Nolan Alexander (Host): Welcome to the Live Greater podcast series, information for a healthier you from the University of Maryland Medical System. I'm Nolan Alexander. And today, I'm here with Dr. Jennifer Baima from the University of Maryland Medical System. We'll be exploring a vital topic, how exercise can help during and after cancer treatment. Dr. Baima, thanks for joining us once again. How are you today?

Jennifer Baima, MD: Great. Thanks for having me here.

Host: It's certainly our pleasure. And to start, how can cancer treatment affect the body, including strength, energy, and even bone health?

Jennifer Baima, MD: Cancer treatments such as chemotherapy and radiation can affect strength and bone health by causing weakness, numbness and tingling of the hands and feet, fatigue and decreased endurance.

Host: So, why specifically can exercise be helpful for people during cancer treatment and in recovery afterward?

Jennifer Baima, MD: Well, it's kind of counterintuitive, but we actually treat cancer-related fatigue with exercise. I know that's surprising for a lot of people to hear. You are tired, you should move more. But what happens, cancer-related fatigue is not the typical fatigue we think of when we have a tough day at work. This is a total body metabolic process that's very different. And we know when we study people at the cell level that it responds to exercise. So although it can be very difficult to get started and we have to tailor the timing to your individual needs, it can often be very helpful for cancer-related fatigue.

How it's helpful for numbness and weakness is often improving the delivery of chemotherapy or radiation, or improving the tolerance so you can last longer in those sessions and get more of the lifesaving treatment that you need, and that's what makes it work better.

Certainly, I wouldn't recommend exercise without your chemotherapy or radiation. It's just one of those nice enhancements that if you can tolerate it at a time that's appropriate for you, it can make the difference in getting better sleep, which will make overall less fatigue, having more energy and having greater strength, which protects not only your muscles but your bones.

Host: And yeah, I am curious about the benefits of this. What have you seen to be some of the biggest benefits patients may notice when they stay active during and after treatment?

Jennifer Baima, MD: I would say fatigue is probably the biggest, just because that's one of our hardest to treat And so many of the treatments cause this problem. And not only do the treatments cause this problem, a lot of the medications we use to treat things such as nausea, which can occur with treatment, cause fatigue. So, it's kind of a double problem in that it can be related to the cancer itself, it can be related to the cancer treatment, or it can be a side effect of the medications we are using for the cancer treatment. So, that's because it's one of the more common deficits, it's probably a greater area of change.

The difficult part comes when sometimes patients are just too tired to exercise. So, finding the cause of that, is that something that's going to change? Do they have a treatment cycle that we can work with? When is the beginning and end date? When is the preferable time? Are they what we call a lark, an early morning person, or an owl, a night person? And how can we find a way to maximize their personal circadian rhythms to help them use exercise to improve that. Exercise can also be helpful for pain. It can also be helpful to prevent falls.

Host: Dr. Baima, it really seems like there is a strong personal touch and time listening and patience with patients, right? And it's not just a cookie-cutter program, so to speak.

Jennifer Baima, MD: You've heard me speak before about things like osteoarthritis and osteoporosis, and we do always tailor our programs to the patient, but I would say it's pretty easy for me to come up with a cookie-cutter knee osteoarthritis program. It's very Difficult for me to come up with a cookie-cutter cancer program, because not only is everyone's cancer journey different, everyone's type and location and the aggressiveness, or what we'd refer to in medical terms as the stage of cancer is different.

So, we look at a couple things. Where's the cancer in your body? What are the treatments that are going to be used and how bad is it to determine what exercises are best for you and when. And, you know, when in doubt, I always ask the patient. Patients aren't going to do something that is making them feel bad. So, I try to figure out working backwards with cancer, "What's making you feel bad? Can we fit exercise in there? Well, if we can't now, please come back and see me when we can.

Host: That certainly makes sense. So, I'll reverse it a little bit and say, in general, what types of exercise are usually most helpful for people with cancer?

