Advantages of Exercise

[chicagoetc]

I'm sure this has been discussed before but I thought this recent article from the BBC was interesting/helpful:

http://www.bbc.co.uk/news/health-14417084

Melanie

[Ellie F]

This has also just been on TV along with a piece about how good dragonboat racing is for arm lymphoedema.

Ellie

[Debbie L.]

I've been thinking about this a lot lately, in relation to breast cancer mostly but also just in general. We (the big societal "we") have a lot of information about how activity, normal weight, and a reasonable diet can improve our lives, and our health (and with so few side effects!). Increasingly over the past few years, there is more information about fewer breast cancer recurrences in active people. I will quibble that I don't think we have ANY idea exactly how much activity might be the "right" amount. But still, getting moving is an excellent thing.

Yet even though people know this, there is not much change happening. Obesity, just for one example, is an epidemic in our country. No one sets out to become obese, certainly. Many obese people struggle to change their eating behaviors, and research has shown that while almost everyone is capable of weight loss -- keeping it off is extremely difficult (and rare).

The other aspect that concerns me is that for people who are aware of the various recommendations about exercise and avoiding obesity, and would like to follow them but are unable (for whatever reason) to do so -- there is guilt, shame, and discouragement. Lots of it. Just ask a smoker with lung cancer how difficult it is to deal with that judgement, both personal self-judgment and that of others.

So is there a better way to deliver these lifestyle messages? A way that might better motivate and encourage people? A way that is less guilt-producing, shaming, and discouraging? I don't know the answers to these questions but I'm beginning to wonder if we shouldn't put some of these research dollars to work to see if we can deliver the messages in ways that are more likely to produce change.

I have seen studies where the intervention studied is the formal exercise class or education series. But I don't know that people need some certain exercise class. It's not that complicated. It can be as simple as a walk around the block or some stretching on the bedroom floor. I think what people need is simply more encouragement to get moving at whatever level works for them. If we make it seem too complicated (special classes, etc), then it's less sustainable. Your thoughts?

Debbie Laxague

[tricia keegan]

I saw this earlier and while I've always exercised the one time I could do very little was during chemo due to extreme fatigue, I missed it and if able to I would have continued for my own enjoyment and relaxation but so do agree with Debbie this could make many people feel more stressed at not doing this at a time they are simply unable to!!

[snolan]

My thoughts and how I choose to live is that we have to start with our kids. Instill in them the value of activity/exercise, healthy eating to include sitting at the dinner table together. These values ,I think, have been lost. We have seen so many stories on how the introduction of fast food, video games, the effect of both partents working etc has had. That does not mean we have to fall into the habits that are laid out for us. We may not be able to change the world, I certainly don't try to, but I do try to instill the changes to my kids and hope they can pass it on and lead by example.

I think it will eventually come to head when insurance companies will start to be more strict when it comes to paying for preventable diseases. My thoughts only.

[chicagoetc]

My oncologist only told me to do one thing re food/exercise when I started chemo: Walk 30 minutes a day five days a week. It was not hard. I walked as slowly as I needed, faster later. It gave me more energy than I thought. It's not that I didn't crash out later, after I walked. Many months later I decided to decrease my fat content. And later (months) I did more. They were lifestyle changes that actually worked/helped and were not hard to implement given they were incremental, slow, and self-directed.

I still try to walk at least 30 minutes a day. [Ok in the winter I did floor exercises, calisthenics for 30 minutes when it was too cold or I could not get to a treadmill.]

I had to stop when on Taxol (could not walk due to discomfort/pain) and was fatigued by it when receiving radiation. But I never felt guilted into exercise or eating changes. Nor had I a clue when I started re how to lose weight.

Weight problems are epidemic. My health insurance company is actually beginning to reward members for healthier living, more preventative health. How to address it on a broader scale is far beyond what I know or could imagine.

But I am thankful for my oncologist's advice.

Melanie

[Trish]

Debbie I couldn't agree more about guilt and blame being self defeating. I worry about legitimate public health messages induucing guilt and self blame and I am unsure of the way forward but I think setting up an environment that encourages health is key. The reduction in smoking gives me some hope. I live in Australia and 25 years ago smoking was acceptable in public buildings,workplaces and a lot of people's homes and now it is unthinkable to smoke in restaurants and even in bars smoking is highly restricted. Reduced advertising has made a big contribution to that shift in mentality I'm sure. Perhaps restriction of advertising of high fat and salty fast foods would help reduce the prevalence and accepatability of "junk foods". I was mildly offended the other day when a paper bag advertising a well known hamburger chain blew into my garden-more than the littering I disliked the fact that the presence of the bag somewhat legitimises a product and more importantly a mentality that contributes to obesity. I was bemused by the fact that it wouldn't have bothered me in the past but the problem of obesity has shifted my thinking. I am far from a health puritan and actually benefit from the good role models around me. Seeing people out walking, riding and cycling always encourages me to keep up my level of activity. Design of cities that makes it easier and more pleasant to cycle and walk certainly helps people to integrate physical activity into their lives.The trick is to facilitate healthy lifestyles and discourage unhealthy habits without stigmatising those who are struggling. Easier said than done of course.
Trish

