Exercise Improves Mood (couldn't we all use a little of that sometime?)

As many of you know, fitness is a second career for me. I got into this because of my experience with exercise and cancer. (about Julie) When I exercised all during treatment I felt better - had less nausea, fewer headaches, more energy, etc. Exercise also boosted my mood; I was less anxious, and generally calmer and happier (all good things when fighting cancer). I started Life-Cise because I believed others could benefit from what I had discovered.

While I started this because of potential improvements in quality of life, it now is evident that exercise can also improve treatment (see studies by Courneya, et al; and Mastro) and outcomes (see Nurses Study - breast cancer; and Irwin HEAL study; among others).

But now, let's go back to quality of life. Exercise improves mood - this is well-documented. But a new study presented this last week at the American College of Sports Medicine's Annual Meeting in Seattle shows that the mood-boost from moderate exercise may last much longer than previously thought. The study found benefits to mood for up to 12 hours for the exercise group compared with the resting group.

According to lead author Jeremy Sibold, ED.D., ATC, "These positive effects on mood occurred in all types of participants, regardless of age, gender, or fitness level."

People facing cancer often experience anxiety, stress, worry, and depression (duh...right?) Well, exercise can be a really useful tool in managing those feelings. And it's totally in your control.

Nobody's saying you have to go run 10K or bench press 200lbs. Do an appropriate amount of exercise for you. For some of you, that might be running 10K, but for some it could be simply walking to the mailbox. Just get some exercise most days - you will feel better!

Julie

Women treated for DCIS not getting Regular Mammograms

A team of researchers from Harvard Medical School has found that among women who have been treated for ductal carcinoma in situ (DCIS), regular mammogram followups decline over time. This is in spite of the women's higher-than-average risk for recurrence of breast cancer. Dr. Larissa Nekhlyudov and colleagues followed more than 3,000 women for a median of 4.8 years. The women all had a diagnosis of DCIS and were treated with breast conserving surgery.

About 20% of women with DCIS have a recurrence within 5 years, and their risk of contralateral breast cancer is 2 - 4 times higher. Because of their higher risk, women are generally recommended to have annual surveillance mammograms. The Harvard study, which have been published online in the Journal of Clinical Oncology (J Clin Oncol 2009; 27), found that adherence to annual mammograms declined every year after treatment for DCIS.

I find this a fairly disturbing study. We are all responsible for ourselves; no one can force us to go for followup. Our doctors can give us all the right information and make good recommendations, but ultimately, it's up to us. It can be scary to go for followup scans - we know all too well that sometimes bad results are had. We would like to leave cancer and the fear & worry behind. But our reality is that we are at a higher risk for future cancers. Ignoring that won't make it go away. And our best chances for beating a recurrence is to find it early. So, please, don't be one of the dropouts; follow your doctor's advice and go for your yearly mammogram. Might it be scary? Yes. But if you don't get the scan, do you really not ever think about it?

Julie

Memorial Day - Gratitude

Here on this Memorial Day, while most Americans are heading out to picnics and ball fields, I've been thinking about my brother, and by extension, Memorial Day. We often get caught up in the joy of the long weekend, the good weather, the start of the summer season. We sometimes forget that the holiday, as I mentioned in yesterday's post, is somber. No matter what one's political or moral views, today should be a day of respect and remembrance.

Yesterday, I stumbled upon some photos and interviews of my brother (former Army Ranger, 3rd Bat., Co. B, out of Fort Benning) that I don't remember seeing before. Years ago, he was interviewed by Mark Bowden for a series at the Philadelphia Inquirer. That newspaper series became the basis of Mark's book, "Black Hawk Down."

I listened to the interview clips and stared at the photos of my brother that, in some ways, bear so little resemblance to the middle-aged , middle-class, middle-America, sometimes a little pudgy around the middle husband and father he is now.

When I was diagnosed, Mike was the first person I called (he told me a joke, a sadly appropriate joke about a man whose leg had been cut off to save his life). I knew where his matter-of-factness and grim humor in the face of death came from, and I found it oddly comforting. Later, as I grew weary and tired of my treatments, he was the one I knew I could turn to. I didn't have to say much, nor did he, but I knew that he understood. More than anyone else of my family or friends, he understood the weariness of facing death.

Fairly often, as I went to work or the gym with my little bald head, people would tell me how brave I was, how heroic. I'm sure they thought they were being encouraging, but I never really understood that - I was just living. I've encountered that same perplexed sense when I've talked with my brother, or other soldiers, or first-responders on 9/11. None of them thought they were doing anything heroic; they were just living their lives, doing their jobs.

