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Episode 26: Cancer and Resistance Training
365 Plays1 year ago
Welcome to Episode 26 of the Movement Logic Podcast! In this episode, Sarah discusses her experience with cancer treatment, and the guidance (or lack thereof) around how and when to exercise. She covers:
- The current exercise recommendations for people going through cancer treatment
- The most recent research around strength training and cancer treatment, specifically chemotherapy
- What going through chemotherapy is like, and how it can be difficult to figure out what to do when in terms of exercise
- Her personal experience using strength training during treatment and how it changed everything for the better
References:
Sarah’s website and mailing list
High-intensity strength training improves quality of life in cancer survivors
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Transcript
Introduction to Movement Logic Podcast
00:00:03
Speaker
Welcome to the Movement Logic podcast with yoga teacher and strength coach Laurel Beaversdorf and physical therapist, Dr. Sarah Court. With over 30 years combined experience in the yoga, movement, and physical therapy worlds, we believe in strong opinions loosely held, which means we're not hyping outdated movement concepts. Instead, we're here with up to date and cutting edge tools, evidence, and ideas to help you as a mover and a teacher.
Shift in Podcast Topic to Cancer and Strength Training
00:00:33
Speaker
Welcome to episode 26 of the Movement Logic podcast. I'm Dr. Sarah Cort, physical therapist. And today I was originally going to talk to you all about posture and pain and whether or not they're correlated. And then I got COVID and I did not have the energy to do the research that I need to do for that episode. So that episode will be coming up in season two.
Dr. Court's Cancer Diagnosis and Prevalence
00:01:00
Speaker
spoiler alert, we're doing a second season and instead today I'm going to talk to you about something that I already have the research on and that I also went through personally myself and that is cancer treatment and the value of strength training. As you may or may not know, I was diagnosed with breast cancer in April of 2021 and I subsequently went through surgery and chemotherapy
00:01:26
Speaker
And I'm currently on hormone treatment for the next, you know, five to 10 years. And I am cancer free, which is great. But there are so many women out there who are going to be diagnosed with breast cancer. The current figure is one in eight, which was just mind blowing to me when I learned that. So I wanted to talk about how I dealt with cancer treatment from a physical therapist perspective.
00:01:51
Speaker
and to share it with you so that you are informed in case you or your students or clients are going through cancer treatment themselves and wondering about like how and what and when and where they can exercise.
Unique Cancer Treatment Journey
00:02:04
Speaker
So I'm going to start by telling you my story, what I did from a movement and rehab perspective, the issues that I ran into in terms of the beliefs and availability around rehab,
00:02:16
Speaker
what I found in the research and how I ultimately changed what I was doing during my treatment, which created a huge difference in how I felt. I have to start with a huge disclaimer, which is that this is my personal individual cancer experience and my personal individual treatment program, which will vary greatly from person to person.
00:02:40
Speaker
Even within the breast cancer world, there are so many different types of tumors and different types of treatments.
00:02:47
Speaker
And so just because this worked for me doesn't mean it's for everyone. And you or your client must get clearance from your oncology team before you do anything at all. Okay? So in April of 2021, I was diagnosed with breast cancer. It was discovered on a routine mammogram. So this is a plug for getting your annual mammogram, even though it's annoying. I get it, but it literally saved my life.
00:03:17
Speaker
And after a whole bunch of testing and a lot of doctors appointments and all of that stuff, the treatment that was appropriate for me was sort of two parts. It was surgery first, and then it was chemotherapy.
00:03:32
Speaker
So part one, the surgery, I had a bilateral mastectomy, which is where they remove all of the breast tissue. And the process of that is usually that they either then at a later date schedule the reconstruction part and in the interim they have
00:03:48
Speaker
For one of the better word placeholders, I started calling them my lorem ipsums, which is sort of a, you know, copywriter's joke. It's not that funny. But in any event, I had surgery. And, you know, it's a pretty, it's a pretty big surgery, you have drains afterwards, which is sorry, if that already starts turning anyone's stomach, it's, it's basically as gross as it sounds.
00:04:09
Speaker
So for three weeks following surgery, I was not permitted to lift my arms higher than shoulder height and certainly not carry anything heavy. And sort of typical upper body post-surgery protocols that you would see in any kind of ortho surgery, orthopedic surgery, you know, is pretty standard as far as that goes. It wasn't anything specific to cancer.