[Mary Jo]

Great post Debbie and I agree with every bit of it. Although we all know what we should do, doing it is difficult. I remember when treatment was over for me, trying to do ALL the right things to stave off a recurrence. Then when I slipped up felt so guilty and thought "oh my gosh, what if it returns, it will be my fault." Then I got realistic I realized, life is life. We all slip up. Getting a recurrence or not has nothing to do with whether or not I do or don't do all the right things. Since then my philosphy has changed. My philosphy is this.......each day when I get up I thank God for my health that day. Then I set out to take the best care of myself I can. Some days I do a great job. Some days I don't. I exercise almost every day. I powerwalk anywhere from 2 mile to 5 miles per day. I TRY to eat the right foods but always have a "treat" of some sort everyday. Some days (on the "great job" days) I have one "treat." On the (not such a "great job" day) I may have a few treats. Here I am 6 years since diagnosis. No recurrence as of yet. It has nothing to do with what I have or haven't done. I know that's true because I don't do it all well. Just ok. As you so perfectly stated Deb......the guilt..the shame....OH we surely don't need to add any of that to the mix. What good does THAT do? Now THAT probably causes more harm then good.

Thanks for a great post Deb.

Hugs and much love....

Mary Jo

[Jackie07]

A 13-year Non-Hodgkins Lymphoma survivor, Mother's motto is: "In order to stay alive, a person has to 'move'".

A new study of Chinese cancer patients also suggests exercise adds advantage to survival:

Cancer Prev Res (Phila). (http://www.ncbi.nlm.nih.gov/pubmed/21795422#) 2011 Jul 27. [Epub ahead of print]
Exercise after diagnosis of breast cancer in association with survival.

Chen X (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Chen%20X%22%5BAuthor%5D), Lu W (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Lu%20W%22%5BAuthor%5D), Zheng W (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Zheng%20W%22%5BAuthor%5D), Gu K (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Gu%20K%22%5BAuthor%5D), Matthews CE (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Matthews%20CE%22%5BAuthor%5D), Chen Z (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Chen%20Z%22%5BAuthor%5D), Zheng Y (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Zheng%20Y%22%5BAuthor%5D), Shu XO (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Shu%20XO%22%5BAuthor%5D).
Source

1Vanderbilt Epidemiology Center, Vanderbilt University Medical Center.

Abstract

It has been suggested that exercise following breast cancer diagnosis is inversely associated with mortality. However, controversy exists regarding the causality of such associations.

We evaluated associations of exercise after breast cancer diagnosis with total mortality and recurrence/disease-specific mortality after accounting for conditions that restrict exercise participation. The analysis included 4826 women with stage I-III breast cancer identified 6 months after diagnosis through the population-based Shanghai Cancer Registry and recruited into the study between 2002 and 2006.

Exercise was assessed approximately 6, 18, and 36 months post-diagnosis and metabolic equivalent (MET) scores were derived. Information on medical history, cancer diagnosis, treatments, quality of life (QOL), anthropometrics, and lifestyles were obtained by in-person interviews at 6 months post-diagnosis. Medical charts were abstracted to verify clinical information.

During the median follow-up of 4.3 years, 436 deaths and 450 recurrences/cancer-related deaths were documented. After adjustment for QOL, clinical prognostic factors, and other covariates, exercise during first 36 months post-diagnosis was inversely associated with total mortality and recurrence/disease-specific mortality with hazard ratios of 0.70 (95% confidence interval (CI): 0.56-0.88) and 0.60 (95% CI: 0.47-0.76), respectively. Significant dose-response relationships between total and recurrence/disease-specific mortality rates and exercise duration and MET scores were observed (all Ptrend<0.05).

The exercise-mortality associations were not modified by menopausal status, comorbidity, QOL, or body size assessed approximately 6 months post-diagnosis. An interaction between disease stage and hormone receptor status and total mortality was noted.

Our study suggests that exercise after breast cancer diagnosis may improve overall and disease-free survival.

[pibikay]

Hema went to her periodical check up.The Onc had earlier advised to walk and climb stairs.He asked a pointed question whether she was walking and later said she should go for walks botn in the morning and evening.The minimum being 30 mts a day

[Debbie L.]

Great discussion, so good to read everyone's perspective. Thanks for chiming in.

I agree (snolan) that if we can start with our children that is important. But I worry about the children who don't get that start -- how and when can we best help them enjoy the benefits of an active body?

