Researchers are finding exercise can help patients recover from diseases

Sep 7, 2017

Less than five months after a stem cell transplant, Darrell Kuzyk was left with such severe nerve pain in his feet that he was confined to a wheelchair. His physiotherapist at the Cross Cancer Institute suggested he try ACE, the Alberta Cancer Exercise program for cancer survivors, to heal his feet. He signed up.

Kuzyk is an employee with the City of Edmonton Department of Drainage. He was in good shape before being diagnosed with acute myelogenous leukemia shortly after his 57 birthday in March 2016. But cancer, chemotherapy and transplant had taken their toll. He barely had the energy to get through his first class.

“The class was an hour long, and the first three or four times he went, he kept saying, ‘I won’t make it,’” recalls his wife, Allison.

Kuzyk stuck with it, giving everything he had to get through the twice-weekly classes, which were designed to improve the balance and strength that his treatment had all but erased. He began going to the Castle Downs YMCA a half-hour early to warm up on his own, lifting weights and alternating between walking on the track and riding an exercise bike until class started.

The difference in how he feels is “night and day” from how he felt when he started in January. In April, he began another 12-week session. Before his cancer diagnosis, Kuzyk relied on his job to keep fit. Now, thanks to ACE and trainers and occupational therapists in the program and at the Cross Cancer Institute, he feels stronger than when he was healthy.

“I’ve got good energy, and I try so hard when I’m in that class,” he says. “I give it all I’ve got. They’re always telling me to slow down, slow down.”

Until recently, many doctors told patients with chronic or acute diseases not to exercise at all. Dr. Christine Friedenreich, PhD, recalls that when she began investigating the benefits of exercise for patients with cancer in the 1990s, “there was a lot of unease,” in the medical community. A former Alberta Innovates researcher, she found medical oncologists were wary about researchers asking patients to exercise.

“But we started doing studies and showing it was safe and effective, and the medical community has gradually come around and they are starting to embrace it.”

Women in one of Friedenreich’s more recent studies, the Alberta Physical Activity and Breast Cancer Prevention Trial, showed improved insulin resistance and reduced endogenous estrogen, body fat and inflammation, all associated with cancer risk. Those in another of her studies, the Breast Cancer and Exercise Trial in Alberta, benefited from even moderate forms of exercise, such as walking.

“I would never say that someone can prevent cancer if they exercise,” says Friedenreich, who is an Alberta Health Services researcher and adjunct professor in the Faculty of Medicine and Faculty of Kinesiology at the University of Calgary. “But you can reduce your risk of developing it and if you do develop it and maintain your activity levels, you have a better chance of getting through your treatment and a better chance of improved survival after cancer.”

For her current project, the Alberta Moving Beyond Breast Cancer (AMBER) study, Friedenreich and co-principal investigator Kerry Courneya, PhD, of the U of A are recruiting 1,500 women newly diagnosed with breast cancer and following them for 10 years.

The women will be assessed when diagnosed and again one, three and five years after. The researchers want to determine how physical activity and health-related fitness can improve survival and quality of life for breast cancer patients.

Not all people with health problems benefit from exercise and activity. For instance, patients undergoing chemotherapy may have dangerously low levels of white blood cells or hemoglobin. The former can increase their risk of infections that their bodies are ill-equipped to fight. The latter can leave them too tired to even climb a flight of stairs.

Fatigue is one of the most common cancer symptoms. But it’s a different kind of tired than what someone who is healthy experiences. For many people with cancer, “rest does not make it better, exercise does,” says Margie McNeely, PhD, the Alberta Innovates researcher who developed ACE along with Nicole Culos-Reed, PhD, from UCalgary.

One reason is that cancer-related fatigue isn’t necessarily a result of sleep deprivation: it’s tied to a loss of muscle mass, a common side-effect of treatment. Exercise can give people with cancer a better chance of getting through treatment

McNeely is an associate professor with the Faculty of Rehabilitation Medicine at the University of Alberta. She says “people become very deconditioned. They are not able to be as active as they once were. Their body becomes unfit, and they often do not have a good sleep at night.”

ACE is based on research showing that fighting fatigue with exercise can improve muscle strength, cardio-respiratory fitness, pain and overall quality of life. Classes are held at four sites in Edmonton and four in Calgary. Participants are tested for a baseline fitness level and can choose from two exercise options: a group setting with a trainer who supervises individual exercises or an activity-and-movement class led by an instructor. They’re retested after 12 weeks and encouraged to continue with the program when new sessions begin.

Our goal is to change their behaviour and have patients adopt a more active lifestyle. If we can get them to do that, the implications in terms of health benefits and benefits to our healthcare system would be considerable.Margie McNeely, PhD, Alberta Innovates

Alberta Innovates researcher Dr. Donna Manca is also focused on providing patients with tools to improve their health, but she is approaching it from a slightly different angle. Manca and colleagues at the U of A, University of Toronto and Memorial University in Newfoundland and Labrador are piloting a program in Alberta, Ontario and Labrador.

They want to learn whether offering health and lifestyle guidance in a primary care setting will improve cancer and chronic disease prevention and screening. The BETTER WISE Project will include people who have and haven’t had cancer. All will see a family physician, but half will also see a “prevention practitioner,” a healthcare provider working in family medicine. The practitioner will learn about the study subject’s family history and lifestyle and consider those factors when creating a health plan with the person.

“As family physicians, we have a lot of guidelines, too many to deal with in a short time, so we tend to focus on a disease or organ system,” Manca says. “We don’t look at a lot of the root causes of the illnesses that our patients get, the things that are maybe leading to the diabetes or the heart disease.”

BETTER WISE builds on a previous study by Manca and family doctor Eva Grunfeld, in which practitioners collected information to help educate patients about fitness, nutrition and risk factors. Patients then chose what areas to work on.

“We hope that when the study is done, there will be more support for this kind of approach. Our goal is to help family physicians provide patients with the tools they need to make positive, long-term changes that will enable them to live fuller, healthier lives,” Manca says.