I do not mean to equate facing cancer with being a soldier in a was zone! I can not imagine what that's like. But I do know what it's like when all of your choices suck. And I'm not talking about you might lose some money in the market or you might not get that promotion. I'm talking about every option is bad and there's a good chance you aren't going to make it - those are the bad choices I'm talking about. And so you make your choices, even if they suck, and you keep going. And in the morning you do it all again. You just keep moving no matter how tired you are because, really, what's the option - you just stop?

And that is what my brother understood.

Here we are, Memorial Day 2009. We're both many years past our respective life & death struggles. We've added years, pounds, degrees (in my brother's case), and joy. But once in a while, there's still a hint of something in the eyes, or a faraway sound in the voice when asked certain questions that belie a darker moment. So, for all the comfort and understanding that his struggle allowed me, I am grateful.

I apologize for the somewhat rambling nature of this post. These are rather elusive thoughts for me and I'm struggling for coherence. What I want to express most is gratitude - thank you.

Julie

Happy Memorial Weekend from Life-Cise

Here in the US, we're in the middle of Memorial Weekend - important for three things. Most of us think first of barbecues! In backyards and parks all over the country families and friends are getting together (assuming the weather cooperates) for barbecues. Enjoy!

But the real reason for the long weekend is somber. It's a remembrance of our service men & women who have lost their lives in conflicts past and present. Be sure to take a moment in all the fun to remember those who have given their lives.

And it's also the beginning of the summer season. OK, it's not officially summer, but in many people's minds this weekend kicks it off. (We at Life-Cise are grilling, gardening and hiking this weekend)

For people currently in cancer treatment or recovering, this is a good time to talk about getting/staying active. It can be frustrating to be heading into a typically more active season if you're weakened from illness and treatment. What you could do before cancer is not as important as what you can do now. Thinking about what was is not so useful as thinking about what is right now and what can be. Try (as much as possible) to just be grateful for what you CAN do.

So find activities that you enjoy and do them. Walk, garden, bike, clean your house (if that's what you're into) - just be active!

If you're just beginning an exercise program - GOOD FOR YOU! You're much more likely to stick with it if you choose activities you like. Don't just get on the eliptical machine because other people do it or some trainer told you to. Get on the eliptical if you like it; lots of folks like it because they can read or watch TV. But if you hate it, find something you do like. Exercise should be something fun, something to enjoy - not a punishment.

Begin at an appropriate, moderate level. Remember, what is moderate for someone else may not be the right level for you. On a scale of 1 - 10; 1 being almost no effort, 10 being maximum - you're about to drop - effort, try to work at around 5 or 6. If you are really deconditioned, start out at 3 or 4. You should feel like you're expending some effort, but not ready to pass out - you're heart should be pumping a little harder, you should be breathing harder - but you should still be able to speak. If you can sing all the lyrics to your favorite song, you can step it up a bit - remember, you should feel like you're expending some effort. However, if you can't respond to a question with more than 1 word, drop back some. You get the idea - find your appropriate level.

Ideally, you should get 30 minutes of exercise 5 or more days per week. But you may not be able to start there. If you can only do a few minutes of moderate activity at a time, that's OK. This is only you're starting point. Try doing a few minutes several times during the day.

As you get stronger and want to improve, begin building slowly. Especially if you're at a higher risk for lymphedema or recovering from treatment, it's very important to increase your workout gradually. You can increase intensity (how fast or how hard), or frequency (how often), or duration (length of time) of the workout. Just don't increase all things at once! Only increase one at a time. Think about making increases of around 10% at a time. If you're walking 10 minutes, increase by 10% - that's just one minute more.

So, here's to a beautiful, healthy, and active summer season. Enjoy the weekend.

Julie

They Said What?!!?!?

After hangin' with the girls at our little breast cancer breakfast yesterday, I am prompted to write some new Cancer Rules. These come from a pretty common conversation among cancer survivors: the things people say to us. - Toward the end of my chemo, I was eating my lunch outside, sitting there with my bald head, picking at the only food that didn't turn my stomach that day (I think it was chickpeas & couscous - beige food). It was just a few days after a treatment, so I was pleased to have found something that I could eat a few bites of. A total stranger walked up to me and told me I was eating the wrong food. I had to eat only red food if I wanted to stay alive! - So this list of rules is for our friends, co-workers, strangers walking down the street, and yes, sometimes even our families.

