I have a really special guest in Sami who is an expert in exercise and cancer who will share why exercise is so crucial during cancer, and how you can do it in a way that really helps you to get the outcomes that you want and also do it in a way that is safe and is really going to make you feel better over the long-term! Here are some things we cover today:
- Why exercise is crucial during cancer treatment
- Types of exercise that will help you most during recovery
- Surprising fact: doing exercise saves you money on health
- The key to living an active lifestyle that serves you
- Simple rules of thumb for better nutrition
- and much, much more!
Joe: Sami, you know cancer and exercise, you don’t think of the two that go together. Tell me, why is exercise important during cancer and after cancer? Is it even safe?
Sami: Definitely, I’m going to address the safety thing first. The safety and feasibility studies on exercise and cancer have been going on about 15 years now. We’ve really determined that or nearly every single type of cancer, maybe some of the real rare cancers we haven’t studied in clinical trial, but the safety and feasibility has always been great. You’ll certainly see an adverse event once in a while but not very often.
I think one of the biggest things that we know about cancer and exercise is that so many of our cancer treatments, or just the experience of cancer, the more sedentary behaviour, just the lifestyle changes and also, the not feeling so good, lead people to be more deconditioned. Exercise when done correctly really helps combat those side effects. I think what’s really important for people to understand is, if they exercise, if they improve their strength, their function, it helps them reduced side effects even years after their diagnosis and treatment.
People that don’t exercise after treatment don’t always rebound the same way that somebody that exercises. Not only is it safe, I think it’s one of the most effective and under-utilised tools. I think in large part because people are scared. They’re just not sure what to do, which we understand as exercise oncology people, it is the biggest barrier that we have.
Joe: Yes, fantastic, Sami. What do you do? What sort of exercise can help you during treatment?
Sami: I think one of the most important things people need to understand is not all exercise is the same. I think that’s the exact question we ask. One thing to keep in mind is that walking tends to be the most recommended or prescribed type of exercise, but walking is really the same muscles as doing your activities of daily living or taking care of your daily activity, making food or getting dressed, etc. For a lot of folks with fatigue, it’s not helpful for them to dip in the same gas tank and use the same muscles. We’re really pushing people to resistance training, to build those strength muscles back.
Let’s say you were doing laundry, every single week, you were carrying four or five loads of laundry up the stairs, down the stairs in your house. Right, then you go through cancer treatment and what happens to that task? Well, somebody might do it for you because people want to help which is great. Whatever those lifestyle changes are, and you don’t do that laundry for maybe two months. When you go back and do that load of laundry, the first time you go walk up the stairs, it’s hard.
A lot times, those strength muscles that you don’t use, you lose, and so we really recommend a lot more of the resistance training type of exercise because that’s actually going to reduce fatigue the quickest and help people get back to their activities of daily living. Resistance training simply means overloading muscles. Standing out of your chair might be resistance training for some, just with body weight. Others, they might need to add five-pound weight or a sack of flour or a milk jug. Anything that overloads muscles is always considered to be resistance training. Honestly, the most effective type of exercise.
Joe: Fantastic. Tell me about this idea of prescribing exercise, is it like an individual program that you create for people?
Sami: It’s always individual because you have to ask people, what do you like to do? What do you not like to do? People always say to me, “Well, I don’t want to run.” I’m like, well, that’s good because we don’t really recommend running as the first type of exercise. We take into account a few things. We take into account people’s history. If they’ve never exercised in their life, just them starting to move in a different way may feel different and they’re not sure how their muscles should feel. They’re not sure how to adjust for what feels like pain, which you and I might know as muscle burn, but they might say, “Why are my muscles hurting?” We take into account that and their preferences, what their availability is? Do they need to exercise at home, in a gym, at work, in the basement? Whatever that is.
We also really take into account their cancer, their treatments and their side effects, and anything related to maybe surgical changes. When you boil all of those things and dump them into a big pile, it does become very individualised, but keeping in mind that we really do prescribe and recommend strength training first. I always start with, okay, I want you to be as active as possible, but your exercise program is going to be focused on building muscle. Here’s how often you do it and here’s something that you avoid etc. Individualisation is key but honestly, the exercise recommendations that we have that are really basic and kind of simple don’t allow or teach exercise professionals how to individualise.
Those are some of the gaps that we’re working on literally throughout the world. How do you take somebody with certain types of cancer or stages of disease and make it individual? I think that’s the big struggle right now even for our cancer survivor population, is finding professionals that really look at them for them and not for their cancer. I’d love to say that we’re really good at it. I think some people are. I think that’s the biggest barrier for our survivor population, is knowing how do I find somebody and what do I do? Or what do I not do? Because it is very individual.
Joe: Speaking of cancer survivors, we have some probably pretty unique challenges, as in, first of all, your body may be deconditioned after treatment, but you’re also worried about late effects and after affects, all sorts of things. What advice do you have on that front, that is specific to cancer survivors?
