The good news is, today lots of people are surviving cancer.
But the treatment can leave a person weak and deconditioned.
In this segment, Dr. Liat Goldman, will discuss the importance of fitness before, during and after cancer treatment.
Selected Podcast
Why Fitness is Important for Cancer Patients
Featured Speaker:
Liat Goldman, MD, physical medicine and rehabilitation, Courage Kenny Rehabilitation Associates, specializes in cancer rehabilitation, lymphedema, integrative medicine and acupuncture.
Learn more about Liat Goldman, MD
Liat Goldman, MD -Physical Medicine and Rehabilitation
Liat Goldman, MD, physical medicine and rehabilitation, Courage Kenny Rehabilitation Associates, specializes in cancer rehabilitation, lymphedema, integrative medicine and acupuncture.
Learn more about Liat Goldman, MD
Transcription:
Why Fitness is Important for Cancer Patients
Melanie Cole (Host): The good news is today lots of people are surviving cancer but the treatment can leave a person weak and deconditioned. My guest today is Dr. Liat Goldman. She’s a cancer rehabilitation physician with the STAR Program at Courage County Rehabilitation Associates. Welcome to the show, Dr. Goldman. Tell us a little bit about cancer rehab. Really, who is a candidate for it and how does it work?
Dr. Liat Goldman (Guest): Cancer rehab, the STAR Program that we work with is designed for rehabilitation for all phases of care. We’re talking from diagnosis to survivorship to end of life, if that’s what it comes to. When people think about this stuff, they often think, “Well, right now I don’t have an issue so I don’t need rehabilitation” or they think, “Well, I’m too sick for rehabilitation.” The truth is, that there’s always something that we can do to promote mobility and assist with mobility in all phases of care. In earlier phases of care, a lot of it is education on what cancer-related fatigue is; on maintaining a mobility program during treatment; and on the data and information that we are discovering more and more that shows that’s beneficial. Down the line, it’s dealing with how we maintain mobility in light of any functional issues that may develop whether they develop as a result of treatment or whether it be related to prior issues that have gotten worse during treatment.
Melanie: You mentioned that some cancer patients think that they are too sick to exercise and, really, we know that it’s just the opposite. What do you tell them and how do you get them motivated to even just begin moving around and walking?
Dr. Goldman: What I usually tell them is, we used to think 20 years ago that if somebody has cancer and they are getting treatments, they need to preserve their strength and what we are finding more and more is that two things happen if you don’t move around. One is that you get weaker from the treatment and the other is that you lose muscle mass and strength from that. Actually, the recommendations for mobility now are that for mobility during treatment are the same as recommendations for mobility for someone who isn’t in treatment. It’s the same American College of Sports Medicine guidelines of 30 minutes a day/5 days a week. What I’ll usually tell people is, I’ll use an illustrative story that will coincide with their level of mobility. One of my favorite stories is of a woman that I was working with when I was in fellowship who really was so weak when I first saw her in the hospital that she really couldn’t sit at the edge of the bed without support. With someone like that who’s already so very weak, how do you proceed? You proceed doing a very small but very consistent activity. So, she advanced her program by having a lot of assistance with sitting up in bed. Her husband would help her with sitting up in bed. We gave her a bunch of bedside exercises. While she was in the hospital over the course of that couple weeks, we got her to where she was walking about 150 feet with a walker and was able to go home. Sometimes people can really have quite substantial progress with a very low baseline, some with what I could call a technically low baseline or where they feel like they are way too weak to do something. They way that you approach that is in small but very persistent bursts of activity.
Melanie: So, when in the cancer treatment process do you recommend getting involved in therapy and fitness activities?
Dr. Goldman: Right away. What I tell people who I see early on is, “If you never see me again, if you take nothing else from this appointment, just take that you need to be moving on a regular basis. Do not stop moving when you are tired or you’re having a bad day. It doesn’t matter. Do something. You can do something a few times but don’t stop. If you stop, you’re going to have a much harder time than if you maintain your mobility on a regular basis starting now.”
Melanie: Tell us about the STAR Program. We’re hearing about that more and more with cancer patients and your program and you are STAR certified. What is that? What does that mean?
Dr. Goldman: The STAR Program also has a very interesting back story. The person who really spearheaded this is a lady named Julie Silver who was a rehabilitation physician at Harvard and wound up being diagnosed with breast cancer. As she was having her treatment and subsequent to treatment, she had gone from this very active lifestyle and she had all these issues with fatigue and mobility and really felt like, “I’m a rehab doctor. Normally, we’re the specialists with this and I don’t really have a great set of resources of where to send myself. I’m fatigued. I’m having these mobility issues so on and so forth and I don’t really know where the next place is to go.” And kind of out of that impetus, she started working a lot with cancer rehabilitation and that program that she started has really grown to be a nationwide program. That program is the STAR Program and it stands for “Survivorship Training and Rehabilitation.” It is designed as a partnership between oncologists and rehabilitation physicians in order to target functional impairments early on in the process of treatment and to address them and to provide a coordinated program of care for function while patients are having treatment and then also subsequent to treatment. That program is now a nationwide program. The STAR certification is an additional training that the physicians do, that all of the physical therapists that work with our program do. I’m pleased to say--and part of the reason I wound up here is--that we have one of the most well developed STAR Programs and network of outpatient services for physical therapy, occupational therapy, speech therapy for these patient populations. I did my fellowship at MD Anderson in Texas which is typically the number one or number two cancer hospital in the country. We did not have as well developed outpatient physical therapy services, occupational therapy services, and ancillary services for those patients who were having treatment or subsequent to treatment. We didn’t have that there. We have that here. So, we are really lucky in Minnesota in that we’ve got a really well-developed system with a number of providers.
Melanie: What a wonderful program. Tell us what types of fitness activities because we’ve heard that strength training might be a little iffy is someone is going through breast cancer treatment. It can exacerbate lymphedema. Tell us about the fitness activities that people can do while they’re going through cancer treatment.
Dr. Goldman: The easiest thing to start, what I will often give people, is just a walking program. If they are not doing mobility walking, we can start them with walking. That’s a very simple thing to advance. Additionally, there are a lot of misconceptions, actually, about what you can do; what are the risks of lymphedema and the benefits or the negatives of exercising with lymphedema. It actually is not entirely true that you should limit or not do weight training if you have a diagnosis of lymphedema. Typically, what people will do will be lower weights and often they will need to exercise with a lymphedema sleeve on. There’s no clear correlation between exercise and development of lymphedema. Typically, mobility and strength training actually is beneficial for maintaining blood flow in the arm. Things that you avoid, particularly if you’ve had multiple lymph nodes removed and you have lymphedema, are often repetitive activities especially if there’s a downward or gravity kind of focus. The patients that have that will sometimes get some lymphedema exacerbation, get it from things like vacuuming the floor where there’s this sort of jerky, repetitive back and forth motion with the real downward kind of movement. So, the grading of the force is really down. We do have patients that have lymphedema that do strength exercises. What we will usually do is set them up to see physical therapy and get some really good guidance on what they can and can’t do because certainly there are some things that can make it worse if you don’t have support with that. Typically, if you want to be referred for the STAR Rehabilitation Program, you can ask your oncologist when you see them. You can ask them to meet with a STAR Provider or you can ask your surgeon, if you’re going to be seeing a surgeon first to meet again so you can get set up with cancer rehabilitation services. You just ask your physician that you’re seeing for the referral and then we’ll get set up to see you from there.
Melanie: Dr. Goldman, in just the last few minutes please give your best advice to the listeners for fitness and cancer and the benefits of staying active and fit while going through cancer treatment and how someone with cancer can access the Courage County Cancer Rehabilitation Program.
Dr. Goldman: Again, if there’s nothing someone listening to this takes, I would say, “Please don’t stop moving around. Don’t stop doing what you need to do. I know you might feel tired. I know you might feel some days you don’t really want to do anything. A lot of people say that and it’s very true but if you can do even a little bit every day, you’ll do way better than if you do nothing.” Sometimes with this stuff, your strength is going to wax and wane. If you’re having a bad day, do a little less. Do it a little more frequently. If you’re having a good day do more. Listen to your body but do something daily. It will help keep you stronger. It will help keep you more active. It will help you tolerate your treatment. It will help with your mood. There’s more than 100 different studies that I’ve read on the benefits of mobility during treatment. All I can say is that our previous conceptions of what you need to do are not correct. The best thing to do is to keep moving.
Melanie: It’s great information. Thank you so much. You’re listening to The WELLCast with Allina Health. For more information you can go to AllinaHealth.org. That’s AllinaHealth.org. This is Melanie Cole. Thanks so much for listening.
Why Fitness is Important for Cancer Patients
Melanie Cole (Host): The good news is today lots of people are surviving cancer but the treatment can leave a person weak and deconditioned. My guest today is Dr. Liat Goldman. She’s a cancer rehabilitation physician with the STAR Program at Courage County Rehabilitation Associates. Welcome to the show, Dr. Goldman. Tell us a little bit about cancer rehab. Really, who is a candidate for it and how does it work?
Dr. Liat Goldman (Guest): Cancer rehab, the STAR Program that we work with is designed for rehabilitation for all phases of care. We’re talking from diagnosis to survivorship to end of life, if that’s what it comes to. When people think about this stuff, they often think, “Well, right now I don’t have an issue so I don’t need rehabilitation” or they think, “Well, I’m too sick for rehabilitation.” The truth is, that there’s always something that we can do to promote mobility and assist with mobility in all phases of care. In earlier phases of care, a lot of it is education on what cancer-related fatigue is; on maintaining a mobility program during treatment; and on the data and information that we are discovering more and more that shows that’s beneficial. Down the line, it’s dealing with how we maintain mobility in light of any functional issues that may develop whether they develop as a result of treatment or whether it be related to prior issues that have gotten worse during treatment.
Melanie: You mentioned that some cancer patients think that they are too sick to exercise and, really, we know that it’s just the opposite. What do you tell them and how do you get them motivated to even just begin moving around and walking?
Dr. Goldman: What I usually tell them is, we used to think 20 years ago that if somebody has cancer and they are getting treatments, they need to preserve their strength and what we are finding more and more is that two things happen if you don’t move around. One is that you get weaker from the treatment and the other is that you lose muscle mass and strength from that. Actually, the recommendations for mobility now are that for mobility during treatment are the same as recommendations for mobility for someone who isn’t in treatment. It’s the same American College of Sports Medicine guidelines of 30 minutes a day/5 days a week. What I’ll usually tell people is, I’ll use an illustrative story that will coincide with their level of mobility. One of my favorite stories is of a woman that I was working with when I was in fellowship who really was so weak when I first saw her in the hospital that she really couldn’t sit at the edge of the bed without support. With someone like that who’s already so very weak, how do you proceed? You proceed doing a very small but very consistent activity. So, she advanced her program by having a lot of assistance with sitting up in bed. Her husband would help her with sitting up in bed. We gave her a bunch of bedside exercises. While she was in the hospital over the course of that couple weeks, we got her to where she was walking about 150 feet with a walker and was able to go home. Sometimes people can really have quite substantial progress with a very low baseline, some with what I could call a technically low baseline or where they feel like they are way too weak to do something. They way that you approach that is in small but very persistent bursts of activity.
Melanie: So, when in the cancer treatment process do you recommend getting involved in therapy and fitness activities?
Dr. Goldman: Right away. What I tell people who I see early on is, “If you never see me again, if you take nothing else from this appointment, just take that you need to be moving on a regular basis. Do not stop moving when you are tired or you’re having a bad day. It doesn’t matter. Do something. You can do something a few times but don’t stop. If you stop, you’re going to have a much harder time than if you maintain your mobility on a regular basis starting now.”
Melanie: Tell us about the STAR Program. We’re hearing about that more and more with cancer patients and your program and you are STAR certified. What is that? What does that mean?
Dr. Goldman: The STAR Program also has a very interesting back story. The person who really spearheaded this is a lady named Julie Silver who was a rehabilitation physician at Harvard and wound up being diagnosed with breast cancer. As she was having her treatment and subsequent to treatment, she had gone from this very active lifestyle and she had all these issues with fatigue and mobility and really felt like, “I’m a rehab doctor. Normally, we’re the specialists with this and I don’t really have a great set of resources of where to send myself. I’m fatigued. I’m having these mobility issues so on and so forth and I don’t really know where the next place is to go.” And kind of out of that impetus, she started working a lot with cancer rehabilitation and that program that she started has really grown to be a nationwide program. That program is the STAR Program and it stands for “Survivorship Training and Rehabilitation.” It is designed as a partnership between oncologists and rehabilitation physicians in order to target functional impairments early on in the process of treatment and to address them and to provide a coordinated program of care for function while patients are having treatment and then also subsequent to treatment. That program is now a nationwide program. The STAR certification is an additional training that the physicians do, that all of the physical therapists that work with our program do. I’m pleased to say--and part of the reason I wound up here is--that we have one of the most well developed STAR Programs and network of outpatient services for physical therapy, occupational therapy, speech therapy for these patient populations. I did my fellowship at MD Anderson in Texas which is typically the number one or number two cancer hospital in the country. We did not have as well developed outpatient physical therapy services, occupational therapy services, and ancillary services for those patients who were having treatment or subsequent to treatment. We didn’t have that there. We have that here. So, we are really lucky in Minnesota in that we’ve got a really well-developed system with a number of providers.
Melanie: What a wonderful program. Tell us what types of fitness activities because we’ve heard that strength training might be a little iffy is someone is going through breast cancer treatment. It can exacerbate lymphedema. Tell us about the fitness activities that people can do while they’re going through cancer treatment.
Dr. Goldman: The easiest thing to start, what I will often give people, is just a walking program. If they are not doing mobility walking, we can start them with walking. That’s a very simple thing to advance. Additionally, there are a lot of misconceptions, actually, about what you can do; what are the risks of lymphedema and the benefits or the negatives of exercising with lymphedema. It actually is not entirely true that you should limit or not do weight training if you have a diagnosis of lymphedema. Typically, what people will do will be lower weights and often they will need to exercise with a lymphedema sleeve on. There’s no clear correlation between exercise and development of lymphedema. Typically, mobility and strength training actually is beneficial for maintaining blood flow in the arm. Things that you avoid, particularly if you’ve had multiple lymph nodes removed and you have lymphedema, are often repetitive activities especially if there’s a downward or gravity kind of focus. The patients that have that will sometimes get some lymphedema exacerbation, get it from things like vacuuming the floor where there’s this sort of jerky, repetitive back and forth motion with the real downward kind of movement. So, the grading of the force is really down. We do have patients that have lymphedema that do strength exercises. What we will usually do is set them up to see physical therapy and get some really good guidance on what they can and can’t do because certainly there are some things that can make it worse if you don’t have support with that. Typically, if you want to be referred for the STAR Rehabilitation Program, you can ask your oncologist when you see them. You can ask them to meet with a STAR Provider or you can ask your surgeon, if you’re going to be seeing a surgeon first to meet again so you can get set up with cancer rehabilitation services. You just ask your physician that you’re seeing for the referral and then we’ll get set up to see you from there.
Melanie: Dr. Goldman, in just the last few minutes please give your best advice to the listeners for fitness and cancer and the benefits of staying active and fit while going through cancer treatment and how someone with cancer can access the Courage County Cancer Rehabilitation Program.
Dr. Goldman: Again, if there’s nothing someone listening to this takes, I would say, “Please don’t stop moving around. Don’t stop doing what you need to do. I know you might feel tired. I know you might feel some days you don’t really want to do anything. A lot of people say that and it’s very true but if you can do even a little bit every day, you’ll do way better than if you do nothing.” Sometimes with this stuff, your strength is going to wax and wane. If you’re having a bad day, do a little less. Do it a little more frequently. If you’re having a good day do more. Listen to your body but do something daily. It will help keep you stronger. It will help keep you more active. It will help you tolerate your treatment. It will help with your mood. There’s more than 100 different studies that I’ve read on the benefits of mobility during treatment. All I can say is that our previous conceptions of what you need to do are not correct. The best thing to do is to keep moving.
Melanie: It’s great information. Thank you so much. You’re listening to The WELLCast with Allina Health. For more information you can go to AllinaHealth.org. That’s AllinaHealth.org. This is Melanie Cole. Thanks so much for listening.