Said the doctor to the cancer patient: Hit the gym

AS the group of women trickled into the aerobics studio at the Bendheim Integrative Medicine Center in Manhattan on a recent Thursday morning, there were subtle signs that this was no ordinary fitness class.

One woman told the instructor that she had missed a string of previous classes because she was grappling with fatigue, a side effect of her new cancer medication. Others wore colorful wraps on their arms, containment sleeves meant to protect against lymphedema, a painful swelling of the arm stemming from breast cancer surgery.

Sponsored by Memorial Sloan-Kettering Cancer Center, this class for cancer patients has been around for some time, mostly in a league by itself. But in recent years, following studies that found exercise to be beneficial in combating the effects of cancer, the class has gained some company.

Gyms and fitness centers have begun stepping in to meet a small but growing demand for programs designed to not only hasten recovery but to address the fatigue of chemotherapy, the swelling of lymphedema and the loss of muscle tone.

There have always been athletically inclined patients who stayed active, even competitive, in the wake of a diagnosis. A recent high-profile example is Eric Shanteau, an American Olympic swimmer who decided to put off testicular-cancer surgery until he had competed in Beijing.

But most of the roughly 10 million cancer survivors in the United States are not amateur Lance Armstrongs. Many, though, are inspired by celebrities like Armstrong, seeing them as models for how to come out on the other side of often-debilitating treatment regimens.

A new program from the YMCA, in partnership with the Lance Armstrong Foundation, offers cancer fitness classes at more than a dozen Y's in 10 states. At the women's gym Curves International, researchers from Fox Chase Cancer Center in Philadelphia are looking at whether overweight breast-cancer patients can keep to a five-day-a-week Curves routine for six months. And survivors are organizing their own classes.

"There used to be this understanding that if you're getting treatment you're supposed to be in your bed," said Pam Whitehead, an architect and survivor of uterine cancer who started the Triumph Fitness Program at gyms in Modesto and West Sacramento, California

In some cases, oncologists are prescribing exercise, gently prodding patients to tackle whatever activity they can manage: light walking, simple stretches, exercise with resistance bands.

"I started in 1992 and that was really a time when not as many patients were exercising," said Alexandra Heerdt, a breast surgeon at Sloan-Kettering who is conducting a pilot program involving exercise. "If a patient came to me back then and asked about exercise, I would have said there wasn't really any information."

But now, she added, "they have a lot of options."

Wendy Rahn, 46, an associate professor of political science at the University of Minnesota, knows this well. After a double mastectomy, her shoulders hurt so much that she was often hunched in pain. Then, while researching her illness, she discovered a 2005 study on cancer and exercise.

"The effects — what we call effect sizes in statistical research — were enormous," she said, "and I was like 'How come no one is talking about this?' " She had given up exercise a decade earlier, but the study inspired her to go back to the gym.

"I started feeling so much better," she said. "And it struck me that if I'm feeling this good, then every cancer survivor should."

So she founded a nonprofit group called Survivors' Training, and in January opened a fitness studio in White Bear Lake, Minnesota, offering yoga, strength training, Pilates and Nia, which combines dance and martial arts. "I like to think of it as a support group that moves," she said.

Cancer experts say the shift in thinking began in the mid-1980s, coinciding with a greater awareness of health and fitness. Oncologists were faced with questions about exercise that they had never heard before: how much was allowable and when?

Scientists also took notice of studies showing that those who were physically active and eating well were less likely to develop cancer. They then asked what impact exercise and diet would have on those with the disease, said Charles Fuchs, an oncologist at the Dana-Farber Cancer Institute in Boston who studies cancer and exercise.

In the last eight years, a dearth of research has become a flood of studies. Among them is one sponsored by the National Cancer Institute in 2006 that looked at the effects of moderate exercise on groups of breast and prostate cancer patients undergoing radiation therapy for six weeks.

But most of the roughly 10 million cancer survivors in the United States are not amateur Lance Armstrongs. Many, though, are inspired by celebrities like Armstrong, seeing them as models for how to come out on the other side of often-debilitating treatment regimens.

