Authors: Jörg Blech
Since then, this thoroughly fit woman, who is considered as good as cured, has turned her story into a job. Research grants from the National Institutes of Health enabled her to carry out scientific studies on the subject. In the resulting publications Schwartz has shown that exercise indeed ameliorates the fatigue syndrome and makes patients stronger again.
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Since then, Schwartz has been offering horse riding for cancer patients in Cave Creek, Arizona, has been giving talks, and has written a book about fitness and cancer.
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The preface was penned by Lance Armstrong who, after overcoming testicular cancer, won the Tour de France seven times. Armstrong himself has declared that he was better and stronger after his illness than before. “When people are diagnosed, their first impression is ‘Oh my god, I am going to die,’” he once said. “Over time, they lose that impression. They get the confidence back, they know they are going to live, they get back to life, they get back to work and they get back to exercise.”
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Encouraged by Armstrong’s incredible story, cancer patients began improving their odds and their lives by exercising—although many oncologists still dismissed sports, thinking its strain and stress would only weaken patients’ immune systems. By now, however, this patients’ movement has led to a change of thinking among many doctors, says Julia Rowland of the National Cancer Institute in Bethesda, Maryland. Many new studies have been initiated to reveal the impact of exercise on cancer patients.
The results, says Rowland, have shown that the oncologists’ worries have been unfounded. In many cases exercise actually does improve the mood of the patients and their strength, while lowering the side effects of radiation and chemotherapy.
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When breast cancer patients try strength training two days per week, both physical and mental strength improve significantly.
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Yet exercise does not need to be a daunting activity or even an organized outing to produce significant rewards for breast cancer survivors, researchers at the University of Texas M. D. Anderson Cancer Center, in Houston, have found. Over the course of six months, they regularly met with women who had gone through breast cancer treatment and led sedentary lives. At the meetings the women were encouraged to integrate physical activities like brisk walking and climbing stairs into their lives, five days per week, at least 30 minutes at a time.
After six months, the mobilized women showed many improvements. In contrast with inactive patients, they felt much healthier and had less pain and fewer handicaps. Their constitutions were substantially strengthened, which was documented by a small competition at the end of the study: the active women were able to walk faster than the inactive ones. “The wonderful take-away message from this study is that simple exercises, such as walking during coffee breaks or parking farther away from work, can have beneficial effects on physical health and functioning,” says the study’s principal investigator, Karen Basen-Engquist.
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By now, some doctors prescribe exercise even when chemotherapy is still under way or right afterward. Most patients, it is true, do not feel like working out at all. Chemotherapy and radiation therapy not only destroy cancer cells, but also kill stem cells, which give rise, among other things, to cells of the immune system. Thus, immediately after treatment patients have few bodily defenses and are isolated in separate rooms to protect them from potentially deadly viruses and bacteria.
However, this well-intentioned isolation comes with a price, says the sports physician Klaus Schüle. In his pioneering work, he has found that bed rest significantly lowered the physical resilience of these individuals. The more rounds of cancer treatment they receive, the harder it is for them to recover. To change that, Schüle and three colleagues did something unheard of: they placed stationary bikes in the rooms of 32 patients and encouraged them to pedal for 10 to 20 minutes once or twice a day. Unlike 32 patients that had been isolated the old, sedentary way, these exercising patients recovered faster and more thoroughly from the side effects of cancer treatment. Even very sick patients actually do profit from exercise. They gain muscle strength and endurance without worsening the primary disease.
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EXERCISE AND SURVIVAL
Even the most optimistic physicians never seriously expected that physical exercise might prolong the life of cancer patients.
But in recent years data have started to emerge indicating that exercise indeed improves survival rates. The effects seen so far are modest in absolute numbers but relate to two of the most widespread and dangerous cancers. Two of the trials involve patients with colon cancer. One included 823 patients with early-stage or slightly advanced tumors that had surgery and adjuvant chemotherapy.
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Six months after the completion of the therapy, Jeffrey Meyerhardt at Dana-Farber Cancer Institute in Boston asked them to report how much physical activity they had engaged in. The data show that exercise corresponding to walking for 60 minutes, six days per week “appears to reduce the risk of cancer recurrence and mortality.”
Meyerhardt has produced similar results in another study in which he and his colleagues observed 573 women who had been treated for colon cancer.
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Patients who started exercising after their diagnosis lived longer than sedentary ones; the survival rate was increased by 50 percent. Since that study, Jeffrey Meyerhardt tells his patients that “exercise might be advantageous for them.”
Finally, the epidemiologist Michelle Holmes of Brigham & Women’s Hospital in Boston has found a similar effect for breast cancer.
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She and her colleagues analyzed the cancer progressions of nearly 3,000 women and found a significant correlation between the level of activity and survival. If a woman walks three to four hours per week, the risk of breast cancer death is lowered by 50 percent.
When an effect in a similar range is seen using a conventional cancer drug, leading doctors are quick to talk about a “major advance” or a “major turning point.”
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Meyerhardt and Holmes are much more cautious and say that their findings are not proof at this point. A correlation between cancer survival and exercise level does not prove that exercise was the cause. There is no study yet that would say a person can literally run away from cancer. However, more and more data point to the benefits of physical activity.