Post-Surgery Rehabilitation
00:04:34
Speaker
Part of the issue that I ran into when I was able to start rehabbing was the fact that I had not lifted my arms higher than shoulder height for three weeks, but also they had done a biopsy of some lymph nodes in my armpit. And on that side, because of where the surgery scar was, there was a ton of restriction and pulling and loss of range of motion.
00:04:56
Speaker
more than on the other side in terms of movements on my shoulders. Once I was able to start doing rehab, I'm a PT, I could have outsourced it and gone somewhere else, but I felt like I was probably well-equipped enough to take care of it on my own. I put together a pretty standard protocol for rehab that involved increasing range of motion, increasing strength,
00:05:22
Speaker
I did have a couple of my PT friends come over and do some manual therapy on me and do some massage because that's something that you can't really do on yourself. But after about, I would say six to eight weeks, I was definitely back to full range of motion and I was getting pretty close to my upper body strength again. I just had little noodle arms for a while because I hadn't been using them for anything. So that's pretty standard rehab, I would say, period for something like this.
Challenges of Chemotherapy
00:05:53
Speaker
any sort of time you're having a surgical intervention, whether it's for cancer or otherwise, you will require some standard physical therapy afterwards. It's going to change depending on the body part, it's going to change on the size of the surgery, things like that. But there was nothing about that part of it that was really any different than like, if I had had a shoulder injury that I had had surgery and then was rehabbing, you know, it was pretty standard.
00:06:19
Speaker
So it's the second part of my treatment, the chemotherapy part that I wanted to talk about in terms of
00:06:25
Speaker
exercise and what treatment is like if you're not familiar. I hope you haven't been through it because it's pretty gnarly, but you may know someone who has. Chemotherapy is pretty wild. Essentially, you're poisoning yourself because you're hoping to also be poisoning any of the cells that might be thinking about making a return
00:06:50
Speaker
a return to the stage of cancer, right? And, you know, and this is just a bit of an aside, but it's true. Having cancer didn't feel like anything to me, because I'm fortunate we caught it very, very early. The treatment for cancer was really what just messed my body up, messed me up for a while, you know, it's pretty brutal. And it's it's really kind of a
00:07:18
Speaker
trip mentally to be like, I was feeling fine, and then some people told me I had cancer, and then because of that for about a year, I just went through this gnarly, gnarly treatment program. But it is what it is. So with chemo, everyone's experience, again, can be different. There's different chemotherapy drugs. There's different levels of terribleness, I guess, for want of a better descriptor.
00:07:45
Speaker
Most people do multiple rounds, but the number of rounds and often the amount of space between rounds is going to vary, again, based on your diagnosis, based on the specific tumor and what they found research-wise that the tumor responds to. My treatment was four rounds of chemotherapy that were spaced three weeks apart. So every three weeks, I would go in for an infusion, and I did that four times in a row.
00:08:16
Speaker
And they do something called chemo school before you go through chemo, which sounds a lot more, I don't know, fun maybe or interesting.
00:08:27
Speaker
than it really was. Essentially, chemo school is you and the nurse talking about all of the drugs that you have to take before, during, and after each infusion in order to prevent certain things and to help certain things. And some of those drugs are for the side effects from chemotherapy. And then there's a second tier of drugs for the side effects from the side effect chemotherapy drugs. So you're taking
00:08:55
Speaker
So many drugs, essentially, to basically make it through as best you can. Again, everyone's experience is different. People have different physical responses. People have different kinds of side effects, worse than others, depending on the type of chemo, depending on your personal makeup.
00:09:15
Speaker
But essentially, the way it works is my infusions were always on Wednesdays. So Wednesday, I would go in, I would have the infusion, and I would go home. And you basically feel the same that day. And then the next day, you know, start to feel maybe a little funky, but not terrible. You might start losing your appetite a little bit, but you know, feeling a little, you know, maybe body aches or something like that. Day three,
00:09:41
Speaker
is when it really started to become clear that, oh, something not good is going on. Chemotherapy itself is incredibly constipating, as is the medication that you take to reduce your nausea. So that was my big symptom for every single round. But the first five, six days of every single round, that was mine.
