Melanie Cole, MS (Host): Welcome to AHN MedTalks, an informative resource for physicians across various specialties as we delve into the latest medical insights and best practices, ensuring you stay at the forefront of your field. I'm Melanie Cole and joining me today is Dr. Colin Champ. He's a Radiation Oncologist at AHN and a Certified Strength and Conditioning Specialist, and he's here to highlight today exercise and cancer; the dose required in the cancer setting. Dr. Champ, thank you so much for joining us today. I'd like you to start by telling us about some of the effects of exercise on cancer treatments and the quality of the life of a patient while they're going through these treatments.

Colin Champ, MD: Thanks, Melanie, for having me first off, and I would love to talk about this. It's a topic near and dear to my heart. We know that in the past, we were perhaps a bit off when we told cancer patients that they should take it easy and kind of sit around during treatment. We certainly know that that's not the right approach after treatment.

And so what we've found as a field, is that when individuals undergo exercise, and that's to varying degrees, and we could dig deeper in that in a moment, but when they exercise, it does improve quality of life. It can offset side effects from treatment like fatigue from radiation. It can actually help with dosing of chemotherapy to ensure individuals get optimal dosing. And then it can do things like help muscle mass and decrease fat mass, both of which correlate quite strongly with outcomes after treatment for cancer.

Host: Well, it's similar in the way that it's evolving, Dr. Champ, to the way that we used to think about cardiac events and the same lying in bed after your event. But now, boy, we get them right up same day, if possible. And so we're realizing more and more the effect that exercise has. When you're talking about exercise, and I'd like you to speak about what kinds of exercise we're talking about, but can it affect the cancer itself? Is there any studies you'd like to cite? Anything that we know about exercise and the effect on the actual cancer, whether good or bad.

Colin Champ, MD: Yeah, that's the million dollar question there. There are preclinical studies and animal studies showing that if you exercise mice, it can improve outcomes, cancer specific outcomes. There's a recent study that came out looking at individuals undergoing actually a decent amount of resistance training showing that it, those individuals undergoing exercise during chemotherapy for breast cancer get higher therapeutic doses.

They have to less often reduce their dose of chemotherapy and they had a higher complete response rate to chemotherapy. So that's kind of the highest level study that we've seen in terms of exercise impacting cancer outcomes. The biggest issue with those studies are one getting cancer patients in a setting where they can safely exercise; which we've been fortunate to be able to do at AHN. And then number two, getting enough patients through these studies to statistically show that it can impact an outcome. And that, a big mountain to climb.

Host: Well, it certainly is, and when we're talking about setting up a program like this, what kinds of exercise? You mentioned strength training, resistance training. We think of cardio, functional training, know, there's so many different kinds now. What do you think has the best effect for patients?

Colin Champ, MD: I think the way to basically hit the most nails on the head, is through resistance training. And I think through resistance training, you can actually change up the repetitions, the rest time, the time under tension to get both conditioning and muscle stimulating activities through one type of exercise.

I think having individuals chug away on a treadmill is not the answer because so much data shows how important muscle mass is. And there's really only one way to increase muscle mass, assuming your protein consumption is adequate, and that is through resistance training. So I think that has to be the crux of every exercise program.

And also it has to be heavy resistance training. You have to hit much like with my radiation treatment. If I don't hit a certain dose, it's not going to work. You have to hit that threshold with resistance training to cause enough damage to muscle mass so that it increases, that it grows and that you, cause hypertrophy; and luckily if you hit those thresholds, that's often the same threshold that increases things like bone mineral density, metabolism, gets you stronger, gets you moving better and just gets you performing better on a daily basis, or performing and functioning better at life.

Host: As we're adding more and more resources for patients going through cancer treatments, cancer exercise specialists are another provider that can come in and know a bunch of this stuff. Yes, I mean, are we looking at people with a specialty in cancer and exercise?

Colin Champ, MD: I'm very partial to certified strength and conditioning specialists. I think, they're vital because they're basically there to train professional athletes. And I think it's vital when you train professional athletes that you can't injure them, right? Cause that a career ending injury would cost millions of dollars, but you have to be efficient and effective.

I view our cancer patients as the same way. They're, professional athletes. We need to push them, but we need to do it safely and effectively. So I think that, that certification is important. But I think that also having like we have, I'm in the room with these patients. I'm a certified strength and conditioning specialist, but I'm also a physician.

