Dr. Melinda Irwin talks about the benefits of exercise for breast cancer patients—and everyone—and how to fit it in right now
Finding 30 minutes to exercise each day can be tough—and that’s during normal times. Between fitness centers being closed across the country and the challenges of remote work, stress around cancer treatments, and other markers of life during COVID-19, exercise may be an afterthought right now.
But research shows that regular exercise can improve everything from breast cancer outcomes to the immune system, making it all the more important during this crisis.
BCRF investigator Dr. Melinda Irwin is a professor of epidemiology at the Yale School of Public Health where she directs a research program examining lifestyle behaviors and interventions (such as exercise, nutrition, and weight management) and their effects on cancer prevention and outcomes. She’s the recipient of the Ann Taylor and Loft Award (a subsidiary of ascena retail group inc.) from BCRF.
BCRF spoke with Dr. Irwin about some of exercise’s more surprising benefits—especially for breast cancer patients—and her tips for staying active while homebound.
What do we know about the link between lifestyle factors, including exercise, with breast cancer outcomes?
Dr. Melinda Irwin: There has been a lot of research showing that physical activity lowers our risk of developing breast cancer, along with more than 10 other cancers. We know that if we exercise after a cancer diagnosis, we can improve our overall survival and our cancer-specific survival.
What’s your research focus?
MI: Specifically, here at Yale, we have been researching the role of exercise, nutrition, and weight management before, during and after breast cancer treatment.
We've been looking at how exercise before surgery can improve various tumor markers. We've also been looking at exercise, nutrition, and weight management after finishing treatment—showing that it improves various pathway markers that are related to cancer risk and mortality. And, more recently, we're conducting a trial with women receiving chemotherapy for breast cancer looking at how exercise and nutritional intervention during treatment can improve chemotherapy completion rate. This is really important because we know upwards of about 50 percent of women do not complete the chemotherapy regimen that's prescribed to them because of side effects. We're looking at how exercise and nutrition can reduce those side effects to improve a woman’s chemotherapy completion rate.
Right now with COVID-19, certain chemotherapy regimens are being changed to more dose-dense therapies to limit hospital visits. Our intervention can look at how exercise and nutrition might impact chemotherapy completion rate for dose-dense therapies and other therapies that have longer cycles. Our intervention is telephone-based, so we’ve been able to continue our study.
What's your advice to breast cancer patients who are trying to stay physically active at home?
MI: Most everyone knows that exercise is beneficial, but many of us struggle to add it into our daily routines. There are a number of reasons for that. Prior to COVID-19, it might have been because we're very busy. We spent a lot of time commuting to and from work, and we're still busy now with Zoom calls, helping our kids with online education, and so much more. There's always the time issue. There are location challenges. Maybe you don’t have a well-lit street or sidewalks. There are weather-related issues. And then lastly, some people just don't find exercise enjoyable.
A lot of the advice we give to our study participants is that it has to be something that you find fun. Research shows that you see the biggest benefit from exercise when you go from nothing to something. While the recommended target is about 30 minutes a day, or about two and a half hours per week, doing anything is better than nothing. To start, don’t focus too much on the intensity or the duration or even the type of exercise you’re doing. First and foremost, just focus on making it something you enjoy doing. And then from there, work up to 30 minutes a day and increase your intensity. And then focus on the benefits: A lot of our research shows the mechanisms of how exercise can improve cancer outcomes, as well as cardiovascular disease, diabetes, stress and anxiety, and more. When we know more about the benefits of exercise, that can help motivate us, too. Once we're motivated, we prioritize and schedule it.
There are other tips to help get exercise in. Some people know if they don't get a workout in first thing in the morning, they're not going to get to it later in the day. Others wake up and they have too many other things to do, so finding time in the afternoon is a good approach. Exercising later at night helps us digest our dinner and sleep better. Some people dress in exercise gear, so if we have 15 or 20 minutes, we can easily pop out the door and go for a walk or do a quick online class. But right now, we want to focus on the idea that anything is better than nothing.
What if you don’t have a lot of room to exercise?
MI: If you're truly homebound or you don't really want to go outside, there are so many different types of classes online. If you're on Facebook or other social media, people are posting videos. If you're new to certain routines, you can find five-minute videos showing how to do certain floor exercises. You can use the space next to your bed or next to your couch to do floor work.
If you can, walk outside and maintain social distance from people. Doing weight-bearing activities, such as walking, is really going to help us maintain our lean body mass. Try to do it at a moderate intensity where you're getting your heart rate up a bit for 30 minutes.
Is there any evidence that exercise can reduce the effects of COVID-19—or even prevent it—because of its immune-boosting effects?
MI: This is a really important topic, and I imagine there's going to be a lot of research on this going forward. We know that exercise has a profound impact on our immune system. And we know that when we do an acute bout of exercise, certain proteins are released from our muscles. They're called muscle-derived cytokines, such as Interleukin-6 (or IL-6), IL-7 and IL-15. These cytokines are released into the blood to help our immune function. A number of trials have looked at the effects of exercise on these immune markers for a number of diseases: cancer, cardiovascular disease, diabetes.
There hasn't been any current research looking at exercise with COVID-19 specifically, but we know that the mechanisms might be similar. So, while exercise is not going to prevent us from getting the virus, it might lessen some of the side effects associated with COVID-19. It might even be more beneficial for certain population groups, such as older individuals or those with a higher body mass index.
Any last advice or thoughts?
MI: We want to follow all our guidelines, and we want to make sure we're maintaining our social distance at this time and wearing our masks if we're out in public. But exercise is really beneficial. If you're finding it challenging to get motivated: What I always do is think of the benefits and how I'm going to feel after I finish a workout. There are very few people who don't feel good after they finish an exercise session.
Dr. Irwin’s top 5 tips for staying active right now:
- Something is better than nothing.
- Focus on doing something you actually enjoy.
- When in doubt, go for a brisk, 30-minute walk.
- If you can’t leave the house, give online workouts a try.
- Think of the benefits of exercise on cancer outcomes and immunity to get motivated.