Functional Medicine Bitesized
Functional Medicine Bitesized
Exercise as Medicine in Cancer Care
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In this episode of Functional Medicine Bitesized, I had the opportunity to sit down with Chris Fitzmaurice, clinical exercise physiologist at the University of Miami Health System and certified cancer exercise specialist, to explore the powerful role of exercise as medicine in cancer care.
It was a fascinating chat unpacking how aerobic and resistance training act as “molecular medicine”—modulating inflammation, supporting the immune system, and changing the tumor microenvironment to make standard treatments like chemotherapy and radiation more effective and better tolerated. Chris used a brilliant analogy explaining how exercise can be thought of as turning the tumor’s “paradise beach” into “Antarctica,” disrupting its ability to thrive.
Listen in to hear more about personalised exercise prescription for different cancer types and stages, the emerging science of myokines and exerkines as well as the mental health impact of movement, including how exercise can prevent and treat depression in cancer survivors
We also discussed highly practical strategies including one of my all time favourites, "exercise snacks" and why, when it comes to exercise, anything is better than nothing.
Links mentioned in this episode
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SUMMARY KEYWORDS
Exercise oncology, clinical exercise physiologist, cancer survivors, exercise benefits, molecular medicine, inflammation modulation, immune system, depression treatment, prehabilitation, rehabilitation, muscle strength, cardiovascular fitness, mental health, exercise guidelines, personalized treatment.
SPEAKERS
Peter Williams, Chris Fitzmaurice
Peter Williams 00:00
Hi and welcome everyone to the new episode of Functional Medicine Bite Size, I'm going to be interviewing Chris Fitzmorris. More morning for you, Chris
Chris Fitzmaurice 00:14
morning, thank you so much for having me
Peter Williams 00:16
Chris currently resides in Miami. I'm going to give you a little bit of a brief before we get into it. But we are going to be exploring exercise and all of my mechanisms that are going to be so helpful for us, particularly, which is obviously Chris's expertise, I suppose, is exercise oncology. So we're going to dig into that. But Chris is a clinical exercise physiologist. He's at the University of Miami healthcare system. He's a certified cancer exercise specialist, and he's also a CSCS. So this is a Certified Strength and Conditioning Specialist, which, if you always see my stuff, I've carried that certification for 25 years now, and it really is a certification that is recognized around the world, from a point of view of people who probably have a deeper understanding of how to apply strength and exercise to populations, although I could laugh about that because I was in the gym. I'm trying to I'm trying to become a master sprinter. Chris me and my mate are working on that we've been on the track for the last year. And of course, I stupidly did some hex bar jumps in the gym yesterday and completely spasmed my lower back. So I'm in a bit of strife today. You think you know it all, and actually, you realize you probably know very little on a day to day basis on that side. So Chris, the reason why I brought you on is because you are one of the key persons that I actually follow on LinkedIn, because your LinkedIn posts with regards to exercise and exercise oncology, they're really good mate, and there's a lot of thought that's obviously gone into him, and they just spectacularly interesting pieces. And you know, we chatted offline before. This is why you're getting a lot of a lot of people liking your posts, because you're obviously putting a lot of time into and they're hugely informative. So I'm going to put all Chris's details at the end, because he's well worth following. Chris. You have an Instagram as well?
Chris Fitzmaurice 02:15
Yes, yes. It's, it's simply called Exercisebeatdiseases, alright?
Peter Williams 02:20
So again, we'll put, we'll put that in the coat, in the notes, because, again, this is a guy that you really want to follow. So Chris, look, we always want to have an understanding of why you've got to the point of what you're doing now. So why don't you give us the background?
Chris Fitzmaurice 02:36
Yeah, so, so make, make a long story short, I've, worked in exercise oncology for about five years. I've worked as an exercise physiologist with all different types of cancer populations. So I've seen many cancer survivors, whether they are going through rehabilitation during treatment and post treatment, and just when I was working in that position, it gives, it gave me a lot of perspective and a lot of experience working with a diverse group of cancer survivors, and just with the exercise background that I've had Out of all the different pathologies out there, you know, and I'm pretty sure many people out there can agree with this, cancer is one of the most complex diseases with with working when you're working with them, it's this every exercise prescription that you give to each different survivor, even if they have the same cancer may be a lot different from from the other person. So it's a it's a great experience that I appreciated to having.
