Scherezade Mama, Dr.P.H. (Host) Hi, I'm Dr. Scherezade Mama, an associate professor in the department of Health Disparities Research at MD Anderson. And I'm here today with Dr. Karen Basen-Engquist, professor in the department of Health Disparities Research, and this is the Cancerwise podcast. Hi, Karen. Thanks for being here. We're here to talk about incorporating walking into your exercise routine, which is an exciting topic, I know, for both of us. So, can you start us off with telling us why walking is a good activity? 

Karen Basen-Engquist, Ph.D. Absolutely, Scher, and thanks so much for inviting me here today. This is really exciting. So, I love talking about walking because I think it is the most accessible form of exercise for most people. And I do want to acknowledge, of course, there are certain people who can't walk, and that's a challenge. They need to find other kinds of activities, but for most of us, we already know how to walk. We have the equipment we need, right? You need a good pair of comfortable shoes and you can walk anywhere in your environment. So, it's it's very accessible. It also is, especially when done at a brisk pace, is a considered a moderate intensity aerobic exercise so it can improve our cardiorespiratory fitness. 

Scherezade Mama, Dr.P.H. (Host) You talked about walking at a moderate intensity, improving cardiorespiratory fitness. What are some of the other health benefits of walking specifically or being more physically active in general? 

Karen Basen-Engquist, Ph.D. Sure. So, being more physically active in general is associated with a lower risk of a lot of chronic diseases. And that's true of everybody: people who've had cancer and people who haven't had cancer. So, it's something we recommend for everybody. For cancer survivors specifically, there are some additional benefits, right? So, cancer survivors who are more physically active have been shown to have a lower risk of dying of their cancer. In addition, there's a lot of randomized trials to show that exercise and physical activity reduces certain symptoms and side effects that cancer survivors experience. Exercise can help improve fatigue and improve quality of life and reduce psychological distress, reduce symptoms like anxiety and depression, and improve sleep. So, there's a whole host of outcomes that can be helped by being more physically active. So, I know you do a lot of research as well with physical activity and cancer survivors and people who haven't had cancer, have you, what kind of benefits have you heard your research participants talk about after participate? 

Scherezade Mama, Dr.P.H. (Host) I think I've heard about some of these, right. It helps with energy, like reduces fatigue, helps control pain sometimes. But I think one of the biggest ones for my participants that I've heard them say over time is, you know, it also gives you, as a cancer survivor, a sense of control. You've received a cancer diagnosis. A lot of times you feel like this is out of my control, right? Treatment is out of control. Whether I respond to treatment is out of my control. And so then having, engaging in an exercise routine or a walking routine kind of gives them a sense of control. And I think the mental health benefits of having that sense of control are so much more important to them than, let's say, you know, some of the physical benefits that we often talk about when we talk about the importance of walking, being physically active or exercise. 

Karen Basen-Engquist, Ph.D. That's so true. It's something that they can do to help improve their chances and improve their quality of life. I also hear people talk about self-esteem and also, you know, kind of feeling like they're it's getting them back to normal after a cancer diagnosis. 

Scherezade Mama, Dr.P.H. (Host) Yes. Yes, for sure. 

Karen Basen-Engquist, Ph.D. That it's a very normal, usual type of activity. They're getting back into a routine and really value that. And I've even heard some of the participants in our Active Living after Cancer program talk about their, some of their numbers getting better, things like their blood sugar control getting better and their cholesterol getting better. 

Scherezade Mama, Dr.P.H. (Host) Yep. 

Karen Basen-Engquist, Ph.D. Their blood pressure getting better. So, those are really important. 

Scherezade Mama, Dr.P.H. (Host) Yes, I think there are numerous benefits to being physically active, right? That, you know, all the ones that we know as researchers, but then many more that we get to hear from participants, which is wonderful when we talk about the benefits, you know, is it okay for cancer survivors to exercise or be active? Are there any risks involved with being physically active or adopting a new walking routine? 

