Easy, at-home exercise program can help cancer patients

Dec. 13, 2012 — It has been known for some time that exercise is important for cancer patients, but few studies have looked at the practicality of exercise programs and whether even a minimal workout can help. Exercise can reduce cancer-related fatigue, improve sleep, boost a sense of wellness, and reduce the recurrence of certain types of tumors. A Mayo Clinic study published in the Journal of Pain and Symptom Management found that a brief, at-home exercise program -- dubbed the Rapid, Easy, Strength Training program, or REST, -- was sufficient to increase cancer patients' mobility and reduce fatigue.

"We talk a lot about how important it is for cancer patients to exercise, but until now, nobody has questioned whether less may be more for patients negotiating the demands of cancer treatment," says lead author Andrea Cheville, M.D., of the Mayo Clinic Department of Physical Medicine and Rehabilitation. "This was the first trial to investigate what's feasible and helpful for patients with limited time and energy."

An interdisciplinary team of Mayo Clinic researchers developed an at-home exercise regimen, involving a pedometer-based walking program and a series of gentle resistance movements -- lifts and curls using a resistance band -- that can be done standing or seated. The workout takes only a few minutes a day, with minimal cost to patients.

In a randomized, controlled study of 66 adults with stage IV lung or colorectal cancer, researchers found that patients who exercised at least four times a week for two months showed improved mobility, had less fatigue and slept better when compared with those who didn't exercise. Though other measures such as pain were unaffected, the study suggests that the exercises can address several important disabling effects of disease and that even patients with late-stage cancer are able to perform the brief regimens.

The exercise program and study have significant implications for cancer care, Dr. Cheville says. Other studies have suggested that cancer-related exercise programs may impose financial burdens; patients can learn the REST regimen in a single physical therapy session. A muscle-building exercise regimen may help patients at all stages of cancer treatment.

"Muscles may atrophy during cancer care," Dr. Cheville adds. "Our regimen preserves muscle mass so that if patients develop complications from cancer or treatment, or require hospitalization, they have the reserves necessary to ensure that their bodies heal."

The study was funded by the National Institutes of Health; grant number KL2 RR024151-01. Other authors include Jenny Kollasch, Justin Vandenberg, Tiffany Shen, Axel Grothey, M.D., and Jeffrey Basford, M.D., Ph.D., all of Mayo Clinic, and Gail Gamble, M.D., of the Rehabilitation Institute of Chicago.

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Rethinking body mass index (BMI) for assessing cancer risk

Nov. 8, 2012 — A study by researchers at Albert Einstein College of Medicine of Yeshiva University suggests that body mass index (BMI) -- the most commonly used weight-for-height formula for estimating fatness -- may not be the best measure for estimating disease risk, and particularly the risk of certain types of cancer.

The study was published today in the online edition of the American Journal of Epidemiology.

BMI is calculated by dividing a person's weight (in kilograms) by his or her height in meters squared, or W/H2. Most of the early studies that used the formula, starting roughly sixty years ago, were conducted among middle-aged men. BMI has become the most widely-used weight-for-height index in large population studies of children and adults, thanks mainly to its ease of calculation and the ready availability of weight and height data. Newer technologies have since been developed for measuring body fat, but they can be prohibitively expensive and time consuming.

A BMI between 18.5 and 24.9 is considered ideal; obesity is defined as a BMI of 30 or greater. According to the Centers for Disease Control and Prevention, the higher one's BMI, the greater the risk for a range of diseases, including heart disease, high blood pressure, type 2 diabetes and certain cancers.

"It has long been recognized that BMI is an imperfect indicator of body fat because weight does not distinguish between lean body mass (muscle, bones, blood, water) and fat mass," said lead author Geoffrey C. Kabat, Ph.D., senior epidemiologist in the department of epidemiology & population health at Einstein. "This means that two individuals can have the same BMI but can have very different percentage of body fat." Furthermore, when using weight and height data, a single BMI formula may not be appropriate for all populations and all diseases."

The goal of the current study was to determine whether alternative weight-for-height measures resulted in stronger associations with risk of specific cancers compared to BMI. Using weight and height data on nearly 90,000 Canadian women enrolled in the Canadian National Breast Screening Study, the researchers varied the BMI formula -- changing the value of x in W/Hx -- to see whether any of these variations on BMI better predicted the risk of 19 different cancers.

All values of x in W/Hx that showed significant associations with specific cancers were below the value of 2.0 (i.e., BMI) and included 0.8 for endometrial cancer, 1.3 for lung cancer in those who never smoked, and 1.7 for postmenopausal breast cancer.

While these findings need to be confirmed in other studies, they suggest that the optimal value of W/Hx may differ depending on the population studied as well as on the disease of interest, and that BMI may not be optimal for all purposes.

Dr. Kabat's paper is titled "Scaling of weight-to-height in relation to risk of cancer at different sites in a cohort of Canadian women." Other contributors include Moonseong Heo, Ph.D., and senior author Thomas E. Rohan, M.D., Ph.D., both at Einstein, and Anthony B. Miller, M.B., at the University of Toronto, Canada.

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Journal Reference:

Geoffrey C. Kabat, Moonseong Heo, Anthony B. Miller, and Thomas E. Rohan. Scaling of Weight for Height in Relation to Risk of Cancer at Different Sites in a Cohort of Canadian Women. American Journal of Epidemiology, 2012; DOI: 10.1093/aje/kws270

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