We (those of us who have had a diagnosis of cancer) do understand that we make you (those of you who have not been diagnosed with cancer) uncomfortable. We are scary; cancer is scary; we point out your own frailty to you. We realize that you probably mean well, and just don't know what to say or do. But there are certain things you just should NEVER say!

1.) When someone tells you she has cancer, don't immediately start telling her of all the many people you know who have died of her disease.

2.) Similar to #1., don't describe, in detail, all the suffering of your friend/parent/whomever who you nursed as they died a slow, painful death.

3.) We also don't need the simplistic "just think positive - you can beat this if you just stay positive". We're doing the best we can: sometimes we feel good, full of joy and life; sometimes having cancer just SUCKS! And if all it takes is loving life & staying positive, then this Earth would be way more overcrowded than it is. Attitude is important. A good attitude certainly impacts how we feel about what we're going through, and may have some impact on how our bodies deal with the disease, but fighting our disease is so much more than just "keeping our chin up."

4.) Whatever choices we have made for our treatment, PLEASE, do not launch into a long harangue about what alternative treatments you've read about! We have carefully considered our options and chosen treatments that we feel have the best chance of success.

5.) Similar to #4, Whatever our choices, do not insist that you know best what we should be doing in terms of treatment. My feeling is that, unless you have been the one to sit alone in the middle of the night, facing choices of how you will live and maybe die, you have no right to tell someone else what they should do! And if you have faced that, you probably won't be insisting on your ideas for someone else's treatment - you know better than that.

6.) Unless you've actually been through this, don't try to commiserate. Don't tell us that, because you had to see a dermatologist this year to have some moles looked at (luckily they were fine), you know exactly what we're going through. Trust me, you don't! Don't tell us that you know exactly how we feel going through chemo because you recently had the flu. Trust me, you don't!

7.) Don't tell us how we brought this on ourselves. Many of us have led healthy lives, done good things for the world - we didn't cause our illness. If cancer could all be explained by bad behavior, how do we account for children and babies, or dogs getting cancer?

8.) Don't tell us that this is just God's will. Do you really want us to believe that God is out to get us?

9.) Especially when talking to someone who has a secondary cancer, don't say things like, "If I were facing death..." or "If my death were imminent, I would...." Sorry man, that is just insensitive!

10.) If you are a man, unless your dick has been cut off (apologies for crudeness), do not tell a colleague who's just had a mastectomy that it's no big deal - hey, it's only one. Of course, if you are our husband or boyfriend, this rule does not apply - we want, we need you to tell us (and believe) that it really doesn't change any of the good things about us.

Generally, we try to understand that you just don't know what to say. We understand that our illness brings up your own fears. We try to understand that you really do mean well. We understand that you would like to help if you could. We need your love and support, but please, just think before you speak.

I think most of us would be happy with a simple, "How are you?" and "If you need anything at all, please let me know. I'll be here for you."

Julie

National Women's Health Week

Yesterday, Mother's Day, began National Women's Health Week. Coordinated by the Office on Women's Health at the US Department of Health & Human Services, National Women's Health Week seeks to empower women to make healthier choices and make their own health a priority. Click here to visit the NWH web page to find information and events in your area.

An important element is this initiative is to encourage women to take simple steps towards a healthier life. At Life-Cise and in my workshops, a lot of attention is paid to helping women make healthier choices. There are so many ways to build a little exercise into your day even if you can't get to the gym for a full workout. Take the stairs instead of the escalator, walk a few blocks before hopping in a cab, do some straight-arm raises or bicep curls with the groceries while you put them away, do some squats while wainting on hold when you call your bank - you get the idea. I may sound like a broken record on this, but it really does make a difference.

It's all about making healthier choices. No one is expecting you to suddenly be training like some super athlete or eating a perfect diet. All the recommendations and studies can seem a bit overwhelming (and even off-putting). I find it helps to just think about making realistic choices. Don't worry about being perfect - no one is. Just make one choice today. Choose one healthier thing - order the salad instead of french fries, walk up two flights to your meeting instead of taking the elevator, make the appointment for your mammogram that you've been putting off.... And tomorrow make one more choice for health, and the next day, and the next.

Julie

Mother's Day Wishes

Happy Mother's Day to my mom and all moms. My hearty wish for Mother's Day is that no mothers should have to face a diagnosis of cancer, or sit by their sons or daughters as they face cancer, or their husbands or partners. What I wish for, as always, is a kinder, gentler world that is free of cancer.