Karen Basen-Engquist, Ph.D. So, you know, as we mentioned, the research really points to a lot of benefits of physical activity and exercise for survivors. Not that many risks really. And I think the, you know, there there are some cautions, right, as with any health condition. Like if you are experiencing things like a lot of nausea, vomiting, diarrhea, you're having trouble staying hydrated, you need to be, you know, get that under control first. There are certain limitations on some kinds of exercise I give for survivors who are at risk for lymphedema. They need to be a little careful with resistance training exercise. That's not walking. So, it's it's more like weightlifting or any kind of strength building exercise, but walking is a very safe activity. That's, I think that's another one of the benefits that makes it such a good form of exercise. Just, you know, stay alert when you're walking in traffic and all those things. And I think another thing that people don't talk about very much is the risks of not being active. 

Scherezade Mama, Dr.P.H. (Host) Yes. 

Right? And so I know you've done some work and studied some the kind of risks of too much sitting. So, can you talk about that a little bit? 

Scherezade Mama, Dr.P.H. (Host) Yeah, for sure. I mean, I think so, this is an emerging area, right? You've probably heard the term now - I think a lot of people actually hear the term now, you know, "Sitting is the new smoking." Right? And I think you're right. When people ask me, "What are the risks to being physically active or exercising? Can I exercise too much?" And I really think the question should be like, "What happens if I don't exercise or I don't become physically active?" And there are known risks to being, sitting for an excessive amount of time or being sedentary for too long. I think right now the research is pointing to well, so I guess a reduction in sitting time by an hour a day reduces your risk of premature death by 20%. That's a statistic not a lot of people know. So, all you have to do is sit one hour less per day to reduce your risk of dying. And then when we introduce that into the cancer space, of course, we need more evidence around that. What are the specific benefits for cancer prevention or control? But I think this is an exciting new emerging area of research. You know, what are the risks to sitting too much? We know that they're there. But quantifying that, I think, is is where we're starting to put time and effort. So, yeah, I think. The shift needs to be focused. Not necessarily what are the risks to being physically active, but what are the risks to really not being active? And can you afford that? And none of us can. 

Karen Basen-Engquist, Ph.D. And I think even what's so exciting about some of the research on reducing sedentary behavior is that even some light activity can be beneficial, right? So we talked about different activity intensities. When we when we think about moderate intensity activity, which is where there's a lot of research showing the benefits. It's - we say moderate intensity is like a brisk walk, right, where you're walking to get somewhere quickly. Or we tell people if you can talk but you can't sing, you're doing moderate intensity activity. So, you know, it's, it's you're working a little bit. But even if you're doing lighter activity, you know, if you get up and walk around the room every hour or so to try to reduce your extended time sitting, that can help perhaps reduce your disease risk. 

Scherezade Mama, Dr.P.H. (Host) I think you really nailed it. It's really just breaking up your sitting time, right? I think that's where the data is showing right now is, you know, not these prolonged bouts or periods of sitting, but instead breaking it up a little bit. So, we've talked about the risks of being physically inactive. You know, so let's say I want to start walking and I want to adopt a program. How do you get started or how does one get started? 

Karen Basen-Engquist, Ph.D. Well, I think first you get up out of your chair, right? And then you walk across the room and I'm only being a little bit facetious, right? I mean, it really I think taking those first steps is probably the hardest part. But what what we recommend in in a lot of our programing is really starting slow and starting with things like setting goals around activity. So, it might be that you set a goal for, you know, how many minutes you're going to walk each day and keep track of that on a piece of paper or on a calendar on your refrigerator or something. Or you might decide you want to invest in a step counter of some kind, a wearable or most smartphones will also monitor steps if you're carrying them around and you open the right app. 

Scherezade Mama, Dr.P.H. (Host) They monitor everything. 

Karen Basen-Engquist, Ph.D. They monitor everything. So, you can you can look to see where you are, what's your baseline, and then increase it a little bit each each, each day, each week over and over to to try to get your fitness level up and your tolerance of walking more up in our Active Living after Cancer program, which we can talk about a little bit, we teach people certain behavioral skills and cognitive skills to help them make that change, like setting goals so you can set a goal for gradually increasing your steps and then doing that self-monitoring to keep track of whether you're achieving that goal and rewarding yourself when you do. 

