Cancer survivors hit the gym

Pilot to improve outcomes through exercise moves to the mainstream
July 20th, 2016

Pilot programs, be they on television or in cancer centers, come and go. A precious few, though, find a devoted audience and become a core offering.

That’s been the case with BFitBWell, which the University of Colorado Cancer Center and the CU Anschutz Health and Wellness Center rolled out in late 2013. The idea was to get patients with a cancer diagnosis or already in treatment (collectively called “cancer survivors”) exercising, which research shows to be as good for cancer survivors as it is for the general population.

Tom Purcell, MD, MBA, the Cancer Center’s medical director, pulled together money from grateful patients and other sources and worked with John Peters, PhD, the Wellness Center’s chief strategy officer, and his staff to develop exercise programs tailored to individual cancer survivors. As of early 2014, the program was enrolling about four patients a month.

ErnestoSalcedo
Ernesto Salcedo works the battle ropes as Ryan Marker and Becca Ruiz look on during his BFitBWell workout at the CU’s Anschutz Health and Wellness Center on Wednesday, June 29. Salcedo, who has pancreatic cancer, is participating in a program aimed at improving the well-being of cancer patients through exercise.

Two-and-a-half years later, it’s doubled that average and sometimes far exceeded it: BFitBWell has started 17 new patients this month. Despite surging capacity, there’s still a two-month waiting list, said Nicole Klochak, the BFitBWell program manager. The aim is to expand the pioneering fitness program further yet, Purcell said, placing it firmly in the supportive cancer care fold with such mainstays as nutrition, psycho-social services, financial assistance and oncofertility support.

Purcell and colleagues would also like to see rehabilitation and fitness for cancer patients join the ranks of cardiac rehabilitation for heart patients and pulmonary rehabilitation for lung patients – that is, as standards of care at University of Colorado Hospital and beyond.

“This is an underutilized area in cancer care and we’re very excited to be national and international leaders on how to combine fitness, training and cancer care to get optimal outcomes,” Purcell said.

Be fit

The basic idea is simple: The more fit the body, the better it can handle cancer treatment, whether it’s chemotherapy, radiation therapy or recovery from surgery. In addition, BFitBWell aims to help patients make exercise a long-term habit so they can reap its benefits over the long term.

Elaine Massey
Elaine Massey works the Technogym Kinesis machine under the guidance of BFitBWell trainer and Metro State University student intern Emily Woessner.

Elaine Massey hadn’t worked out in four years prior to starting BFitBWell, and one couldn’t blame her. Massie, 71, has lung cancer as well as a slipped disc. But for more than a month now, she’s been at the Wellness Center three times a week. With a dumbbell weight in each hand, she steps up on a wooden box with one leg, then the next. When she’s done with the set, someone asks her how she’s doing.

“Terrible!” she said. With a smile, she adds, “It’s a good workout. They up it every time, and they’re great with everybody.”

Massie is here because she saw a flyer in the Cancer Center; her oncologist, Ross Camidge, MD, PhD, also suggested it. Her cancer is inoperable, and her treatment entails chemotherapy every three weeks. “They’re trying to turn it into a chronic illness,” she said.

Massie said she has noticed differences since starting BFitBWell. “I can get off a chair without leaning on things. I can walk up the stairs, mostly.” But also, the BFitBWell team has taught her something more basic: how to breathe correctly, a lesson she now constantly applies.

She doesn’t always look forward to coming, especially when she’s in the middle of a chemotherapy round. But she tells herself to “dress up and show up,” and she finds that she always feels better on the way out of the Wellness Center than she did on the way in.

The BFitBWell staff are sensitive to her needs, but also push her. There’s variety – “every day it’s something different, so you’re not bored, and I like that,” she said. “It’s a good program. I would encourage people to participate,” she said.

Tailored plans

That variety is deliberate, as is everything associated with Massey’s and other cancer survivors’ training plans, Klochak said. She and fellow exercise physiologist Becca Ruiz, the BFitBWell program coordinator, review the patient’s medical history, details from his or her physician clearance, and insights from an hour-long up-front assessment to develop initial exercise plans.

But there are wrinkles, too. A patient undergoing chemotherapy may show up drained (or with compromised balance, which can be a chemotherapy side effect) compared to just the week before. And so the program is tailored not only to the individual patient’s capabilities and goals, but also to how that patient’s feeling on a given day – a departure from what one might find in a traditional fitness center, where participants rarely have huge swings in strength and endurance week-to-week.

