Exercise and cancer: More doctors recommending physical activity for Long Island patients

After Renee Shutowich had a double mastectomy to remove a breast cancer tumor, another operation to take out multiple lymph nodes, and three reconstructive surgeries, she battled severe pain, weakness and fatigue.

The East Northport woman then began exercising, on her own and in a class specially designed for people with cancer.

"I saw a benefit immediately," said Shutowich, 62.

She now goes to the gym, skis and plays pickleball, and the motion in her arms, which had been greatly limited after the surgeries, is back to normal.

For years, many oncologists advised patients going through cancer treatment like chemotherapy, or in recovery from treatment or surgery, to rest and avoid physical activity. Rest still is recommended in some situations, such as just after surgery. But an expanding body of research indicates that aerobic exercise and strength-training can improve the chances of survival of people with cancer, decrease the possibility of recurrence and lead to better overall physical and mental health.

"The data is so profound on how beneficial exercise is," said Dr. Jonas Sokolof, director of oncological rehabilitation for Catholic Health. "It works like a medicine."

Although a growing number of oncologists now recommend exercise, some still tell their patients to rest, Sokolof said.

"Intuitively [some] physicians feel patients are in a weakened state, so they’re not inclined to recommend physical activity because they’re fearful that their patients will become weaker," he said.

But that’s changing, as oncologists hear about research on exercise at medical conferences or read about it in medical journals, said Sokolof, who is on a scientific panel for the American College for Sports Medicine, a nationwide sports medicine group that distributes educational materials to doctors on exercise and cancer.

"We’re trying to shift the paradigm to make exercise the standard of care in oncology," Sokolof said.

Exercise helps activate cancer-killing cells and reduces inflammation, which is a driver for cancer, he said.

Lack of data until '90s

Research has long shown that exercise can help prevent many types of cancer. But until the late 1990s, "there really wasn’t any data" on the benefits of exercise post-diagnosis, said Dr. Lee Jones, head of Memorial Sloan Kettering Cancer Center’s exercise oncology program.

"A clinician would not talk about exercise or its benefits because there was no data to suggest it was beneficial," he said.

Since then, evidence has mounted on how exercise can help people with cancer.

In 2022, the American Society of Clinical Oncology, the country's largest association of cancer doctors, advised oncologists to "recommend regular aerobic and resistance exercise during active treatment," after experts reviewed dozens of studies on the effect of exercise on people in cancer treatment.

A separate review of studies released in 2022 concluded: "Physical activity improves quality of life, increases survival and reduces mortality, fatigue, side effects of treatment and the risk of recurrence."

Multiple other studies have reached similar conclusions.

Jones led a study published in 2023 that found that people with cancer who exercised lived a median of 25% longer than those who did not. The study looked at deaths from any cause, not just cancer.

More research is needed on how exercise affects different types of cancer, and on what level and type of exercise should be recommended, Jones said. Almost all the research has been based on self-reported exercise, and there could be other factors helping people, such as better diet or sleep, he said. That’s why randomized controlled trials, in which researchers select people with similar ages and health profiles and then compare them, are needed, he said.

Jones is leading one such study, comparing men with localized prostate cancer who exercise and those who do not,

The new study builds on a previous one led by Jones that found that 225 to 375 minutes a week on a treadmill led to significant improvements in men with localized prostate cancer. Yet 450 minutes, although better than no exercise, had fewer benefits than the "sweet spot" of 225 to 375, he said.

That points to the importance of coming up with specific amounts of recommended exercise tailored to the type and extent of cancer the patient has, Jones said.

"Exercise in general seems to be beneficial, but it will be even more beneficial and safer if it’s personalized to the individual," he said.

People with cancer should talk about exercise with their oncologist, who can assess whether exercise is recommended and, if so, what type of exercise may be best, Sokolof said. For example, some people have physical impairments, such as neuropathy or limb pain, that may make certain types of exercise inadvisable, he said.

Fatigue is a common effect of chemotherapy and other cancer treatment, and it seems "counterintuitive" to recommend exercise to someone who has a lack of energy, Sokolof said. But scientific data shows that it helps, he said.

Elizabeth Cuccia, who has stage four metastatic breast cancer, takes multiple medications that cause fatigue, as well as diarrhea, constipation, weight loss, loss of appetite and other symptoms.

She heard about a free exercise class for people with cancer in Lake Success held by the Kings Park-based nonprofit Strength for Life, but "when I first went to the class, I thought, ‘This is hard,’ and I didn’t know if I could do it," said Cuccia, 61, of College Point, Queens.

But she felt better after class and kept returning.

"The class has given me more energy to walk, more energy to just do everything in my life," said Cuccia, who now walks five to 10 miles a day.

Strength for Life, which conducts classes in 13 cancer-exercise locations throughout Long Island, focuses on bone and muscle strength, but participants are encouraged to do cardio activity outside the class, said the group’s cofounder Debbie Hughes, a personal trainer. Cuccia said the strength training has helped keep her balanced as she walks.

The YMCA of Long Island’s free exercise classes for cancer patients and survivors in Bay Shore, Huntington and Patchogue, in conjunction with the Texas-based Livestrong Foundation, also include nutrition advice.

The Nancy Marx Cancer Wellness Center at the Sid Jacobson Jewish Community Center in East Hills offers three free in-person classes and three via Zoom.

Glynis Cattaneo, 69, of Elmont, has been attending classes there since 2022. She underwent breast cancer surgery in late 2020, followed by chemotherapy and then radiation. For months afterward, she said, she walked "like a drunken sailor" and couldn’t lift objects.

"At the time, the body was just shot," she said.

Cattaneo now attends three wellness center classes, including a weekly outdoor walking group. At first, she could only walk during half the hourlong class.

"Now I can do the full hour," she said.

Other cancer patients and survivors motivate her to return each week, she said.

"I really wouldn’t be walking without the support," she said. "I wouldn’t have the incentive."

At a recent exercise class that included balancing techniques, instructor Andrew Millman urged Cattaneo and nine other participants to "think of a monkey grabbing the limb of a tree" with its toes when they move forward.

"When you go to balance yourself, you want to press that foot deep into the ground before you ever think to lift the other leg," he said. "If this leg is not ready, never lift [the other] leg, because you’re not giving your body proper information."

Cattaneo said that the "monkey toes" advice has helped.

"As I started gripping and strengthening the core, I found I was getting more and more balance," she said.

During the class, participants clapped as Cattaneo got up from her gray plastic chair without holding onto the chair arms.

"You’ve come a long way," Millman said.

"I had to hold on to stand up," Cattaneo said. "Now I don’t."

By David Olson

david.olson@newsday.com@DavidOlson11

David Olson covers health care. He has worked at Newsday since 2015 and previously covered immigration, multicultural issues and religion at The Press-Enterprise in Southern California.