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Fighting back with fitness

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Carolyn Kaelin believes exercise can help women with breast cancer, and not just because she’s a doctor. She’s also a patient.

Diagnosed with breast cancer last July at the age of 42, she’s had chemotherapy, a mastectomy and is currently undergoing breast reconstruction. But that doesn’t stop her from getting to the gym as often as she can.

“It’s the one thing that I can do for myself that I know is beneficial,” says Kaelin, director of the Comprehensive Breast Health Center at Brigham and Women’s Hospital in Boston.

Experts say physical activity appears to help not only breast cancer patients, but those with various other malignancies as well. It can help lift depression, for instance, and reduce treatment side effects like fatigue and nausea.

Weight-bearing activity, Kaelin says, can help counteract some of the bone loss that may occur with chemotherapy and lead to fractures down the line. Strength training helps reverse muscle loss from chemo or prolonged periods of inactivity. Stretching enables patients to regain range of motion after surgery.

And burning calories can help prevent weight gain, a side effect of some chemotherapies. That can be important for breast cancer patients because fat produces estrogen, which often fuels breast cancer growth, according to Kaelin.

Longer survival?
What's more, while some researchers have long believed that regular exercise can help prevent certain cancers from developing in the first place, there's new evidence that exercise may increase survival, at least in breast cancer patients.

Research involving more than 2,000 women enrolled in the ongoing Nurses’ Health Study, who were followed for up to 16 years, showed that walking as little as one to three hours a week reduced a woman’s risk of dying from breast cancer by a quarter, compared with a more sedentary lifestyle. And walking three to eight hours per week slashed the risk by half.

Dr. Robert Mayer, director of the Center for Gastrointestinal Oncology at the Dana-Farber Cancer Institute in Boston, says he advises all of his patients to get moving.

Though much more research is needed to determine whether exercise improves the effectiveness of cancer treatment or truly boosts survival, he says, physical activity certainly can help on the psychological side.

Cancer treatment can be grueling and emotionally draining. Patients may gain or lose weight, watch their hair fall out and experience other devastating side effects.

"Exercise makes them feel better about themselves and cope with their treatment better," Mayer says.

It may also provide a much-needed distraction. "A lot of the nausea is 'emotional nausea,'" he says. "You sort of get this pit at the bottom of your stomach." But by exercising and keeping busy, he says, "after a while you sort of forget about it."

In addition, physical activity may allow patients to tolerate their treatments better because they're in better shape, he says.

Go slowly at first
Of course, patients who've had extensive treatment including surgery should take it slowly at first, in consultation with their doctors. But even short walks around the neighborhood can help, according to Mayer.

Sometimes specific rehabilitation regimens are recommended. Kaelin, for instance, says a program of slow, progressive strength training of the upper body may help breast cancer patients who've had lymph nodes removed from their underarms. These women are at risk for arm swelling, but the exercises seem to help counter that effect some, perhaps by promoting drainage in the area, she suggests.

More doctors are starting to encourage their cancer patients to exercise, but this is far from the norm, says Dr. Anne McTiernan of Fred Hutchinson Cancer Research Center in Seattle, who's a co-author of "Breast Fitness: An Optimal Exercise and Health Plan for Reducing Your Risk of Breast Cancer."

Some in the health profession view exercise as too taxing for cancer patients or they may be unsure what's appropriate, she says. Others may wish to recommend physical therapy but refrain because of a lack of insurance reimbursement.

Whatever the hurdles, a growing number of doctors now say it's a good idea for cancer patients to try to be active when possible.

“It really needs to be part of the prescription for patients,” Kaelin says.

Patients can learn more about exercise programs and events in their area through their local chapter of the American Cancer Society or