Now, many oncologists are eager to explore the cancer-fighting properties of exercise further and to carry out more studies. Which kind of exercise would be the best? What would be the ideal amount? However, will the drug industry fund such research? “There is no doubt that the pharmaceutical industry would back an agent with potential to reduce cancer recurrence by at least 50 percent,” says Wendy Demark-Wahnefried of Duke University Medical Center in North Carolina. “But who will back a trial that evaluates the potential benefit of sneakers and sweatpants?”
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Longevity, Potency, and Resilience
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T AGE 20 THE IDEA OF GROWING OLD IS SOMETHING TO THINK about later in life. The body is still going strong; injuries and wounds and broken bones heal rapidly, and there is no moaning and groaning to be heard first thing in the morning. At age 40 wrinkles and the first aging marks appear and love handles may have established themselves in the midsection, but there is still no time to think about getting old. At age 60, people may have gone through one or two operations, perhaps after an unfortunate fall while on vacation. Among friends and acquaintances, the first deaths occur. Subtly one starts to get accustomed to the fact that the body may not be in the best shape. Hearts may start to beat out of rhythm, legs may be swollen in the evening, sleep is no longer so predictable.
This scenario is true for many people—but not for everyone. Around us are people who hardly seem to age, who look nearly the same in the course of many years. In the science department of my magazine there is a slim female colleague who, in the ten years I’ve known her, has never really changed. People guess that her age is about 48, but she is 61. Not long ago, such a woman would have been marveled at. In 1900, life expectancy at birth in the United States was 47 years,
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but now it is 78 years at birth for the total population in the United States.
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This increase in life span is remarkable—and unevenly distributed among the people. One person struggles with bad health and dies at age 60, while another lives to be 100. Why is it that some people’s bodies break down, while others remain radiant with health?
When you pose this question to people who are blessed with long and healthy lives, it’s striking to see how frequently they mention physical activity. On a campground in Sequoia National Park, in the Sierra Nevada Mountains in California, I met an 83-year-old man, Alan Buckley, and asked him about his secret as we held sticks with marshmallows into the fire. Even though many men of his age live in old people’s homes, Buckley camps every summer in the mountains and looks in the evenings at the Milky Way before going to bed. So what is his secret? Buckley says he simply always walks when he moves around on his walnut tree plantation. He shakes his head when he thinks about the “weekend warriors,” as he calls them, who sit in their cars and offices and armchairs during the week and try to make up for the missed exercise on the weekend.
Antonio Pierro also was always in motion. He was born in 1896 in Forenza, Italy, and sailed at a young age on a ship of immigrants from Naples to New York. He fought as a soldier for the United States in the First World War and then settled in New England. During his entire life, he was active, raking leaves and shoveling snow until he died at age 110. Antonio Pierro also said exercise was his secret. He once told a reporter: “If you don’t have exercise, you get stiff, you’re not worth anything.”
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There are many such examples. In our family, it was grandfather August. He lived in the country outside Cologne, Germany, and worked as a carpenter at a time when craftsmen took a nap in the hay after lunch. Every day, August took an evening stroll for an hour, and he lived to be 98 years old.
These long and fulfilled lives are more than just chance. Epidemiological studies of thousands of men and women have shown that the regular use of our muscles is the only means capable of prolonging the human life.
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Being fit reduces mortality by 50 percent. People who burn 1000 kilocalories per week by additional exercise increase their probability of surviving by 20 percent. And if people become physically active but also quit smoking, they will live eight years longer, on average.
After all, we are born to run. We evolved the ability to run long distances—and this, believes the anthropologist Daniel Lieberman at Harvard University, was crucial for our evolution. When it comes to endurance, we are among the best athletes in the animal kingdom. Leopards, for example, might sprint much faster, but over long distances, the big cats will be worn out before long. Actually, most mammals are not capable of running or trotting for longer than 15 minutes. Chimpanzees, with their bowlegs, come off especially badly. In contrast, humans evolved to become true endurance runners. Thanks to our uncovered skin and our sweat glands, we are able to regulate our body temperature even when we move for an extended time in hot weather. And unlike all the other apes, the human body sports a large gluteal muscle,
Musculus gluteus maximus
, which in biomechanical terms enables us to run. Because our potential for endurance running is genetically hardwired into our bodies, we can utilize it even in old age. “Humans are astonishing athletes,” Lieberman says. “They can keep running.” And yet physicians traditionally thought older people would not have these capabilities. When older runners started attempting marathons, doctors and organizers wondered whether they would need additional care. But these runners did just fine: older athletes can reach the finish line just as comfortably as the younger ones. It is not age that matters but preparation and fitness.
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Bob Matteson of Bennington, Vermont, began his running career at age 69. By now this ancient gazelle is in his 90s and belongs to the fastest people of his age group.
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The course of our lives is often set in middle age. Good strength of grip and normal weight are predictors for an unusually long life. Conversely, the risk of dying because of cancer increases by 29 percent among sedentary women. If a person does not exercise at all, basic strength decreases every year by 1 to 2 percent. At some point, strength falls short of a certain threshold, leaving the muscles unable to fulfill their function—until finally one day a person is too weak to get up from a chair. Comparing this loss of 1 or 2 percent of strength per year with the gain of 30 to 40 percent that can be achieved by training makes it clear that the potential for renewal amounts to 15 to 20 years, which beats any antiaging remedy by far.
Any person who was born healthy can reap the good effects of exercise. Contrary to common belief, this is little affected by an individual’s genetic makeup. The impact of the genes on the life expectancy is much smaller than most people would imagine. A survey among thousands of twins revealed that the physically active member of the pair has a significantly lower mortality than the sedentary sibling.
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