Scherezade Mama, Dr.P.H. (Host) That's important, right? 

Karen Basen-Engquist, Ph.D. Yeah. Yeah.

Scherezade Mama, Dr.P.H. (Host) The rewards are important. 

Karen Basen-Engquist, Ph.D. The rewards are important. 

Scherezade Mama, Dr.P.H. (Host) They keep you going. 

Karen Basen-Engquist, Ph.D. Keeping it fun. And we also kind of help people challenge some of their thinking patterns about activity. So, I think one challenge that a lot of people have after cancer, especially if they were active before, is they feel like, "Well, if I can't do what I did before, there's no point." 

Scherezade Mama, Dr.P.H. (Host) There's no point. Yep. 

Karen Basen-Engquist, Ph.D. But that's absolutely not true, right? 

Scherezade Mama, Dr.P.H. (Host) Right. 

Karen Basen-Engquist, Ph.D. You need to start where you are and gradually increase and any activity is better than no activities. 

Scherezade Mama, Dr.P.H. (Host) This is a really great segway to my next question because I think we hear a lot, you know, you need to achieve 10,000 steps a day. You know, how much walking do you really need to make a difference? And is it actually 10,000 steps? 

Karen Basen-Engquist, Ph.D. The 10,000 steps thing is really interesting, right? Because it it was really more of a marketing thing. So, there was a company in Japan that created a step counter that they called the 10,000 step counter. And it is, you know, if you're if you're walking 10,000 steps a day, you're probably walking about five miles. There's nothing really magic about that number. So, it's really about like - 

Scherezade Mama, Dr.P.H. (Host) Balloons don't come up. Confetti doesn't come out of the sky. 

Karen Basen-Engquist, Ph.D. No, no. And you don't like become instantly healthy when you hit 10,000 steps a day, sadly. But but it does -  it can, it can be a target. And I think it's much more important to see where you are if you are currently getting 2,000 steps a day, your goal for that week should not be to to get 10,000 a day. 

Scherezade Mama, Dr.P.H. (Host) Right. 

Karen Basen-Engquist, Ph.D. It should be to get maybe 2,500 or 3,000 and gradually increase. And that's that's probably the most important thing is to just keep building on your successes. 

Scherezade Mama, Dr.P.H. (Host) Gradually increasing. I think that that's a lot of what I tell my parents, like my participants as well. It is. 

Karen Basen-Engquist, Ph.D. I tell my parents, too. 

Scherezade Mama, Dr.P.H. (Host) I tell my parents that to. You know, so actually, that was an accidental slip, but actually is quite accurate, right? Starting somewhere, right. And every little bit counts. Just like breaking up sitting time is important. You know, every little bit of activity, anything we do offsets sitting time too, right? If I'm being physically active, then I can't be sitting and every little bit helps. So, I think that's a great message. 

Karen Basen-Engquist, Ph.D. What are, what are some of the skills or techniques you teach people in your interventions? 

Scherezade Mama, Dr.P.H. (Host) Yeah. I think in our programs we really focus on psychological well-being and managing stress. And I think I've heard a lot from my participants that, you know, if I am mentally not well, you know, putting effort towards being more active or walking more that day, you know, kind of comes later, right. It's a low priority for me because I am just wondering how to get out of bed. I've had participants tell me that, like, "I'm just trying to get out of bed today. You know, I'm not even thinking about being more physically active." And so we really try to think about, well, exercise is actually - walking in particular - is really helpful for improving your mood, reduce, like increasing endorphins. Right? Making you feel good throughout the day. And again, one of those strategies to kind of help take some control when you're feeling a little bit like what, what can I do? Right? And so, we talk a lot about stress management acknowledging these kinds of feelings that come up and what role could physical activity play in helping you with stress management. And I think, you know, there's data that shows physical activity is equally effective for treating depression or depressive symptoms as medication. Right? I think that's a hidden secret. Why is it a secret? 

