April 3, 2000 (Nederland, Colo.) -- Back in 1993, when 36-year-old Julie Main was diagnosed with breast cancer, it simply didn't occur to her to stop working out. She felt healthy and strong, so she scheduled her chemotherapy treatments in the mornings and went to her step-aerobics class in the afternoons. Throughout her cancer treatment, she kept up her full-time job as a health club manager in Santa Barbara, cared for her two young children, and even managed a trip to Europe.
Despite Main's vigorous schedule, she handled the treatments surprisingly well. So well, in fact, that her doctors wanted to know what she was doing that their other patients weren't. After a closer look, her medical team concluded what Main herself strongly believes: Exercise had made the difference.
Less than a year after her diagnosis, Main teamed up with her doctors and her employer, the Santa Barbara Athletic Club, to launch an exercise program for cancer patients -- one of the first such programs in the country. Participants met with Main twice a week for supervised group workout sessions that included weight lifting and aerobic exercise. "People told me the program was the best thing that ever happened to them," Main says. Her program, Well-Fit, is now filled to capacity with 240 participants.
Today, Main isn't the only believer. She has helped to pioneer a new trend in cancer treatment, one that incorporates exercise as a vital part of the recovery process.
"What we're finding is that recommending bed rest probably exacerbates fatigue. It's counter-intuitive, but it seems that being sedentary during treatment can be a greater risk than doing the exercise," says Kerry Courneya, an exercise physiologist at the University of Alberta in Canada. That's not to say that exercise is right for everyone with cancer, but Courneya says that most patients, especially those whose cancer is in the early stages, can benefit.
Last year, Courneya published a review of 28 studies that examined how exercise affects cancer patients. His conclusion: Exercise can bolster patients' ability to withstand the rigors of treatment while significantly improving their quality of life. Courneya's review, published in the Annals of Behavioral Medicine, volume 21, number 2, uncovered an array of benefits linked to exercise, including improved sleep, increased strength, and less depression, anxiety, nausea, and fatigue. No one knows whether physical activity might stave off recurrences. But, says Courneya, "Exercise can help you get your life back."
Main and the people who've gone through the Well-Fit program would agree. "Two of the biggest side effects of most cancer treatments are fatigue and a lack of muscular strength," says Main. "It's a downward spiral. People feel tired, so they stop exercising and become weaker. When we get people on a weight-training program to build lean muscle tissue we see a huge improvement."
Indeed, researchers who have studied Well-Fit found that participants were substantially less tired -- and perhaps even more important -- less anxious than patients who were sedentary. A 1998 study, published in the Journal of Strength and Conditioning, volume 12, number 1, tracked 20 Well-Fit participants who had a variety of cancers. The researchers found that the program improved the patients' strength by an average of 43%, doubled their aerobic endurance, and boosted their energy levels. And a 1998 study published in Oncology Nursing Forum, volume 25, number 1, showed that exercise significantly eased anxiety and depression in breast cancer survivors. Study author Michelle Segar, president of the National Center for Women and Wellness in Ann Arbor, Mich., says that the women who exercised handled stress better and felt more in control of their lives than those who didn't.
The American Cancer Society has taken notice of these findings: Officials are drafting the organization's first exercise guidelines for cancer patients, to be published later this spring. "Our recommendations will point to evidence that moderate exercise can substantially improve cancer patients' sense of physical well-being," says Tim Beyers, an epidemiologist at the University of Colorado Health Sciences Center in Denver and a member of the group developing the guidelines. "We're not saying that if you run marathons, your cancer will go away. We are suggesting that people be active."
Exercise physiologist Cad Dennehy is spearheading a program she hopes will make it easier for patients to put that suggestion into practice. Dennehy and her colleagues at the Rocky Mountain Cancer Rehabilitation Institute in Greeley, Colo., are developing the first-ever cancer exercise specialist certification program, which they hope to have up and running next year. The program will teach health professionals how to tailor exercise programs for cancer patients; its developers hope that exercise will eventually become an integral part of every cancer rehabilitation program.
Main says the change is overdue. "When you're diagnosed with cancer, it strips you of the pride you have in your body. You feel like your body has betrayed you. Exercise is all about regaining that pride."
Christie Aschwanden is a freelance science writer based in Nederland, Colo.