We all know that exercise is good for us. But did you know that exercise can help lessen your chance of getting breast cancer? Exercise also helps during breast cancer treatment and recovery. In this podcast, learn from Dr. Kamila Choi why exercise helps, what kinds you need to do, and whether it is helpful for preventing other cancers as well.
Additional Resources:
https://www.cancer.gov/about-cancer/causes-prevention/risk/obesity/physical-activity-fact-sheet
https://www.cancer.org/latest-news/get-moving-to-help-reduce-your-risk-of-breast-cancer.html
https://health.gov/our-work/nutrition-physical-activity/physical-activity-guidelines/current-guidelines
https://www.cancer.gov/news-events/cancer-currents-blog/2020/breast-cancer-survival-exercise
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Exercise and Breast Cancer
Featured Speaker:
Dr. Choi strives to give her patients access to the most advanced cancer care technologies and rigorous clinical trials. Her primary clinical interests include the treatment of breast, gynecologic, thoracic and central nervous system malignancies as well as use of advanced radiotherapy techniques.
Dr. Choi received a bachelor's degree in biology from Bryn Mawr College in Bryn Mawr, Pennsylvania, where she also conducted research on DNA methylation. She earned her medical degree from Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia, Pennsylvania. She also completed her medical internship and residency at Thomas Jefferson University Hospital. During her residency, she conducted clinical research in several areas, including meningioma biology, heart-sparing techniques and the effects of metabolism on patient outcomes. Her research resulted in multiple peer-reviewed publications and presentations at national conferences.
Learn more about Dr. Choi
Kamila Nowak Choi, MD
Kamila Nowak Choi, MD is an assistant professor in the Department of Radiation Oncology at University of Maryland School of Medicine. Her primary practice locations include University of Maryland Upper Chesapeake Health and the Maryland Proton Treatment Center.Dr. Choi strives to give her patients access to the most advanced cancer care technologies and rigorous clinical trials. Her primary clinical interests include the treatment of breast, gynecologic, thoracic and central nervous system malignancies as well as use of advanced radiotherapy techniques.
Dr. Choi received a bachelor's degree in biology from Bryn Mawr College in Bryn Mawr, Pennsylvania, where she also conducted research on DNA methylation. She earned her medical degree from Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia, Pennsylvania. She also completed her medical internship and residency at Thomas Jefferson University Hospital. During her residency, she conducted clinical research in several areas, including meningioma biology, heart-sparing techniques and the effects of metabolism on patient outcomes. Her research resulted in multiple peer-reviewed publications and presentations at national conferences.
Learn more about Dr. Choi
Transcription:
Exercise and Breast Cancer
Maggie McKay (Host): We've heard it most of our lives. Exercise is crucial for good health, both mind and body. But when it comes to breast cancer prevention, how does exercise fit into that equation? Dr. Kamila Nowak Choi, a radiation oncologist with the University of Maryland Medical System, gives us one more very good reason to get out there and move.
Host: Welcome to the Live Greater podcast series, information for a Healthier You from the University of Maryland Medical System. I'm Maggie McKay. Welcome, Dr. Choi. Thank you so much for being here today.
Dr Kamila Nowak Choi: Thank you. So happy to be here. Very excited to be talking about this topic.
Host: Oh, I can't wait to hear more about it. Can exercise help prevent breast cancer? Right off the bat, let's get to that.
Dr Kamila Nowak Choi: Absolutely, a hundred percent. So, we know that in general, exercise is good for overall health. But more and more studies are showing that women who exercise regularly have a much lower risk of breast cancer compared to women who are less active.
A relatively recent study that pulled together 38 different studies following thousands of women showed that women who are active had up to 21% lower risk of developing breast cancer in their lifetime. And this holds true for both pre and postmenopausal women.
Host: And what is produced during exercise that can kill or slow cancer cells?
Dr Kamila Nowak Choi: So, we know that metabolic dysregulation, including things like insulin resistance, diabetes and hyperglycemia, as well as chronic inflammation are all factors that are associated with a higher risk of developing cancer, as well as worse outcomes for patients who are undergoing cancer treatments.
