Note: In support of this study, Christina Dieli-Conwright, received SC CTSI pilot funding and biostatistics support.
When Napha Phyakulquach was approached to join a research study on the positive effects of exercise on breast cancer survivors at the Women’s Health and Exercise Laboratory (WHEL) at USC’s Division of Biokinesiology and Physical Therapy, she wasn’t thrilled at the prospect of working out.
Prior to her diagnosis in 2014, she was a self-described “bump on a log” who said the closest she got to cardio machines was seeing them in TV commercials.
While quick to crack a joke, Phyakulquach refers to the offer as heaven sent. She had undergone six months of chemotherapy, a lumpectomy and then radiation.
“I knew I needed to do it if I wanted to stay alive,” she said.
Breast cancer patients often gain weight during chemotherapy, and while there is no proven direct link between the treatment and weight gain, side effects of the drug, such as inactivity due to fatigue and a change in dietary habits, can cause an increase in body mass.
One on one
Funded by the National Cancer Institute, WHEL’s study was established in 2012 with the goal of using exercise to reduce metabolic syndrome (a group of medical conditions such as high blood pressure, obesity and high blood sugar that can lead to heart disease, diabetes or stroke) in women who have undergone treatment for breast cancer.
“It’s a 16-week program for women who have finished treatment within the past six months, had Stage 1 through 3 breast cancer, have undergone chemotherapy and/or radiation and are overweight or obese,” said WHEL director Christina Dieli-Conwright PhD ’09. “We are trying to offset the side effects they would potentially experience from chemotherapy and radiation.”
To be eligible, participants also had to be sedentary, which the study defines as partaking in less than 60 minutes of structured physical activity per week.
Back to the gym
Before being diagnosed with breast cancer in 2015, Sylvia Kast took morning walks with friends but hadn’t stepped foot in a gym for years. With three kids in college, she was too busy. So when asked to sign up for the program, she didn’t hesitate.
“I was excited because before I got diagnosed, I was trying to get into shape,” she said.
Similarly, Carla Sanchez bowled three times a week but had never lifted weights, a pattern Dieli-Conwright noticed with a lot of the women in the study.
“It’s one on one with a personal trainer, which is absolutely fantastic because most of us women in particular have never done any weight training ever,” Sanchez said.
From sedentary to strong
Aerobic and resistance training is combined to expose survivors to the benefits of weightlifting for muscle strength as well as bone density and balance. One-hour workout sessions are given three times a week, with two days spent on a combination of aerobic and resistance exercises and one dedicated only to aerobic activity.
The women begin with a five-minute cardio warmup on a stationary bike, rowing machine or treadmill. On resistance days, there are eight exercises, four for the lower body and four for the upper, which are done in superset fashion. The workout is capped off with 20 to 35 minutes on a cardio machine. Aerobic day includes the choice of treadmill walking/jogging, rowing or cycling at 65-80 percent heart rate max for 20 (week 1) to 35 (week 16) minutes.
“The program is progressive in that every three to four weeks, things get harder,” Dieli-Conwright explained. “They lift more weight, do more repetitions and do aerobic exercise for a longer period and with higher intensity.”
Kast has completed 12 weeks of the trial but is already feeling its effects.
“Physically, I feel stronger,” she said. “I feel both arms getting stronger, my legs a little stronger.”
It’s a sentiment echoed by Sanchez: “All of the new exercise has made me stronger, and that is important for maintaining my range of motion and protecting myself from injury.”
Phyakulquach said the transition wasn’t just physical, but mental. She was suffering from “chemo brain,” a side effect of the treatment that causes disruption in cognitive function such as memory loss and an inability to concentrate.
“Exercising helped me clear up my mind and focus for that hour,” she said. “I didn’t have to think about it because I had a trainer — a physical therapy student — who was spotting and encouraging me. ‘I need to do these 12 reps and then I’m going over there to that machine.’ It’s very linear.”
Data on 40 of the 95 participants has been analyzed, and results from the study found HDLs (the “good cholesterol”) increased, while blood pressure, glucose, cholesterol and waist circumference decreased.
“There are some who come in here and leave saying, ‘You saved my life.’ And ‘I never thought I’d be able to exercise again,’” Dieli-Conwright said. “It has a very strong impact on their well-being. It’s very helpful and motivating to know that we can impact their lives.”
Funding for this program will finish next summer, but WHEL is going to keep it going through donations from past participants. The goal for the future is to expand on this study by researching the effects of exercise to combat breast cancer recurrence. It will take a longer and larger trial, one for which Dieli-Conwright said they are now trying to get a grant.
“It’s a more invasive study and involves taking fat tissue samples from the abdomen to see how exercise affects fat biology,” she said. “We hope to be able to start something like that within the next year or so.”
Studies such as these, she noted, bring more visibility to the field of movement science, exercise physiology and physical therapy by constantly promoting exercise and movement.
For Phyakulquach, the program changed how she thought about exercise.
“In the beginning, I asked Christina about people who get a high from exercise. I said, ‘When is that going to happen to me?’”
She’s proud to announce that she purchased a rowing machine and kettle bells and is now working out at home.
“My sister can’t believe it,” she said with a laugh. More importantly, it’s made her feel whole again. “For a year, I didn’t own my body. The cancer, the doctors, the chemo owned it. But through this program, I was able to take my body back.”