The comments (Trish) about how encouraging it is just to see activity modeled (like people out walking or cycling, etc) is so true. Maybe it will be that we just need to keep at it, and we'll get to a "tipping point" (great book, if you haven't read it, check it out), and suddenly we'll notice that the majority of people are getting outside and getting moving. As you also said, it IS encouraging to look at how smoking behaviors have changed, at least in the older (not teens) age groups.

I didn't mean to say that I didn't think there's hope that more and more of us can be more active. And MaryJo, I'm leaving it at that -- "more active", vs. "inactive". Let's keep it simple and not stress when we don't meet our own (perhaps stringent, smile) expectations. You almost exactly describe me and my attempts to "be good", it made me laugh. I'm no poster child for any of this, having been overweight all my life, and pretty inactive/unathletic. Now (since breast cancer), I try to be sure that at least if I'm eating too much, it's fairly decent things that I'm eating. And I am grateful to have found a few activities that I truly enjoy, that help me stay active.

Just like everything else, we have to encourage people to find what's right for them -- for each individual -- in this. I may feel nearly-claustrophobic on a treadmill in a gym and you may feel freaked out by bugs and dirt hiking a dusty trail -- and we're BOTH right, for us individually.

Debbie

[tricia keegan]

I feel it's good to get this message across and if someone feels able to do this they know now it's helpful, but if not they can plan an exercise regime after their treatment, without feeling guilt!

[Rich66]

Strange that with such a youth and body conscious society folks don't put it together for the sake of vanity etc.
But I think chicagoetc makes a good point that excercise makes people feel better..so it doesn't have to be viewed as a dutiful chore on behalf of a healthier society. Be selfish..do it for yourself. Same with diet. Don't view the endless sources of insulin distorting carbs and sugar as your friend..they make it hard to get through the day without feeling hungry and tired between meals..as well as making you overweight and more prone to cancers.
i.e. be selfish..this is what you want, this is what you don't want.

[snolan]

A good point mentioned that what ever activity you chose you need to enjoy it or you won't stick with it. Going to the gym for some people is not fun. One thing I have seen here locally in our high school is incorporating life sports (i.e. those sports our bodies can tolerate thoughout life). This would include biking, swimming. I can't imagine a day without my bike, but back in high school all I was concerned about was basketball and tennis, neither of which I play anymore. If we can give our kids skills that they can carry with them as they progress through life they may have more success with maintaining a healthier life style. As for the rest, hopefully as was mentioned, as more people start to get active it will become the norm.

Being a workout freak I could keep posting on this topic forever. So sorry if I ramble on too much.

[PinkGirl]

just be careful when you exercise ...

809

[schoolteacher]

Pink,

Glad to see you on the board.

Amelia

[Elizabethtx]

Pink,
That made me laugh out loud! Which by the way keeps down stress, another risk factor!

[Laurel]

Pink, may I just say that I love you! That was hysterical!

[LoisLane]

Pink so funny!!! I need to figure out how to find that picture and email it to my sisters. They will probably fall off the chair when they see this......you are one funny lady....

[MJo]

I am six years out and I am taking everything for granted, so I need to be reminded. It's hard to believe that after all the terror and treatment, I would turn into a couch potato and eat a lousy diet. It's almost criminal, frankly, since I got my second chance. But that's the human animal - at least some of us. So I am glad to be reminded to eat right and exercise. I hope I "get it" eventually.

[BonnieR]

I hear you MJO! I think part of the problem is how very active I was shortly after diagnosis. Running to lots of classes designed for recovery. I felt pressured. So now I am at the other end of the spectrum and feeling lazy. I even got my husband involved in "Fit After Fifty" exercise 3 times a week. HE still goes but I no longer can get up that early (8am class) so I stay in bed.
Now I hear the reports that even slightly elevated BP can cause stroke. I know that exercise would help in that area too.
So it makes me feel MORE guilty. And resentful! I need to find something enjoyable. I have 2 dogs who would love longer walks.
Maybe I am just tired of all the "shoulds". Thanks for letting me vent. Oh, and I love dessert! lol
Keep the faith everyone.

[AlaskaAngel]

When I think about the younger generations, I feel so very lucky to have been young in the time period when I was young! So many of the changes that have made life "easier" for them than it was for me, aren't the really important "improvements". There were times I didn't like back then, but those times were nothing compared to how difficult the really important things are now for young people. I know if I were young now it would be much harder to find a job than it was for me back then.

When I had treatment, the only discussion from health care providers I had was to be careful to eat enough so that I wouldn't lose weight. At least that seems to have changed and they (and we) are a little more aware of the risks of weight gain.

I do believe that understanding and applying metabolism practices is key when it comes to cancer, and that there is much more to it than just having an initial period of treatment that is hit or miss and is focused so myopically on "killing cancer cells".

AlaskaAngel

P.S. Thanks Rich, for your post in the other thread about the conference overseas. I am interested in seeing what Tak Mak from U of Toronto has to say there, about metabolism and cancer.

http://her2support.org/vbulletin/showthread.php?t=51435