“If they come in depleted by chemo, we adjust,” Klochak said. Throughout, BFitBWell aims to improve flexibility, mobility, core strength overall strength and cardiovascular fitness. “Preserving lean mass is really the goal for everyone,” Klochak said.

Medical research is also a central facet of BFitBWell. Ryan Marker, PT, PhD, a post-doctoral fellow with the CU School of Medicine and the Wellness Center, explains that there is a large body of research showing the positive impact of exercise on cancer survivors. For example, a team of researchers recently considered 71 prior studies and found exercise to reduce cancer mortality risk among the general population as well as among those already diagnosed with cancer. The studies they reviewed included ones showing exercise to lower the risk of dying of breast, colorectal and prostate cancers.

Despite such findings, Peters said, “there have been very few clinical programs that actually offer what comes out of this research to patients. It’s really quite striking.” BFitBWell emerged through the recognition that the Anschutz Medical Campus hosts a rare combination of a National Cancer Institute-designated Cancer Center and the facilities and expertise embodied in the Wellness Center, he added.

‘Going to fight it’

Marker is working with Klochak and Ruiz to improve the BFitBWell team’s ability to initially assess patients and track their progress over time – both vital to establishing an evidence-based foundation to elevate cancer-survivor physical fitness and rehabilitation to standard-of-care status. He’s also looking to fill in those research gaps and at data from about 100 BFitBWell participants, including those with breast, lung, prostate, pancreatic, colorectal, lung and other cancers. He found BFitBWell graduates to have about 30 percent more strength, 15 percent better flexibility, and about 25 percent less fatigue and depression as compared to their scores and measures before they started the program.

“This is a shining example of how exercise can improve quality of life and medical outcomes both before and after cancer treatment,” said Peters, who advises Marker.

In May, Marker launched a study involving pancreatic cancer patients going through pre-surgical chemotherapy and radiation therapy. He aims to enroll 15 patients who will participate in BFitBWell and compare their outcomes with those of a similar number of pancreatic cancer patients who don’t do the program.

Harold King
Trainer Ian Moran, an intern from Colorado State University, works with BFitBWell participant Harold King, 77.

Ernesto Salcedo, 71, is one of the participants. Salcedo, a  cardiologist and cardiac imaging expert at UCH, was diagnosed with pancreatic cancer three months ago and has been doing BFitBWell for two months. He just wrapped up a two-month course of chemotherapy and is about to begin a 10-day radiation regimen.

The main goal of his training is to steel his body for removal of the tumor via a Whipple procedure planned for August. This is major abdominal surgery, one that reorganizes much of the digestive tract in the process of removing the tumor.

Salcedo is lean and fit, the product of years of running, biking and swimming. Still, the lime-green Polar heart rate monitor watch on his wrist hits the mid-130s as he works the battle ropes, not far from his maximum.

His aim is to roll into the surgical suite in the best shape possible, Salcedo said, which he feels will ultimately help him get out of bed sooner after surgery and speed his recovery. Plus, he said, it improves his state of mind and keeps him positive.

King, a kidney cancer survivor now in chemotherapy, joined the program because he thought it seemed like a good idea – plus it might help his golf game, he figured. Six weeks in, he said, he’s feeling better and his flexibility has improved. But, he added, “as far as dropping my score, I don’t think it’s done much.”

“My pancreas may be in bad shape, but I’m in good shape and I’m going to fight it,” Salcedo said.

Creative growth

Keeping up with demand for BFitBWell has pushed the team to get creative. To keep up with demand, they’ve brought in health and exercise science students from Metro State University and Colorado State University. Working with support from Ruiz and Klochak, the students satisfy their graduation requirements and also amass enough hours – roughly 500 – to qualify for cancer exercise trainer certification from the American College of Sports Medicine, Klochak said.

Out-of-pocket patient costs remain low – just $59 a month for an Anschutz Wellness Center membership as of July 1, compared to per-patient program costs that Purcell pegs at about $2,000. In addition to leveraging student interns, BFitBWell is transitioning to small-group workout sessions for the second and third months of the program. By that point, patients are familiar with the exercises and the equipment, Klochak said. In addition to helping participants become independent exercisers, the shared sessions function as impromptu peer-support groups and vehicles for establishing relationships with other cancer survivors, she said

Relationships of a different sort are the bedrock of BFitBWell itself, she adds.

“The partnership between the Wellness Center, the Cancer Center and UCHealth is the sort of collaboration that we’re trying to build more of here on campus,” Klochak said.