Peter Williams 03:51
And I suppose that really comes down to personalization of treatment. Each individual is going to have a unique presentation and and I suppose it's the skill of the exercise scientist or strength conditioning specialist to be able to know, how do you move them along the line over time, and the nuances that are involved with that. Can we dig into because obviously, cancer is one of the most recognized diseases worldwide, just Behind the biggest killer, which is obviously cardiovascular disease, but it, but it obviously the rates have jumped massively over the last 20 years. Can we dig into sort of exercise as molecular medicine, if you like, really, how maybe aerobic and resistance exercise, how we can use that training to modulate stuff like inflammation and immunity, and even sort of the sort of the tumor environment, or the micro environment of the tumor I mean, what have we learned, and what do we know, and how do you apply that on a daily basis?
Chris Fitzmaurice 04:57
No, absolutely, you know in the. You brought you brought up some really, really good, good points, you know. You know, when we think of, you know, Molecular Medicine in terms of what exercise does for cancer, you know. So we all we, we all know, as clinicians, you know, the various great treatments, especially chemotherapy, you know, and even hormone therapy, What? What? All these different treatment regimens does for the different cancer survivors, you know, but if you think about it, exercise, in the sense in terms of dealing with the the adverse effects with those with those treatments, it's, it's almost, it's almost kind of like the exercise. In a sense, it's almost kind of like poison to the cancer in terms of modulating effects. So, so, for example, you know, a lot of them, and you kind of alluded to it with the inflammation and in the improvement in the immune system. I like to think of it exercise, you know, and when we talk about the tumor, micro environment, it's almost like when the tumor, when the tumor itself is is living and thriving in in in the body, it's almost like it's in paradise. It says it's on a beach and everything. The moment exercise comes around, it's almost like you turn that beautiful beach into, like Antarctica or whatever, like for, for like the tumor, you know, that's kind of like the analogy I like, I like to on to give it, you know. So exercise, in a sense, slows down the the processes, like even the metabolic processes, like, for example, with the the tumors, because you know, once when the you know the tumor is growing and growing, it's, it's almost like it's, it's like it's, it's its own living tissue where it's thriving off of metabolism, is thriving off of nutrients. It's, it's kind of like a parasite, and in a sense, well, it is. And exercise, in a way, helps to buffer a lot of those, a lot of those factors out of it, you know, not just, you know, improvement in the blood flow, in terms of allowing chemotherapy and some of the different treatments to do it's job better, because that's the thing. Like, I know it sounds like I give a lot of flack against the medications out there. Now I'm really not. Exercise. It's almost kind of like a gate opener to allow these, these cancer medications to do their jobs, to do the the job better, and also it it enhances, you know, the recovery process, like for the patients, so they're able to get more of the stronger effect of the medication, but they're able to to deal with the the adverse effects, like better, you know, and a lot of it does have to deal with reducing a lot of the inflammatory factors that are that are associated with these treatments, and also this enhancing the overall immune system. So when we're talking about natural killer cells, B, T lymphocytes, I mean, exercise helps to to increase, like a flourish of them. So you're getting, you're ultimately getting more of a reduction of the bad and a enhancement of of the good. And that's, that's the beauty of what movement does. In this case,
Peter Williams 08:39
an interesting thing about this is that you you see this. So it's a little bit when I'm two aspects, the sort of vascular diseases, as far as cardiovascular disease, and, you know, the neurodegeneratives, whether it's vascular dementia or Alzheimer's, one of the key aspects of this, which is, which I think was a point that most people forget is that human bodies are designed to be moving all the time, and a lot of the mechanisms and biochemical pathways, and I just think about stuff like nitric oxide, they're dependent on movement. And I think that, you know, you think about the increase of capillarization, etc, the increase of nutrients that can come in, they are going, as you just eloquently explained, are the mechanisms that are allowing things to get to better places. So we see this. We see this all the time, don't we, with physical exercise and its capacity to increase immunity and bring some of those cells that you're talking about, the killer cells, the lymphocytes, etc, to far off places, because you've been able to drive increased blood flow to peripheral places. Chris, how does that? So can you ask? What I want to sort of do now is that, can you give an example of that you know, of a patient? Where you've you give an example of a patient who has a certain cancer, and how, and how does it work in in real time, because obviously, they're in a pretty dark place. Physically, they're in a dark place. So, you know, we're not talking about putting them through a really strenuous 10k so can you give an idea of just what you might want to give someone, or maybe use an example that you've had, an enormous example of just getting people to do a bit of work. I mean, I can think about one of our patients who had breast cancer, and we didn't really do anything with do when we were in the gym. Just getting to the gym for her at the time was a massive, sort of breakthrough for her. So can you give us an example of some really good examples of where you know, you're using exercise, whether it's resistance or whether it's aerobics, to sort of demonstrate what, what would happen in real time?
