Maggie McKay (Host): This is BayCare HealthChat. I'm your host, Maggie McKay. Joining us today are Juan Torres, medical fitness supervisor and exercise oncology educator, and Dr. Peter Blumencranz, surgical oncologist and medical director of BayCare Cancer Institute, to discuss exercise oncology. Thank you both for being here today.

Dr. Peter Blumencranz: Thank you for having us.

Juan Torres: Thank you for having us.

Maggie McKay (Host): Yes. I'm excited to hear more about this and learn what is exercise oncology and why does it matter, Dr. Blumencranz?

Dr. Peter Blumencranz: Well, exercise, as most everyone knows, has some benefits in general, improves our physical function, good for your heart and lungs, may help weight control, mental wellbeing, and probably increases longevity. But how does it relate to cancer? The patients who have cancer treatment may get surgery, radiation, chemotherapy, but all these can lead to side effects: fatigue, anxiety, depression, they lose strength, muscular decline, and so on.

And so some of these change due to the cancer or from the treatments. And we've really addressed these issues for them, usually after the treatment when they're debilitated. Where exercise oncology comes in is to provide the benefits of exercise right up front at the beginning of their diagnosis to stop some of that wasting and lack of energy, So, it changes the course of their therapy.

Maggie McKay (Host): Juan, anything to add?

Juan Torres: Basically exercise oncology, as Dr. Blumencranz mentioned, all the benefits, is when we integrate structure individualized exercise into cancer care, it helps patients maintain strength, energy, resilience during and after treatment. And something that we need to emphasize at the beginning of this conversation is that exercise does not replace treatment.

It helps the body tolerate and recover from treatment.

Maggie McKay (Host): And Dr. Blumencranz, could you share with us some evidence-based benefits of exercise for cancer patients?

Dr. Peter Blumencranz: Yeah, actually it was a very nice study on colorectal cancer patients, published just last year in 2025. And there's been lots of sort of soft data, but this was a prospective randomized trial, really high quality evidence, and it showed that in patients who received this kind of structured exercise program from the time of diagnosis as they were going through the therapies actually had a benefit in survival that is not having a recurrence or dying of their cancer that equal the effect of chemotherapy. Really profound. So imagine if you're gonna get the effect of a course of drug therapy with no drugs and none of the side effects.

Maggie McKay (Host): Wow. That is amazing. Juan, could you address some of the safety concerns and common misconceptions about exercise oncology?

Juan Torres: Yes. And to understand that, we need to say that for many years patients were told to rest during cancer treatment. Exercise oncology has evolved dramatically over the last 20, 30 years. In the late 1980s, started with some first trials testing whether if exercise was safe during cancer or exercise was a cure for cancer patients.

Then in 2010, the American College of Sports Medicine in a round table basically had a consensus that exercise is not just safe, but actually beneficial for survival. Then in 2019, the same organization, American College of Sports Medicine, had a foundation with a specific evidence-based exercise recommendations tailored to different cancer type. That was huge.

2022, some of the ASCO guidelines meant basically saying that now oncology providers are being told to actively recommend both aerobic and resistant exercise during treatment, not just after the treatment. And what Dr. Blumencranz mentioned, one of the biggest and most important challenge trials, the 2025 challenge trial, that basically show how structure exercise actually improve disease free survival in colon cancer patients.

So exercise has become one of the most empowering tools during cancer journey. One of the strongest findings is that exercise helps reduce cancer-related fatigue, which is one of the most common and distressing side effects of patient's cancer care. And basically when the patient goes through a cancer journey, it's very important not only to educate them on the benefits, but what are the different tools and resources that they may have.

Maggie McKay (Host): Absolutely. And so you touched on this a little bit, but let's get into it a little deeper. Does exercise help manage side effects of treatment and how so? How does that work?

Dr. Peter Blumencranz: A good example is many patients with even chemotherapy have something called peripheral neuropathy, where the nerve endings get affected by the chemotherapy. They often, they sort of can't feel their feet very well. They lose balance and so on.

And it turns out that if you start this kind of fitness program before they get the chemotherapy-induced neuropathy, it actually will be less intense if it occurs. And patients might, for example, have to abort their chemotherapy and not finish the course because the side effects are that drastic.

There's evidence that more patients will complete their full course of therapy because they have the diminished side effects doing the exercise. So that's really an important message.