Sami: I think the biggest thing that we really work on is educating a survivor of how important and what exercise is going to do. I think we all know we should move more, and we should eat healthy, right? Then what’s to say that I go, I’ll just forget it, I’d rather have my glass of wine and sit around and watch Netflix all day. We really sit down with people individually and especially our survivor population and explain to them why this is so important. Everything from reducing side-effects during and after treatment, to sometimes impacting survival.
Or another really great study that just came out recently for cost of healthcare out of pocket, was cancer survivors and breast, prostate, and colorectal, that met the minimum physical activity recommendations per week, which were 150 minutes, that’s about 22 minutes per day. They had 36 percent less out of pocket expenses related to healthcare. What we felt was those patients, and this is what the study said, really looked at how in the big picture exercise, just fitting those recommendations impact how that person lives.
Financial barriers are one of the biggest challenges for patients and something that we hear a lot. Looking at, hey, this is a way that you can improve your life after cancer. To me, that’s a survivor, someone living well after cancer, that’s the goal of survivorship. It’s selling that to people individually. Some people will say to me, do you know what? I lost all the muscles in my arms, or I can’t get on the floor with my son or daughter, or I can’t take my dog for a walk. It’s really addressing how are we going to help them get their life back.
For most survivors, they really think that cancer took that away. Before the cancer, they were living a certain life. Then the cancer experience happened, and all of these things happened and now, their life is different. How do we use exercise to get back their ideal life? I think that’s the opportunity that we, as exercise professionals, need to hone in on and really push forward. We’re not going to hurt you. If chemotherapy and radiation didn’t hurt you, I assure you we won’t. Right. It’s sad. People are like, “Well, am I okay?” You’re in chemo right now, I assure you, this is much better. It’s so true.
Joe: Yes, absolutely. It’s so great that not only exercise makes you live longer, but as you say, it can also help you save some money. One thing that I personally never realised before starting exercise, is it also gives you more energy in your day-to-day life. I used to be the type of person who would laugh at people who would say they feel better after exercise. Now, I can’t believe it, I just feel so much better. Why does it happen? Why does exercise give you all this extra energy, right?
Sami: Well, there are two ways exercise helps. The first way is that quick way, which is just endorphins. Those feel-good hormones. You get the same endorphins when you run into somebody you enjoy hanging out with, or you watch a great show and you laugh a lot. I tell people that are just not motivated, you know what, before you get off the couch, I want you to pull up your phone or your iPad or whatever and I want you to pull up funny animal videos. I want you just to laugh for a little bit, it will change your mood in that dopamine response in your brain, now go work out. If not, you’re just thinking, “I’m so tired.” Those are those endorphins. I tell patients, that’s what happens in the first few weeks after exercise. Over time, we really are building up your engine.
I’m not really a great car person, I’m married to a car guy, so I’m going to use a car analogy because I think it suits most people. It’s like I tell people, I live in the mid-west in the United States, so we have trucks here, right? If you’re driving your big truck, instead of your V8 engine, we give you some little two-cylinder European car engine. Your trucks is not going to move as fast or it’s just going to be a slow grind. If you have that little engine, everything is going to be harder. If we can build your engine, which comes from exercise as well as nutrition, everything is going to get a little bit easier.
I always tell people, what’s your favourite sports car or your fast car and let’s build your engine to be that sports car. That makes sense to people. If they go through this experience of cancer, they also forget what their sports car was like. Do I believe exercise improves energy? Heck yes. We have to start somewhere. We also need to be mindful that just because you’re motivated doesn’t mean that you should start with an hour a day. It’s really being smart with that and really talking to somebody about, hey, what’s a great place to start?
I’d rather people get consistent and build up what they do daily before they start increasing their amount per day, or even really their intensity. Consistency is really a key.
Joe: I love the car analogy that you used. Speaking of nutrition, I know that’s a whole huge area in itself. What is your take on nutrition and cancer?
Sami: Really, one of the most important things we tell people is, food is fuel. You have to eat. Also, this goes back a little bit to my car analogy, you’re not going to take your car and zip it to the back of your house, get your garden hose, and fill up your car tank, right? If you put junk in your body, you’re not going to run as well. While I don’t think there’s a great cancer diet, per se, I think it’s really important to lean on good nutrition, quality foods when possible. I realise that there are also barriers to getting things that are fresh or even organic.
I tell people, do the best that you can. Try to eat the least processed that you can. Protein is actually going to be one of the most important things for people that I work with. The only fuel for your muscles is really protein. If you’re eating just carbohydrates, you will get energy from those because that’s a source of fuel for your energy output, but not for your muscles. That’s probably the number one thing that we push patients, either in the cancer treatment world or even in survivorship or clinical exercise world is, protein, protein, protein. Sometimes even outside of the clinical recommendations. Everybody is really individual. Gender plays a role here. Pre-existing body comp plays a role. That’s actually why finding someone that’s knowledgeable is key. The biggest thing I want to address about nutrition is the concerns that people have related to specifically eating sugar.