Chris Fitzmaurice 10:58
Oh, absolutely, you know. You know, one of the things and well, and actually, and many of the cases that I've worked with, and you actually alluded to it, you know, many of them are in a dark, dark place. You know, whether they just got the diagnosis, whether they're just, you know, they're just going against the daily burden of living with cancer. And you know, the different adverse effects of it, and obviously the medications, you know, one of the big emerging issues that you know, I mean, I want to say all cancer survivors go through is depression, depression and anxiety, all of these and it all encompasses around stress, you know, just with with with just having the diagnosis and dealing with the issues itself. But one of the the miraculous things about Exercise and Movement is exercise Prevents and Treats depression. And when you when you factor this in, for the for cancer survivors, you know, it's almost like it's, it's, it's already medicine for them, it's, it's, it's a, you know, obviously, you know, exercise is not the chemotherapy. It is not the radiation therapy that it's, you know, it is effectively killing the tumor in terms of the robust effects of of the of of those medications, however, excess exercise treats depression and you know, when you lift that big boulder off of, off of the cancer survivors, it really, it really improves a lot of other issues that are going on. It's almost kind of like maybe cancer is 40% of the problem, but maybe depression is 60% of the problem, you know, and just, and I know it's more complex than than that, but you know, when I'm working with these survivors, especially when I do or when I do these telehealth group exercise sessions, you know, some of them, they show up, but they, you know, they're in pain, or they're just not feeling good, but it's almost miraculously again, when we get done, I'll see in the comment section, I'm like, Oh my gosh. I feel so great. Oh, Chris, this was the best thing that I've needed. You know? I feel good. I have more mobility in my shoulder, you know? You know, I I was feeling a bomb, bombed out, but I'm feeling so much better now. So it's like that uplift, that immediate, acute effect of being uplifted from the issues with the depression is something that I see all the time, like with them, and it's great, because it's almost kind of like that reminder that, hey, you know what, if we can at least get them, whether it's a two minute walk or an or a one hour lifting session, we know that you know what that thing in most of the that that exercise thing for them is going to to uplift them.
Peter Williams 14:14
And that's what what you saying, Chris. Because the reality of a lot of what you're saying isn't, we're not just talking about the molecular mechanisms of putting people through movement. We're talking about giving them just some degree of time away from their cancer, but also inducing community, giving them more purpose and giving them a responsibility that you know this is not going to be what they think about 24/7 because they've got something to do. So I never, I always think it's quite miraculous that the importance of those aspects within the bigger constructs of just giving someone chemotherapy, radiotherapy and then nothing else. So I'm assuming the data really supports this as well.