Juan Torres: As I mentioned, and we need to emphasize, exercise is not a substitute for medical treatment. But think of exercise as creating an optimal condition for treatment to be effective. This goes beyond simple exercise activity or simple exercises. It is more a biological signal that affects the entire body of the patient, the systemic part.

When a patient faces cancer, it creates some stress across multiple body systems, immune system, cardiovascular system, metabolic, psychological. So exercise addresses many of those same systems simultaneously. Really, the goal is to support the body's ability to respond to and tolerate treatment and all of those side effects.

Maggie McKay (Host): And tell us about the collaborative and individualized approach to care you have.

Juan Torres: So at BayCare, to do things right, we partner with one of the gold standard organizations in exercise oncology, the Maple Tree Cancer Alliance, that basically allow us to have our highly qualified staff being trained under their evidence base protocols to offer structure and individualized approach to each single patient.

Our program starts with obviously first a conversation between the oncology team and the patient. And the patient is being referred to one of our programs and they begin with an initial health-related fitness assessment. And we basically review with the patient current fitness levels, medical history, treatment stage. Very important that exercise is individualized and supervised to ensure safety and effectiveness.

As I mentioned, our program follows the Maple Tree Cancer Alliance Protocol and a based framework that is used nationally for oncology exercise programs. Our exercise adapt the cancer journey, as Dr. Blumencranz mentioned, we are able to work with the patient at the beginning, at the time of diagnosis. Also, we can help the patient during treatment, before surgery or after surgery, or even when they are continuing with immunotherapy.

Maggie McKay (Host): And how does somebody with cancer get started? What do patients need to know to start?

Dr. Peter Blumencranz: Well, part of this is a matter of our internal preparation, so we started along with this new program, educating our physicians. The change has to be not just that exercise is offered as an adjunct to therapy. One of the problems that we've had is even if oncologists recommended exercise in the past, often patients would decline.

They feel that they don't have lack of energy, maybe due to their cancer itself, or they're out of shape. Or maybe these people never exercise, you know, really in their lives. They're very sedentary and they just feel they can't do it for various reasons. So we've gotta change that approach and that requires starting with the physicians themselves so that treating physicians know how important this is.

The idea is to really have the patients and the doctors consider exercise as part of the treatment plan. Just like we included prescription for surgery, radiation, chemotherapy. We really need to add on that plan a prescription for exercise that's part of the course of treatment, not something extra or something to be declined.

Juan Torres: From the patient's perspective, it's very important and sometimes many changes occurs at the time of diagnosis, they are overwhelmed with everything that's going to happen with information, appointments. Everything changes in their psychological state. They need to understand, and that's part of our role as exercise oncology professionals, is to let them know that they don't need to be fit to start. They don't need to have a background of being active. They don't need to have a background of understanding exercise. That's the reason we are here. To educate them and progress them gradually with movements as simple as walking, light resistant training, light mobility work.

The sessions are adapted to how they feel during the day, how they feel during that week, and that's very important for the patients to understand that at the beginning it can sound a little bit overwhelming. They will be guided by exercise oncology professionals. That's what exercise oncology brings to the table, to put professionals in front of those patients so they can understand.

They don't need to take that challenge to learn on their own. We will guide them, we will educate them, and we will make sure that they can have first, a safe and secure programming and experience, and then they can feel the difference and understand how the outcomes that they will feel.

Dr. Peter Blumencranz: Yeah. One of the other benefits, also to this program, so when they start the program, they get a rapid assessment, but they're assigned someone like Juan or the people he has trained, who is certified in this program. And they have a personal coach for at least 12 weeks going through their treatment.

Patients who are going through cancer treatment sometimes don't have family support. They may be alone. If they're elderly, even transportation can be a problem. We have a way of handling this by, Juan can comment on this if you'd like, but by telemedicine, and that is video. They don't have to come in-person, even if they can't manage, but there's a benefit to some of these patients that they will express that they felt they had a partner along the ride with them as they're going through the treatment because that coach really becomes their buddy during that period of time.

Maggie McKay (Host): That's so special. I bet that that makes a huge difference just to have that one-on-one support. And, I love what you said, Juan, about how every day is different. Maybe some days they don't feel as strong as others, and so you tailor the exercise to how they're feeling that day, which has got to be invaluable to the patient because you can't possibly be feeling good every day, going through what you're going through. So let's talk about some success stories and patient experience.

