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Exercise for life.

In recent years there has been a compelling avalanche of scientific data demonstrating the benefits of exercise in the prevention and treatment of disease. Evidence-based retrospective data demonstrates significant survival benefit for patients that exercise following the diagnosis of breast (1) and colon cancer (2). Despite the evidence, there has been no concerted effort by the medical community to incorporate exercise into clinical practice. FitSTEPS for Life[R] (FSFL) is an exercise and nutrition program created to bridge this gap for incorporation into clinical medicine. This community-based program has focused primarily on cancer patients; however, because 70% of the patients referred have more than one disease FSFL is applicable to most any co-morbid chronic disease. Interventions such as FSFL have the potential to save millions of dollars of health care expenditures not to mention potentially extending a participants life.


In 2001, as a retired oncologist, I started the program in Tyler, Texas, a community of 100,000 with a service area of over 600,000. It began in one location in the family life center of a local church. Over the past nine years FSFL has expanded to nine locations in the Dallas Metroplex and eight locations in East Texas and surrounding communities. Facilities hosting the FSFL program include churches, cancer centers, hospital wellness centers, commercial fitness centers, community centers, and a hospital inpatient oncology floor.

All patients are physician referred, and the program is provided without charge. FSFL is an individualized, structured program with no limit to duration of participation. All referred patients are encouraged to remain in the program permanently to achieve maximum benefits and incorporate exercise as a lifestyle behavior change.

Exercise components are easily mastered and consist of aerobic activity (treadmill and elliptical machines), muscle strengthening (stability ball, stretch bands, dumbbells, and squat machine), and flexibility exercises. Measured metrics during exercise include pulse oximetry, heart rate, blood pressure, and heart rate recovery. Group sessions using the stability ball and Pilate's technique are also provided. Home exercise components include stability ball, stretch bands, dumbbells, and pedometer use.

The clinical staff is degreed in kinesiology and trained and certified to ensure competency in program administration.

Participant adherence is encouraged through relationship building, goal setting, building self-efficacy, and accountability through exercise logs and frequent telephone communication. Research evaluating the effectiveness of the FSFL program is done in collaboration with University of Texas at Tyler. Over the past two and a half years, data analysis from survey forms (see table on page 6) have demonstrated remarkable benefit in physical and mental functioning within the first month of participation, which is sustainable. In addition, FSFL incorporates social Cognitive Theory (3) techniques and empowerment (4) to change the devastating cancer experience by inspiring new hope and meaning in the lives of participants.
Medical Outcomes Survey Short Form (SF-36 and SF-8)

Concept/Subscale      Low                      High

Physical Functioning  Limited a lot if         Performs all types of
                      performing physical      physical activities,
                      activities (bathing,     including vigorous

Role-Physical         Problems with work or    No problems with work
                      daily activities due to  or daily activities due
                      physical health          to physical health

Bodily Pain           Severe and limiting      No limitations due to
                      pain                     pain

General Health        Evaluates personal       Evaluates personal
                      health as poor and       health as excellent
                      believes it will get

Vitality              Tired and worn out all   Full of energy
                      the time

Social Functioning    Interference with        Normal social
                      social activities due    activities
                      to physical or
                      emotional problems

Role-Emotional        Problems with daily      No problems with daily
                      activities as a result   activities
                      of emotional problems

Mental Health         Feelings of              Feelings of peace,
                      nervousness,             happiness, calmness

Since 2004, 890 different physicians including 170 oncologists have referred over 6,000 patients. Annually there are approximately 2,500 new patients referred and 60,000 visits to our facilities.

Financial support for the program is provided by physician and health care provider contributions, participant contributions, grants, and private donations. In-kind contributions are significant as all host facilities provide free space.

In conclusion, FitSTEPS for Life[R] represents a community-based exercise model that is effective, cost efficient, and applicable to most any community setting. It is recommended as a model for "standard of care" for implementation of exercise into the clinical practice.

Dr. Kimmel is a retired physician of medical oncology and hematology and is the founder of Cancer Foundation for Life[R] and FitSTEPS for Life[R]. He receives no compensation from FitSTEPS for Life[R]. If you have questions for Dr. Kimmel regarding the program, please contact him at or visit the website


(1.) Holmes MD, et al. Physical activity and survival after breast cancer diagnosis. JAMA 2005; 293(20); 2479-2486.

(2.) Meyerhardt JA, et al. Physical activity and survival alter colorectal cancer diagnosis. J Clin Oncol 2006: 24(22): 3535-3541.

(3.) Bandura A. Social Foundations of Thought and Action: A Social Cognitive Theory. Englewood Cliffs, NJ: Prentice-Hall, 1986.

(4.) Frankl V. Man's Search for Meaning: An Introduction to Logotherapy. Boston, MA: Beacon Press, 1992.

By Gary T. Kimmel, MD
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Author:Kimmel, Gary T.
Publication:AMAA Journal
Geographic Code:1USA
Date:Mar 22, 2010
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