Jennifer Baima, MD: in general, we're looking at aerobic strength training and balance. And a lot of times, I'm looking at what do you like to do? So if I have a patient who really enjoys cycling, that's a popular pastime here on the eastern shore, the beautiful eastern shore of Maryland. We want to get them back to cycling, And we want to do that in a way that is helpful and appropriate for them.

So, aerobic can be anything like walking or cycling. Strength training doesn't have to be with weights. It can be with exercise bands or with body weight. And that can always be tailored to the individual size and gender of the patient. And then, with balance exercises, it could be as simple as standing on one foot while brushing your teeth, or as complicated as getting a patient back to yoga. Maybe they need to wear a mask. Maybe they need private lessons. How can we connect them with that exercise they used to enjoy during a time when they may be having immunosuppression, which is trouble with their immune system related to their cancer treatment.

Host: So if someone feels exhausted, they feel weak or maybe overwhelmed during treatment, how can they start moving safely?

Jennifer Baima, MD: Please ask your providers. We're always here to help. I, as physiatrist, my enjoyment in life is connecting people with exercises that are helping them. But certainly, we want the opinion of your medical-oncologist. We want the opinion of your radiation-oncologist. We want the opinion of your surgical oncologist. When is appropriate?

 A lot of patients with abdominal surgery do better. They get out of the hospital faster if they're having exercise. So, their surgeon has an interest in them walking around more too, because then they have less complications from that surgery and everybody's happier.

Host: So if treatments, it's weakened the bones or it's increased fracture risk, are there times with that when exercise should be modified or avoided?

Jennifer Baima, MD: Absolutely. So, we always want to make sure a patient doesn't have a pathologic fracture. So, how is that different than a stress fracture, an osteoporosis fracture? So, I'm going to back up because I work with orthopedic surgeons. And we see traumatic fractures. So traumatic fractures are when you have a significant fall. A fall from a height, not a fall from standing. When you have a significant fall or a very hard surface, or a high-velocity trauma, that's what we call a traumatic fracture. When you fall from standing and you break something, that's usually an osteoporosis or a weak bone fracture. Pathologic fractures are a whole different category, and those are when the bone is weakened by the cancer itself. And then, you break at a time or place we didn't expect you to break, but not necessarily because of osteoporosis. You could have osteoporosis in cancer, but sometimes you just have cancer, and that's how the cancer is found from a fracture. So, that's something I can help the patients with, is where is it appropriate to image to look for that fracture, and how do we figure what tests are best to help figure out if you have a fracture? Because certainly, we don't want you exercising a broken body part.

Host: It just seems like this is a comprehensive effort by so many people. So, how can patients work with their cancer team, physical therapist, or a rehab specialist to find the right exercise plan for them?

Jennifer Baima, MD: The first step is just asking, and I know the biggest question is: how long this is going to take and how long will I survive with cancer? So once those questions have been answered and a plan is in place, or maybe you're still waiting for that plan and you're waiting for testing, please ask us, ask all of your providers. And if you don't know, please say, "I'd like to see Dr. Baima," because I'm happy to ask those questions for you if you need me to advocate for you.

My prior research area was in pre-habilitation, which is using exercise before an event such as a surgery, chemotherapy or radiation to improve outcomes after. So, one of the things I love about that, not only because I'm a lark and an early morning person and I like to be prepared. "Chance favors the prepared," Louis Pasteur said that. But also, there is often a time period between this biopsy where you are told you have something bad and the final test where you're told, "This is what we're going to do about your something bad." So, I have experience in seeing patients during that time period. If you would like to have exercises before an intervention, we can help with that also.

Host: And to wrap it up here, Dr. Baima, what is one message you want listeners to remember about exercise during and after cancer treatment?

Jennifer Baima, MD: We can always find something that's going to be helpful for you. And if you can't do it now, we will find a time and a place and a type of exercise that is best for you.

Host: Dr. Baima, thank you once again so much for your time and your insight today. We truly appreciate it.

Jennifer Baima, MD: Thanks for having me.

Host: Listen to more at umms.org/podcast, YouTube, or your favorite podcast platform. 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, and please share this on your social media.