While I wish that we could say black and white we knew, because honestly, if we knew sugar caused or fuelled cancer directly, if we had clinical evidence, which we just don’t, it would give us a solution or tool in the cancer world. We don’t. However, sugar, sometimes it okay. If you enjoy it once in a while, have your sweet an enjoy it. Daily, we really see that sugar is more of an inflammatory. Also, a lot of our patients have diabetes issues, of pre-diabetes issues, or body composition issues that cause them more insulin production.
I think the big thing that we need to realise is that it’s not helping you feel better. Do I say not eat sugar? Well, no. I just showed you my piece of chocolate. I think once in a while is good. Honestly, thinking about food as fuel is really what’s key. Eating clean, non-processed foods whenever possible is ideal.
Joe: Yes, I love this kind of analogy, again, because I think what you’re saying is, you’re using fuel, just in a sense that you only need a certain amount to really keep you going, right?
Sami: Exactly. I think that’s where our culture, you know, we really go towards the bigger meals because we think we’re getting more for our money. Not really understanding what your body needs and what your metabolism or your caloric output is, it puts a lot of us in a bad place. People struggle with gaining weight. This clinical evidence is not necessarily that the cancer treatments cause us to gain weight. Certainly, hormone suppressive in certain populations, whether it’s breast or prostate, or even testicular, all of those populations will lead to loss of muscle.
Based on the treatments because we’re supressing those hormones. That muscle loss leads to slower metabolism. What happens if you have a slower metabolism, you can’t eat the 2,000 calories a day that you did before cancer, your metabolism might only burn at 1,500. Well, if you’re eating 2,000 calories a day, what’s happening to those extra calories? It becomes storage. That storage is usually what people complain about. Although, it’s important to exercise, it’s also important to eat right for you. That’s actually where sometimes people get lost. I encourage people if they are struggling, track what you eat for a few days. Really look at what you do. I’ve done that. It’s not always fun and pleasurable to go, well, there you are.
If you really want to make changes, sometimes putting your calories and your foods into one of the apps on your phone or even on the computer, it’s really eye-opening. Weighing out food for a few days. Not that you have to do that all of the time, but if you really want to make changes, sometimes you’ve got to get down and dirty and really look at what you’re doing, or what you’re not doing. I think those are some of the most important things and body composition is helpful for all of us.
Joe: Growing muscle helps boost metabolism?
Sami: Yes, because muscle is the only metabolically active tissue on your body. Your heart is a muscle, right? If you think about that, that’s your primary muscle, that’s the most important muscle. All of your muscles that you use, your arms, your legs, your head, your neck, everything, all of those muscles when you use them, they’re like their own little engines. They need fuel. The more muscle you have – think of your big bulky people that you meet; do you know those big bodybuilder guys and how much food that they eat every single day?
Or someone that’s really active, I know rugby is pretty big down under. We’ve got American football here. I think it’s really the amount of calories that those individuals eat, but you look at the amount of muscle that they have. If they don’t eat those calories, they lose their muscle because they’re burning so much every single day just at rest and then also when they’re active. For patients, we need to really think about what their goals are. If they’re wanting to gain muscle, and most people really need to gain muscle for strength goals and functional goals, as well as metabolism, we need to keep that in mind.
If a patient, as an example, is underweight, and they start exercising. I have a really specific talk with them and use the dietician to say, “Okay, you now are going to be burning more calories because you are putting muscle on you and that muscle is active, so you need to eat more. You can’t just eat what you used to eat.” We have to also be mindful of what adjustments we need to make, as we go.
Joe: That makes so much sense, Sami. Is there anything else that you would recommend for someone to be in good shape mentally, socially, emotionally when it comes to cancer?
Sami: I think community is really key. I think a positive community is one of the most important things. I think finding people that you can just talk to, or just know that they get it makes a lot of sense. We run a functional fitness program in Kansas City and we have felt that the power of that group is the community. The people know that the person standing next to them understands the same fears that they have. I find that putting cancer survivors together and the work that you do with your podcast just makes them say, “Yes, we me. I totally thought that.”
Or, “I had that same fear and I didn’t know who to ask.” Communities are a really key piece. I also think finding recovery or enjoyment in life is a really key piece. We always go, go, go, go, go. I’m certainly that person. Then I hit this time point in my week that I’m done, I put my phone down, I put my computer away. It’s just myself, my family, or my loved ones. You just do something fun. I don’t really care if someone texts me or if an email comes in. I think that it’s sometimes hard to disconnect for people and really focus on that recovery.
