U.S. Army Medical Research and Materiel Command

Exercising for life

Penn State study examines whether exercise can speed women's recovery following chemotherapy for breast cancer

Centre Daily Times

UNIVERSITY PARK -- When Sandra Hutton works out, her goal is to get in shape.

But for Penn State microbiology professor Andrea M. Mastro, Hutton's workout is aimed at unlocking a cellular secret: Can exercise speed recovery of the immune system following chemotherapy for breast cancer?
Trial participation low

12,000-member American Society of Clinical Oncologists reported last July that only about 3 percent of cancer patients participate in clinical trials.

The organization attributed the low rate of participation to lack of funding, an emphasis on basic science versus clinical studies, and the denial of insurance coverage for treatment in clinical trials.

In addition, not all cancer patients are eligible to participate in clinical trials because of previous treatment or the stage of their disease.

In its May 31 issue, Business Week magazine attributed low participation in cancer trials to financial pressures on doctors to spend their time treating patients as opposed to devoting time to explaining clinical trials and recruiting patients for them.

Some funding organizations and drug companies reimburse doctors for time spent enrolling patients.

To answer this question, Mastro has recruited Hutton and eight other area breast cancer patients to participate in a study of the effect of resistance exercise, such as weightlifting, on a type of white blood cell called a T-helper cell. These cells trigger the immune response to fight off tumor cells and viruses.

Twenty participants are needed for the exercise arm of the study along with a control group of 20 non-exercising participants.

If the study shows resistance exercise does boost the number of T-helper cells, cancer patients will have a way to work toward recovery after surgeons, oncologists and radiologists have done their jobs, Mastro said.

The study requires a commitment to a six-month exercise regimen, which is tailored to each participant. Nancy Williams, assistant professor of kinesiology at Penn State and co-investigator, is designing and supervising the exercise portion of the study.

Participants start by exercising three times a week for three months with a trainer at Noll Laboratory on the Penn State campus and then continue the workout at home for another three months.

Five blood samples collected over the six months permit researchers to assess the effect of the workouts.

Warming up on a stationary bicycle in the lab recently, Hutton said after a mastectomy last fall she underwent eight weeks of chemotherapy followed by six weeks of radiation, all of which left her feeling weak and tired.

"Even walking was an effort," Hutton said.

Such fatigue is common among cancer patients because chemotherapy drugs can't distinguish cancerous cells from healthy cells and so they attack both. Along with unwanted side effects such as hair loss, many patients end up with low white blood cell counts which play a critical role in the immune system. When white blood cell counts drop, patients are left with weakened resistance to fight off bacteria, viruses and tumor cells.

A number of studies have shown that exercise increases aerobic fitness and muscle strength and reduces the risk of developing heart disease and metabolic disease such as diabetes.

But Mastro's research focuses on one particular cell, the T-helper. She cited a National Cancer Society study that found some subjects' T-helper cell levels remained very low up to 18 months after chemotherapy.

A previous study in Penn State's department of kinesiology in the College of Health and Human Development tipped off researchers that T cells appeared to increase in number in response to resistance exercise.

Mastro is working with Dr. Aaron Bleznak, a surgeon in State College; local oncologist Dr. Richard Dixon and Judy Underwood, head of Centre Community Hospital's Cancer Center, to find patients willing to participate in the study.

The three-year, nearly $300,000 study is sponsored by the Idea Awards program of the Department of Defense's Breast Cancer Research Program. Along with funding from Congress, this research program received some $800,000 in the past year from the sale of a special Stamp Out Breast Cancer postage stamp.

Fitness goal

A resident of Petersburg who works in donor services at Penn State, Hutton, 40, said she agreed to participate in the study this spring because she saw exercise as helping her recover her energy and stamina.

Three times a week she goes to an exercise room at Noll Laboratory where she warms up on a stationary bicycle for five minutes and then works out under the supervision of trainer Sheri Foura, a Penn State senior majoring in kinesiology. The exercises include abdominal crunches and the use of resistance bands, long latex bands that come in different widths offering varying degrees of resistance as they're stretched.

Hutton wraps up with 35 minutes on a treadmill or a brisk walk on campus.

"I'm not a person who enjoys exercise, but I think it has helped," she said. "I feel like I've toned up."

The plan is for her to continue this exercise routine at home for three months, providing periodic blood samples at her doctor's office that will be analyzed in a Penn State lab.

If the study does show exercise speeds recovery of these white blood cells, exercise might then "become part and parcel of post-treatment," Mastro said recently during an interview in her small fourth-floor office in Frear Building on campus.

Currently, she noted, cancer patients who have had surgery, chemotherapy and/or radiation often ask what they can do to speed recovery and prevent a recurrence.

"We think the study will show exercise has a direct effect on the immune system," Mastro said, but at the least exercise can be expected to improve a patient's strength and energy level and quality of life.

"You'll just feel better," she said.

"I hope anyone eligible for this study would see it as not just a study, but as an opportunity," Mastro added.

Reprinted with permission.