00:10:07
Speaker
uh day let's see saturday saturday's were the worst day so that's like day four or something day three um saturday's were the day where and i can really only describe it as the worst food poisoning you've ever had on top of the worst like stomach flu you've ever had
00:10:29
Speaker
On top of the worst flu flu you've ever had, I would have a day or two where the effort of lifting my head was more than I could handle, and the effort of watching something on television was more than I could handle. I couldn't
00:10:48
Speaker
I couldn't escape from what I was going through. Some of the time you're in this kind of, I can lie on the couch and watch TV, but I feel kind of crappy. But there's a certain period of it where you're like, I can't even do that. And you're just kind of spending the day waiting for the day to be over.
00:11:07
Speaker
And so then by Sunday, it would be a little better. By Monday, it would be better than Sunday. Usually after about a week, I was at the point where I was like, oh, I think I'll go back outside again. You know, and it's, it's hard to describe. That's why I sort of make the comparison to having like food poisoning and the flu and the stomach flu at the same time, because it's really just this, you've essentially poisoned yourself, right? And so your body is trying to deal with that.
00:11:35
Speaker
Uh, there was a lot of gastrointestinal distress. I will spare you the details, but essentially you go, and I understand this was not exclusive to my experience. You go from.
00:11:46
Speaker
severely constipated to severely diarrhea within the space of a couple of hours. There's no grace period in between. A lot of intestinal distress. You lose your appetite completely for a period of time. You're essentially not eating much. What would always happen to me is I would lose the ability to eat
00:12:14
Speaker
And then when I started being able to come back to food, it all had to be white. I don't know why. But so rice, like boiled chicken, cheese, crackers, like everything had to be toast. It was all white food, banana. And then eventually during so it's the each infusion is a three week period. Right. So that first week, terrible.
00:12:36
Speaker
But after about a week, I'm able to start eating more, able to start reintroducing foods that have color, and really slowly able to reintroduce exercise.
Exercise During Chemotherapy
00:12:49
Speaker
And in the beginning, it would be, you know, at the start of that week two, it would be like, I can walk around the block. I can walk for 20 minutes. I can walk for 40 minutes.
00:13:00
Speaker
And you know, eventually by the end of that, what's what's so just heinous is that by the end of that three week period, you're feeling pretty much back to normal. And then that's right at the point where you get another infusion. So it's it's quite brutal to deal with. And it can also be, you know, obviously, as a PT, I was extremely motivated to do the exercise part of it. And
00:13:27
Speaker
But for someone who maybe isn't, I could see how you just be like, F this. I'm going to keep lying on the couch. Why would I bother to go exercise when I know next week I'm getting another infusion and I'm just going to feel like shit again? It's very clear. The way it was described to me was this rollercoaster of you feel terrible and then you feel okay.
00:13:56
Speaker
and then you repeat that, but they sort of, it was described as if that was happening on a downhill graph. So each time you're feeling better, but you're not feeling better to the level that you were before chemo so that you're feeling better, but you're increasingly, there's an overall decrease in the level of how good you feel over the course of your whole chemotherapy treatment. And so it was emphasized to me
00:14:25
Speaker
that I should exercise. And it was emphasized to me by my oncologist. And what he emphasized in the beginning was cardiovascular exercise. And the reason why he emphasized it was there is a lot of research around cardiovascular exercise as being a way to stave off fatigue and some pain and just the general crapness of going through chemo. He was also involved in a lot of the research around cardiovascular exercise.
00:14:55
Speaker
So for that first round, that's what I was told to do. And so that's what I did. To be fair, though, the level of cardiovascular exercise that I could tolerate wasn't great. I wasn't a runner to begin with. So I certainly wasn't week three going for a jog. I don't know that I would have been able to, to be honest. So my cardio was sort of like long walks.
00:15:19
Speaker
not in a romantic hinge way, just not long walks on the beach at sunset, just walking around my neighborhood. I had access to a swimming pool, so I would go and kind of swim around a little bit in the pool, but I certainly wasn't doing, like, you know, laps for time or anything like that.
00:15:38
Speaker
And overall, that first round, the first round was the worst, partly because that's when you're figuring out what combo of all the different drugs that they told you about at chemo school are actually helping you. Separate note, marijuana is illegal in California. And to be honest, the only thing that really consistently helped with all of my symptoms, no matter what they were, was marijuana. And that's just a different story.
