The strength-training class doesn't look that different from any other -- men and women are lying on mats, stretching hamstrings before beginning work with elastic bands, stability balls and dumbbells. Then you notice a few uncommon things.
One woman has doffed her long, blond wig to reveal a low pile of fuzz on her head. The instructor mentions that a particular upper body exercise is especially good for people with brain tumors. And some participants are out of breath after a few ab crunches.
The people in this bare room in a Santa Monica office building are undergoing cancer treatment or recovering from it. Despite fatigue, neuropathy, surgical scars and nausea, they have decided to push their bodies toward physical fitness, whether they feel ready or not. Over the next hour, they follow Wellness Community instructor Kate Schmidt through stretching, balance and strength-training, some modifying the drills to accommodate low lung capacity, stiffness from surgery or weak muscles.
For cancer-traumatized bodies, the experience can be challenging -- but it is becoming increasingly common. As studies mount up showing the benefits of regular, moderate physical activity before, during and after treatment, cancer rehabilitation facilities, wellness centers and YMCAs are offering exercise programs to help people through the disease.
For those weathering, or about to weather, surgery, chemotherapy, radiation or medication regimens, cardiovascular and strength training can help counter side effects such as extreme fatigue and muscle wasting.
For those recovering from treatment or who are in remission, exercise can bolster healing, propelling them back into normal life faster.
"This is a population that is not unlike people who have cardiac disease -- they have a damaged body system that can be helped by exercise," says Kathryn Schmitz, assistant professor of epidemiology at the Center for Clinical Epidemiology and Biostatistics at the University of Pennsylvania.
That's not to say that launching an exercise routine under such circumstances is easy.
To begin with, Schmitz says, people may feel a bit betrayed by their bodies: "Like, you're not sure if you're best friends with your body right now."
Then there are the effects of treatment. Surgery can cause muscle imbalances, weakness, pain and scarring. Steroid drugs can cause muscle breakdown; interferon often leads to intense fatigue; and some medications, such as sunitinib (used to treat some kidney and gastrointestinal cancers) and the breast cancer drug trastuzumab, may cause heart damage.
Good for everyone
But what exercise does for healthy people -- increasing energy, improving flexibility and cardiovascular function, strengthening muscles and bones -- it also does for those with cancer, oftentimes more profoundly.
"I knew it was really good for me to do it," says Los Angeles resident Barbara Converse, who was diagnosed with rectal cancer in 2005. She's been coming to Schmidt's strength training workshop at a Santa Monica branch of at the Wellness Community, a cancer support and education center, for 2 1/2 years. "I knew it would make me feel like a whole person again, not just a poor little tree that dropped its leaves at the wrong time of the year."
She started the class not believing she could even do the exercises. Her shoulder was immobile from a fall while on chemo. (She whips her arm around in a complete circle to demonstrate her improvement.) Exercise has helped her with balance and fatigue so strong she used to head for the bed after climbing a flight of stairs.
"The class gave me more confidence to get out of the house," she adds, "and I had the endurance to be able to do things for hours at a time."
Where trend began
The Rocky Mountain Cancer Rehabilitation Institute at the University of Northern Colorado in Greeley was one of the earliest facilities to use exercise and nutrition as rehabilitation for cancer patients. Like many such programs, it was started by someone who had first-hand experience with cancer.
Carole Schneider, a professor of exercise physiology at the university, was diagnosed with cervical cancer in 1995. After going through extensive radiation treatment, she says, "I was so fatigued, and felt awful and so weak. I asked my physician what to do, and he didn't really know."
When she started to look into the side effects of chemo and radiation -- muscle loss, heart damage, fatigue -- she realized that exercise was a viable antidote. A few early nurses' studies on the positive effects of exercise for cancer patients bolstered her beliefs.