A new program from the YMCA, in partnership with the Lance Armstrong Foundation, offers cancer fitness classes at more than a dozen Y's in 10 states. At the women's gym Curves International, researchers from Fox Chase Cancer Center in Philadelphia are looking at whether overweight breast-cancer patients can keep to a five-day-a-week Curves routine for six months. And survivors are organizing their own classes.

"There used to be this understanding that if you're getting treatment you're supposed to be in your bed," said Pam Whitehead, an architect and survivor of uterine cancer who started the Triumph Fitness Program at gyms in Modesto and West Sacramento, California

In some cases, oncologists are prescribing exercise, gently prodding patients to tackle whatever activity they can manage: light walking, simple stretches, exercise with resistance bands.

"I started in 1992 and that was really a time when not as many patients were exercising," said Alexandra Heerdt, a breast surgeon at Sloan-Kettering who is conducting a pilot program involving exercise. "If a patient came to me back then and asked about exercise, I would have said there wasn't really any information."

But now, she added, "they have a lot of options."

Wendy Rahn, 46, an associate professor of political science at the University of Minnesota, knows this well. After a double mastectomy, her shoulders hurt so much that she was often hunched in pain. Then, while researching her illness, she discovered a 2005 study on cancer and exercise.

"The effects — what we call effect sizes in statistical research — were enormous," she said, "and I was like 'How come no one is talking about this?' " She had given up exercise a decade earlier, but the study inspired her to go back to the gym.

"I started feeling so much better," she said. "And it struck me that if I'm feeling this good, then every cancer survivor should."

So she founded a nonprofit group called Survivors' Training, and in January opened a fitness studio in White Bear Lake, Minnesota, offering yoga, strength training, Pilates and Nia, which combines dance and martial arts. "I like to think of it as a support group that moves," she said.

Cancer experts say the shift in thinking began in the mid-1980s, coinciding with a greater awareness of health and fitness. Oncologists were faced with questions about exercise that they had never heard before: how much was allowable and when?

Scientists also took notice of studies showing that those who were physically active and eating well were less likely to develop cancer. They then asked what impact exercise and diet would have on those with the disease, said Charles Fuchs, an oncologist at the Dana-Farber Cancer Institute in Boston who studies cancer and exercise.

In the last eight years, a dearth of research has become a flood of studies. Among them is one sponsored by the National Cancer Institute in 2006 that looked at the effects of moderate exercise on groups of breast and prostate cancer patients undergoing radiation therapy for six weeks.

For Health, Body Size Can Be Misleading

Many overweight and obese people are metabolically healthy, while large numbers of slim people have health problems typically associated with obesity, a new study shows.

The findings, based on national health data collected from 5,440 adults, shows that weight often is not a reliable barometer for health. In addition to looking at height and weight, the study, published this week in The Archives of Internal Medicine, tracked blood pressure, “good” cholesterol, triglycerides, blood sugar and an inflammatory marker called c-reactive protein, all of which are viewed as indicators of cardiovascular health.

Overall, thin people were still metabolically healthier than people who were overweight or obese. But being a normal weight was not a reliable indicator of health. In the study, about 24 percent of thin adults, or about 16 million people, posted unhealthy levels for at least two of the risk factors.

By comparison, among the overweight, about half the people had two or more of the risk factors. But half of them were also metabolically healthy. And nearly one out of three obese people were also metabolically fit.

While it’s long been known that it’s better to be fit and fat than being thin and sedentary, the new data are believed to be the first time researchers have documented the unreliability of body size as an indicator for overall health.

Study author MaryFran Sowers, a University of Michigan obesity researcher, told The Associated Press that the results show that stereotypes about body size can be misleading, and that even ‘’less voluptuous'’ people can have risk factors commonly associated with obesity.

Dr. Sowers said that when it comes to weight and health risks, “We’re really talking about taking a look with a very different lens.'’

Running Slows the Effects of Aging

Aug. 11, 2008 -- Regular running slows the effects of aging, according to a new study from the Stanford University School of Medicine that tracked 500 older runners for more than 20 years.
Older runners have fewer disabilities, remain more active as they get into their 70s and 80s, and are half as likely as non-runners to die early deaths, the study shows.
"If you had to pick one thing to make people healthier as they age, it would be aerobic exercise," James Fries, MD, an emeritus professor of medicine at the medical school and the study's senior author, says in a news release.
Researchers tracked 538 runners over age 50, comparing them to a similar group of 423 non-runners. The runners were part of a nationwide running club.
The participants, now in their 70s and 80s, answered yearly questionnaires about their ability to perform everyday activities such as walking, dressing, grooming, getting out of a chair, and gripping objects. The researchers used national death records to learn which participants died and why. Nineteen years into the study, 34% of the non-runners had died, compared with only 15% of the runners.
At the beginning of the study, the runners ran an average of about four hours a week. After 21 years, their running time declined to an average of 76 minutes per week.
Everyone in the study became more disabled after 21 years, but for runners the onset of disability started later. Perhaps not surprisingly, running was linked to lower rates of cardiovascular deaths from causes such as stroke and heart attack. However, it also was associated with fewer early deaths from cancer, neurological disease, infections, and other causes, according to the findings.
The study appears in the Aug. 11 edition of Archives of Internal Medicine.

By gum: good teeth mean more disease

Australians are more likely than ever before to have a full set of natural teeth, but the trend will lead to an epidemic of complex oral diseases not seen in past generations, dentists warn.

Having at least 20 teeth has traditionally been an indicator of good health and around 80 per cent of NSW residents are now in this category. Four out of 10 people have all their natural teeth.

But dentists are warning older Australians that keeping teeth for longer can increase the risk of oral health problems, including decay affecting the roots of teeth, serious gum disease (periodontal disease), extensive dental erosion and gum recession, commonly known as "getting long in the tooth".

Australian Dental Association president Dr John Matthews said a person aged in the 30s and below could expect to keep most of their teeth for life, thanks to fluoridated water, better hygiene products and general awareness about oral health.

The proportion of people who had all their natural teeth missing decreased substantially in NSW from 8.2 per cent in 1998, to 5.7 per cent in 2005.

But this trend means people must be even more careful about maintaining their teeth as they age.

"People aged 65 and older are the age group with the most dental problems due to wear and tear, less saliva production and they're more likely to be on multiple medications, which can cause dry mouth," he said.

Dental caries (tooth decay) and periodontal diseases (gum diseases) are two of the five most prevalent health conditions in Australia. Although preventable, almost half of Australians do not attend the dentist regularly.

"People spend a few hundred dollars on a car service but baulk at doing the same to keep themselves in good health," Dr Matthews said.

He said there has been a huge uptake of the $150 rebate paid towards a dental check-up for eligible teenagers aged 12 to 17 since it was introduced by the Rudd Government on July 1.

But he called on the Government to change its plans to abolish a Howard government scheme under which up to $4250 worth of dental care was available under Medicare for the chronically ill.

He said that through May 130,000 services had been performed under the scheme, which began in November. The plan continued to be popular, he said, and a move to axe the scheme has been held up in the Senate.

Prue Power, executive director of the Australian Healthcare and Hospitals Association, said patients with chronic conditions such as diabetes could place further strain on general practice and the hospital system if they did not get regular dental care.

The treadmill's place in evaluating hearts

Each year hundreds of thousands of Americans, including some 700,000 Medicare recipients, get on a treadmill not for exercise but to try to determine if their hearts are healthy.

Tim Russert, the NBC journalist, had such an exam, called an exercise or treadmill stress test, six weeks before he died of a heart attack last month at age 58. His results had been deemed normal, prompting people to question how worthwhile this test could be.

Two weeks before Russert died, Todd Miller, a cardiologist and co-director of the Mayo Clinic's Nuclear Cardiology Laboratory in Rochester, Minnesota, published an assessment of the test's ability to predict the presence of potentially life-threatening cardiac problems. Miller elaborated on his report, in The Cleveland Clinic Journal of Medicine, in a telephone interview.

The test is meant to be used "almost exclusively" for people who have symptoms of heart disease, Miller emphasized.

"But in the real world," he said, "it is often used as a screening test for people without symptoms who are worried about their risk. The accuracy of the test depends on whom it is used. It is most accurate among populations with a high prevalence of coronary disease. But in most people without symptoms, the prevalence of disease is so low that the accuracy of the test is low, too

End to the pain of injection

Good news for needlephobes: a team of Japanese and Indian scientists has created a painless injection method that mimics the way a female mosquito sucks blood, says the Daily Times (Pakistan). The scientists from Tokai University and the Indian Institute of Technology in Kharagpur have developed a microneedle that emulates the way a female mosquito sucks blood by flexing and relaxing muscles in its proboscis, which creates suction and draws blood. Their microneedle has a pump in it which creates suction, making it painless in comparison with traditional needles. It is also strong enough to penetrate up to three millimetres into skin and reach capillary blood vessels, and can be used to inject insulin or other drugs into patients.

Why smart people underperform

Dear Khun Munthana, A problem has developed at work regarding the performance of one of my team members and I'd appreciate your advice on it.
When the young lady first came to work for me five years ago, she was an outstanding manager - obviously bright and keen, with excellent presentation skills and a willingness to take on projects.
However, in recent weeks she has become noticeably unorganised, easily upset, forgetful and tardy. She is also developing a tendency to procrastinate, miss deadlines and 'drift' mentally when she should be concentrating.
Basically her performance has become inconsistent: Brilliant one moment and unsatisfactory the next. An added worry is that she is having difficulty communicating with others at work and more and more seems to prefer working alone. I know that outside of the workplace she is happy and enjoys hanging out with her peers. I'm also assured that she is in good health and has no major personal or emotional problems. All of which leads me to assume that the change in her performance must be work-related.
Any advice on how I can re-motivate her would be appreciated.
Melanee
Dear Khun Melanee,
This sounds like a classic case of a smart and ambitious young manager reacting to having more on her plate work-wise than she can manage. I'm willing to bet her early promise and willingness to be involved has resulted in her getting more assignments and greater responsibility.
She's been with you long enough to be trusted with a heavier workload, the demands of which may be making it difficult for her to maintain her early high level of performance. As with any over-worked manager, this is a situation that often causes feelings of resentment and certainly distraction; she wants to be able to meet her work commitments but gets side-tracked by the number of things she has to do and so ends up doing some things well, others not so well. This is a recipe for frustration.
Eminent psychiatrist Edward M. Hallowell, founder of the Hallowell Centre for Cognitive and Emotional Health in Massachusetts, talks about a neurological phenomenon called attention deficit trait or ADT. He says that ADT is basically caused by brain overload and that this is something that is becoming epidemic in large, busy organisations. The core symptoms of ADT, which appear gradually, are distractibility, inner feelings of frenzy and impatience. People with ADT also have difficulty staying organised, setting priorities and managing time, all symptoms shown by your manager as her performance has dipped.
Whether your team member actually has ADT or not, Dr Hallowell's suggestions for controlling it certainly constitute good, constructive advice for your manager - indeed anyone who feels they have too much on their plate at work.
Here is some advice: In general
- Get adequate sleep.
- Watch what you eat. Avoid simple, sugary carbohydrates and moderate your intake of alcohol. Add protein and stick to complex carbohydrates (vegetables, whole grains, fruit etc).
- Exercise vigorously for at least 30 minutes at least every other day.
- Take a daily multi-vitamin and try to get in some omega-fatty acid.
At work
- Do all you can to create a trusting, connected work environment.
- Have a friendly face-to-face talk with a person you like every four to six hours.
- Break large tasks down into smaller components.
- Keep a section of your work space or desk clear at all times
- Each day, reserve some "think time", which is time free of appointments, emails and phone calls in which you can sit quietly and think.
- Before you leave work each day, create a short list of three to five items or priorities you will attend to the next day.
- Pay attention to the times of day when you feel that you are at your best; do your most important work then, and save the rote work for other times.
When you feel overwhelmed
- Slow down!
- Do an easy rote task: re-set you watch, write a note about a neutral topic (such as a description of your house), read a few dictionary definitions, and even try a short crossword puzzle.
- Take a break and move around: Go up and down a flight of stairs or take a brisk short walk outside.
- Ask for help, delegate a task, or brainstorm with a colleague. In short, do not worry alone.
As a hard-working team leader you can pre-empt ADT, not only within yourself by following theses suggestions, but also by communicating them to your team and encouraging its members to share their burdens.
I hope this helps.
Munthana
Munthana Thamlikitkul is chief executive officer and managing director at Tricor Outsourcing (Thailand) and Tricor Executive Recruitment. She was formerly a partner in the executive recruitment business at Pricewaterhouse Coopers.