Fatigue is part of the territory for people undergoing brain cancer treatments. Happily, there is a dogged group of health professionals at the University of Calgary unwilling to accept it at that. Exercise is the group’s intervention, and avocation, no matter how much fatigue limits a patient.
“It’s a rewarding population to work with,” Nicole Culos-Reed says of the cancer patients she sees at the Thrive Centre (University of Calgary) or in the Health and Wellness space at the Holy Cross Hospital in Calgary. “People are really motivated to feel better.” She is an associate professor of Kinesiology at the University of Calgary and has researched the impacts of exercise since 2001. While she’s researched mall walking, exercise motivation, coaching techniques and worked with adolescents and breast cancer patients, one group remained out of the loop: people with brain cancer.
IN IT TOGETHER: Kathryn Wytsma and Lauren Capozzi work with cancer patients to improve their symptom management and quality of life.
Photo Joey Podlubny
“It’s not as simple as the other populations. There are physical, cognitive and mental challenges for people with brain cancer,” she says. “Balance is an issue, memory is an issue, or cognition can be impaired.”
Three years ago, she partnered with Dr. Jay Easaw, the tumour group lead at the Tom Baker Cancer Centre in Calgary, and applied for a grant to study fitness changes over the course of treatment. Preliminary results indicated a very sharp decline in fitness measures once cancer treat-ments began.
“The treatment for brain cancer is really harsh, so the sooner we intervene with exercise the better,” says Culos-Reed. Her team measured fitness markers such as V02 uptake, balance and strength, and is currently analyzing the full data set.
An additional pilot program is Exercise for Neuro and Head and Neck Cancer (ENHANCE), an intervention delivered at the Thrive Centre and the Holy Cross wellness space. Nurses and oncologists from the neuro-oncology clinic referred patients to the Thrive Centre, and 54 patients attended free of charge, from June to December 2011.
Lauren Capozzi took charge of evaluating the data as part of her U of C graduate work. She was struck by the effects of brain cancer treatments, medication and other factors in some patients. “It’s very hard for someone to experience a 20- or 30-pound weight gain in a few months,” Capozzi says. She worked with the participants to achieve 150 minutes of moderate exercise a week, plus two strength-training sessions.
“In the beginning, people couldn’t get up or down stairs. They had muscle wasting and a lack of confidence.” She remembers a patient who came in with his wife, both overweight. “He was unsure if exercise would fit into his life.” The couple took the program together, exercising once a week at U of C, then doing more at home. Capozzi says the patient’s symptom management increased and he felt better. “He increased his functional ability – the ability to do everyday tasks – considerably,” Capozzi says. “He lost 20 pounds – so did his wife.”
The ENHANCE group measures progress and is planning to publish its findings on items such as six-minute walks, strength, and overall well-being. In an Alberta Cancer Foundation-funded extension of this lifestyle program, Capozzi is undertaking doctoral research in a subset of head-and-neck cancer patients about whether it’s better to intervene during or after cancer treatments. Kathryn Wytsma is continuing the original program in the neuro-oncology population (called B-ON-PACE) and is an exercise physiologist who works with the patients.
“Sometimes you start the day with Plan A, and by the end, you’re at Plan B,” says Wytsma of the patients. She works within the parameters of their limitations to increase their overall fitness levels, including strength training and light stretching, to see if positive effects improve overall function.
At the same time, Culos-Reed began to wonder if yoga would help brain cancer patients. She practises regularly and met another researcher from Wake Forest University (North Carolina) at a yoga conference. Together, they ran a two-city yoga program for brain cancer patients who attended yoga sessions with a support person once a week. Some participants questioned whether they could manage it.
“But the beauty of yoga is that it can be adapted to everyone,” Culos-Reed says. “Yoga has so much to offer in terms of the psychology, the mindfulness.” She wanted to know if it was a feasible option for brain cancer patients and how it impacted fatigue. “Brain cancer patients report feeling more energized; we know we can get the acute changes through yoga.” She’s currently analyzing the data for a manuscript submission.
The team’s work builds on a growing body of studies of the relationship between cancer-related fatigue and exercise. Once an under-serviced group, people with brain cancer have new advocates and exciting new findings that indicate they can feel better with exercise.
EXERCISE THE OPTIONS:
An extension of the ENHANCE program, specifically for neuro-oncology patients, is currently underway at the Holy Cross Hospital in Calgary. Neuro-oncology patients from southern Alberta can ask their doctor for a referral or call 403-210-8482 and talk to Kathryn Wytsma for more information. Check out a class in action.