For example, in insulin resistance, you have increasing levels of insulin that are required to lower blood glucose, but that can also be harmful because insulin is a growth promoter that can stimulate cancer growth. We know that skeletal muscle cells are a major side of glucose disposal and exercise can greatly both improve insulin sensitivity as well as mitochondrial function and actually reduces chronic inflammation, which are all factors that are associated with cancer development.
Host: How does exercise help during treatment? Does it reduce treatment side effects? And going into recovery, how does exercise help with that?
Dr Kamila Nowak Choi: So, that is absolutely an excellent question. I think a lot of patients are concerned about fatigue and about having to reduce their general activity. But in fact, exercise is very helpful both during treatment and in recovery. And in fact, the American Society for Clinical Oncology recommends regular exercise during treatment.
We know that different studies show that staying active and exercising during treatment can decrease fatigue, which can be a major issues for patients that are undergoing treatment. It also preserves cardio-respiratory, fitness and strength. And for some, it may also improve quality of life during treatment and decrease anxiety and depression. Of course, the same is seen as well in cancer survivors. We can see that exercise improves both outcomes after cancer treatment and also helping with residual symptoms and their quality of life.
Host: And what types of exercise help? Does something as low impact as walking or dancing help? Or does it have to be something more strenuous?
Dr Kamila Nowak Choi: Patients always ask, "What kind of exercise will give us the best benefit?" And actually, the American Cancer Society has a guideline that is asking that specific question. So in general, what the American Cancer Society recommends is to engage in anywhere between 150 to 300 and minutes of modern intensity physical activity or 75 to 150 minutes of vigorous intensity, or a combination of both.
Now, what are examples of moderate and vigorous intensity? So, moderate intensity will be something like brisk walking, dancing, slow bicycling, yoga, things that are a little bit lower impact. Whereas vigorous intensity will be something like running, jogging, bicycling, swimming, anything that will get your heart rate elevated.
Strength training is also beneficial and can help with muscle strength and mobility, as well as bone strengthening, which of course can be an issue in breast cancer treatment as well as other cancers. One of the fears of patients is that strengths training can trigger or even potentially worsen lymphedema, and I certainly would recommend checking with your surgeon before beginning a new strength program. However, . Overall. Studies show that patients who start with lightweights and progress the training gradually are not at an increased risk of lymphedema.
The other important thing, of course, is in addition to exercising, it's also important to limit the time that you spend sitting outside of your exercise time. Especially nowadays, a lot of jobs are certainly more sedentary. And so, sitting at the desk for long stretches can also increase potential risk of both cancer and potential side effects, so trying to stand up as much as possible, taking a stretch, taking a walk during the day is also very important.
Host: That's what my trainer says. He's like, "Sit as little as possible," basically. So, how much or how frequently is exercise recommended when it comes to breast cancer prevention?
Dr Kamila Nowak Choi: So in general, it is best to be consistent and try to exercise a little bit every day. But again, the ballpark would be somewhere between 75 to 150 minutes of vigorous intensity activity per week, 150 to 300 minutes per week of moderate intensity, or a combination of both.
Host: Can exercise also prevent other types of cancers?
Dr Kamila Nowak Choi: Absolutely. We have strong data suggesting of high benefit in cancer prevention in many different cancers, including colon, endometrial, esophageal, kidney, stomach and prostate.
Host: Wow. What about people who smoke or maybe breast cancer is hereditary in their family, if they exercise, is that going to help even with those other factors?
Dr Kamila Nowak Choi: So, of course, we want to try to counsel patients to not smoke. But in general, we see a benefit in breast cancer reduction from exercise regardless of other potential risk factors. For example, there was a study from Columbia University that was looking at the risk of breast cancer and association with exercise in patients with a BRCA mutation, which is one of the mutations that are commonly associated with familial types of breast cancer. And basically, what they saw is that people who exercised had a 20% lower risk reduction of developing breast cancer if they exercise, regardless of whether they were BRCA positive or not. In addition, the other interesting factor from that study was that the reduction of breast cancer risk was consistently seen regardless of when patients started exercising. So, for example, people who were not very active as teenagers or young adults, but started exercising later still had a high benefit in breast cancer reduction. And to me, the moral of that study is it's never too late.
