By: Lisa Marshall

In the second-floor weight room at the Anschutz Health and Wellness Center, 44-year-old Kristine Boyle is digging deep. Her face is flushed, biceps pumped, as she strains through the 10th repetition of a rowing exercise designed to strengthen her arms and back. Nearby, her classmate Kim Peters, 55, is also working up a sweat, making her way through squats, hamstring curls and explosive “sand-ball slams” aimed at strengthening her abs and legs and jump-starting her metabolism.

At first glance, the 50-minute circuit workout looks a lot like what you’d find in a health club class. But these participants are unique. Along with her Spandex, Boyle wears a blue surgi­cal mask to protect an immune system made fragile by a recent stem cell transplant for acute myeloid leukemia. Beneath Peters’ workout clothes is a chemotherapy port, in place to support the infusions she still gets every three weeks to battle ovarian cancer. For them, this is more than a workout – it’s medicine.

“I couldn’t control that I got cancer, and I haven’t been able to control a lot of the things that have happened to me since. But this I can control,” explains Peters, in between sets. “This has been a gift.”

Boyle and Peters are among the more than 220 cancer patients to have benefited from the University of Colorado Cancer Center’s BFit BWell program, an individualized program that teaches cancer survivors how to exercise safely while studying the long-term benefits of fitness in cancer survivors. Now in its third year, the clinical/research program provides sharply discounted, one-on-one or group training for patients – many of them still in treatment – to help them gain stamina, boost lean muscle mass and, if necessary, lose fat. By doing so, research suggests they not only feel better short-term, they might also live longer.

“We know that patients who improve their fitness and body composition improve their ability to receive treatment, and in certain cancers – including colon cancer and breast cancer – can improve their chances of survival,” says Dr. Tom Purcell, associate director of clinical services for the cancer center, and the architect of BFit BWell. “We see it as an important component of an overall treatment plan.”

The obesity-cancer link

Researchers have known for more than a decade that being heavy or sedentary can boost the risk of developing cancer in the first place. One 2010 report published in the journal Oncologist estimates that 20 percent of all cancers are attributed to being overweight or obese, with obesity the cause of 11 percent of colon cancer cases, 39 percent of kidney cancer cases, and 37 per­cent of esophageal cancer cases. Another recent study concluded that “just as smoking cessation leads to a reduction in lung cancer risk” when overweight, post-menopausal women slim down, they can reduce their risk of breast cancer by 50 percent.

The potential mechanisms behind the link are varied, explains Purcell: Excess fat tissue can boost the presence of hormones like estrogen, insulin, insulin-like growth factor 1, and adipokines which all play a role in the development, growth, or proliferation of cancer cells. Being overweight or sedentary can also boost inflammation, another key risk factor. But as Purcell, a clinical oncologist, points out, once a patient reaches his office, the more pressing question is this: Can starting an exercise and healthy eating program improve outcomes for patients who already have cancer? Absolutely, he says.

“Say I am diagnosed with Stage 3 colon cancer and I am labeled obese. If I can get my BMI down to less than 30, my overall chance of surviving colon cancer – chemotherapy aside – improves by 5 percent. That’s significant,” says Purcell.

Research on the impact that improved fitness and body composition can have on cancer survivors is mixed and relatively small, but growing. Some studies show that women who gain weight after a breast cancer diagnosis have worse survival rates; on the flip side, those who engage in regular physical activity are less likely to experience a recurrence. Obese colon cancer survivors have been shown to have shorter disease-free survival intervals and greater mortality rates. In contrast, among men who have prostate surgery to treat cancer, those who are lean and physically active afterward are less likely to suffer symptoms of incontinence than obese or inactive men.

Purcell stresses that his approach, and the BFitBWell Program, is more about building muscle and stamina and trimming fat than “losing weight.” In fact, he says, losing weight too fast post-treatment can be counterproductive.

“Many of our patients don’t need to lose weight at all, but they do need to gain fitness,” he says. “We want them to be strong, not skinny. Strong is the new healthy.”

Taking back control

The BFitBWell program is open to patients diagnosed with cancer and currently undergoing treatment, with many finding their way to the program via referral or word of mouth within weeks of diagnosis. Each undergoes a personalized assessment at intake to determine what side effects from drugs or surgeries they may be experiencing, and how their trainer can custom­ize a program to ameliorate or work around them. Patients pay roughly $20 per month to work out with a trainer one-on-one or in a semi-private group twice a week for three months. If they are willing when they graduate, they undergo a detailed post-program assessment and their information is entered into a comprehensive data-base, enabling researchers to follow their health long-term.

Nicole Klochak, the program manager, notes that often physicians don’t talk with their cancer patients at a
ll about exercise, and when
they do it’s with a vague recommendation to “stay active.” While general group yoga or exercise classes for cancer patients can be helpful, customization is optimal. “What we are offering is a program tailored to the unique needs of the individual,” Klochak says.

Ultimately, CU researchers would like to use the program as a platform for answering key questions: How can an individually-tailored exercise program impact things like recurrence and long-term survival rates? Do specific exercise protocols work better for certain cancer types than others? Do those with less common cancers, like pancreatic cancer, also benefit from exercise? And if so, when should they start? Two pilot studies are already underway, and several others are in the works.

“There is just not enough research yet for programs like this to be standard of care,” notes Ryan Marker, PhD, a postdoctoral fellow heading up the BFitBWell research effort. “We’re doing what we can to help push things in that direction.”

Already, research and patient testimonials are uncovering a wealth of short-term benefits, Marker says. Cancer and cancer treatments can lead to muscle wasting, fatigue, and loss of func­tion, but exercise can help counteract all that. It can also help boost strength in areas weakened by surgery, like the abdominal area after treatment for ovarian cancer, or the shoulder after a mastectomy. And it can help fend off the weight gain that can sometimes result from fatigue and certain medications.

“We also know that exercise is safe for most cancer survivors, whether they have completed treatment or are still undergoing it,” Marker says.

Boyle joined the program September 8, less than three months after undergoing a stem cell transplant. She was weak from more than a month in the hospital, and her immune system was shot from two rounds of chemotherapy. But her trainers nudged her to do more than she thought she was capable of, and each week she got a little stronger.

Today she has more energy, better balance, sleeps better and has more mental clarity – all benefits she attributes to exercise. But most importantly, she’s starting to feel like herself again.

“I remember laying in my hospital bed saying ‘I can’t wait to be able to work out again,’” recalls Boyle, an avid hiker and Crossfitter. “I’m not the person in that hospital bed anymore.