Chris Fitzmaurice 15:01
Absolutely, I mean, just whether it's exercise and effects, effect of depression and you know, and how depression associates with cancer risk and other issues, but just also how this goes back to cancer again. Because, you know, again, depression is, is highly prevalent, and many cancer survivors, so, so yeah, like you, you just nailed it right there. Yes, one part of its molecular, molecular medicine. Of it the molecular effects of what exercise does, but even to a broader sense, just overall mental health, for example, just like what exercise does holistically for mental health, and how that ties into all of this.
Peter Williams 15:47
So can we move on with regards to how strength and fitness can become, sort of that can almost become almost like prognostic vital signs. You know why muscle strength and cardiovascular fitness can predict treatment tolerance, recurrence, risk and survival. On that side, what does the data tell us?
Chris Fitzmaurice 16:09
Well, just, just from what I know, there's, you know, there's a lot of studies looking at in terms of, like, hand grip strength, you know about how that's a big prognostic sign for for cancer survivors, you know. So the data will tell us, you know, if they relatively have a strong hand grip strength, you know that's going to dictate a longer survival rate for them and And conversely, you know the opposite for weaker hand grip strength,
Peter Williams 16:41
so nothing really again, what we're suggesting here is that the predictors of cardio respiratory fitness, muscle strength are, well, I mean, they are the predictors across almost all chronic disease. And what you're saying is that specifically, we see the same with regards to cancer outcomes on that one, what about reoccurring risk? Is that, because of everything that we've just talked about, is because the molecular mechanisms that exercise gives you better immunity, better vascular flow, etc, reduction in depression are again mitigating that sort of reoccurrence risk and survival rates because of everything that they bring to the table?
Chris Fitzmaurice 17:29
Yeah, yeah, no, absolutely. Because, you know, when we think of and again, cancer is still a big is a major enigma of what we're really trying to figure out all the different complexities, like with it, I mean, at the end of the day, exercise and even other you know, lifestyle factors can really help to address many of those channels and those links into Those factors of cancer risk or even cancer reoccurrence, but you know, compared to what we what we know now, to what we knew 10/20, years ago, is, you know, is beyond amazing, but because we know so much More especially get taken that deeper dive into the molecular effects, because there really wasn't a lot into a lot of research going into that. You know, we get into exokines and things like that, but that's on a whole nother ball game. You want
Peter Williams 18:34
to just, do you want to just give an overview of that, just a real simple overview. Because really, in the last 30 years, we've discovered that muscle tissue is this incredible endocrine organ that is producing through exercise or movement, all of these molecules that seem to float around, but both locally and systemically, float around the body and generally do just an incredible job of keeping us healthy. But can you maybe sort of extrapolate that a little
Chris Fitzmaurice 19:06
bit more absolutely, absolutely like the I remembered when I was an undergrad and even grad school doing exercise science and clinical exercise physiology, back in 2000 and, and, you know, around like 2005 I mean, yeah, long time ago, but, but during that time, I never heard our muscles at that time, yeah, being called an endocrine organ, yeah, you know. And it's, and it's just when I heard that for the first time, I would say, maybe within the last couple of years, it's just like, Oh my gosh. Like, you know, I've been doing my thing like forever, but I've never, ever heard of it being referred to that and that and just and the reason why I'm saying that is because, you know, we're understanding so much more about, you know, what? Exercise again at the. Molecular, molecular level does for cancer, but, but just just how our muscles, for example, when we're talking about problem prognostic markers and just why muscle health is so important, you know, not just for cancer, but just for a lot of chronic diseases out there, just because the our muscles, for example, are almost kind of like gatekeepers for the release of these various myokines So, which are basically messengers throughout the body that exerts, exerts, cross talk, like ways within our organs. You know whether it's the pancreas, whether it's it's it's the liver, you know, whether it's, you know, the the the thyroid gland, like all of these different cross talk messages to to elicit various improvements in our body, whether it's dealing with inflammation, whether it's improving our our immune system, And it's almost kind of like our muscles or movement is it's almost kind of like the the process of pushing on the master switch, which is in our muscles, to release all of these, these messengers throughout our body. And we're just now having a deeper understanding about this and in just the implication of what it does against cancer,
Peter Williams 21:26