But that's not happening - so instead, go for a walk. For Mother's Day, take your mother for a walk. It's fine to have a nice brunch, but afterward, at least walk around the block. Better yet, skip the brunch and take a walk in the park. If you don't live close (like me), encourage her to go out for a walk when you call her.

Moderate exercise, like walking, has been shown to reduce the risk of breast and other cancers. It also reduces the risk of recurrence in breast cancer. In 2005, results were released from the Nurses' Study which showed that regular, moderate exercise (3-5 hours of moderate exercise, like walking, per week) lowered the risk of breast cancer recurrence by around 50%! The Health, Eating, Activity and Lifestyle (HEAL) Study, carried out at Yale School of Medicine, found that moderate-intensity exercise reduced the risk of death (both from breast cancer and other causes) by 67% in women who remained active two years after a breast cancer diagnosis. There are other studies, as well, which find reductions in risk of breast cancer death by around 40-55% associated with exercise. And the benefits are not limited to breast cancer alone. The National Cancer Institute has estimated that 25-30% of all colon, breast, endomitrial, kidney and esophageal cancers are associated with lack of activity and obesity.

So my wishes for a suddenly cancer-free world are not realistic, but your ability to take control to reduce your own risk for cancer is. This is something that is firmly in your control. These are HUGE numbers! The numbers in these studies for reducing risk are as strong as those for many standard treatments. And trust me, going for a walk is a whole lot easier than chemo! (I'm not saying that exercise should replace standard treatment! I'm just saying that the evidence for the benefit of exercise is worthy of serious consideration. I believe in taking advantage of every effective tool in fighting cancer.)

Go for a walk today and take your mom. It's good for you and for her. And Happy Mother's Day, mom. Now, turn off the computer and go out for a walk.

Julie

Oncologists Should Recommend Exercise to Patients

The American Association for Cancer Research (AACR) believes that oncologists should talk to their patients about exercise. At the AACR Annual Meeting, Dr. Melinda Irwin, associate professor of epidemiology and public health at Yale School of Medicine, said evidence shows that exercise can improve both the prognosis and quality of life for cancer patients. The strongest evidence comes from studies of exercise and breast cancer which show reduction of risk of recurrence and death from all causes. There is also some evidence of similar benefits for several other cancers, including colon and prostate. Dr. Irwin said that she would "strongly hypothesize that the benefits from exercise - particularly for improving quality of life - would extend to all cancers", according to Medscape Oncology.

Since many patients are interested to learn what they can be doing to help themselves as they go through treatment, oncologists are well-placed to recommend exercise to their patients. Patients whose doctors talk to them about exercise are much more likely to take part in exercise. Unfortunately, at least half of patients studied said their oncologists had not mentioned exercise.

Of course, doctors are busy and have a lot of details to cover, but at Life-Cise we hope that, because of the strong accumulating evidence of the benefits of exercise, doctors may begin to discuss it with their patients. We believe it is wholly appropriate for doctors to be talking about exercise with their patients: for some cancers, studies have shown improvements of 40-50% in recurrence and death for people who exercise regularly - that's as much improvement as many standard medical treatments. Doctors do not have time or need to discuss details of an exercise regimen - there are fitness professionals who are trained to do that. But they can recommend that patients make an effort to remain or get active, and seek guidance from a qualified professional.

At Life-Cise, strong emphasis is put on appropriate exercise during cancer treatment. This came out of my own experience during my treatments for breast cancer. Exercise can greatly improve quality of life during chemotherapy, but increasing evidence shows that exercise may also improve outcomes for some cancers. I am hoping this recommendation from the AACR may spur more oncologists to begin a discussion.

Julie

Expo

Last weekend was the Women's Health & Fitness Expo. I really enjoyed meeting some new folks - thanks for stopping by. As you can see in the pictures, I had some lovely dogwood from my yard (I was very proud of how nice they looked!). It was a gorgeous day on Saturday, so I liked having just a little bit of nature inside with me.
And I love my new Bodyhoop. The Bodyhoop booth was across from mine and it was great fun to watch people trying out the hoops. In the end, I had to buy one and join the fun. After careful consideration, I chose a red & purple one.

Julie

Fitness for Survivors Workshop

I will be leading a Fitness for Survivors Workshop at the Women's Health & Fitness Expo tomorrow, May 2, from 10:00-11:00am. Join me for information on exercise and cancer, a little exercise, and some fun.

During the rest of the day, I will be manning the Life-Cise booth in the fitness area.

If you are in or around Kingston, NY tomorrow, stop by the Tech Center and say hello.

Julie