Host: Absolutely. I do this bootcamp program and the ages amaze me. It ranges from college students to a woman who is literally in her 80s. It's unbelievable. So, big believer of that for everything. In closing, Dr. Choi, any takeaways for our listeners?
Dr Kamila Nowak Choi: I think the takeaway, it's never too late to start exercising. The benefits are not just cardiovascular, but we see tangible benefits in reduction of cancer incidents. Patients who exercise do better with their treatment and after treatment.
Host: Dr. Choi, this has been so informative and useful. I'm sure you've inspired a lot of listeners to get out there and move, so thank you so much.
Dr Kamila Nowak Choi: Thank you for having me.
Host: Again. That's Dr. Kamila Nowak Choi. And to find more shows just like this one, go to uums.org/podcast and on YouTube. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to. Thank you for listening to Live Greater, a Health and Wellness podcast, brought to you by the University of Maryland Medical System. We look forward to you joining us again. I'm Maggie McKay.
Exercise and Breast Cancer
Maggie McKay (Host): We've heard it most of our lives. Exercise is crucial for good health, both mind and body. But when it comes to breast cancer prevention, how does exercise fit into that equation? Dr. Kamila Nowak Choi, a radiation oncologist with the University of Maryland Medical System, gives us one more very good reason to get out there and move.
Host: Welcome to the Live Greater podcast series, information for a Healthier You from the University of Maryland Medical System. I'm Maggie McKay. Welcome, Dr. Choi. Thank you so much for being here today.
Dr Kamila Nowak Choi: Thank you. So happy to be here. Very excited to be talking about this topic.
Host: Oh, I can't wait to hear more about it. Can exercise help prevent breast cancer? Right off the bat, let's get to that.
Dr Kamila Nowak Choi: Absolutely, a hundred percent. So, we know that in general, exercise is good for overall health. But more and more studies are showing that women who exercise regularly have a much lower risk of breast cancer compared to women who are less active.
A relatively recent study that pulled together 38 different studies following thousands of women showed that women who are active had up to 21% lower risk of developing breast cancer in their lifetime. And this holds true for both pre and postmenopausal women.
Host: And what is produced during exercise that can kill or slow cancer cells?
Dr Kamila Nowak Choi: So, we know that metabolic dysregulation, including things like insulin resistance, diabetes and hyperglycemia, as well as chronic inflammation are all factors that are associated with a higher risk of developing cancer, as well as worse outcomes for patients who are undergoing cancer treatments.
For example, in insulin resistance, you have increasing levels of insulin that are required to lower blood glucose, but that can also be harmful because insulin is a growth promoter that can stimulate cancer growth. We know that skeletal muscle cells are a major side of glucose disposal and exercise can greatly both improve insulin sensitivity as well as mitochondrial function and actually reduces chronic inflammation, which are all factors that are associated with cancer development.
Host: How does exercise help during treatment? Does it reduce treatment side effects? And going into recovery, how does exercise help with that?
Dr Kamila Nowak Choi: So, that is absolutely an excellent question. I think a lot of patients are concerned about fatigue and about having to reduce their general activity. But in fact, exercise is very helpful both during treatment and in recovery. And in fact, the American Society for Clinical Oncology recommends regular exercise during treatment.
We know that different studies show that staying active and exercising during treatment can decrease fatigue, which can be a major issues for patients that are undergoing treatment. It also preserves cardio-respiratory, fitness and strength. And for some, it may also improve quality of life during treatment and decrease anxiety and depression. Of course, the same is seen as well in cancer survivors. We can see that exercise improves both outcomes after cancer treatment and also helping with residual symptoms and their quality of life.