that's a really good way to say it the master switch I've again, I think this comes back to whenever I'm presenting or speaking to people that is always a conversation of everything about your body is Designed for movement. Biology and Genetics don't work as well, well, nowhere near as well, unless daily movement is applied to that body. Doesn't have to be super hard, but it needs to be happening, because things just don't work as well. And this is clearly what we're finding in the last 25 years in particular, about there just seems to be nothing that it can't do, and nothing that it can't influence, and yet, most people, well, probably for you as well, is that they just don't even hit the basic guidelines. And you know, you'll probably see this all the time, because, you know, the guidelines are, well, certainly as pens, where we look for them, but really for us, it's 150 minutes of moderate or 75 minutes of, you know, higher intensity aerobic and then two sessions a week in the gym, that would be minimum requirement. So it's almost like saying this is what you need to keep treading water, if you like. That's the minimum requirement. And just for most people, they just have never hit that. And even with people, Chris, the problem is, is that if you take a sedentary individual, you can't just suddenly bring them up to the guidelines, can you? Because, you know, there is, this is the skill of, as I say, of understanding how you apply exercise that is a graded approach over well, for the rest of your life, we can't just jump you into you know. I mean, it's a little bit like me, you know, at 56 think I'm pretty damn fit for 56 but me and my 56 can't even tell. Well, yeah, but the key for this is, is that there was a point when we first started on the track again. We're doing one session a week on the track sprint training, and the first few sessions, I was like, I just don't think I can handle this. I'm just, I just don't think I've got the body to be able to handle this anymore. And so we've got to be very careful about applying what we think in the literature. So I call it great science wrongly applied, because you've got to be very, very careful. You've got to personalize that treatment strategy, because if you overcook it, you're going to get injured, or you're going to sort of take it the other way, where you depress the immune system, etc. So it's a real, it's a real tricky pathway to follow, right? But again, can we, sort of, can we go through sort of, because I think this is, this can be really important section. There's going to be people who'll be listening to this, either have cancer, have had cancer, or know people who are going through cancer care, currently about training through treatment. What would be your best practical strategies for prescribing movement or exercise whilst they're on whilst or maybe on chemotherapy, radiation, they might be on immunotherapy, hormone therapy, whatever, what, what works in general, what's safe, and I appreciate this is obviously a patient by patient conversation. But what's the overview? What would be the overview? What would be the practicalities that you would advise that you could give
Chris Fitzmaurice 24:57
absolutely no and right? Points there. So, of course, depending on the person, and depending on, you know, the the treatments they're going on, and obviously how they're dealing with the treatments, and just, and also just their, you know, their desire to to actually move, you know, because obviously, you know, it needs to be important to them. So, so I'm really big on micro dosing the patients, like, you know, just to kind of get them to start it. Because, because a lot of the times, you know, when we think of exercise, we we kind of frame it in terms of, and I used to be guilty of this, like, Oh, you have to meet the guidelines. You have to do, you have to do the two to three days of strength training, you know, eight to 10 different muscle groups, yada yada. Or, you know, you have to, you have to walk, you know. Or yet, you have to get 100 150 moderate, moderate physical activity. Or some, I used to think of that all the time. Those are just, those are guidelines at the end of the day, it's, it's, it's, it's not mandatory that they have to achieve that. Like, maybe, maybe it's more of like, you know, what, if I can just get them to do 10 minutes or or five minutes or something like, maybe, maybe it's not like, maybe the person needs to lose weight at the end of the day, as it relates to their their cancer so, so a lot of the the gynecologist, like a lot of the gynecological cancer survivors I would work with, a lot of them did suffer from obesity, you know, and it's yes, if they lose weight, we are going to fix a lot of issues. But you know what, some of the people that I've worked with, you know what? There's a lot of resistance and flack that they're wanting to achieve those guidelines. So it's like, you know what? Instead of focusing on just the weight management side of it, let's just focus on just feeling better with exercise. So let's get that mental benefit. Let's get that mental benefit aspect of it. So sometimes I would just do something like five minutes with them, and I would kind of check with them to see, hey, how does that feel? How do you How are you feeling right now? And it's like, you know, Hey, Chris, this is not that bad, you know, I thought this was going to be much harder. Yeah. It's like, you know what? Instead of doing, instead of doing 30 minutes, maybe just try to do 6 periods. Of like a five minute, minute blocks, like throughout the day, and just try to focus on just feeling this good, because it all adds up, like the 30 minutes or whatever. So it's kind of like that micro dosing aspect of it would work great for them, because again, coming back to the issue with most of them are dealing with most of them are dealing with depression. It's almost like, you know what? We're going to focus on improving the mental health aspect of it, without me having to say anything. So they're feeling good, they're enjoying the activity. So once, when they basically, when they improve intrinsic motivation, like for them, you know when that, when it becomes a part of their routine, their established routine, that they have to do in the day. Then it's kind of like, Okay, from here, we can really build up to it, we can build up to the duration. We can build up to the frequency and obviously, intensity of the exercise, so that in the end, long term wise, they're successfully achieving the benefit, like with the exercise.
