What these results mean for you
The most important finding from this study was that
the HIG had better long term outcomes on cardiovascular fitness and body
composition. These findings are important because cardiovascular fitness and
body composition have been directly linked to disease free survival by many
other studies. Below are the graphs of these two results with additional data
to help give them meaning.
Aerobic fitness: In the chart you can see that
both groups improved their fitness to a level that would reduce their risk of
cardiovascular disease, but only the HIG remained above this threshold. This
indicates that you should perform aerobic exercise at least at 70% of your
maximum (this was the level the HIG actually exercised at).
The Red Zone starts at 15.6 mL/kg/min. Below
this level, you are at imminent threat of cardiovascular disease or death. The
top of the yellow level is 24.5 mL/kg/min. The yellow area represents a high
risk of developing some cardiovascular disease. The light blue area represents
a significant reduction in cardiovascular disease risk. The ideal target, which
would effectively diminish your risk of cardiovascular disease to the level of
a completely healthy individual around 60 years old, is 34.6 mL/kg/min for
women and 44.2 mL/kg/min for men.
Research has shown that aerobic fitness is the
best predictor of survival. One of the most prolific researchers in health
today, Dr Stephen Blair, has found that aerobic fitness makes all other factors
negligible when considering survival and cardiovascular disease risk, including
smoking, hypertension, and obesity. While it is hard to be both fit and an
obese smoker, it is possible. His take home message is that people should
concentrate on fitness and not fatness. Every improvement in aerobic fitness
(VO2max) of 3.5 mL/kg/min equates to a 12-15% increase in survival.
The minimum change in VO2max that is meaningful is 2.1 mL/kg/min.
Body fat %: Both groups started out slightly
over weight. The LIG reduced to and stayed at the threshold of being
overweight, while the HIG became normal weight.
The reduction in body fat seen in this study was
exceptional. Most exercise studies in cancer survivors do not elicit body
composition improvements. There are two major reasons for this. The first is
that diet is just as important as exercise for losing fat, which most exercise
studies do not include. The second is that the lasting side effects of
chemotherapies and hormone therapies make fat loss very hard. The results of this
study show how important high intensity exercise is for reducing body fat. The
strength training is a major component of this, as having more lean muscle
raises your metabolism, which will mean you are constantly burning more
calories.
In addition to helping
with body composition, strength training is important to undertake to improve
or maintain function as you age. Strength and balance training become more
important as you reach your 80s, as research consistently shows that falling
and breaking a hip is a major risk factor in elderly people who do not
regularly exercise.
I would like to take a
moment to distinguish between weight loss and fat loss. In this study,
participants experienced a significant fat loss without any change in weight.
This is much better than if people had lost a significant amount of weight
without changing their body fat. The reason why society focuses on weight
rather than body fat is it is simply easier to measure. For this exact reason,
a lot of research has been conducted on the impact of weight (not body fat) on
health risks. For example, a recent study found that breast cancer survivors
have a 12% increase in mortality for every 5 kg they put on after diagnosis. In
summary, as long as you are not piling the weight on, you may not need to concentrate
on losing weight, as long as you are getting fitter. And again, aerobic fitness
is much more important than even weight and body composition to your long term
health.
I want to share with
you the results of another study that described mortality risk amongst breast
cancer survivors. The researchers found that women who met both the physical
activity guidelines and the fruit and vegetable consumption guidelines (5
vegetable and 2 fruit servings per day) had a 50% reduced mortality risk
REGARDLESS of obesity. This is an encouraging finding, because it shows that if
you are doing the right things, in terms of diet and exercise, you are making a
significant impact on your health even if you are not seeing the weight and
body composition changes you were hoping for. Remember the result of this study
if you get discouraged, and let it encourage you to continue with your healthy
behaviours. Just by doing them you are improving your health.
A recent set of
epidemiological studies have discovered that what you do after cancer diagnosis
is much more important that what you did prior to cancer diagnosis in terms of
your overall health and prognosis. These studies have shown that increasing
your physical activity levels, regardless of how much you were doing before, is
important for improving disease free survival. I have summarized (in a grossly
simplified way) these results to help illustrate the point in the next table.
|
Activity Level Before Diagnosis
|
Activity Level After Diagnosis
|
Change in Activity Level
|
Impact on survival
|
|
None
|
moderate
|
increased
|
improves
|
|
moderate
|
moderate
|
no change
|
worsens slightly
|
|
moderate
|
high
|
increased
|
improves a lot
|
|
moderate or high
|
low to none
|
any significant decrease
|
may increase the mortality risk by 4X
|
The take home message is that you must do more physical activity now
than you did before diagnosis.
I need to highlight the
result in that table that people who already were active still need to increase
their activity levels. Most participants in my study were already quite
fit—there was one guy who even consistently beat me on the cycle test! But
everyone could benefit from a little more. The results of my study, and many
other studies, argue that what you need is NOT more time exercising, but more effort
or intensity in the time you already have. Fitness is all about efficiency,
both in terms of your body’s metabolic and oxygen capacity as well as the
structure of your exercise program.
One final comment on
the results: the fact that many people started with high fitness and quality of
life scores, and still made significant improvements, is a testament to how
hard everyone worked during the program. Everyone should be very proud of what
they achieved during the course.
Recommendations for Your Future
The number one
recommendation I can make is to get back in contact with the people you did my
course with, or get your family and other friends together, and do your
exercise in partners or groups. For most people, it is so much more fun and
motivating to exercise with others, and it is a great way to hold yourself
accountable.
There are lots of options of structured programs available in the Perth metro area.
- The gym at Notre Dame University is now available for you to rejoin on a membership basis if you desire. It’s also cheaper than almost any other gym you could go to. If that interests you, please call Michael Jennings on 0404045153.
