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This is a great piece on ‪#‎lungcancer‬ survivor Jane Elterman. Jane participates in LUNGevity's Breathe Deep DFW event every November. Read and share!




Move Every Day Exercise can improve quality of life and decrease the odds of cancer diagnosis or recurrence.


By Heather Stringer




After 28 chemotherapy infusions, Jane Elterman could not even imagine integrating exercise into her life, despite gentle encouragement from her care team at Cancer Treatment Centers of America® (CTCA) in Tulsa, Oklahoma.

At 49, Jane had been diagnosed with stage IV adenocarcinoma in late 2008 after going to the doctor for a simple neck ache. Jane, who lives in Carrollton, Texas, was in disbelief when she learned that cancer had spread to her lymph nodes, jugular vein and all five lobes of her lungs.

Initially told that she had three to five months to live, Jane sought a second opinion at CTCA®

Learning to be a survivor, however, has presented its own set of challenges. A year after she completed chemotherapy, Jane still suffered from neuropathy (tingling and numbness in her toes and fingers) and severe pain, she was exhausted by simple tasks like loading the washing machine or driving to the store and she needed at least two naps per day.

Then, in 2013, she heard something that completely changed her mindset about the importance of overcoming these barriers to become more active: a naturopath at CTCA mentioned that exercising 30 minutes per day five days per week could reduce the risk of cancer recurrence.

“It was a lightning bolt for me,” says Jane, now 56. “I knew I could not get rid of the cancer that was still in my lungs, but it was really important to reduce the risk of metastasis. I wanted to do whatever I could to be around for the major life events like births, weddings and graduations for the people I loved.”

Inspired, she started by swimming a few laps in her pool. Although it was intensely painful to walk down the steps of the pool into the water, Jane kept swimming every day. After a month she noticed her endurance improving, and eventually she could swim continuously for 30 minutes. Next she braved the elliptical machine at the local gym. She cried most days during the first week from the neuropathic pain, but slowly that decreased. She then worked up to 30 minutes of walking on the treadmill, and now she looks forward to walking outside three to four miles per day with her two dogs. Her energy level is higher than ever, and she has even started job hunting for work in the nonprofit sector.

Defining Exercise
Although Jane’s journey included visits to the local gym, Physical Therapist Kelly Prater Whitmore, PT, CLT, is quick to remind patients that exercise can include a wide variety of activities beyond typical gym options. “Many people think they can’t exercise because it means lifting weights at the gym and running on a treadmill,” says Whitmore, who works at CTCA in Newnan, Georgia. “But exercise can be marching your feet, tapping your toes or doing exercises in a chair. It really depends on your level of strength and endurance.”

The American Cancer Society recommends that adults get at least 150 minutes of moderate intensity or 75 minutes of vigorous intensity activity each week. Moderate intensity is defined as anything that “makes you breathe as hard as you do during a brisk walk,” which could include mowing the lawn, dancing, walking and golfing. Vigorous activities cause a noticeable increase in heart rate, faster breathing and sweating, which could include jogging, singles tennis and swimming.

“For patients who have been diagnosed with cancer and are in some stage of treatment, it is best to meet with a medical professional before starting an exercise routine,” Whitmore says. “We evaluate their strength deficits and can tailor the program accordingly.”

A typical program includes cardiovascular, strength and flexibility exercises with a physical therapist and a home exercise program to build on this, Whitmore explains. She typically offers several options for home exercises and suggests that patients pick the ones that work best for them. For example, someone could walk the aisles of a grocery store for 15 minutes before shopping for food, or complete 10 to 20 repetitions of an exercise during television commercial breaks.

Although some patients express fear that exercising will increase their level of pain and fatigue, Whitmore teaches them that usually the opposite is true. A study published in the Journal of Clinical Oncology in April 2015 found that exercise decreased pain in breast cancer patients who were suffering from joint pain while taking aromatase inhibitors. The participants who increased their exercise time to approximately 160 minutes per week experienced nearly a 30 percent decrease in their pain levels, while women who did not exercise experienced a 3 percent increase in pain.

Joints are more prone to become stiff, achy and painful when people are not moving because the muscles become weaker, which can cause more stress on the joints, Whitmore says. In addition to lessening pain, exercise can decrease other side effects from treatment, such as fatigue, bone loss, scar tissue, shortness of breath, insomnia, diarrhea, constipation, anxiety and depression, Whitmore says.

An increasing number of studies also suggest that staying active can be an effective preventive strategy. According to the American Cancer Society, poor diet and inactivity are two key factors that can increase a person’s cancer risk. These factors have the potential to increase an individual’s amount of excess weight, which causes the body to produce and circulate more estrogen and insulin—hormones that can stimulate cancer growth.

A French study published in 2014 found that postmenopausal women who exercised moderately for four hours per week in the previous four years had a 10 percent lower risk of breast cancer than women who exercised less than that. The researchers also found that risk-reducing benefits quickly disappeared if women stopped exercising.

Now Is the Time
Although it may be tempting to procrastinate when it comes to exercising, Whitmore encourages people at any stage of life—regardless of whether they have cancer—that any movement is better than no movement. When she graduated from physical therapy school 25 years ago, patients were discouraged from exercise during treatment, and the consequences of this became evident. “People would get so deconditioned that they felt it was harder to become active again than to overcome the side effects of chemotherapy and radiation,” Whitmore says.

She acknowledges that cancer treatment has many phases, and consequently exercise routines will likely need to be modified as patients go through these phases. For Jane, moving every day has become an essential part of life that gives her serenity despite an uncertain future.

“After feeling betrayed by my body, it was truly empowering to see myself continue to get stronger,” Jane says. “That sense of accomplishment helped me regain my confidence, and I even sleep better because I am not worrying about whether I will be around for the next special milestone.”
No case is typical. You should not expect to experience these results.

Research is ongoing into the role of exercise in cancer prevention and wellness during treatment. If you’d like to learn more, take a look at the following references cited in this article:

1. Irwin, M. L., Cartmel, B., Gross, C. P., Ercolano E., et al. (2015). Randomized exercise trial of aromatase inhibitor–induced arthralgia in breast cancer survivors. Journal of Clinical Oncology, 33, 1104–1111. doi: 10.1200/JCO.2014.57.1547
Abstract online: http://jco.ascopubs.org/content/early/2014/12/01/JCO.2014.57.1547.short?rss=1
2. Fournier, A., Dos Santos, G., Guillas, G., Bertsch, J., et al. (2014). Recent recreational physical activity and breast cancer risk in postmenopausal women in the E3N cohort. Cancer Epidemiology, Biomarkers & Prevention, 23, 1893–1902. doi: 10.1158/1055-9965.EPI-14-0150
Abstract online: http://cebp.aacrjournals.org/content/early/2014/07/31/1055-9965.EPI-14-0150.abstract




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