YMCA program fights cancer with a workout
Twelve-week regimen in Hamilton offers exercise and education for survivors, and may prevent disease from returning
After her breast cancer surgery, Christine Carey found it so excruciating to reach up that she had her dishes moved from the kitchen cupboard down to the counter.
Now the 34-year-old is at the gym lift- ing 20-pound weights above her head.
Doctors used to tell people like Carey, who had surgery last year to remove both breasts and17 lymph nodes, to take it easy and rest during treatment. But a growing body of research shows exercise helps many cancer survivors feel better.
More importantly, it may prevent the disease from coming back.
That’s the theory behind CanWell, an exercise and education program for cancer survivors at a Hamilton YMCA that’s attracting widespread interest.
Carey’s body took a beating with the surgery, chemotherapy and radiation treatments, but she mustered the strength last fall to join CanWell. Thanks to a regimen that includes Pilates classes, the elliptical trainer, stationary bike and treadmill, the microbiologist has regained her strength and range of motion, allowing her to once again reach that top kitchen shelf. Plus, a boost in her energy has put an end to the need for daily naps.
For those living with cancer, exercise is about more than feeling good. A growing number of studies show exercise helps most cancer patients manage the side effects of chemotherapy and radiation, including nausea and cancer-related fatigue. In some cases, that allows them to complete more of their treatment. And for those with breast, prostate or colon cancer, physical activity may be linked to improved survival and reduce recurrence.
In the past decade, studies have shown exciting results, says Kerry Courneya, Canada Research Chair in Physical Activity and Cancer and a professor at the University of Alberta. According to a report co-authored by Courneya, published in May in the Journal of the National Cancer Institute, researchers reviewed 45 studies related to physical activity, cancer survival and biomarkers, or blood markers, linked to cancer survival.
In 27 studies, physical activity was associated with reduced death rates among breast cancer and colon cancer survivors. And 13 reports looking at the effects of exercise on biomarkers suggested exercise reduced inflammation, boosted immunity and improved insulin levels and circulation.
But more research, with large randomized controlled trials, is needed to determine causality, says Courneya. He is co-leading a landmark study that will monitor nearly 1,000 colon cancer survivors in Canada and Australia over10 years. The aim is to look at whether exercise reduces the risk of the disease coming back, as well as its effects on quality of life, physical function, anxiety and depression.
“You’re seeing programs like CanWell starting up because the evidence is starting to become compelling enough that oncologists are recommending exercise, but they don’t know where to refer patients to go for these types of programs,” says Courneya.
Many cancer centres don’t have the resources or capacity to offer exercise programs, so referring patients to community-based programs, with trained individuals, is an important option, he says.
The idea for CanWell surfaced after nurse practitioner Jan Park Dorsay and physiotherapist Oren Cheifetz, both from Hamilton Health Sciences, surveyed about 700 cancer patients on their knowledge about exercise. About 60 per cent said they weren’t given information on the importance of exercise and the majority said they wanted to exercise in a community setting with instructors trained to handle their specific needs.
The duo poured over the available research and put the evidence into practice. The result was CanWell, a 12-week pilot program launched in 2009. Developed by the Les Chater Family YMCA in Hamilton, McMaster University and Hamilton Health Sciences, the model was unique in that it’s a communitybased program blending physical activity, academic research and health expertise.
It was so successful, with participants showing improved endurance and less fatigue, that it became a fixture at the YMCA.
“This partnership is really a model of what the future of health care can look like,” says Genevieve Hladysh, the YMCA’s general manager of Community Health Program Development for the region. “Not everything has to be within the walls of a hospital.”
“People tell us that exercise has helped them regain their confidence. Being able to go out into the community helped them feel like a strong person again.”
JAN PARK DORSAY
NURSE PRACTITIONER
To date, about 150 men and women have participated in CanWell, exercising at least two times a week. During designated hours, a kinesiologist, physiotherapist and nurse practitioner are available. Before working out, participants get their vital signs checked and are asked about new pains or symptoms. Those at risk also get checked for lymphedema, swelling that occurs when the lymph vessels are blocked.
“This is the standard of care every cancer survivor should have,” Dorsay says one morning while in the YMCA’s health office. “We spend all kinds of money treating cancer and this is such a value-added for a little amount of money . . . And the cost to the health-care system in the long run is significantly lower.” With cancer, there’s no cookiecutter approach to exercise. People have individual needs depending on the type of cancer and their treatment. And other conditions can surface because of the cancer or treatments, such as osteoporosis, diabetes, heart disease, respiratory problems and peripheral neuropathy. At CanWell, exercise programs are individually tailored and fitness instructors are trained to work with survivors at any stage of treatment. That includes those with a PICC line (a tube that provides intravenous access for prolonged treatments, such as chemotherapy). YMCAs across Canada have expressed interest in CanWell, but it’s not offered nationwide because each association chooses its own programming. The YMCA of Greater Toronto, which has eight locations, has expressed interest in learning more about it. Susan Ireland joined CanWell in October 2010 on the advice of a friend, who is a breast cancer survivor. Ireland, 61, was diagnosed with uterine cancer in May 2009. She was devastated. “I was physically and emotionally vulnerable,” says the retired teacher. “I had no idea my body was betraying me.” After undergoing surgery, chemotherapy and radiation treatment, Ireland joined CanWell and credits it with helping her settle into her new normal. “The focus is on health, getting past (cancer), finding a new norm and adapting your life to a healthy way of living.” Cancer survivors say they enjoy exercising in a community facility such as the YMCA, which their loved ones can join. They prefer an environment where the focus is on wellness, rather than working out in a hospital or cancer centre. For some, the mere smell of the cancer centre induces nausea. “People tell us that exercise has helped them regain their confidence,” says Dorsay. “Being able to go out into the community helped them feel like a strong person again. “They’re taking some control over their life and experience of cancer.” For Carey, CanWell has also pro- vided a network of peer support. Because she’s only in her 30s, and no one in her family has had breast cancer, she turns to other breastcancer survivors for advice.
“If they’re going through the same aches and pains, it gives you a bit of comfort,” she says.
She also finds solace in talking to them about the emotional, physical and mental aspects of the disease and the treatment — something her family and friends can’t relate to.
During a recent Pilates class, where most of the participants are cancer survivors, the benefits of exercise seem clear, with many displaying improved strength, mobility and balance.
Looking on, Dorsay says being involved with CanWell is one of the most rewarding things she’s ever done as a nurse. “This is a reminder that cancer is not a death sentence.”