Exercise for Breast Cancer — An In-Depth Doctor's Interview

Why are you so passionate about working on cancer?

Dr. Bortz: Cancer is one of the fundamental demons of our lifetime. So many of us, every one of us I would bet, is touched in a very deep way. My mother-in-law died a terrible miserable death in her 50s because of cancer. My best friend just died of brain cancer. You don't have to go very far before it affects you intimately. So, whenever there is a project that comes as an opportunity to do good for cancer, that brings out the best in us.

What has been the thought in the past about exercise for cancer patients?

Dr. Bortz: I'm a great exercise enthusiast for everything. I think it's almost the universal preventive and therapy. In all my years as a practicing physician, almost anything you brought into my office, be it a hangnail or a tension headache, my prescription was exercise. Now, you don't draw an immediate connection between exercise and cancer, but you don't have to scratch the surface very far before you see some close relationships. I was reading a story just yesterday that obesity, which is partly due to a lack of exercise, is linked to breast cancer. When you're overweight your estrogens are running free, which renders you more susceptible. So, there is very strong data that ladies who are fit get less breast and ovarian cancer.

So exercise can be seen as preventive?

Dr. Bortz: Yes. As a preventative, exercise has strong credentials. After someone received a diagnosis, advice in the past has been not to exercise. Why is that? Dr. Bortz: It's almost a universal story of exercise and medicine. If there's something wrong with you, lie down. When I was in medical school, if you had a heart attack you were in bed for two weeks. If you had heart failure, oh, you have to rest your heart. If you have a sore joint, rest it. That's all changed now. The whole story is 180 degrees away. The story with cancer is it's a burden, and it wears you out. You're carrying a heavy load when you have cancer, and sometimes the treatment is almost worse than the disease. So, you're carrying the double burden of the disease and its treatment. It's very debilitating. Your initial response is to lie down. But, we've now found exactly the opposite. Exercise is wonderfully good, not only for good biologic markers for strength, pain tolerance, and sleep, but for all the right psychological reasons as well.

What exactly is exercise doing for cancer patients?

Dr. Bortz: It hits you on every level. I look at exercise as energy flow. What happens when you put your leg in a cast? What happens when you put your brain at rest? Everything withers when you don't use it, and the same thing occurs with cancer, only probably at an accelerated rate. So what are you going to do about that? What pill are you going to take to make you feel terrific? We don't have that, but we know very clearly that people who are going through this double burden of cancer and its treatment do remarkably well with an exercise program. Rather than making them more tired, they feel refreshed and invigorated.

What is it doing for them psychologically?

Dr. Bortz: Norman Cousins was a close friend, and Norman used to say that nobody is smart enough to be a pessimist. So, the person with cancer has lots of reasons to be pessimistic. They've just gotten kicked and cuffed around, and they have nothing to help them hold on. They're kind of sliding down the inside of a stainless steel cylinder without anything to grasp on to. And the medical system, unfortunately, is not often a congenial partner in this enterprise. So, we look for ways to make the person stronger. How do we grapple the people to their own strengths? We can just show them they can walk, take the stairs, and push the door open. Those little tell-tales have immense effects on body and spirit.

What have the results of your new study shown in your patients?

Dr. Bortz: I believe without exception every person that's gone through this study has given rave reviews. A lot of it is just the plain exertion of the exercise, it's bulking up, but a lot of it is the social content of it. It's the sharing of experiences. The little story that I revere from my childhood, "I think I can, I think I can, the little engine that thought it could." Well, as you get older, and if you get cancer and do treatment, do you still think you can or do you think you can't? Is it too late for me? Nobody is more susceptible to feeling hopeless and helpless than the person who has gone through the great indignity of having cancer and then having doctors tramp up and down over them. If you say to yourself, "I'm pretty helpless, I'm pretty hopeless," that then feeds on itself. The downward spiral gets increasingly steep and depressing.

How do the cancer patients look at life after they become involved in this exercise program?

Dr. Bortz: You'd like to think that exercise is adding some positives into a life that's just full of negatives including nausea, pain, sleeplessness, depression, and on and on. What can you do? That's the very simple premise of this exercise program. You're not asking them to change their color, their age or their sex. You're asking them to exercise a little bit. Can you lift this weight? Can you climb this stair? One of our favorite mentors here at Stanford is Albert Bandera, the great psychologist, and he says the first way of getting control is small steps of mastery. So, you don't try to render yourself cancer-free, you don't try to deny it, but you accept and address it. The point is to take charge of yourself and the disease. "I'm going to fight back, and exercise is a wonderful part of that." I just submitted an article to "Runner's World," and my title is "Exercise as Armor". You don't identify that as you are getting fitter, you're wearing a set of boilerplate around you. I think that's fun imagery. You have to find a way to think about exercise instead of the usual, predictable and dreary terms. You have to find what's positive about it. When you are fit, you find yourself immune to a lot of the arrows that life throws your way. I think this would allow the cancer patient to say, "I'm better today."

Is there any scientific evidence of the benefit of exercise?

Dr. Bortz: We don't yet have proof that exercise allows people to live longer. I'm sure that it does, but we just don't have the concrete information. We can't yet say if you do this, you'll live six months or two years longer. I'm encouraging our group to look at that to make the case stronger. Right now, all we can say is it is going to make you feel better and improve the quality of life. You certainly cannot belittle the quality of life. If you give me 100 people who put their tails down and go scurrying off avoiding exercise vs. the 100 others who've got their tails up going to exercise everyday, I'll bet on this last gang with absolute confidence that they're going to do better.