It’s one of the most under-utilised things that we have, is taking care of ourselves. If I don’t take care of me, I can’t take care of others. I think those are probably two key pieces that we don’t talk about enough, but people should find. Honestly, I tell people, again, if you’re having a bad day, funny animal videos. Always funny animal videos. It’s the way to go. It’s easy, it’s free, and it’s always fun.
Joe: Yes, that’s fantastic, Sami, you give such great advice because so often, we spend a lot of time looking after other people. Sometimes, especially if you go through tough times, you’ve got to put yourself first, right?
Sami: Yes, absolutely. I think that really goes back to just the basis of diet and exercise. If I’m eating junk just because someone around me is eating junk, then I’m not taking care of me. I think sometimes it’s hard to say no to something or to turn somebody away. In cancer, I tell people cancer comes with casseroles. People want to take care of you. They’re like, “I’m going to bring you a casserole.” You feel bad, but you don’t really want to eat it. I’m like, well, why not? Be confident in taking care of you or tell people what you want.
Be specific. At the end of the day, we all individually are most responsible for ourselves. I know that I need to take the time to exercise every day. I need to take the time to go see people that are fulfilling to me and do things that I love. I need to eat well and also, I enjoy a good glass of wine now and again. Really, what is Sami want? What is it Joe wants? What are those important factors? I think we forget that as we go, especially when you go through a cancer experience and you kind of forget who you are.
Joe: Yes, absolutely. That makes so much sense. Tell us about your exercise program that you’ve got for those folks dealing with cancer.
Sami: We do a couple of things. I’ve been doing exercise and cancer for about 15 years. I started really seeing people way out, like, three/four/five years out of a diagnosis and treatment. They just were like, “I never really got my life back. I never really got me back.” Then I started working in the clinical setting and seeing people very early and seeing them in the clinical world, where there are exam rooms and treatment facilities. I realised that to teach people to move, I need to move with them or show them how to move or coach them how to move.
We started a community-based program that’s a small group program. We do functional fitness. Functional fitness is basically exercising that mimics improving everyday life. Remember my laundry basket example from earlier? We teach people to do the same exercise that will help the with their activities with daily living, but just living well. I want them to be able to get something off the floor, get themselves off the floor, put something on the top shelf, carry something heavy. All of our exercises are based upon those kinds of movements. We also really work on increasing people’s heartrate, because I want them to get aerobically conditioned, as well. We do mobility and recovery.
We do all of that in a group setting because it’s more fun as a group and people will work harder if the person standing next to them is also working hard. There’s this psychological piece of, you look out of the corner of your eye and you think, “They’re doing it, I’ve got to keep going.” We realised the power of the community. Our community is all different types of cancer. It’s men and women. We’ve got everything from pre-vivors, people who have had the genetic mutation gene diagnosed and surgeries, all the way to individuals with advanced illness. We have a two-time pancreatic cancer survivor, we have a head, neck, colorectal, ovarian.
You name it. We’ve got a variety of groups. It really doesn’t matter what type of cancer they have or exactly what their course of treatment or surgeries is, but they get it, because they’ve all been affected by that word. Our community also extends into caregivers and supporters because we feel like cancer affects everybody. I think it’s also important for our caregivers to have something to help themselves, because they’re often very busy caregiving.
We measure a lot of outcomes in our program, we measure fatigue, we measure depression, we measure body composition. We’ve really learned that people that do these exercises really three to four times a week only, for 30 – 45 minutes, they have had significant improvements. No matter where they are in their stage. I think it’s the pixie dust, that people should be moving. I think it’s the community that makes it so impactful.
That’s something that I can’t do myself. I just built a place where they can come and that’s actually what I’ve done other time. They show up, they bring others. They stay, it’s amazing. I just sit back and smile because I just see how positively it impacts them and impacts me.
Joe: That’s fantastic, Sami. What’s the website?
Sami: Our main website is: Cancerwellnessforlife.com. We are actually just opening up a new fitness facility that we’ll own. We had partnered in another facility. That new fitness facility, so depending on when your listeners listen, is Webuild4life.com. That’s actually going to be our fitness-based program of our company. That gym is going to be opening up here a few weeks in Kansas City. We had some great opportunities and we’ll get getting some grants to build up some fitness videos.
One thing that I’m really excited about is also to develop some YouTube and online content, because I want people anywhere in the world to be able to get what we do, and to be able to access it, no matter where they are, what time-zone they’re in or what they need. That’s really one of my biggest goals, is to spread it out. We’ve got some great funders. It’s my dream come true, to be honest.
Joe: That’s so fantastic, Sami. Good luck with that. Thanks so much for your time and thank you so much for what you do in the world. I think it helps so many folks.
Sami: Thank you for having me. I appreciate it so much. Thanks for great questions. Have an awesome, awesome, day.
Joe: Thanks. You too.