00:16:10
Speaker
Hey guys, it's Sarah. Laurel and I really hope you're enjoying the new Movement Logic podcast. We are having such a good time. We both really love sharing ideas with each other and getting sparked by things that the other person has learned. Our goal for the show was to help you feel the same way so that you can feel excited and inspired by what you're learning and even maybe take some of these ideas into your teaching. That would be amazing if that's what happened. I'd be so happy. Because I know, oh my God, we both know
00:16:40
Speaker
what it feels like to be uninspired, to be stuck in a rut, desperately trying to come up with new ideas. So you take another training and it just ends up you fall back into your old habits of things you already know how to do because it's too hard to change who you are as a teacher. We've all been there. The whole reason why we created the movement logic tutorials was so that you can enhance what you're already good at instead of trying to be some other different kind of a teacher. Every movement logic tutorial contains
00:17:09
Speaker
so much to help you do that. Hours and hours of anatomy, kinesiology, myth busting. Myth busting is maybe my favorite part of the whole thing, but most importantly, dozens of exercises that help you
00:17:22
Speaker
with strength or flexibility or functional movement, whatever you and your clients want to do in their life. Because we're so grateful that you are listening to our podcast, we have a podcast exclusive discount to say thank you for supporting our efforts with your years. What you can do is you enter the coupon code podcast at checkout to receive
00:17:43
Speaker
10% off of your entire purchase. You heard that right. You go to movementlogictutorials.com, take a little scroll through all
Benefits of Strength Training During Chemo
00:17:52
Speaker
of our different tutorials, stick some of them in your cart, the ones that you're like, ooh, pelvic floor, ooh, shoulders, and then enter the code podcast at checkout and you'll receive 10% off your entire purchase because we appreciate you. So thank you and go forth and save.
00:18:14
Speaker
So I did my first round. I did my only cardio. But you meet with your oncologist, certainly after the first round, to just be like, hey, how'd it go? We're doing round two. Here we go. And so I met with him and we discussed all the different things. And I said, you know, I did I did my cardio.
00:18:35
Speaker
But I wasn't able to really get my heart rate up that much because you don't have it, you just don't. But he still emphasized it and I was like, I might start to investigate doing some strength training. And he's like, that sounds fine because he knew me and he was a physical therapist. He knew I wasn't going to just go out there and do some crazy whatever. So I went into the research because I just had a feeling based on what I knew about how strength training has
00:19:03
Speaker
improved so many things for me in my life. In fact, my own strength training has improved my cardiovascular exercise hugely in terms of my tolerance and my fatigue. So I went into the research and I pulled out all these studies on strength training, resistance training, high intensity interval training or HIIT, you might know it as, and chemotherapy, specifically for women going through breast cancer.
00:19:29
Speaker
And I found study after study after study, and I'm going to link to a few of them in the show notes so that you can read for yourself. But essentially, the sort of big, big takeaways were that high intensity interval training, which is not the same as just strength training, right? That's when you're doing something, it's like a Tabata or something like that, where there's like a period of time where you're working really, really hard. And then there's a period of time where you're resting.
00:19:56
Speaker
So a study on high intensity interval training during chemotherapy found that it reduced pain sensitivity. OPS, everything hurts. Your entire body, your hair hurts if you had any hair because you just lost your hair. Round one, I still had my hair. By round two, I shaved it because it was just coming out in handfuls.
00:20:21
Speaker
High intensity interval training during chemotherapy reduced pain sensitivity, it improved muscle strength, and it improved cardiopulmonary function, all of which take a big blow. And so that's really cool. And then another study or other studies on resistance training
00:20:40
Speaker
found that they mitigated physical fatigue and improved quality of life, pain, and muscle strength. So yes, high intensity interval training helps, but also just regular resistance training is helpful. So that was really huge. And then I also found a study that showed a one-year follow-up for people who continue to strength train after they were done with chemotherapy, found that the benefits that they received continued into that next year.
00:21:12
Speaker
So I thought, okay, well, I'm the kind of person who is more than willing to experiment on myself for something like this, especially if it means that my experience is going to be better, and especially if it means I can then go and share those results with people like you listening right now. So I decided for rounds two, three, and four that after week one, I knew that week one was going to be
00:21:38
Speaker
No pun intended, a shit show. And that continued to be true. But in weeks two and week three, as I could tolerate it, I started to add back strength training, using weights, using resistance bands, being very mindful about my own fatigue, certainly not training the way that you might for, you know, an event. I wasn't training in a way that I was trying to make gains happen. That's gains with a Z.
00:22:06
Speaker
I wasn't training in a way that I was trying to make gains happen. I was doing it in a way that I was trying to feel the improvement in things like my energy levels and how my body felt and what I felt like I could do and how the quality of my life felt. So I was sort of working
00:22:26
Speaker
less than I ordinarily was because I was already at a deficit, but I wasn't trying to push to get back to where I was yet. I was trying to just slightly improve the status quo.
00:22:38
Speaker
And the things that I noticed, and this is anecdotal, obviously, for me, but this is what was found in the literature as well, I found that the rebound in that period, the two weeks before the next infusion, it was much faster. And it got increasingly better with each round. So whereas before,
00:23:05
Speaker
I really didn't start to come out of it until, you know, day six or seven. I was still not feeling great over the weekend, you know, day four, five, but starting on like day six, I was noticeably better. And over the period of that second week, the improvement was faster, right? I got better faster.
00:23:28
Speaker
Psychologically, I felt so much better. And that may be due to a few things. It may be my own personal response, the way that my body responds to strength training, which is I always feel psychologically better. It may be that I felt like this thing that was happening at me, which is what cancer treatment feels like, I now had some amount of like a response to or
00:23:55
Speaker
Certainly not that I was in control of it, but that I could do something about it a little bit. That felt really good. I enjoy the feeling of feeling strong in my body, so to feel stronger than I was feeling was psychologically positive for me. I had more energy. Absolutely. I mean, I would see people socially now in that period of time. Not in a huge way, but like,
00:24:20
Speaker
I would go maybe for a hike with a friend with a mask on because I was totally immunodepressed at that time. But I remember going on a hike with my friend Trina Altman and her commenting on how chatty I was. And I was like, oh, yes, no, I'm on steroids because I start my next infusion tomorrow. But again, it's like I put you on steroids. But, you know, feeling well enough to do things like that. I felt more like I was in my body. My body felt like it was kind of mine again.
00:24:49
Speaker
The period of infusion and post-infusion was still terrible, but I wasn't expecting that time period to change. So that's what it is. So that was really, really valuable to me. And I know that across the board, there is an understanding within the oncology field that yes, your patients should exercise when they can as much as they can.
00:25:15
Speaker
When you go online though, what you see is because I did a search and I was like, well, what is out there for people? I'm a PT. I know enough to go into PubMed and how to do the research and all my keywords and blah, blah, blah. I know enough to create my own strength training program and create parameters that are going to work for me and change it as I need and all that kind of stuff, blah, blah, blah. But what would the average
00:25:38
Speaker
lady, man, person do without that background. And so if you go on YouTube and you look up, you know, exercises for cancer and things like that, it sort of falls into two camps. It falls into like restorative, gentle yoga, which is great. I mean, the first thing that I felt like doing was child's pose. It certainly was not a deadlift, you know, so that's absolutely appropriate. Or it showed like full on weightlifting.
00:26:08
Speaker
And I was like, okay, well, you know, if I, if I didn't know how to transition from the restorative yoga to the full on weightlifting, then I'm also kind of at a loss, right? Because what am I supposed to do in the in-between? And I don't know how many oncology teams are recommending this strength training part. They're definitely recommending, you know, get out and exercise as much as you can, but it's sort of like, you know, exercising quotation marks. It's not anything specific.
00:26:37
Speaker
There weren't any parameters given to me apart from what you can handle. Look, sometimes during treatment, you feel like absolute garbage and it's an effort to even just hold your head up. That's not wrong. It's not that they're leading you astray, but there's not a ton of guidance beyond do what you can do.
Developing a Cancer Patient Exercise Program
00:27:04
Speaker
So this is a bit of a sneak peek and a bit of a crossover moment, and thank you for indulging me in this moment. But I have been creating over the past two years a six-part program for people who are going through cancer treatment
00:27:20
Speaker
probably chemotherapy, but potentially radiation patients might be appropriate for this. And it's six videos that start with very, very gentle restorative yoga and progress all the way through to working with lifting weights and all the steps in between. And I designed it. It's taken me a while for a lot of reasons, but part of it is I really wanted it to have a natural level of progression so that
00:27:49
Speaker
you could start at whatever is the right level for you. You could stay at whatever level is the right level for you, and then you can progress to the next one if and when you felt ready. Even if the progression didn't happen until after chemotherapy, it would be a way for you to get back to or get into some strength training.
00:28:06
Speaker
So that's going to be coming out next year. I'm very excited about it. I'm very proud of it. And if you want to hear more about it, or if you want to make sure you don't miss it when it comes out, then you need to get on my personal mailing list, which is at sarahcourtdpt.com. And I will link to that in the show notes as well. I think the bottom line here that I'd love for you to have as a takeaway is
00:28:33
Speaker
It's not inappropriate to do strength training during cancer treatment. It's in fact recommended in the research alongside cardiovascular exercise. It's going to really depend on things like how many rounds of chemotherapy is someone going through? What was their fitness level going in?
00:28:56
Speaker
Is this someone who already was doing a lot of exercise, already was strength training, or is this someone who maybe is deconditioned? In which case, it would be very hard to go from deconditioned and now going through chemo to then picking up weights. I definitely spoke with someone who told me that their wife was having a hard time even just getting the energy to go on a walk, and I get it. Oh, my God, do I get it. But it is, I think, really valuable to
00:29:26
Speaker
understand that, especially if you are someone who was strength training previously, that it is going to have a beneficial effect on your experience. I'm probably preaching to the choir a little bit because if you're listening to this podcast, you're already interested in all these things. But if you, going forwards, meet somebody or you know someone who's going through cancer treatment and
00:29:52
Speaker
The most annoying thing that people can say is, you got this. That's my own personal bugaboo. But the other thing that's tough is people a lot of the time will say things like, let me know what I can do. And it's so overwhelming going through cancer treatment that you're like, I can't be going through treatment and also coming up with a to-do list for you. So what I tend to do now as someone who's had cancer, and then when I hear about other people having cancer experiences,
Supporting Cancer Patients and Resources
00:30:21
Speaker
talk to them about what my skills can do for them. Hey, do you need any help figuring out how to exercise or what kind of exercise you can tolerate? I would be happy to give you an hour of my time and let's sort something out for you and help you feel better. Stuff like that. If you have that availability in your life, that would be a great, great gift to anyone going through treatment.
00:30:47
Speaker
I hope this has been informative for you and helps you understand the value of strength and resistance training for people going through chemotherapy in particular and how all patients can see improvements in quality of life with some amount of exercise, whatever they can tolerate. Please check out the show notes for all the things that I referenced, the research papers and then my own
00:31:10
Speaker
link if you want to hear about the cancer program that I have created that will be coming out in 2023. And you can also visit the MovementLogic website where you can get on our mailing list for free content and for that all-important sales information. The video version of this is up on our website as well, and that address is www.web.com.
00:31:34
Speaker
I'm just laughing at myself. Do I really need to say www dot? Probably not, right? I think that, I don't think I've had to say that for 10, 15, 20 years, maybe. Anyway, it's at www dot movement logic tutorials dot com.
00:31:51
Speaker
Thank you so much for joining me on the Movement Logic Podcast today. It helps us out so much. If you like this episode, to subscribe and then rate and review it in Apple Podcasts or Stitcher or wherever you listen. We would be super, super appreciative if you did that. If there's something that you would like us to cover in season two, write a review and stick it in your review because we read them.
00:32:17
Speaker
It just is so nice to be getting the feedback from you guys. It's been a great season. There's one more episode next week and then that's it. So join us again next week for Movement Logic and then we're on a break for a bit. Probably February? Something like that. But we'll be back, don't worry. We've still got lots to say. We've still got strong opinions and we're still holding on to them pretty loosely. So that's it for me for today. I hope the
00:32:46
Speaker
the rest of your day. It's great. Why is it starting to sound like the end of an email that I don't know how to finish? Or like, I'm just gonna write love you in like a business email. Okay, love you.