Q&A with Regan Fedric on Exercise for Cancer Survivors
Regan Fedric, CES is an exercise physiologist with more than 15 years of experience supporting cancer patients in their wellness goals through physical activity. For many years, she co-led the UCSF Exercise Oncology Counseling Program. Now, in collaboration with the UCSF Brain Tumor Center and the Sheri Sobrato Brisson Brain Cancer Survivorship Program, Fedric provides exercise consultations specifically for brain tumor patients, survivors, and caregivers.
What is cancer exercise counseling?
Cancer exercise counseling is as a one-on-one conversation with a person anywhere along the path of their diagnosis. Our end goal of each consultation is to provide an exercise program that’s doable and safe (Rx: Exercise). We take into consideration diagnosis and treatment plan, as well as anything impacting the person’s physical, psychological, or cognitive function.
These individualized exercise programs might include in-home exercises, or a connection to local classes or gyms in the community. We then schedule follow-up meetings to assess progress and suggest adjustments as needed. Ultimately, we want to motivate people and give them the tools to stay active while going through treatment and beyond.
One of the unique things about our focus here at UCSF is that we tailor exercise programs to the individual person. The exercise prescription is very different for someone who is pre-surgery versus post-surgery, or exercising during chemotherapy or radiation therapy. All of this is taken into consideration while designing exercise programs for each person.
Why is exercise especially important for patients with cancer?
Published earlier this year, new guidelines from the American College of Sports Medicine and the American Cancer Society1-3 recommend that exercise should be included in standard of care, that it should be part of adjunct care for every cancer patient:
• There’s strong evidence to support the benefit of exercise in improving anxiety, depression, cancer-related fatigue, quality of life, and physical function in cancer patients.1
• There's good data that speaks to reducing recurrence rates and prolonging life for some cancers.2
• Ongoing research is investigating other benefits of exercise, for example, whether exercising during chemotherapy can decrease overall side effects or toxicity of treatment.
More anecdotally, we have participants who have been working with us for 10-15 years and exercise has become a constant thread in their daily life. Anyone that's had a cancer diagnosis, and lived beyond active treatment, understands the underlying fear associated with recurrence. Exercise adherence has a strong place in helping people manage the stress and anxiety that comes with that. We often hear patients, survivors, and caregivers say that exercising gives them a stronger sense of control – that unlike other aspects of their life, this is something they can control.
I’ve been in this field for almost twenty years; it’s still emerging. I’m very excited about the future. Evidence-based research is stronger now, and the conversation is moving towards embedding exercise oncology in cancer clinics and medical centers across the country.
What types of exercise are best for patients with cancer?
One of the unique aspects of our model is that we focus less on a cookie cutter approach and more on the individual components that are unique to a patient’s situation and goals. That's something we’ve been adamant about.
For example, for those receiving steroids as a part of their brain tumor treatment, muscle loss and atrophy is a common side effect. In these cases, exercise programs that specifically target larger muscle groups like legs, chest, back, and core can help mitigate effects of the steroids.
Or, for patients with lymphedema, we often see people that are afraid to use the affected arm or leg. We teach that you can still use that arm, and safely regain function by starting light and progressing slowly over time to regain strength. There's good evidence that implementing a strength training program helps people work and live with lymphedema, which can often be chronic.
What are common questions or concerns you hear from patients with cancer?
A common question from patients is, how much is too much? Sometimes with chemotherapy, people are concerned about exercising too soon or overdoing it. But some of my favorite success stories are from patients who didn't exercise at all and were hesitant to do so because of their diagnosis. Helping them find something that’s safe and doable, and then seeing them succeed and realize the benefit is incredibly rewarding.
For example, I recently saw someone who lost a lot of muscle mass over the course of treatment. She had stopped exercising because she was scared to burn more calories and lose even more weight. But in the consultation, we were able to talk through that and modify her exercise program to include light strength training while decreasing the intensity of cardiovascular components. She was so excited to start exercising again and went home to start immediately following our consult.
Do you have advice for patients with brain tumors?
Anything is better than nothing when it comes to movement. With exercise programming, a cancer diagnosis is like a forced detour in life. As you're going through treatment, just do what you can, even if it’s in small bouts or at a lower intensity level at first. The end goal is to maintain strength and function as best you can, but to do it in a safe and sustainable way.
What’s the most fulfilling part of your job?
The most fulfilling part of my job is getting to help people. Once a person gets started on their program, we often hear that exercise feels less overwhelming and intimidating. We get a lot of stories of thankfulness, and that getting connected with exercise or a group class is a gift. For many, exercise becomes a part of their support system.
I believe in the benefits of exercise. I am thankful for the evidence coming out to support why exercise should be built into standard of care for cancer patients. For many of the people that I see, their motivation is less about the six-pack or great physique – instead, it’s about functioning better, feeling better, and simply living a better life.
References
1. Campbell et al. (2019) Exercise Guidelines for Cancer Survivors: Consensus Statement from International Multidisciplinary Roundtable. Med Sci Sports Exerc 51(11):2375-2390.
2. Patel et al. (2019) American College of Sports Medicine roundtable report on physical activity, sendentary behavior, and cancer prevention and control. Med Sci Sports Exerc 51(11):2391-240.
3. Schmitz et al. (2019) Exercise is Medicine in Oncology: Engaging Clinicians to Help Patients Move Through Cancer. CA Cancer J Clin 69(6):468-484.