Update: Since the time of this article's original publishing, RMCRI has rebranded as the University of Northern Colorado Cancer Rehabilitation Institute. Their new website can be found here.
It used to be common knowledge: when you ended chemotherapy or radiation treatment, you went home to rest and recover. It made sense. Chemotherapy and radiation can be aggressive treatments that take a toll on the body, so rest was believed to be the most logical and practical way to recover from cancer treatments.
However, the specialists at the Rocky Mountain Cancer Rehabilitation Institute (RMCRI) believe that there’s a better way: using exercise to combat the harsh side effects of cancer treatments in order to rebuild their patients’ quality of life.
“There are serious, deleterious side-effects and toxicities as a result of cancer and cancer treatments. The positive benefits of exercise completely offset and attenuate these effects,” says Jessica Brown, Clinical Coordinator at RMCRI.
Founded in 1996 as an entity of the College of Natural and Health Science at the University of Northern Colorado, RMCRI believes that more than anything, cancer survivors want to live normal lives again. For many, that means performing tasks as simple as going grocery shopping, doing the laundry, or playing with their children or grandchildren.
Thus, the goal is to recover a patient’s functional strength, which at RMCRI is defined as “the strength and ability to perform activities of daily living.” And the best way to regain that functional strength back, RMCRI has found, is to improve a patient’s body composition.
Depending on the type of cancer, the location of the cancer, and the stage at which it is defined, the negative changes that occur in body composition can vary widely for each patient. In order to give every cancer survivor a customized recovery plan, an initial physical assessment is performed when a survivor first checks into RMCRI. This assessment includes: a motor strength assessment, flexibility/range of motion assessment, a balance examination, a cardiovascular test, a pulmonary examination, and a body composition analysis.
About 50% of the cancer survivors seen at RMCRI suffer from a condition called cancer cachexia, resulting from cancer and cancer treatments. This condition is marked by a loss of Lean Body Mass and Fat Mass. Loss of Lean Body Mass leads to decreased overall strength, while loss of Fat Mass can lead to feelings of fatigue from the loss of energy stores.
However, some cancers behave differently. Those that are triggered by hormones – estrogen and testosterone – are typically dealt with by reducing these hormones in order to defeat the cancer. However, this strategy can have the unfortunate side effect of unintended weight gain, particularly in the abdominal area.
Depending on each patient’s physical condition at their initial assessment and their individual goals, the Cancer Exercise Specialists at RMCRI create a customized, 12-week “Phase Training” program. The results of a body composition test are used to guide the prescribed intensity of each type of exercise. The amount of Lean Body Mass and Fat Mass are particularly important to assess in cancer survivors.
Almost all patients at RMCRI undergo some type of resistance training to improve Lean Body Mass because nearly every patient experiences some degree of muscle atrophy due to cancer and cancer therapy.
Cardiovascular exercise is another critical component of any 12-week phase, but this type of exercise is prescribed based on the effect the cancer has had on a patient’s Fat Mass levels. With patients who gained a lot of unintentional Fat Mass due to cancer or cancer therapy, the goal would be to reduce Fat Mass to a healthier and more sustainable level.
However, for patients who have lost significant amounts of both Fat and Lean Body Mass, gaining weight is the goal. These types of patients still require cardiovascular exercise in order to improve their overall endurance, but not to the point where they start to lose Fat Mass.
At the conclusion of the 12-week phase, the physical assessment and body composition analysis is performed again to assess the effect the program has had on the patient’s health and to optimize the program, if necessary.
Body composition assessment has always been critical to the designing of customized fitness recovery programs from the start. But the body compositions of cancer survivors can pose unique challenges for caregivers, says Dr. Dan Shackelford, Research Coordinator at RMCRI.
“One of the biggest toxicities from chemotherapy is going to result in involuntary muscle wasting. A lot of times we see clients after treatment, and they have lost a lot of weight because they don’t have a lot of strength. The muscle has been stripped from them.”
“Some other toxicities we see are gastrointestinal. That can go either way: it can cause our clients to lose their appetite, so they’ll lose a lot of body fat. In other cases, it almost enhances their appetite and causes them to gain weight during their treatment, so that aspect of body composition is really variable.”
Because of this variability, everything about RMCRI’s program must be tailored for cancer survivors. RMCRI takes particular care to ensure that all aspects of the program account for their patients’ unique circumstances.
In order to prescribe appropriate cardiovascular workouts for cancer survivors, for example, RMCRI conducted an extensive research study in order to find the optimal VO2 peaks specifically for cancer survivors. So, when assessing body composition, RMCRI saw the need to find a similarly tailored approach for the cancer survivor population.
In the past, RMCRI relied on the 3-site skinfold measurement method using calipers and the Jackson and Pollock equation in their body composition assessments. After years of using this method, RMCRI decided to bring in a more advanced device – the InBody 770 – to assess body composition. This decision was made based on concerns surrounding the equations skinfold calipers use.
“Skinfold measurements and calculations were created using the apparently healthy population,” notes Ms. Brown. “With it becoming increasingly clearer that cancer survivors are not the same population as the apparently healthy, then perhaps our other measures and assessments are not accurate and meant for this population.”
Because the InBody 770 does not use calculations or results from any population to determine body composition, the staff at RMCRI feel more confident using these results for their cancer survivor population than the results produced from skinfold calipers.
The InBody 770 provides RMCRI with a multitude of other capabilities and results - such as visceral fat and segmental lean analysis – that allow for a much more sophisticated understanding about the body compositions of their patients. It also allows them to conduct new research surrounding body composition with the data accumulated from their programs that they plan to use in order to make their programs even more tailored and accurate for cancer survivors.
By improving the body compositions of their cancer survivors, RMCRI is able to guide them on a path to recovering functional strength – giving them the power to do everyday tasks. However, improved body composition doesn’t only improve physical well-being. By giving cancer survivors the ability to perform everyday tasks they used to be able to do, they also recover mentally and emotionally.
For Gayle Duggar, a liver cancer survivor and RMCRI patient since 2014, this is especially true.
“Getting to the grocery store was an all-day chore for me,” she remembers, “because I was so weak and emotionally spent.”
Gayle has spent over a year working with the specialists at RMCRI, and by improving her body composition and physical well being through the Phase Training program, she has gone from having difficulty walking around the grocery store being able to comfortably run on a treadmill. But it’s the mental and emotional benefits that have given her a completely new outlook on life.
"This place is the most amazing place," she says. "I can truly do things that I never could do."
It’s stories like Gayle’s that prove to Ms. Brown that exercise and body composition development is what makes the program so successful. The program is so successful, in fact, that in many cases the effects of the program are almost immediate.
“After the first week, our client’s quality of life and fatigue levels are improved. At our initial assessment, we measure fatigue, depression, and quality of life via established questionnaires. After the 12-week intervention, we see huge, significant improvements in each.”
Dr. Shackelford agrees: “It’s really amazing to us that a lot of oncologists and doctors are still telling their patients after a treatment to stay home and rest. That came out 20 years ago. Right now, there is so much research out there to tell you how beneficial exercise is; what it can do for a client.”
To learn more about the University of Northern Colorado Cancer Rehabilitation Institute, visit them at: http://www.unco.edu/nhs/cancer-rehabilitation-institute/