Experience tells us: got cancer? Get an extended warranty!Longevity has been a topic of great interest among members of the American Medical Athletic Association. Our nation is home to 70,000 centenarians Here is a list of well-known centenarians (people who lived to be or are living at 100 years or more of age), with the still living ones bolded and italicized. This list is divided into sub-lists, according to how the centenarian (mostly) became well-known. . And according to United Nations projections, "Close to 1 in 20 American boomers are expected to live to 100, thanks to breakthroughs in treatments for heart disease and cancer and longstanding memberships at the gym." Science has given us the tools to effectively detect, manage, and even cure many forms of cancer. It is realistic to assume that cancer does not have to be an impediment to attaining great longevity, and in attaining longevity, living a life of continuing vigor and good health. A decade ago, it was rare to see cancer survivors participating in strenuous endurance athletic events. As an oncologist, it was almost never part of my job to counsel patients about aerobic exercise aerobic exercise, n sustained repetitive physical activity, such as walking, dancing, cycling, and swimming, that elevates the heart rate and increases oxygen consumption resulting in improved functioning of cardio-vascular and respiratory systems. , resistance training, weight management or healthy lifestyle choices. My professional efforts were overwhelmingly dedicated to the "war" against cancer, and all of the battlefields encompassed therein--the alphabet soup of chemotherapy regimens, dealing with terminal illness, the potentially life-threatening side effects Side effects Effects of a proposed project on other parts of the firm. of treatment and a multitude of medical and personal crises. All that has changed. We have gained more knowledge about the biological basis of cancer and have developed a better toolbox for treatment of the disease and management of symptoms during treatment. There is now a cohort of 9 million cancer survivors in this country. And in this group, there are individuals who have been affected by cancer and have developed careers as accomplished athletes. Many survivors are exemplary role models of fitness and health. They seem to have the physical prowess to remain healthy forever; however, survivors are susceptible to a variety of long-term sequelae sequelae Clinical medicine The consequences of a particular condition or therapeutic intervention of their illness and its treatment. They may end up with second cancers, heart disease, diabetes, hormone deficiency and/or cognitive disorders. On personal and professional levels a couple of years ago, I became convinced that as a cancer specialist I needed to focus my energy on a different "toolbox" for my patients and indeed for all cancer survivors. Many cancer survivors are truly motivated to achieve the best possible fitness and health. To this end, the majority (60-84%) has invested in complementary cancer treatments and is willing to incorporate a wide range of therapeutic interventions into conventional medical treatment and recovery plans. Patients are investing time, energy and money in a wide range of supplements, herbs, therapeutic touches, spiritual retreats and so forth. Some are making radical changes in their lifestyle choices, diets and exercise regimens. Although few of these complementary and alternative therapies have been shown to impact cancer risk, recovery and prognosis, one intervention has repeatedly been shown to be effective--exercise! [ILLUSTRATION OMITTED] Instead of incorporating fitness counseling and exercise prescription into traditional medical oncology practice, I have chosen to focus my practice on helping cancer survivors become physically active and stronger, improve body composition and make healthy lifestyle choices. This can help them attain a realistic goal of longevity, and in working toward this goal, an improved quality of life. The "Skinny" on Activity and Prognosis Recent studies have examined the therapeutic value of exercise during primary cancer treatment. There is good evidence that exercise is not only safe and feasible but can enhance physical capabilities and functional well-being while recovering from surgery, undergoing radiation, receiving chemotherapy or hormonal therapy Hormonal therapy Use of hormone medications to inhibit menstruation and relieve the symptoms of endometriosis. Mentioned in: Endometriosis , and even while undergoing bone marrow transplantation Bone Marrow Transplantation Definition The bone marrow—the sponge-like tissue found in the center of certain bones—contains stem cells that are the precursors of white blood cells, red blood cells, and platelets. . Integrating the exercise program into treatment is possible and requires a highly individualized in·di·vid·u·al·ize tr.v. in·di·vid·u·al·ized, in·di·vid·u·al·iz·ing, in·di·vid·u·al·iz·es 1. To give individuality to. 2. To consider or treat individually; particularize. 3. evaluation and prescription with frequent modifications as treatment progresses. To accomplish this, we conduct very comprehensive intake examination. We interview the patient to understand their current medical status and details of treatment as well as pre-existing conditions which could impact on an exercise program. We learn of their exercise preferences and dislikes, their accomplishments, goals and insecurities. We ask about clothing, footwear, where they live and who might accompany them in an exercise program, including family pets. We ask about eating, drinking, sleeping, intimacy, mood and other lifestyle matters. Physical examination includes a calculation of body mass index along with other vital signs, calculation of predicted maximal heart rate, and body composition analysis. Careful attention is given to cardiopulmonary cardiopulmonary /car·dio·pul·mo·nary/ (kahr?de-o-pool´mah-nar-e) pertaining to the heart and lungs. car·di·o·pul·mo·nar·y adj. Of, relating to, or involving both the heart and the lungs. systems and the neuromuscular exam. Almost everyone is then objectively assessed for fitness level with formal testing so that we can individualize an exercise prescription. This includes a 12 lead EKG EKG: see electrocardiography. stress test, V[O.sub.2]max, strength and balance analysis, and calculated lactate Lactate A salt or ester of lactic acid (CH3CHOHCOOH). In lactates, the acidic hydrogen of the carboxyl group has been replaced by a metal or an organic radical. Lactates are optically active, with a chiral center at carbon 2. threshold. A comprehensive exercise plan is then developed, and patients are brought in to exercise two or three times per week. Each session is individually supervised and monitored by an exercise physiologist, physical therapist or graduate student intern. Physical activity has convincingly been shown to improve aerobic fitness aerobic fitness Clinical medicine A value obtained from exercise testing, which is expressed as either VO 2 peak–O2 consumption at peak exercise, or Wpeak , muscle strength, body composition and immune function Immune function The state in which the body recognizes foreign materials and is able to neutralize them before they can do any harm. Mentioned in: Herbalism, Traditional Chinese, Stress Reduction in cancer survivors. There is also reason to believe that exercise can impact favorably on risk of cancer recurrence and survival. Suggestive epidemiologic evidence for this effect has been shown for survivors of breast cancer and prostate cancer prostate cancer, cancer originating in the prostate gland. Prostate cancer is the leading malignancy in men in the United States and is second only to lung cancer as a cause of cancer death in men. . It may be mediated by the effect of regular exercise on total energy balance and obesity. Obesity and high body mass index are now known to be risk factors for the development of many cancers. They are also likely to be adverse prognostic factors for cancer recurrence. Don't Worry, Be Happy Cancer survivors who exercise have much less fatigue, anxiety and depression. They also have improved mood, body image, and self-esteem and quality of life measures are definitely improved for cancer patients who exercise. Happiness is rarely mentioned when speaking of cancer survivorship survivorship n. the right to receive full title or ownership due to having survived another person. Survivorship is particularly applied to persons owning real property or other assets, such as bank accounts or stocks, in "joint tenancy. . Yet happiness is something we would like very much to give all our patients. Here's some excellent news. A recent study published in the austere Journal of Clinical Oncology The Journal of Clinical Oncology is a medical journal published by the American Society of Clinical Oncology. The Journal was founded in 1983 and publishes original research and review articles on topics relating to cancer. It is published 3 times a month. found that exercise training had a beneficial effect on the happiness of cancer survivors. While participating in an exercise program, the percentage of time spent "happy" increased by 17.3% in the exercise group compared with 0.8% in the control group (8). Assuming a 16-hour waking day, this translated into 19 hours, or about one more day, of happiness per week! This is something any cancer survivor (or for that matter, anyone at all) could use. What other intervention on the "recovery" shelf can have this much of an impact on happiness? About That Extended Warranty My oncology practice is in the business of designing and offering life's extended warranty after the cancer experience. The exercise and fitness prescription gives cancer survivors the means to improve health, longevity, quality of life and happiness. That's not to say that the body won't break down, suffer wear and tear, and need maintenance or an occasional repair. But, this warranty is my bet that longevity after cancer is an attainable goal, even one that can extend up to 100 years. REFERENCES 1. Berman, Mason, and Hanc. The FORCE Program: The Proven Way to Fight Cancer through Physical Activity and Exercise, Ballantine Books, 2003. 2. Dominus, S. Life in the Age of Old, Old Age. Times Magazine 2004; February 22, p. 26. 3. Cassileth, B. and Deng, G. Complementary and Alternative Therapies for Cancer. The Oncologist 2004; 9:80-89. 4. Amling, et al. Pathologic Variables and Recurrence Rates as Related to Obesity and Race in Men with Prostate Cancer. J Clin Oncol 2004; 22:439-45. 5. Neugut, et al. The "Skinny" on Obesity and Prostate Cancer Prognosis. J Clin Oncol 2004; 22:395-307. 6. Calle, et al. Overweight, Obesity, and Mortality from Cancer in a Prospectively Studied Cohort of US Adults. NEJM NEJM New England Journal of Medicine 2003; Vol. 348, p. 625. 7. Rayson and Reyno. Exercise and Cancer: No Pain, Some Gain? J Clin Oncol 2003; 9:1651. 8. Courneya, et al. Randomized ran·dom·ize tr.v. ran·dom·ized, ran·dom·iz·ing, ran·dom·iz·es To make random in arrangement, especially in order to control the variables in an experiment. , Controlled Trial controlled trial Clinical research A clinical study in which one group of participants receives an experimental drug while the other receives either a placebo or an approved–'gold standard' therapy. See Blinding, Double-blinded. of Exercise Training in Postmenopausal post·men·o·paus·al adj. Of or occurring in the time following menopause. postmenopausal Change of life Gynecology adjective Referring to the time in ♀ when menstrual periods stop for ≥ 1 yr Breast Cancer Survivors: Cardiopulmonary and Quality of Life Outcomes. J Clin Oncol 2003; 9:1660-1668. Fran Mason, M.D., is the Medical Director of the Cancer Exercise Program at Healthlinks Clinic, University of Colorado University of Colorado may refer to:
by Fran Mason, M.D. |
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