- The Cancer Council runs several free programs throughout the metropolitan and regional areas, and is working on expanding their services. These classes include gym programs, yoga, and meditation.
- I was hired to help start an exercise program specifically for men with prostate cancer, which is now up and running. That runs in Leederville Tuesday and Thursday mornings, and currently costs $10/session (we are working on securing grant money to reduce that cost). You can contact me directly, via email, for more info.
- As far as normal gyms go, I am familiar with the Melville and Fremantle Leisure centres, which are both well staffed and have nice equipment. Additionally, the Exercise For Life gym in Palmyra is also very well staffed, and could provide a higher level of service for people with joint problems like bad knees or backs.
On to exercise recommendations. I have discussed
that you need to exercise at a high intensity, but what exactly does that mean?
The simplest definition of high intensity exercise is a level of exercise that
you can not keep up for more than 1 minute continuously. How do you get in a
full workout if you can only exercise for 1 minute? The most common and popular
way to do this is through interval training. This involves alternating between
high and low intensity. The most common and comfortable way to do an interval
workout is on a bike, but you could do it jogging, swimming, or even lifting
weights.
With the men I work with currently, we do
intervals on stationary bikes. We go for 10 minutes total (this should sound
familiar from your last day at my course). While the exact timing changes each week,
we basically go as hard as we can for 20 seconds, then pedal easy for 40
seconds. In this way, we achieve 10 intervals of high intensity activity. As
you increase your fitness, you may be able to work up to doing 40 seconds hard,
20 seconds easy. Research has shown that this kind of an exercise routine,
performed 3 times per week, may improve your aerobic fitness in 2 weeks by as
much as most people improved in the whole 2 months of my research intervention.
Like I said earlier, it is all about efficiency. (Note: we do 3-5 minutes of
easy riding for both warm up and cool down around the interval, for about 20
minutes riding total).
Keep in mind, that intensity is an individual
and relative concept. If you bike as hard as you can for 20 seconds, and I bike
as hard as I can for 20 seconds, you would expect that I would ride further,
because I am larger and stronger. That doesn’t matter. It only matters that you
put in as much effort as you can. If you are pushing your hardest, while
working within whatever limits you have (I’m thinking especially of knee pain
here) you will see great improvements. Another thing to consider is that
intensity can be a combination of speed and resistance. Two examples: if you
can’t run, you can increase your walking resistance by going up hills or
stairs. The sand dunes near Cottesloe or Jacob’s ladder are two great
challenges where you can go slow and still have a hard workout. On a stationary
bike, you can either keep a low resistance and pedal very fast, or put on a
high resistance and pedal a little slower (though you should still try to pedal
as fast as you can). When choosing speed over resistance, you should consider
two factors.
1)
Pain
and practicality: if running hurts, or if you find going too fast on a bicycle
awkward, then increase the resistance; and visa versa: if you find a high
resistance on the bicycle painful, then lower the resistance and try to
increase the speed.
2)
Personal
preference and comfort: for myself, I find it more natural to have a lot of
resistance and go a little slower. This tends to be true for larger taller
individuals, and shorter smaller individuals tend to find it more comfortable
to go quickly with less resistance.
One final note on exercise intensity: for most
people who participated in the program, walking on a flat surface did not
significantly increase their heart rate. Walking up the Roundhouse usually
worked, but there were some people who also did not significantly increase
their heart rate while walking up that small hill. If you think you were one of
these people, please accept that walking can no longer count as exercise for
you. It is not going to do you any good in terms of improving your fitness. If
you enjoy your daily stroll, then by all means don’t give it up, but please add
something more to your routine to ensure you are significantly improving or
maintaining your health. As I’ve said several times above, even just adding in
some hills to the walk would be enough to make it worthwhile again.
I’ve recommended how hard to exercise. Next I’d
like to discuss how much to exercise. I would recommend you perform 4 days of
planned exercise per week. Ideally, you should perform high intensity aerobic
exercise 2 days of the week. This could be as quick as a 10 minute interval
surrounded by a warm up and cool down. Then on 2 days you should perform a set
of strength, balance, and core exercises. If your main goals include improving
balance or flexibility, you should work on those every day, even if only for 5
minutes each day. Stand on one foot with your eyes closed every time you wait
for your tea or coffee—you’ll be amazed at how much you improve. In total, if
your exercise sessions are high intensity and efficient, you could exercise as
little as an hour total each week.
My only recommendation on what type of exercise
you should do: whatever you enjoy.
If normal gym type exercise sessions bore you or just seem a chore, think of
all the other things you could do. Here’s a small list of activities that are a
great workout, which may seem more fun to you. At least one person who
participated in the research project was performing these activities at the
follow up assessment:
1)
paddle
boarding
2)
dancing
(in many different forms, from taking salsa lessons, to Prime Movers, to
putting on cabaret shows)
3)
riding
horses
4)
water
polo
5)
orienteering
(which is hiking on a set course trying to find checkpoints)
6)
kayaking
7)
building
furniture
8)
snorkelling
In conclusion to this section, I’d like to do a
little bit of self promotion. If you do enjoy going to a gym, but are running
out of ideas for your workouts, take a look at my blog:
fitnessforcancersurvival.blogspot.com. I post all the workouts that we do in
Leederville, with pictures and videos. Additionally on this blog I synthesize
new research that comes out on all areas of health related to living well after
cancer. Hopefully something on there can help you, or at least amuse you for a
short time.
Conclusion
I would like to thank you for participating in
my research and for reading this whole report. It ended up going on much longer
than I had thought it would, but hope that it was worthwhile in helping you
plan for your future health goals. If there’s ever anything I can do to help
you in the future, please don’t hesitate to contact me, wherever in the world I
may be (and considering that I will be all over the globe, it’s probably best
to email me).
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