Peter Williams 28:23
So you bring up a really important point, not just in exercise oncology, but the micro dosing. We like to use the term the exercise snacks, because people will always come, come, come with and time poor to have a big time. And really, this was, so I started an Instagram, probably fat, about five, six years ago. And that was really very much, because with our patients, it was like, here's how we can gain a few more minutes a day. And so my Instagram, that's how it started. It's obviously rolled quite a bit now with quite a few followers, but it was really, that's how it started. It's still fundamentally that thing, here's the here's the snack of the day. And so it's a really, really important thing that you're you're going to hear is that, yes, we know where we know where the guidelines are. We absolutely know that you should be moving more than you are, but you've always got a few minutes somewhere to do it. So, you know, when we break it down on like that, and we've, and we've, we've done this, Chris, with loads of people, this exercise will take you two minutes. And you know what? You can do it in another two minutes somewhere else in a day, and another two minutes somewhere else a day, and suddenly we've got, we've gained six minutes on there where they wouldn't have done it before. The data is actually really quite impressive on, you know, if you can, if you can get people doing something for up to four minutes, you can have some really significant results, if you're multiplying that through the day. So it's like, we're obviously absolutely the same on this, isn't it? We don't really care where it comes from. We don't really. Care what it is, because we're just more interested in Have you done something? I don't care what it is. At the beginning, you know, all of that about this is the best exercise, or this is the best exercise, it's absolutely nonsense. Question is, have we gone from doing nothing to doing something? Because if we are, I don't really care what it is, until we felt it's, you know, yeah, we're dealing with Olympic athletes, then we need to be really specialized and all that sort of stuff. But general population, let's just get cracking. Let's do more. Let's see where we go. And it doesn't matter where we do it, you know. So, so that's, I think, and probably, based on that, it's probably much easier for cancer patients to tolerate, I would have thought as well. I would have thought tolerating long periods would be much more difficult for them as a group. Is that what you've experienced,
Chris Fitzmaurice 30:51
say that again. I'm sorry,
Peter Williams 30:53
would you I'm assuming, you know, as you know, these patients are really not, not well, really, you know, a hugely impact by by the medications, and so trying to, trying to get someone to do a full session is, I'm not gonna say it's impossible, but it's probably very, very difficult for them To do
Chris Fitzmaurice 31:19
absolutely in a lot of the cases, especially if I'm starting out with them, you know, and obviously, if they're going through through treatment and they're having and especially, especially if I'm saying, you know, depending on the timing when I'm actually seeing them, While they are done with a various dosage of something, whether it's chemo or radiation, a lot of the times they, and this is even with them motivated, you know, like, I love the exercise. I know it's good for me. I want to do it, but there are days where they some, a lot of the times they can't finish the entire workout, and I assure I tell them again, that's okay, we still got something in, you know. Because look, if you weren't going through this, if you didn't experience X, Y and Z with this treatment, even though you did three minutes with me, you would, you would have done your normal 30 minutes, you know. So this three minutes synonymously counts for the 30 minutes, because, you know what? You gave it your best, you gave it your best, and that's all what we can ask for, and you chose not to do nothing like for the day. You know, you still did something.
