The Importance of Strength Training for Cancer Survivors
Sometimes we need to feel strong in order to hit the gym, and even stronger to actually lift weights. Ever wonder how people who are recovering from an illness, say, cancer, have the energy and mental stamina to push forward? And is it safe to do, since weight training naturally causes inflammation as a means to strengthen our muscles and bones? And especially because many doctors have said that certain cancer survivors shouldn’t lift over five to 15 pounds of anything for the rest of their lives? Or should they?
Luckily for us, Kathryn Schmitz, PhD, MPH, FACSM is obsessed with these questions and the importance of strength training as it pertains to cancer survivors and how it affects our health. Dr. Schmitz has a Ph.D. in exercise physiology and is a Professor of Public Health Sciences and Physical Medicine and Rehabilitation at Penn State College of Medicine. She is also the President of the American College of Sports Medicine. So, clearly she is an over-achiever as well.
“People always ask me ‘What’s the best kind of exercise to do?’” Dr. Schmitz recently told StrongPath. “My first answer is ‘The one you’ll do’. But my second answer is always ‘Strength training, strength training, absolutely strength training.’”
Strength Training and Cancer Survivors
Dr. Schmitz has studied many aspects of strength training, especially among cancer survivors, and the results of her studies and clinical trials provide a way for clinicians to understand the effects of strength training and exercise among survivors and implement a program for them. She may be most recognized for her work in showing that it is perfectly fine to lift weights as a breast cancer survivor, with benefits ranging from improved body composition and body image (and strength!) to preventing the decline in physical function that often occurs in survivors.
This work was based on the fact that lymphedema is a major concern of breast cancer survivors, as it causes limb swelling and discomfort and impacts the use of the arms. It’s a chronic, progressive and incurable condition, and it’s disfiguring. (The Elephant Man had lymphedema.) Survivors have been advised forever by clinicians to stay away from lifting weights—even five to 15 pounds—to avoid the onset or worsening of lymphedema. Dr. Schmitz wondered how accurate that advice really was. “My children weighed eight and nine pounds each when they were born and a gallon of milk weights eight pounds on average, an average a bag of groceries is eight to 10 pounds and a case of soda 15 pounds. Put this all together and you get a pattern of women who will need to hire personal valets. And I’m guessing that’s not going to happen,” Dr. Schmitz said. So, I thought, “How do we get these women moving?”
That’s why she started a research trial. And the National Institutes of Health funded it. In her Physical Activity and Lymphedema Trial (PAL), Dr. Schmitz proved that the advice to stay away from lifting anything over five to 15 pounds was just plain wrong. The PAL Trial showed that it was not only safe for breast cancer survivors to lift weights progressively, but strength training decreased the likelihood of the exacerbation of lymphedema by 50 percent and reduced the risk of lymphedema onset by 70 percent. “Pretty exciting news for those women,” she said.
Strength ABC teaches Physical Therapists How to Train Survivors
As a result, Dr. Schmitz developed a program called Strength ABC (ABC stands for “After Breast Cancer”) involving weight training for breast cancer survivors. There is a four-hour online course that teaches physical therapists how to set up and run the Strength ABC program in their own facility. And now, Select Medical, the largest rehabilitation service company in the country, has selected Strength ABC as its centerpiece in getting strength training to breast cancer patients.
Strength Training Benefits for Cancer Survivors
Dr. Schmitz has either contributed to or has been the sole author on over 200 papers published in medical and exercise physiology journals. Many of them show the benefits of exercise, diet and weight management for cancer survivors. She believes it is crucial to have strength training as part of a post-treatment healthy lifestyle. “If people are not lifting anything over 15 pounds, then what happens?” she asked. “They decondition. And when they decondition, they get weaker. What happens when they get weaker? They cannot do their normal daily activities and when that happens, they get injured. The very thing you were trying to avoid, you end up causing by asking people to stop moving. Is it me, or when is it ever a good idea to stop people from moving?”
In addition, cancer survivors often feel they’ve aged more than the time that has elapsed during their treatment. “They report feeling older and that at least in part is caused by a loss of lean muscle mass,” Dr. Schmitz said. “Cancer and cancer treatment are like jet fuel for the aging process—and not in a good way.” So, a strength training program can benefit not just those worried about lymphedema, but all cancer survivors, in fact all of us, whether we’ve had cancer or not.
Strength Training and Cancer Prevention
Is there a relationship between strength training and cancer prevention? Dr. Schmitz said that we do know there is a relationship between increased physical activity and cancer prevention, but we usually talk about it in terms of aerobic activity and obesity. But strength training changes our hormones such as testosterone and growth hormone, “also growth factors shift, the ability of the body to respond to genetic mutations shifts, free radical scavengers and oxidative stress, telomeres activities, all these different mechanisms, we know that it comes back to body composition,” said Dr. Schmitz. “And we know that strength training is really particularly good at altering body composition.”
Federal Guidelines on Exercise
The day we spoke with Dr. Schmitz, the federal Department of Health and Human Services had just released their new physical activity guidelines, updated after a decade. The number one recommendation—again—is aerobic exercise. Though the fourth bullet does list “muscle-strengthening activities of moderate or greater intensity… on 2 or more days a week.” Studies seem to focus on aerobic activity more than strength training, which is also why it’s exciting for Dr. Schmitz to make and share her discoveries about strength training. She explained it this way: “Here’s the thing, if you do nothing but walking, your lean muscle mass will go down over time as you age. Your ability to go on the same walk will go down because don’t have the muscle mass to walk around. On the other hand, strength training is like a gateway drug. If you strength train you will maintain muscle mass and you are more likely to keep walking and enjoy it more, because you won’t be huffing and puffing.” Makes sense.
The Importance of Strength Training for Overweight or Obese People
One of the reasons Dr. Schmitz is so enthusiastic about strength training is “overweight and obese people will do it. It doesn’t require them to carry their bulk around which is really uncomfortable.” In the 1980s, she had done her dissertation on the difference between lean and obese women doing normal daily activities. One of her major findings was that the speed at which they completed their tasks was directly correlated with lean muscle mass. “Aha!” she said and began her first pilot study, also funded by the NIH, on mid-life women at risk for small annual weight gains that often lead to obesity. She studied over a period of two years whether women could increase their lean muscle mass and maintain it and the answer was yes. “It’s like a freakin’ miracle,” she said.
“One of the reasons I like strength training so much is that it’s fairly simple, you can get tremendous benefits out of 30 minutes twice a week, you can show up to the gym and be all business and do three sets of six different exercises with fairly heavy weights, progress the weights, go every week and you will maintain that muscle mass.”
Kathryn Schmitz Workouts and Sets Goals
Dr. Schmitz has put her research to work in her own life too. She is currently training for a Century Ride a major accomplishment for any road biker. She is currently “biking ridiculous amounts” and also has a personal trainer she works with twice a week for strength training. “Every year I set a fitness goal. I’m a good student so I like to meet my goals. I set a really high one this year. I want to do 300 workouts, it’s a lot. We’ll see. I have a feeling I will.” We have a feeling she will too.
Her final advice to people reading this? “Get up get up right now, get out of your chair, I mean it, Get up!! Move!”