Karen Basen-Engquist, Ph.D. Why is it a secret? 

Scherezade Mama, Dr.P.H. (Host) Why is it a secret? Yeah. 

Karen Basen-Engquist, Ph.D. Yeah.

 Scherezade Mama, Dr.P.H. (Host) We talk a lot about that, like acknowledging this is part of it, right? Acknowledging that stress is part of it. Mental health and wellness is part of it, and exercise can help with that in addition to all the physical health benefits it can also help with. 

Karen Basen-Engquist, Ph.D. Right. Right. And I think it's, it's a, it's a paradox, right? 

Scherezade Mama, Dr.P.H. (Host) Yes. 

Karen Basen-Engquist, Ph.D. Because you have a symptom or a problem like depression or, same with fatigue, right? 

Scherezade Mama, Dr.P.H. (Host) Yes. 

Karen Basen-Engquist, Ph.D. That really makes you feel like staying on the couch. 

Scherezade Mama, Dr.P.H. (Host) Correct. 

Karen Basen-Engquist, Ph.D. Or not exercising. But the very thing that's that - that symptom is preventing you from doing is a thing that could help make you feel better. So, it's, it's a lot to overcome. 

Scherezade Mama, Dr.P.H. (Host) It is.

Karen Basen-Engquist, Ph.D. But it's really important. 

Scherezade Mama, Dr.P.H. (Host) Feels counterintuitive, right? You know, it's just shifting our mindset, so. Well, so because it's so counterintuitive sometimes, what are some specific strategies that people can use to make changes in their habit and then how can they keep it going once they get started? I think that's - that maintenance piece is what we really struggle with as researchers, right? I mean, we can get people to do almost anything for a very short period of time, but then how do we keep them going, right? And support them as they want to maintain it? 

Karen Basen-Engquist, Ph.D. Well, I think one thing that we need to pay more attention to is how to make it fun. Right? How do you make it into something enjoyable? And and oftentimes, especially if you are feeling a lot of fatigue or have some other physical symptoms, it doesn't feel very fun at first. It takes a while to to develop some fitness and start to feel better. But trying to pair the walking with something that is enjoyable I think is really important. You know, maybe what you do, maybe it's about where you do your walking, right? Maybe you go to a museum or go shopping or go to a park. I really like to be in nature and walk and it doesn't have to be like a hike up a mountain. It can just be a little city park or just going outside and see, looking at your neighbor's flowers or something like that and walking around. So, so pairing it with something enjoyable. I also know people will sometimes listen to podcasts or books, audiobooks while they walk to kind of keep them going and, and you know, they maybe aren't enjoying the work itself, but they're enjoying the book so they keep, keep going. Or if you have a, a treadmill or something at home that you can walk on that watching a movie, you know, or a great TV show while you walk can kind of help keep it fun for you. And I think another thing is keeping that end in mind, right? Like the - what is the ultimate goal? Why is it that you want to be more active? And you mentioned some of the people in your study saying, you know, I really want to be able to play with my grandchildren and have the energy for that. And then we know grandchildren do take a lot of energy. So, yeah, so that, you know, those kinds of reasons, or I want to be able to to travel more with my spouse and - or I want to keep working, you know, and I need to feel better. 

Scherezade Mama, Dr.P.H. (Host) I think that's a great point. You know, keeping keeping your "why" in mind, like, why am I being physically active? And yeah, sure, there's a certain group that really enjoys being physically active. I always tell my - I am not one of those people, right? It is a chore for me too, right? So why am I doing this? And it's I want to live healthy and I want to live longer. I want to be able to show up for my family. And so I think keeping that reason why you're being physically active in mind is really important. And I liked all the strategies that you've suggested, right? 

Karen Basen-Engquist, Ph.D. Yeah. What are some others that that you can think of? 

Scherezade Mama, Dr.P.H. (Host) Yeah, I think so. I feel like tying an enjoyable thing to my activity sometimes is what gets me to do it more. So, like you said, listening to an audiobook, right, where I'm like, "I only get to progress in the book if I do it while walking." Yeah. Or being physically active. And so, you know, thinking of it as a reward rather than a punishment, I think is, "Ooh I get to treat myself to a walk and a book that sounds really exciting." Or sometimes I think this is harder with like our our binge, binging culture nowadays. But I still record television shows so that it has a like a commercial. And so I'm like, "I can only watch this show if I'm walking during the commercial break." Whether it's stepping in place, I could do pushups. I could do sit ups. I could do anything. Walk around my home, you know, but tying some benefit to to that piece. And I'm like, "Ooh, I really want to watch this show. Oh, I guess that means I better put my tennis shoes on if I want to watch the whole thing." 

Karen Basen-Engquist, Ph.D. Yeah, that's a great suggestion. And I think that, you know, we talk about - we often talk about sitting behavior and, you know, sitting with regard to the workplace, right. A lot of us do sit while we work. But we also sit when we go home, right? 

Scherezade Mama, Dr.P.H. (Host) Yes. 

Karen Basen-Engquist, Ph.D. Our entertainment is often sitting. 

Scherezade Mama, Dr.P.H. (Host) Yes. 

Karen Basen-Engquist, Ph.D. And so I think if you can think of a form of entertainment that has you up and moving. 

Scherezade Mama, Dr.P.H. (Host) Yes. 

Karen Basen-Engquist, Ph.D. And not sitting I mean, I love watching, you know, bingeing television shows as much as the next person. But it's also good to think about, well, could you sign up for a dance class once a week?

 Scherezade Mama, Dr.P.H. (Host) Yes!

 Karen Basen-Engquist, Ph.D. Or just something that involves going somewhere? Like I said, maybe a walking club at the mall. 

Scherezade Mama, Dr.P.H. (Host) Yeah. 

Karen Basen-Engquist, Ph.D. And getting together with some friends to walk or something like that. That so, so that you break up that evening time too. 

Scherezade Mama, Dr.P.H. (Host) Yep. I love window shopping, so. 

Karen Basen-Engquist, Ph.D. There you go. 

Scherezade Mama, Dr.P.H. (Host) That sounds great. I like looking and not spending my money, so. And I get a walk out of it. That sounds amazing. 

Karen Basen-Engquist, Ph.D. That's great. That's great. So, I wanted to ask you about standing desks and walking paths and, you know, so is it - is it enough to just stand or does somebody need to actually be walking to have some of the benefits of breaking up sitting time? 

Scherezade Mama, Dr.P.H. (Host) That's a really great question. And I think it is really just as simple as like getting up and breaking up your sitting time. I don't necessarily know if we have enough data to say standing desks are the solution. So, standing desks are really great for breaking up your sitting time, right. They, you know, it's a reminder you can break up your sitting time during the work day in particular where we know we sit for eight hours sometimes, right? If we have really large bladders, otherwise we sit less. But we know that sitting excessively contributes to premature death. But the long term effectiveness of specifically using a standing desk is kind of still unknown. It's a relatively newer area of research. There's also some research that shows the use of standing desks may lead to compensatory sitting later in the day, right. So, maybe it's really great for breaking up your sitting time during the work day, but then you may overcompensate for that later on in the day. I think the key here is that it really requires a multi-strategy, multi-component approach. It's not that the desk alone is going to help you, right, be more physically active and reduce your sedentary time. There has to be other strategies that you couple with the standing desk or the walking pad that kind of help you break up your sedentary time and be more active. So, I think, you know, it's to be determined long-term benefits are to be determined. I've also heard things lately about how, you know, excessive standing can also cause some injuries, right? And there is a lot of ergonomic support that needs to be in place when you, when you get a standing desk or even a walking pad for your desk. And so, I think sometimes there is a way to do it incorrectly. So, it's not to deter anybody from getting one. By all means do it. But the goal is to break up your sitting time, not necessarily to help you be more physically active. 

Karen Basen-Engquist, Ph.D. So, what about, can you tell us more about the walking pads? 

Scherezade Mama, Dr.P.H. (Host) Yeah.

 Karen Basen-Engquist, Ph.D. And what that is? 

Scherezade Mama, Dr.P.H. (Host) I have one. I have one. I think I got it on an on a Prime deal one day, right. What a great deal. And so these walking pads are tend to be portable in light. You can move them around relatively easily. 

Karen Basen-Engquist, Ph.D. They're like mini treadmills. 

Scherezade Mama, Dr.P.H. (Host) Like mini treadmills you can, like, roll it under your desk so that you can walk in place while you work. Usually you need both, right? A standing desk and the walking pad so you can lift your desk and then slip under your treadmill and you can start walking, right. And I think that this may be more beneficial then than than a standing desk on its own. Again, I think these are relatively new and they've become quite popular on social media. And so I think a lot of people are adopting it, but it's really hard to be productive with a walking pad. I think it depends on what you're doing right. Taking a meeting I think is relatively easy. Reading an article or something along those lines is relatively easy. But I've been on a walking pad on meetings with you and you probably see my head bobbing up and down, right. Does it make you sick? Does it cause motion sickness? 

Karen Basen-Engquist, Ph.D. No. No. 

Scherezade Mama, Dr.P.H. (Host) No. Okay. 

Karen Basen-Engquist, Ph.D. There are certain colleagues who I know are going to be kind of bouncing up and down during my Zoom calls, and I'm. 

Scherezade Mama, Dr.P.H. (Host) Used to it. 

Karen Basen-Engquist, Ph.D. Perfectly happy with that. Yes, I'm glad they're doing activity. 

Scherezade Mama, Dr.P.H. (Host) I think this is a fun way to incorporate some more walking into your day. So, if it's working for you, why not? I think keep in mind that you may feel the need like that compensatory effect, right? I walked so many steps on my walking pad during my work day today. But then that doesn't give you license to sit and binge an entire series that night. You know, I think that's something to keep in mind. 

Karen Basen-Engquist, Ph.D. And I think it's good for breaking up, sitting or sitting time. Right. But you're probably with a walking pad because they don't go very fast. You're probably mostly getting light activity, which we've already said there's you know, we're learning more about the benefits of that. But most of the research we have on benefits of physical activity and exercise is moderate intensity. So yeah. 

Scherezade Mama, Dr.P.H. (Host) It'll be exciting to see kind of what research comes out of that. You know, in the coming decade, I think we'll see, we'll see a new new invention. 

Karen Basen-Engquist, Ph.D. Right. But but it helps to like sneak in more. 

Scherezade Mama, Dr.P.H. (Host) Yes, definitely. 

Karen Basen-Engquist, Ph.D. More steps throughout the day. 

Scherezade Mama, Dr.P.H. (Host) Yes. For sure. 

Karen Basen-Engquist, Ph.D. What what other ways are there to sneak in steps? Like, what's what's the strangest place you've walked to get in more steps during the day? 

Scherezade Mama, Dr.P.H. (Host) Oh I mean, I think you can oftentimes see me walking around my home or the office. You know, my wearable device reminds me that, you know, you only need this many steps this hour to be an active hour. And so I'll be walking around the office and I probably look like a crazy person just making laps around the office floor. Or sometimes I just walk back and forth in the hallway. I think that's one. I'm oftentimes at home, you know, pacing around, like, I just need 100 more steps and I've got, I'm going to get it. And so I think those are some of the crazy places that, you know, I think it's not necessarily that it's a strange place. It's just that I look strange doing it. Yeah. Like, what are you doing pacing back and forth? 

Karen Basen-Engquist, Ph.D. Yeah, I do a lot of walking in airports cause I travel a lot. 

Scherezade Mama, Dr.P.H. (Host) Oh, yes! 

Karen Basen-Engquist, Ph.D. So, I try to walk in airports. And I know once I think it's the Atlanta airport that has all these terminals that are connected by a tunnel, and most people are taking the train, but there's a perfectly nice walkway goes between the terminals. And I, I walked, you know, all the way through that once, which I got some strange looks because they're the employees use them. 

Scherezade Mama, Dr.P.H. (Host) Yeah. Yes. 

Karen Basen-Engquist, Ph.D. Right? To walk around but they're not used to seeing somebody dragging their suitcase. 

Scherezade Mama, Dr.P.H. (Host) That's right. I'm thinking of one -  

Karen Basen-Engquist, Ph.D. It was good exercise.

Scherezade Mama, Dr.P.H. (Host) It is. It's great exercise. I'm thinking one between the terminals in Chicago. It's underground, and there's the pretty lights that, you know, kind of are in sync to music. And I've often done that as well, because why - and I try to intentionally bypass the escalator, the, you know, whatever, the people mover. Yeah. And take the steps, right? Because I get more health bang for my back I think. 

Karen Basen-Engquist, Ph.D. Right. Right. 

Scherezade Mama, Dr.P.H. (Host) Yeah.

Karen Basen-Engquist, Ph.D. Yeah. And if you're - so here at MD Anderson, we have a great walking resource. It's sky bridges. So, if you are here at MD Anderson that's a lovely place to walk. 

Scherezade Mama, Dr.P.H. (Host) Yes. You get to see your colleagues. I think with the various fundraising initiatives we do like the wreath auction and the quilts, and, you know, so the sky bridge is often decorated, which also is a lot of fun. So yeah, I think that's a great place to also get a walk. We're very fortunate. 

Karen Basen-Engquist, Ph.D. Yeah, absolutely. 

Scherezade Mama, Dr.P.H. (Host) What do you think are some of the challenges people face when they're starting a new routine? We're talking about like sneaking it in and helping people maintain, but like, what challenges do you often see people facing when they're trying to adopt this new walking routine? 

Karen Basen-Engquist, Ph.D. So, so one challenge is just getting started, right? Like I said, those first steps are the hardest steps. I think the other challenge that people face, as is their own expectations, right, that walking around for two minutes doesn't feel like it's enough, but they have a hard time doing more maybe. So, I think that's - that's a challenge. So, I think you need to manage your expectations and know you might be starting small, you might be starting slow, but that's okay. It's it's more than you were doing yesterday and that's a good thing. And tomorrow you'll do a little more and then the next day you'll do a little more. And gradually you're going to increase your fitness more so that you'll, you know, take a walk in the park or do something that's a little bit more vigorous.

 Scherezade Mama, Dr.P.H. (Host) I think also one of the things that we talk about in Active Living after Cancer and then in some of these other programs is, you know what if I have a lapse? Right? Like, oh you know, I've been doing this exercise routine and, or a walking routine, right? And my goal is to walk 30 minutes a day. But then, ooh last week was really rough. And so I didn't get to walk on a lot of the days, right. And, you know, we teach people that it's okay. You know, we all make kind of these mistakes or we all have busy days or busy weeks. And the important thing is just get back into it as soon as you can. Right. But are there other, you know, strategies that can help people. Again, it's like a mental hurdle. Like, you know, I feel disappointed in myself. How do I get over that hurdle to get started again? 

Karen Basen-Engquist, Ph.D. Yeah. Yeah. It like it, it really is challenging your thinking about it, right? That that a lapse is not a failure. It's just something that happens to everybody. 

Scherezade Mama, Dr.P.H. (Host) Right. 

Karen Basen-Engquist, Ph.D. We all have things that interfere with our ability to exercise or eat healthy or whatever changes we're trying to make. 

Scherezade Mama, Dr.P.H. (Host) All the things. 

Karen Basen-Engquist, Ph.D. And so, happens all the time. And we just, we need to say, okay, it's not failure. It's just tomorrow's a new day. 

Scherezade Mama, Dr.P.H. (Host) Yeah, exactly. 

Karen Basen-Engquist, Ph.D. Every day's a new day. 

Scherezade Mama, Dr.P.H. (Host) Every day's a new day. I love that. 

Karen Basen-Engquist, Ph.D. And so I think, you know, challenging your thinking about it is probably the, the main thing and thinking about setting a new goal, right. Saying, "Okay, I got off track. You know, maybe I was too ambitious and that was part of it. And so I might start a little more slowly, but set this goal. If I meet this goal, you know, I'm going to walk for ten minutes, three days a week next week, and I'm going to, you know, go buy myself a new lovely pair of shoelaces or something for a reward." 

Scherezade Mama, Dr.P.H. (Host) Yes. Yes. a reward at the end. That's important. I think that's a good point because I feel like a term I use in my research a lot is, you know, taking the staircase approach rather than the elevator approach. And I think sometimes with starting new healthy habits like a walking routine or an exercise routine, we think we're going to get from here to here, you know, immediately. And it's like, no, it's gradual, and you're probably going to be more successful if you take the stairs than if you try to shoot up the elevator, right? Maybe that works for the short term, but it may not work for the long term. So, I think that's a great - it's a new day and we all mess up. 

Karen Basen-Engquist, Ph.D. And I think it's as evidenced by the large number of people who are at gyms in January, and the much smaller number in February, right. They they and I'm not saying that going to the gym is bad or anything like that, but or that signing up for January is bad, but that the idea that they kind of try to take a wholesale approach to exercising and really like go all in and and really what they should be doing is is the stair step. 

Scherezade Mama, Dr.P.H. (Host) Yeah. Yeah. Yeah. The small strategies can I do. 

Karen Basen-Engquist, Ph.D. Little bit at a time. 

Scherezade Mama, Dr.P.H. (Host) Yes, exactly. Well that's great. What you know, we talked about some challenges. We talked about how to make it more fun. What other resources are available to help people become more physically active and specifically, what resources are available to help cancer survivors become more physically active or adopt a walking routine? 

Karen Basen-Engquist, Ph.D. Right, right. Well, we've mentioned a couple of times the Active Living after Cancer program. So, this is a a program that has been funded by the Cancer Prevention and Research Institute of Texas for the past 11 years and is offered to MD Anderson patients and others in the community. And so, if you're interested in that program, there is a description and or a link in the description for this podcast. So, check it out. But it is a, it's a group program that's delivered sometimes by Zoom and sometimes in person, depending on the preference of the participants. And it teaches people these behavioral skills, these sort of tricks of the trade for becoming more physically active. And we focus a lot on walking because it is such good exercise and such an accessible exercise. And so, you meet with a group of cancer survivors and an instructor for 12 weeks, once a week for 12 weeks, and we do some physical activity. We teach some of those skills. We talk about some survivorship issues. And, you know, what we found is that people, when we measure quality of life, when we measure fatigue, when we measure functioning before and after, that there are really great improvements. So, hope that people will, more people will check it out because I think it's a it's a really great resource. MD Anderson's website also has a lot of information about the benefits of physical activity and healthy diet and working for cancer survivors and the general public. So, that's another another source to check out for good evidence-based information. 

Scherezade Mama, Dr.P.H. (Host) I think, you know, those are all the kind of questions that I have for you. But is there anything you wish I would have asked you or a final thought you want to leave with our viewers or listeners? 

Karen Basen-Engquist, Ph.D. Well, that's interesting. You know, I think one of the things that I heard somebody say on a video once is that the most important thing is to get people from the sofa to the sidewalk. Right. 

Scherezade Mama, Dr.P.H. (Host) Mmm, yes. 

Karen Basen-Engquist, Ph.D. So it's not - we we think a lot about exercise training and like what's the optimal training regimen? And those, and that is important for elite athletes. And certainly as you advance, you know, as you get more active, you might want to might have an interest in really optimizing your fitness routine. But the most important part of it is getting from the sofa to the sidewalk. 

Scherezade Mama, Dr.P.H. (Host) I love that. Yeah. I like to say, you know, getting you from doing nothing to doing something, you know, and again, we all have to start somewhere. Well, Karen, thank you for being here with me today and having this discussion. For more information or to request an appointment at MD Anderson, call 1-877-632-6789 or visit MDAnderson.org. And thanks for listening to the Cancerwise podcast from MD Anderson Cancer Center.