of being highlighted in pink.