Caitlin Whyte (Host): Welcome to another episode of Flourish, the podcast brought to you by PRISMA Health. I'm your host, Caitlin Whyte. Today we are discussing an important topic with Jason King, the Assistant Nurse Manager at the Center for Integrative Oncology and Survivorship and the Center for Cancer Prevention and Wellness. Join us as we explore the crucial role that physical activity plays during and after cancer treatment.

Well, Jason, we are so happy to have you on the show and to discuss this important topic. To start our conversation today, is it safe to exercise during cancer treatment and what benefits can routine exercise provide those patients?

Jason King, BSN, RN, OCN: Yes, it is definitely safe to exercise during cancer treatment for sure. Studies have actually shown us that during cancer treatment, it's great to exercise to help with fatigue, anxiety, and depression. And it can also improve your mood and quality of life. Exercise builds strength and fitness, which can assist in tolerating treatments better.

We've also seen through research that patients who are more active tend to have improved survival rates. So, there are a few contraindications thoughto exercise that I do want to mention. Definitely for those with heart failure, unstable angina, like an arrhythmia, high or low blood pressure, recent history of blood clot, these individuals really need to be cleared by a medical provider first, prior to starting any treatment regimen. And then also, while patients are on treatment, they need to take their lab values into account. Certain cancer therapies affect the levels of normal blood cells, which can include our white blood cells, which fight off infection, our platelets, which clot our blood. So when patients have low white blood cells, naturally they're at increased risk of infection and with low platelets an increased risk of bleeding.

So when one's white blood cells are low, they really need to weigh the benefit and risk of going to a public gym to work out and maybe consider exercising at home or outdoors and definitely with low platelets, increased risk of bleeding, you know, just watching for like injury, cuts, falls, stuff like that.

Host: Gotcha. Well, considering some of those caveats, what would you say counts as exercise and how much do you need?

Jason King, BSN, RN, OCN: So exercise is really kind of seen as any regular physical activity. So it can include things like aerobic exercise, which would be walking, swimming, cycling, dancing, basketball, soccer. Muscle strengthening activities like lifting weights. Using resistance bands, body weight exercises, flexibility training such as stretching, gymnastics, martial arts, and the balance training that some do, the yoga, pilates, tai chi, and those balance type exercises.

As far as like the recommended amount of exercise, most providers and clinicians and programs use the American College of Sports Medicine's guidelines for exercise, and so those are for adults age 18 to 65, they recommend 30 minutes of moderate intensity aerobic activity five days a week, or 20 minutes of vigorous intensity aerobic activity three days a week, and two or more days of muscle strengthening per week.

Host: All right. Well, of course, when it comes to cancer treatment, fatigue is a common side effect of many treatments. So what tips do you have to help people find that motivation to get up and exercise?

Jason King, BSN, RN, OCN: Definitely. Fatigue is actually the number one complaint of cancer treatment, of patients on treatment. Some tips, definitely start slowly, some movement is better than no movement. Begin at the patient's current fitness level, you know, that could just be walking or doing chair exercises.

Another tip is to choose an activity they like, you know, it could be walking, but it could be dancing. It could be yoga, finding an exercise partner, someone to encourage them. There's also exercise in small bursts. Some people over the past few years have called this exercise snacking. Kind of like when you snack on food, but this is exercise snacking. So it's small bursts of exercise throughout the day. You know, whether that's just be like marching in place at work, running out when you can just to walk around, the block. But definitely don't overdo it. Naturally, people can be very sore and tired the next day if they do.

And give yourself credit is another tip. Even if current abilities do not match what the patient used to be able to do, they need to give themselves credit for moving and improving over time.

Host: I love that giving yourself credit is so, so important, especially when your abilities and maybe your range of motion or just what you can do changes over the course of your treatment. Such a good thing to remember. Well, on that note, are there any exercises or types of exercise that you should totally avoid during treatment for cancer?

Jason King, BSN, RN, OCN: Not typically, unless, as mentioned earlier, someone has a contraindication to exercise due to a heart condition or issue that should be addressed, and cleared prior to starting exercise. Just again, having the patients be mindful of their lab values while on treatment, certainly their treatment team is good at keeping this in check and reminding patients to wash hands routinely, avoiding crowded spaces, you know, if their white blood cells are low. Some patients though, on therapy, may actually have side effects from the medications that prevent them from doing certain activities. An example of that would be treatment for colon cancer. Some of the medications that are given cause severe cold sensitivity. And so when you're in the winter months, just touching a cold door handle, going out into the air and breathing in cold air causes a spasm in the chest. So things like that kind of limits patients from doing things outside. So they need to alter their routine based on their specific circumstances.

Host: Well, would you recommend getting a personal trainer or anything like that during this time?

Jason King, BSN, RN, OCN: Not necessarily. For most patients on therapy, I wouldn't recommend one. They're already under a lot of financial stress, you know, cancer care is expensive. So, many are already out of work while undergoing treatment. I don't think you necessarily need a personal trainer. They certainly have their place.

There are plenty of other avenues, though, that are available for free through, like, cancer support services that patients can utilize. An example of that would be Livestrong at the YMCA, movement classes offered at the local cancer society or cancer support programs, as part of your health system, you know, where they receive care or just other, things in the community or online.

 Some patients, of course, get very deconditioned with treatment. Some are on treatment for long periods of time. So, you know, sometimes you do have to have that one on one, therapy, and typically that's going to be performed by a physical therapist, occupational therapist, and that's going to require a referral to those specialty services.

Host: Well, Jason, wrapping up here today, can exercise help prevent cancer from reoccurring at all?

Jason King, BSN, RN, OCN: It actually can.

Host: Oh, okay.

Jason King, BSN, RN, OCN: We know, yeah, so in many cases, exercise may help reduce the risk of developing future cancers, and we know this from research that's been performed. So when I was getting ready for the podcast, I just looked up an example just to give today. So if we look at an example of some published data, this was in 2021, there's a manuscript titled Physical Activity Reduces the Risk of Cancer Recurrence and Mortality in Cancer Patients.

And this study analyzed eight different studies on exercise and cancer recurrence. It included a little over 15,000 participants. who had breast, colorectal, and prostate cancer. The study demonstrated a higher self reported volumes of post diagnosis physical activity was associated with a 45 percent reduction in the risk of cancer recurrence and among 21 studies that included 38,000 patients, higher self reported volumes of post diagnosis physical activity was associated with 37 percent reduction in mortality. So, the patients who derived the largest clinical benefit from physical activity were those individuals who were physically inactive prior to diagnosis and increased their volume of physical activity after diagnosis.

Host: Thank you, Jason, for sharing these insights on the importance of staying active during and after cancer treatment. Remember, you can find more valuable health and healing advice at prismahealth.org/flourish. Stay tuned for our next episode of Flourish, where we'll continue to provide you with practical tips and information from the experts here at PRISMA Health. Thank you for listening and take care.