The Moving Through Cancer campaign, sponsored by the American College of Sports Medicine (ACSM) and the American Cancer Society, recently published their exercise recommendations for individuals with cancer. The “Guide to Getting and Staying Active During Cancer Treatment” is their latest attempt to treat exercise as medicine. They are appropriately viewing exercise as medicine. And they recently made their “prescription.” Check it out here. Here is a preview of their exercise prescription for multiple issues that can come up from cancer treatment:
You may notice that all of these prescriptions are nearly the same, and as we have discussed in the past, these recommendations will also largely be ineffective to anyone that has ever worked out in a gym at providing their “prescription” to improve their physique, functional capacity, or simply tried to build some muscle. No MD required here to adequately assess whether these “prescriptions” will be effective. Simply head down to your local gym and ask the bro in a tank top. Yet, according to their recommendations (and frankly most around the country at our major academic institutions) as soon as you have cancer, you are no longer able to do exercise that will actually provide you with tangible goals. You are stuck for the rest of your life, and you can only do the equivalent amount of exercise that would be taxing for a 98 yo in a nursing home. Hey, take it easy, do the bare minimum.
Anything is better than nothing…
This statement is said to me often, and it is an absolute killer when it comes to exercise oncology, particularly when you are talking to my patients. Just check the box. According to their “anything is better than nothing” view of exercise as medicine, it’s OK to prescribe one dose of taxol for triple negative breast cancer, or maybe a couple fractions of RT. Maybe or maybe not do a sentinel lymph node biopsy with that lumpectomy (hey, anything is better than nothing!).
And while there is data that shows any activity level is better than none, stretching this to the degree where we tell patients any activity will increase physical function, performance, muscle mass, or bone density is both inappropriate and utter misdirection. It is treating the cancer patient—who, by the way are often much more motivated than the general population—like little helpless children. My breast cancer patients are not helpless, but rather insanely motivated and inspirational individuals ready to travel to Dante’s 9 circles of hell, destroy the place with their bare hands, only to come up for air while punching cancer in the face. These recommendations are insulting to say the least (meet me for a drink and I will tell you my unhinged feelings).
According to Dante, to avoid one of his Circles of Hell, you must avoid just checking the box
To top it off, their “bone-stimulating” recommendation of “muscle-strengthening exercise 2x per week, 2 sets/8-15 reps” has been shown to be ineffective repeatedly in non-cancer populations, so why prescribe it to cancer patients who are at an even higher risk of falls and fractures? This is what we call under-dosing, and the world of exercise oncology is full of it. This entire recent release is under-dosing at its worst. But hey, anything is better than nothing…
Individuals need to know what will help them and what won’t and what results they should expect from their “dose” of exercise. Something may be better than nothing, but an inadequate level of something does not build bones and muscles. In fact, depending on that something, it may hasten bone loss. So why make these under-dosed halfwit recommendations?
I will tell you why—to make the prescribers feel better. These are not recommendations for cancer patients, they are recommendations for us, the care givers (or, as clueless corporate medicine jugheads like to call us, “providers”). These recommendations are reductionist and, worst of all, simply wrong—not supported by data, and part of the recent campaign where we simply want to check the box. Look, we have an integrative or exercise program for cancer patients! Look, we are trying to help patients by promoting exercise as medicine! Look, we are using cancer patients as advertising fodder while not actually trying to help them!
Pure rubbish and our patients deserve better.
I know what you are thinking—man, Champ has been a crab in the last two newsletters. He must be a real blast at cocktail parties. However, don’t you think our cancer patients deserve better? Don’t you think that you deserve better?
Instead, why don’t we get down and dirty with our patients? Learn how to coach them, maybe pick up a CSCS while you are at it, and push them like you would push a professional athlete. Stress their bones to stop bone loss or make them stronger (spoiler alert, it requires a heck of a lot more than the above, in fact, it takes hitting 10% of the stress required to FRACTURE a bone to wake up those dormant osteoblasts and get them to lay down some bone). Do you think two sets of 15 reps are going to do that? If so, check that box, but don’t be surprised when the DEXA scan begs to differ.
Anything is not always better than nothing, especially when you are being told that this “anything” can lead to results that we know will not happen. Let’s be honest with people and give them the info to out-muscle cancer, not just for us to check a box.
Our patients deserve better.
Don’t Just Check the Box
There is a new phenomena plaguing us: checking the box. This push to be happy with the bare minimum not only sells ourselves short, but perhaps most egregious, sells those around us short. We have to constantly push to stay heathy, mobile, and strong, playing the long game so that our actions keep us at our best now and decades into the future. Simply checking the box violates all of these.
Simply checking the box keeps us status quo now, behind the eight ball in ten years, and unable to get up and down off the ground in 20. This mentality explains why from 1999 to 2020 obesity rates in the US increased from 30.5% to 41.9%. It is why falls and deaths from falls has almost quadrupled between 1999 and 2020. We have more money, products, goods, and supposedly knowledge than ever before in the history of humans. Why then are we moving in the wrong direction?
It takes effort to stay healthy and our best. It takes effort every day. We need to take responsibility for our health and remember that pushing for our best health is important for those around us too. No app, website, step counting doohicky on your wrist, or other lifestyle “hack” that checks the box is going to replace the daily effort and stress that our bodies require.
Checking the box is the bare minimum. It is the starting point. It is our daily cup of coffee to start the day, before the real action happens. A culture of simply checking the box will watch the above numbers continue to worsen.
We have to push beyond checking the box.
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