Why This Chemotherapy Ward Includes a Gym

Putting a gym in a chemo ward at first blush, may sound out there.

But in a groundbreaking move, at the Edith Cowan University Cancer Clinic in Perth, Australia researchers located the gym (exercise medicine care clinic) directly next to the chemotherapy suites.

On chemo or radiation days, patients book into the exercise clinic and then go directly from hospital to workout.

And patients aren’t doing just gentle walking, but intense short bursts of weight lifting or jumping, following radiation or chemotherapy. Each cancer patient meets with an exercise physiologist to go through exercises, specifically customized to their tumor or cancer type.

One of the ideas behind exercise medicine for cancer patients is based on tumorogenisis. Tumors grow rapidly, sometimes developing pockets with no functional blood vessels.

By increasing blood flow to tumors, exercise is thought to help drive chemo into the tumors. Working out might also make it easier for our own immune system, to move in and destroy cancer cells.

Typically a cancer patient will lose 10% to 15% of lean body mass during chemo or radiation treatment.

Exercise as medicine had previously been used only after chemotherapy to rehabilitate patients. Oncologists were wary about asking patients to workout directly before or after chemo and radiation treatments.

But science is now learning that precision exercise can help the body maintain muscle, if highly personalized to the cancer, tumor type, and stage of treatment.

“What’s quite astounding is that a patient [with stage three breast cancer] increased her muscle mass during chemotherapy,” explains Professor Robert Newton of Edith Cowan University.

“Bodyweight squats or step ups can have a very large impact on the body,” says Newton. Even ten minutes of intense effort counts and could help make chemotherapy treatment targeted in two important steps:

Step One: Stimulate Immunosurveillance

Science has known that among our white blood cells killer T-Cells are hunting down and killing cancer cells floating around in the body. T-Cells are immunotherapy anti-cancer medicine as evidenced in this microscopic video showing a T-cell in action, hunting down a cancer cell.

According to Professor Newton dovetailing off the way immunosurveillance seems to kill cancer, exercise for cancer patients aims at recruiting the help of the Natural Killer (NK) cell.

Natural killer (NK) cells are the most responsive immune cells to exercise, and seem to mobilize during physical exertion. Exercise-dependent mobilization of NK cells might improve NK recruitment and infiltration in solid tumors.

Step Two: Increase blood flow to Hypoxic Tumors

Tumor cells divide rapidly, and this can create a messy blood supply system with areas of hypoxia. Hypoxia, or low oxygen condition, is a normal physiological response to certain body stressors such as high altitudes. Tumor cell hypoxia results from an imbalance between the oxygen supply available and the oxygen consumption of the rapidly dividing cells.

 “One of the biggest issues with improving delivery of chemotherapy to solid tumors is that only about half of the blood vessels are functional and mature enough to deliver the drugs,” explains Keri Schadler, Ph.D., an expert in cancer tumors at MD Anderson.

By increasing blood flow in the body, the hypothesis is that precision exercise can help get chemotherapy to the places that need it most. Chemo is a blunt instrument, but exercise administered by an exercise physiologist in coordination with the oncologist is precisely tailored. And cytokines or other growth factors released by exercise may help the body’s natural immunosurveillance system find tumors.

Although the exact mechanisms aren’t well understood, early clinical trial data indicates that exercise is doing more than helping cancer patients ward off nausea. Pilot studies in Australia and Sweden and a few early clinical trials are just beginning in the U.S.

Recently Newton told Australia’s ABC news radio, other than in Australia and Sweden, cancer management is behind where the research is.

The problem according to Professor Newton is the way oncologists are currently prescribing exercise to their patients. What type of cancer and where tumors are located matters. He sees little benefit from telling a cancer patient to simply “get out there and move”.