Having that interplay between physicians and exercise physiologists and individuals with CSCS is vital. And it's a new model. As far as I know, we're the only, people doing it in the oncology setting. But again, I think the more we view our cancer patients like athletes, just like the general population, knowing their medical limitations, the better we're going to be able to push them to the next level.

Host: I love that comparison and that analogy, Dr. Champ. I think that's excellent because they are like in a marathon, and it is sort of very similar to athletics and you don't want to injure them. Now, along those lines, what if they're feeling bad? I mean, on some of those chemo days, on some of those radiation days, they're not feeling so great. They're very tired. And that's going to make them more susceptible to injury. Will it take away the benefits or set them back? Do we take a day or two off with them? What do you want providers to know about that?

Colin Champ, MD: Melanie, it's the same as if you or I didn't really feel like working out one day. Sometimes those are the days where you feel the best when you leave the gym. You say thanks to myself pushing me through this. And a lot of times for these individuals, it's the same. Now, obviously, we want to keep it safe.

We do things like heart rate variability to look at their parasympathetic and sympathetic nervous system. We have them rate how they're feeling that day. And we have three different workouts for individuals undergoing chemotherapy. So it's a rough day. If it's a rough day, we'll do a red light workout.

If they're feeling good midway through, we might jump it up to a yellow light or a green light workout. If they come in ready to roll, we hit them hard from the start with a green light workout. And interestingly enough, what we often find is individuals that feel really crummy from chemo one day, or just feel really crummy overall; oftentimes once they get in the gym and start working out, they actually have pretty darn good workout.

Host: I agree with you. Is this something, and we've mentioned safety a few times, Dr. Champ, that you want patients to do at home as well? Would you like to see them doing functional exercise, flexibility training, different exercises at home to coincide with what they're doing in the program?

Colin Champ, MD: I like them doing mobility exercises at home, but I want them working out under my roof. We have them doing lifting, functional movements, compound movements, et cetera. These are things I don't necessarily want people doing at home. And frankly, I think I'm a pretty motivated individual. I don't work out as well at home. I want to be in a setting where someone's laying eyes on me and these individuals for sure should be in that setting. And that's pretty much what we set up and that's where this is unique, where we want to maximize effectiveness of the exercise program, but also maximize safety.

And it is really hard to do that on your own, particularly when you're not feeling really good from your treatment. So I think mobility exercises on a daily basis are great for these individuals, but when they're about to hit the weights, I really want them to come in.

Host: I'd like you to finish off here by telling us a little bit about the program itself. How often you like to see patients, where you see exercise fitting into the future treatment of cancer, and what you would like other providers to know about cancer and exercise and the program at AHN?

Colin Champ, MD: Absolutely. So our program, if someone's on chemotherapy or, or any kind of targeted agent where they're having some difficulties, we generally want them to come in at least twice a week. And again, we have them on a graded workout that goes up or down based on how they're feeling and how they're doing. For individuals that aren't having issues with their systemic treatment; for instance, someone who's undergoing radiation for breast cancer, or radiation for prostate cancer, they really can be pushed just as hard as someone not undergoing those treatments. So for those individuals, we generally want them in at least three days a week. And then those individuals we push pretty darn hard both to offset the side effects they had from the treatment that we did.

So whether it's anti-estrogen treatment, radiation, et cetera, and then also just to make them feel better, look better, move better, be stronger overall and healthier overall. And in terms of where we see this going, I mean, this is a, it's a lifetime membership. We don't want someone in for a month and then go home and stop doing it. We want them to do it forever. And the way we view this is I'm certain that this is going to be just considered part of cancer treatment. So it's going to be part of the treatment, part of the prescription. You know, when you finish, if you're on a medicine that weakens your bones, you have to go to the gym and lift heavy weights so that it causes microfractures in the bones and increases bone density. It's just part of treatment.

Host: I agree with you completely, and thank you so much, Dr. Champ, for joining us and telling us about the program. And to learn more or to refer a patient, please call 844 MD REFER or visit ahn.org. Thank you so much for listening to this edition of AHN MedTalks with the Allegheny Health Network. Please remember to subscribe, rate, and review this podcast and all the other AHN MedTalks podcasts. I'm Melanie Cole.