Juan Torres: When we started the exercise oncology program and before answering that question, I want to also add that, the role of our highly qualified staff, our certified exercise oncology professionals. They are trained to work with cancer patients to understand treatment related risk, to modify the exercises when there's fatigue, when there's neuropathy, after surgery or recovery.

The goal is not pushing intensity with the patients. It's really supporting them in the healing process and maintaining physical capacity and functionality throughout the process. In terms of experience, we have had many patients throughout the programs finishing, our program is a 12 weeks program that integrates exercise session with consultation with a registered dietitian and a health coach.

So a whole multidisciplinary team working with the patient, guiding them, as we mentioned, and we have seen some meaningful results in terms of the outcome. For example, we have seen the majority of the patients improving outcomes like hand grip strength, also, patients improving cardiovascular endurance.

That's an indicator that lets us know that the patient will be able to manage fatigue and manage cardiovascular endurance during their treatment. There has been also many patients, sharing with us about how amazing was the experience throughout the program and how the 12 weeks helped them maintain their schedule up-to-date in terms of their treatment, in terms of their chemotherapy, in terms of their radiation, because they had the energy, they had the will, and they had the support of our team to keep going and keep pushing them to continue.

Maggie McKay (Host): How long has exercise oncology been around?

Juan Torres: Exercise oncology, as I mentioned, has come a long way in terms of since the late 1980s with all of this new research coming out lately. So we can say since 2019 from that first American College of Sports Medicine round table, when the evidence was basically recommending tailored evidence based exercises to different cancer types. And the amount of research I can say right now is coming out weekly with more and more evidence that suggests that supervised exercise programs are often more effective when patients are trying to figure out on their own because the program can be adjusted based on the treatment symptoms and safety needs.

That's the amazing aspect of exercise oncology that because it's an individualized approach, we can really tailor everything to the patient’s current health status.

Maggie McKay (Host): That's so encouraging, Dr. Blumencranz, what do you see for the future of exercise in cancer care?

Dr. Peter Blumencranz: Well, I think at this point the evidence is, we've both been telling you, the evidence is very strong about the benefits. Now it's time for implementation. The Commission on Cancer, under the American College of Surgeons, accredits cancer programs, and in the last couple of years have added as part of your benchmarks that you're measured on, you have to provide an exercise oncology program as part of cancer care. It has to be embedded in the patient's plan of action. The idea of making this an option really going into the future, that shouldn't be the case. It should not be optional to patients. It's almost has to be a requirement. The question is, how do you gently encourage patients who, you know, they find their limitations personally, that we can get you through this? And that's where the personal coach really helps to get over some of those barriers to starting it.

Maggie McKay (Host): Juan, anything to add?

Juan Torres: Exercise is moving from nice to have to part of standard care of patients facing cancer. In the future, more cancer programs will be expected to connect patients to exercise. One example is the 2024 NAPBC. That is from the National Accreditation Program for Breast Centers, that they implemented the standard 5.11: that basically is saying that patients need to be referred to wellness exercise therapy programs, and that's basically almost now being part of the standard care of breast cancer patients. So that is a huge step.

As we have been saying, programs will become more personalized. There are many outstanding and amazing programs out there that helps many cancer patients in their survivorship phase, but the individualized approach will be something that will be needed so the patients can create that foundation of strength, resilience, cardiovascular endurance, to keep going because this is not something that they will do for a couple of weeks.

The intention is that it can be a lifestyle change for the future because that will help them have a better survivorship. And obviously, the evidence is getting stronger. It’s not anymore about quality of life. Also the evidence is showing the different changes that happen at the biological level of the body of a cancer patient.

So, the future looks bright for exercise oncology and we are very proud at BayCare to be at the forefront to offer this to cancer patients and offer this to the community to keep improving the health of all we serve.

Maggie McKay (Host): So thank you both so much. This is such hopeful and encouraging information. Thank you for sharing your expertise again.

Dr. Peter Blumencranz: You're very welcome.

Juan Torres: Thank you for the opportunity and this is a message that we hope that can help patients and other oncology teams to spread the word about what exercise oncology is. There's more information to review, to discuss. And that will be our role to keep emphasizing, to keep bringing awareness.

And once again, thank you for the opportunity.

Maggie McKay (Host): Absolutely. Again, that's Dr. Peter Blumencranz and Juan Torres, and that wraps up this episode of BayCare HealthChat. Head on over to our website at BayCare.org for more information and to get connected with one of our providers. Please remember to subscribe, rate, and review this podcast and all the other BayCare podcasts.

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