Peter Williams 32:34
And what's really this comes down to where, I think, fundamentally, a lot of the skill of a clinician in this situation is being able to let them know how because I think that's a really important point that you said, is that what they've been able to do in the situation that they're in currently would equate to pretty much this. That's how good it is. That's how hard and difficult it is to do it this time. So again, I think, which comes back to the skill of using positive psychology with people to give them an understanding that anything is better than nothing. And this is maybe what this would be proportional to, right? You know, and I know half of our roles in this is not to tell them the ins and outs of talk around the knee joint when they're when they're working certain things. It is a question of, how do we just keep them motivated in a positive way when they feel like absolute shit? I mean, I think that's the key thing, isn't it?
Chris Fitzmaurice 33:34
100% and I'll even, I even say this too, just that goes along the lines with this, like sometimes, a lot of the time. So when I am doing an assessment with with the patient, and you know, when they tell me that and I and of course, I look at it. I'm looking at their body language and everything. Sometimes they're just seeing me again for a reassessment, and I'll ask them, you know, know, what are you doing for exercise? You know? What are you doing to stay physically active? You know. And when they there's like, doing, I'm I'm not doing anything, you know, or I haven't been doing anything for the longest time, I will immediately say, You know what? That's really good. I'm really happy you said that this is actually a great thing. Because no matter what we do going forwards, it could just be taking 10 steps up the stairs, you know. You know. It could be doing something just for five seconds, your body is going to positive, positively respond significantly to this stress, because you haven't been doing anything. So, so it doesn't matter how big or how small, your body is going to positively adjust to it. And I say it in a way where, where it really makes them feel welcome about it. It makes them feel good and that, you know, they don't feel ashamed for for not doing anything, especially when they know that they should be doing something. And for them, it gets it opens a lot of doors, like for them,
Peter Williams 34:56
can we talk about prehabilitation,, survivorship. Can we talk about how giving someone a structured exercise program before they will go into treatment, it within treatment improves not just surgical outcomes, but probably reduces complications, and probably accelerates recovery, and obviously will will enhance quality of life as you go from that. What does the data tell us? What's been your experience on that?
Chris Fitzmaurice 35:29
Yeah, so just rehabilitation is obviously not new. It's been it's been around for a while, in terms of just for, for just all different populations, just, you know, just, you know, recovering as as effectively as possible, like from from surgery. But of of course, in the the exercise oncology, as aspect to it, it's the data is definitely, is definitely emerging, more about it in terms of how much it really does make, make a difference across various, various cancer populations out there, And also even older adults as well, you know, just some of the populations that are even at a higher, higher risk, in terms of when we talk about the cancer type, you know, the staging of that cancer, obviously and then, and also Just of how, of how significant that surgery is for them, we're getting a better understanding that even in the most severe cases or severe outcomes, exercise, just not even exercise, but just prehab, in the sense of the Nutrition, the movement and the psychology aspect, holistically, it does, it does help with outcomes. In the end, it does help them to to not take a significant loss, and it helps them to recover faster. So it's good to see that we're getting a better understanding of what of what prehab has to offer. And it's good to see that many systems are, you know, are, are, are very considerate of, of making rehabilitation in terms of, especially for exercise, for for cancer survivors.
Peter Williams 37:38
I don't know much about that in the UK. I mean, it's obviously, it's not my field, but I don't know how well developed the prehab aspect is. How does that work in the US? Then, is it that you will, because obviously you're in a healthcare system, is that that the patients will come to you immediately, once they've had a diagnosis and before they've had the chemotherapy, and your role there is, in a sense, is to try and make him as healthy as possible with exercise as one of the main modalities. So is it for a lot of people, that is a timeline? You know, I'm going to be in surgery in three months time, we need to get you as fit as we can. And is that how it works? