Several studies have shown a link between exercise and lower cancer risk. However, the message often isn’t well received by patients who think it blames the victim by suggesting they wouldn’t have cancer had they just been more active.
That’s what I learned this week when I blogged about a new study suggesting cancer patients don’t exercise any more than the rest of us. The finding is troubling because some studies suggest exercise improves cancer survival, signaling that cancer patients have much to gain from exercising after a diagnosis.
But more than 100 readers responded to the article, and many of them complained that it was judgmental and blamed cancer patients for their plight. They added that exercise and calorie-counting are not priorities to a cancer survivor. I invited Leslie Bernstein, a noted cancer and exercise researcher from the City of Hope cancer center in Duarte, Calif., to talk about it.
To listen to our conversation, click below.
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welcome to the world of type 2 diabetes.
— AnneThere are well known (at least to me) reasons why exercise is effective for cancer/cancer relapse prevention:
- People who exercise throughout their lives are in better overall shape than those who don’t, are less likely to smoke or take potentially cancerogenic prescription drugs, and less likely to undergo cancer-prone medical treatments, hence their chance of developing cancer is less too.
- Exercise of any kind improves blood oxygenation and circulation, and these two factors are key for (a) cancer avoidance and/or (b) a cancer survival past its initial treatment;
- Exercise reduces the levels of blood sugar and insulin — both implicated in cancer pathogenesis, particularly genitourinary cancers among women (see Carbohydrates and the Risk of Breast Cancer among Mexican Women)
- Exercise mitigates depression — a well known downer of the immune system and potential factor in cancer pathogenesis.
- Finally, patients who retain their capacity for exercise after undergoing cancer treatment are probably in much better shape to begin with, and more likely to survive their initial cancer (as was the case with Lance Armstrong, for example).
Explained in these terms, this issue is no longer as controversial or as offensive to so many.
Konstantin Monastyrsky, author of Fiber Menace
— Konstantin Monastyrskyhttp://www.FiberMenace.com
I hope Dr. Bernstein’s cold gets better.
I’m glad she pointed out that exercise is effective against depression. She might also have mentioned that a carefully tailored program of upper body strength training can help many breast cancer survivors reduce the edema that can make life so difficult after treatment. Where I live, in the Pacific Northwest, we have a kayak race specifically for breast cancer survivors. Many of the participants have said that building their upper body strength has helped their quality of life, both physically and psychologically.
— kalebergI never in a million years thought that I’d say, “I’m a breast cancer survivor.” But, I am. I had a lumpectomy last August (I was in good shape, not a gym rat, but at a perfect weight and physically fit) and knew that exercise was implicated in better recovery, lower risk of recurrence, and increasing survivability. So, I made a game of it by walking from Grand Central to my radiation treatment (67th and 1st Ave) every day, and then to my office at 39th and 5th. I did this for 6 weeks. When the treatments were over, I was so depressed about not having a raison d’etre to continue the walking, that I started to get off my train at 125th street and walk to my office most mornings. That 4 1/2 mile hike has done more to lift my spirits than you can imagine. The other benefit? I’ve lost another 6 pounds without changing a single thing I eat.
If you’re a survivor, GET OFF YOUR BUTTS and DO SOMETHING PHYSICAL!
Ellen
— ellenDr. Bernstein implies that if the benefits of exercise & diet could be given in pill form, it would be the best-selling pill on the market. I’m not sure why the medical community doesn’t offer the same “rehab” support (diet & exercise) to cancer patients as it does to cardiac patients.
Her podcast didn’t go into the specifics of how exercise/diet can lower estrogen levels in women & positively affect their breast cancer prognosis. Dr. Cheryl Rock of UCSD published a study in Cancer Epidemiology, Biomarkers and Prevention on March 6 with just such a message.
“Anti-estrogen drugs can only have so much impact. There are two things apart from these drugs that can help to lower estrogen, or we believe it can, because it can in the general population. One is moderate to vigorous exercise, and the other is healthy weight management, achieving an ideal weight.”
To read more & get a link to the UCSD study click here:
— The Healthy Librarianhttp://www.happyhealthylonglife.com/happy_healthy_long_life/2008/03/women-with-brea.html
Is it blaming the victim to say that cigarettes increase the risk of lung cancer? That usually-healthy dietary choices during pregnancy can hurt the fetus? That taking an aspirin a day can decrease your risk of stroke? What about saying that a lack of certain vitamins and nutrients can result in health issues? That a lack of fiber can cause constipation? I think those are all neutral knowledge until *people* put value judgments on the statements.
There is stuff we don’t know about health. We didn’t used to know that drinking during pregnancy was dangerous (in the 19th Century, pregnant women took laudanum for their nerves!). We didn’t know that a fatty diet causes heart disease, or that a lack of sunlight can cause depression.
At some point, those things had to be discovered and the knowledge publicly shared. At that point, if you’re big on personal responsibility, you can say, “Hey, look, something I can do to improve my health.”
Exercise is a Generally Good Thing. People should do it to the best of their abilities. Anyone who is surprised by another study touting the benefits of exercise just hasn’t been paying attention, and should go sit in a corner with the people who were outraged to discover during the trans fat flap that Oreo Cookies aren’t good for you.
If someone goes to a cancer victim and says, “Hey, you have cancer because you’re a lazy pig, didn’t you know? Also, you’re a loser because you’re too sick to exercise,” well, then, that guy’s a jerk. But saying, “Exercise can help prevent cancer” or “Exercise is important for cancer patients, especially,” that’s just giving people the tools they need to responsibly manage their own health.
It’s information, and information by itself puts no value judgments on individuals. How we treat people based on that information may fall into the realm of blaming the victim, but just giving it out doesn’t.
And yeah, if you’re going through chemo or recovering from surgery there’s a good chance you’re not going to feel like running the track or pumping iron, so I don’t see the point in chastising cancer patients about exercise. But I see people willing to do all sorts of crazy regimens, herbal treatments, yoga therapies, all sorts of things. It stands to reason that it would make sense to let them know that putting some of that effort into a daily exercise regimen might help them more.
— RowanHey sweetie, you need to put your podcast on that iTunes, and stop pronouncing your name TAR-uh. It’s TARE-uh. Your parents were wrong. Trust me on this one– I’m older than dirt and I was there when you were born! If I could turn back time…
— CherActually, Rowan, an article in the Times a few months ago said that the heart disease/fatty diet link is probably a myth.
http://www.nytimes.com/2007/10/09/science/09tier.html?pagewanted=print
As for Tara, I’ve been doing a bunch of other reading on this study, and it doesn’t seem to say what the press release is saying and what you are, in turn, saying. Junk Food Science has a good rundown.
http://junkfoodscience.blogspot.com/2008/04/compassionate-message-was-lost.html
— MeganI have cancer and already I have been critisized for “choosing” to get cancer by the coastal health authorities no less! I was asked when I decided that I wanted to get cancer, and why I selected cancer as my disability. The nurse then went on about how she “chooses” to NOT get cancer, and she simply cant understand disabled people being so very lazy and ignorant that they would choose to get cancer and even claim to be in pain when “everyone knows” that all pain is simply mind over matter. ” Just make a decision to not be in pain and “Poof” all your pain and cancer will just disappear.”
— DanDoctors and researchers tend to focus on lifestyle because these are tangible factors that they can control for in studies.
I have no doubt that environmental factors and pollutants are by far the dominant cause of most cancers. Maybe someday this will be widely known and accepted — when we are more interested in preventing cancer than treating it.
— DianaRowan, how do you “know” that a high fat diet causes heart disease. Personally, since converting to high fat all my indicators have substantially improved. My cholesterol is low, high-density ratio excellent, triglycerides are below “normal” range (my doctor ironically suggested I eat more fat to raise my triglycerides) and my weight (8% body fat) is down to what it was 30 years ago when I was 18. I score less than 1% risk of heart disease under the Framington criteria. Dr. Jay Wortman has been conducting a study of Aboriginal people who have had the highest rates of obesity and diabetes in North America. By switching to a traditional high-fat diet without cereal grains, sugar or other high-carbohydrate sources, they have had the same results I have had. Perhaps we are all anecdotal exceptions, but it does put in issue so-called “knowledge” that high-fat diets cause heart disease.
— murrayIn 1959, after moving to California, I read an article in the L.A. Times (July or August). It told of a 35 year old Montana man who had been found to have a cancerous lung lesion.
This fellow had observed that many people, including John Foster Dulles, became emaciated before they died of cancer. He was determined that if he was going to die of lung cancer, at least he was not going to become emaciated. He began to eat almost constantly for eight to ten hours a day. After three months he returned to his doctor, had more testing, and was told that the lung lesion was gone.
Of course, the man had become quite heavy. The article did not specify what kind of diet he had been on. One can imagine it might have contained much meat and potatoes as well as fruit and vegetables, and that he might have attained similar results by lowering the more fatty foods while continuing the high amount of fruits and vegetables - for 8-10 hours per day.
— LindaWe often look for the one magic bullet to solve complex problems. We are told:
Do not smoke and you will not get cancer. Not true.
Eat healthy foods and you will not get cancer. Not true.
Exercise and you will not get cancer. Not true.
Take this or that magic potion and you will not get cancer. Not true.
Meditate and you will not get cancer. Not true.
Or we are told a story about this person who did this and that and did not get cancer. Maybe not, but because that one person did this or that does not necessarilly make the story, tale or myth true for that person or true for everyone.
We know this much: A) Cancer is in the body for years before it is noticed through symptoms or found by some test; B) its roots and causes are not easily identified; C) Cancer is based on cells that do not function correctly and D) most research or advice that looks for a silver bullet (think prescription drug) to prevent, cure or to some degree resolve cancer has failed.
We also know that the human body is a wonderful survival machine that requires energy and a way to
turn it to a useable form of energy. We also know that the source of the energy should not harm the body’s cells. So we need safe, natural food (which we do not get even when we eat the so-called correct foods) nor clean air to provide adequate levels of oxygen nor living water (we do get so-called pure water that almost always has potentially harmful contains chemicals added or leached from the supply system including lead, chlorine, florine, copper, prescription drug residue, and plastic).
We even have studies indicating that cancer might be a product in some cases caused by the very MCR!
So telling people to eat, exercise and drink water are fine when done in combination with food, living water and proper movement that includes healthy breathing (most of us do not breath correctly) and most importantly with a healthy attitude.
Cancer in humans is nothing more than our cells not functioning properly. Cells invaded with any toxin that does not have the ability to communicate with other cells (think immune system), cannot tranfer the food into useable energy, has insufficient water to keep the body fluid on all levels and a mind that is sending improper messages (bad attitude) will be more prone to disease including cancer.
The answer, as with the cause, requires more than any one action or explaination. And it takes more than most foods, water and movement (think exercise) can provide. We need to learn how to breath, purify our water, take needed supplements (think minerals, vitamins, anti-oxidents, glyconutrients, amino acids, etc.), do the correct movements and breathing to stay healthy as we avoid those toxins that cause the cells to act in ways that we call cancer.
That is why we get endless personal stories of what someone is doing that for the present seems to be working for them to either prevent cancer or allow them to survive.
For a presentation on cancer and related medical care received (MCR) issues, please send an e-mail to healthinfo@delhitel.net with Health Presentation in the Subject line and your name, affiliation, e-mail addresss and phone number in the text.
— healthinfoAs a cancer survivor, I have to say that I am in much worse shape physically than I was 4 years ago before my first bout with cancer… side effects from the first surgery which included removal of lymph nodes resulted in swelling in my legs and problems with veinuous insufficiency… I worked hard on getting back into exercising again as part of recovery from the surgery… Then the next year the cancer returned and I went through 3 months of radiation…
The exhaustion during and after radiation made exercise much harder to find time for and to do…
Unfortunately my physical condition now is worse than it was after the surgery… I am trying to get back to exercise, but I also have to try to keep up with all my work, and the radiation has left me more susceptible to all sorts of colds and flus that further debilitate the body and one’s energy…
However, I am continuing to persevere, and planning to get more physical therapy this year to help with the problems of my legs and knees from the swelling…
— MJI am a breast cancer survivor. Five years ago I underwent a mastectomy, chemo, and radiation.
I love to exercise. I try to go to a jazz dance class twice a week and walking for an hour once a week.
I love my jazz dance class because it combines everything — stretching, toning, cardio, and having fun moving to music. I love walking because it is so easy to do — at any time, without wearing special clothes or driving somewhere — and you get sunshine and fresh air.
I often think that it is so unfortunate that people who don’t exercise don’t know what they are missing out on. It just feels so good. When you are out of shape, it doesn’t feel so good at first (such as after I had a hiatus due to childbirth or surgery). But after you get in the habit, it feels wonderful — relaxing, energizing, detoxifying. You let go of all your stress. You become stronger and more relaxed.
I often wish that the kinds of exercise we do in jazz dance class were available to people who don’t wish to dance. To me, aerobics classes can be stressful and don’t make me feel so good.
I do not exercise as much as I would like to. I have a job and three children, one of whom is handicapped. But half a loaf is much better than none. When I work out, I feel twenty years younger than when I don’t.
Sometimes it is easy to react to advice defensively, and to feel that we are being put down. I agree with Rowan — nobody is blaming the victim. It is just good to know that exercise helps to maintain health, in a number of ways. If you tried it for a while, you might find that you really like it. It’s just a matter of finding something that you like and is convenient for you, whether it is dance, swimming, walking, running, yoga, aerobics, basketball, squash…
— TwylaThere is no co-relation between exercise and cancer. These studies are about blaming the victim. My father has been a lifelong health fanatic. Never smoked, drank or did any substance abuse. Exercises fanatically, takes his vitamins, and eats fruits and vegetables. And guess what, he got cancer last year. Blame it on our increasingly polluted environment, the DDT sprayed, the pesticides used to produce our food. Cancer cannot be cured, it can only be prevented. And the treatment for cancer is itself so toxic, that it condemns the patient to a miserable few remaining years on earth.
— ConcernedAs a holistic physician, I find this to be a great discussion, as it brings up so many issues outside of the one related to how exercise helps cancer. This miscommunication of intentions often suggests a lack of trust both toward the physician and toward the patient.
By the time someone reacts to a simple, seemingly innocent statement of “exercise helps prevent cancer,” that person has been inundated with well-meaning and some not-so-well-meaning people telling them how they had caused their own pain. When you are hurting, that kind of blame doesn’t do an ounce of good for anyone involved,and it can feel like being kicked when you’re down even if the person who made the comment didn’t intend it to have that strong of an impact. I would contend that it even slows down healing.
I am sensitive to this issue for several reasons. When I was younger, a family member got very ill. Instead of treating the family with kindness for the difficulties we were now living with, my parents in particular were blamed for the problem. I felt firsthand the abusiveness of the medical system when it doesn’t treat those who are hurting with kindness, gentleness, and sensitivity.
When I broke my neck several years ago and my arms became paralyzed for a while, I had someone tell me that if I would just get a good attitude about it, I wouldn’t feel the pain. Well, I’ve been a pretty joyful person my entire life, and yet this was an appropriate time to grieve, so that comment felt like a punishment and a judgement from someone who had no idea who I was as a person.
During this injury, I stopped going to my doctor when he said that I should have been over the pain by now, because I could see in his eyes that he had lost his ability to deal with the discomfort of not being able to “fix me.” I understood his discomfort and didn’t blame him for it, but I knew that he could no longer help me to heal.
I did get better, and I think it’s important to say that the people who helped me the most during that difficult time simply held me and gave me the space to cry it out. The grief didn’t last long, and I did find my way back to health.
I think that some of this tendency to judge the patient comes from a feeling that if we blame the victim, we can somehow keep that illness far away from us personally. The nurse in #9 above who said that she has willed herself not to get cancer is likely very afraid of this illness and is trying to establish some control over that fear. I have great compassion both for that nurse and for the person she inflicted that comment on.
The way I talk about this is that every illness has components of mind, body, emotions and spirit to it.
Cancer is a perfect example of how multiple factors can make you more or less susceptible to an illness. Everyone has their areas of vulnerability - for some it is a tendency toward cancer, for others, it may be toward depression, for some it might be more back pain, for others it may show up as a rift in their relationship with their spouse, and the list could go on and on. Imbalances will find the easiest form of expression depending on our bodies and our psyches, and we all have our weak points.
I want to emphasize that EVERYONE has their weak areas, related to our bodies, minds and emotions, our genetic tendencies, our family history, the toxins we’ve been exposed to, our unique abilities to clear those toxins, our sleep habits, our diet and exercise, and yes, even our soul’s path. We all generally do the best we can with the knowledge and energies we have available to us at the time.
If exercise has been shown to decrease the risk and recurrence rate of cancer, then certainly, it ought to be a part of the discussion for how to be as healthy as possible. It’s all in how the subject is discussed, what the relationship has been between the patient and the physician, and a general assumption of good intentions on both their parts that turns that comment into one that empowers the person and sets them on a course of healthy living.
Thanks again for bringing up such a great topic, Tara. Your blog is excellent.
Dr. Molly Roberts
Co-Director, LightHearted Medicine
http://www.LightHeartedMedicine.com
Board of Trustees, American Holistic Medical Association
— Molly Roberts, MD, MShttp://www.HolisticMedicine.org
I am sorry for your father’s illness. However, your statement that “treatment for cancer is itself so toxic, that it condemns the patient to a miserable few remaining years on earth.” is just flat wrong. It could needlessly frighten people who are facing a cancer diagnosis and trying to decide on a course of treatment.
Like everyone else, I have had friends, acquaintances, and relatives with cancer. Some died a terrible death, but most were treated and did very well. I have known two women who survived for more than twenty five years after a mastectomy. One lived it up as a ballroom dancer until she died in her eighties; the other died in her mid seventies. A third friend is doing beautifully after a lumpectomy with radiation. She’s on an aromatase inhibitor, has no unpleasant side effects, and is enjoying her life and her restored health. I also know two women, one of them my aunt, who recovered completely after surgery for endometrial cancer. One of my dearest friends, now about 70, was successfully treated for melanoma years ago. For Pete’s sake, John McCain is a melanoma survivor, and he’s out there running for President.
Cancer is horrible and frightening. The treatments can be horrible, too, and there are some cancers, such as pancreatic cancer, that are almost always fatal. But most cancers can be treated, and yes, some can be cured.
— concernedAre cancer patients justified in sometimes feeling
unnecessarily *blamed* for their having the disease or not preventing recurrence?
For some interesting insights on this subject read Part I and II of “Failing at Cancer,” Laura Zigman’s blog on the Huffington Post.
— D.http://www.huffingtonpost.com/tag/failing-at-cancer
I think open discussion about cancer can only lead to better things. Many different views and points are necessary when trying to combat cancer.
Mark Salinas, MN
— Mark-Salinas-MNThis is a response to the posting by Dan. Are these “coastal health authorities” real medical professionals? I can’t imagine a medical professional stupid enough to ask a patient why he “chose” to get cancer. The best answer I can think of for that one is to ask the nurse why she chose to be stupid.
— Philip FoxPhilip
My father who died of lung cancer as a non-smoker told everyone that he never smoked. In fact, our whole family did–somehow people responded more positively and had more compassion.
My dad also exercised every day post diagnosis and never missed a day of work until the cancer spread to his brain.
Sure, a healthy lifestyle helps in cancer prevention, but some of us are just darn unlucky.
— C.Most people agree that exercise is necessary for good health. However, when considering its specific relationship with the risk of cancer, we can look at the conclusions of the Nurses Health Study, which covered decades and cost millions of dollars. The study “Physical activity and breast cancer risk in a cohort of young women”, reported in the Journal of the National Cancer Institute (1998)concluded that no link between physical activity and breast cancer risk was supported by its findings.
This conclusion does not mean that individuals should not use exercise as one means of cancer prevention. However, it does put the probabity of success in perspective, especially for those who may be inclined to rely too heavilty on exercise, to the exclusion of other strategies.
— Phil, NebraskaI think there is a misconception at the root of this. Saying “Exercise helps prevent cancer and assists in recovery” does not in any way mean that “If you exercise you won’t get cancer,” and it certainly cannot be taken to mean “If you have cancer, you didn’t exercise enough.” These conclusions are OBVIOUSLY illogical, no matter what type of logic you use. Cancer is, by and large, (bad) luck of the draw. However, there are known risk factors, and a sedentary lifestyle is one of them, though not one of the most serious.
All of us are responsible for our lifestyles, and we have to understand that certain decisions may make us more susceptible to certain consequences. Some diseases are more directly linked with behavior than others (for example, it’s practically impossible to contract chlamydia if you never have sex in your entire life), but most risk factors for most cancers are completely unrelated to lifestyle.
My mother is recovering from breast cancer. She had several risk factors, one of them her being her weight. I don’t think she’s responsible for getting cancer, and given the other risk factors, she may have developed it even if she had been at an “ideal” weight. It would be silly to blame her for the cancer based on her control over one relatively insignificant risk factor. Many perfectly healthy people who eat well and exercise regularly become cancer patients.
That said, we should all take to heart the correlations between exercise and cancer. With so few risk factors in our control, why not try to cross one off the list?
— AnneAs long as research funding goes for finding a cure for each disease, meaning ever more expensive diagnostic machinery, evermore expensive and ongoing treatment and magic drugs (that never quite do there majic, if at all, without serious side effects) and just hide or make tolerable the manifestations of disease after the fact and not providing adequate independent basic research into primary prevention, nutrition, life style impacts etc., we will, including me, be shooting in the dark to some extent and depending on s/he says this or that when we need data for larger numbers of people, not antedotes.
— ed gThere is already a great deal of science that offer opportunites for more research based on wellness and health and not profits and more profits.