Host: And what types of exercise help? Does something as low impact as walking or dancing help? Or does it have to be something more strenuous?
Dr Kamila Nowak Choi: Patients always ask, "What kind of exercise will give us the best benefit?" And actually, the American Cancer Society has a guideline that is asking that specific question. So in general, what the American Cancer Society recommends is to engage in anywhere between 150 to 300 and minutes of modern intensity physical activity or 75 to 150 minutes of vigorous intensity, or a combination of both.
Now, what are examples of moderate and vigorous intensity? So, moderate intensity will be something like brisk walking, dancing, slow bicycling, yoga, things that are a little bit lower impact. Whereas vigorous intensity will be something like running, jogging, bicycling, swimming, anything that will get your heart rate elevated.
Strength training is also beneficial and can help with muscle strength and mobility, as well as bone strengthening, which of course can be an issue in breast cancer treatment as well as other cancers. One of the fears of patients is that strengths training can trigger or even potentially worsen lymphedema, and I certainly would recommend checking with your surgeon before beginning a new strength program. However, . Overall. Studies show that patients who start with lightweights and progress the training gradually are not at an increased risk of lymphedema.
The other important thing, of course, is in addition to exercising, it's also important to limit the time that you spend sitting outside of your exercise time. Especially nowadays, a lot of jobs are certainly more sedentary. And so, sitting at the desk for long stretches can also increase potential risk of both cancer and potential side effects, so trying to stand up as much as possible, taking a stretch, taking a walk during the day is also very important.
Host: That's what my trainer says. He's like, "Sit as little as possible," basically. So, how much or how frequently is exercise recommended when it comes to breast cancer prevention?
Dr Kamila Nowak Choi: So in general, it is best to be consistent and try to exercise a little bit every day. But again, the ballpark would be somewhere between 75 to 150 minutes of vigorous intensity activity per week, 150 to 300 minutes per week of moderate intensity, or a combination of both.
Host: Can exercise also prevent other types of cancers?
Dr Kamila Nowak Choi: Absolutely. We have strong data suggesting of high benefit in cancer prevention in many different cancers, including colon, endometrial, esophageal, kidney, stomach and prostate.
Host: Wow. What about people who smoke or maybe breast cancer is hereditary in their family, if they exercise, is that going to help even with those other factors?
Dr Kamila Nowak Choi: So, of course, we want to try to counsel patients to not smoke. But in general, we see a benefit in breast cancer reduction from exercise regardless of other potential risk factors. For example, there was a study from Columbia University that was looking at the risk of breast cancer and association with exercise in patients with a BRCA mutation, which is one of the mutations that are commonly associated with familial types of breast cancer. And basically, what they saw is that people who exercised had a 20% lower risk reduction of developing breast cancer if they exercise, regardless of whether they were BRCA positive or not. In addition, the other interesting factor from that study was that the reduction of breast cancer risk was consistently seen regardless of when patients started exercising. So, for example, people who were not very active as teenagers or young adults, but started exercising later still had a high benefit in breast cancer reduction. And to me, the moral of that study is it's never too late.
Host: Absolutely. I do this bootcamp program and the ages amaze me. It ranges from college students to a woman who is literally in her 80s. It's unbelievable. So, big believer of that for everything. In closing, Dr. Choi, any takeaways for our listeners?
Dr Kamila Nowak Choi: I think the takeaway, it's never too late to start exercising. The benefits are not just cardiovascular, but we see tangible benefits in reduction of cancer incidents. Patients who exercise do better with their treatment and after treatment.
Host: Dr. Choi, this has been so informative and useful. I'm sure you've inspired a lot of listeners to get out there and move, so thank you so much.
Dr Kamila Nowak Choi: Thank you for having me.
Host: Again. That's Dr. Kamila Nowak Choi. And to find more shows just like this one, go to uums.org/podcast and on YouTube. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to. Thank you for listening to Live Greater, a Health and Wellness podcast, brought to you by the University of Maryland Medical System. We look forward to you joining us again. I'm Maggie McKay.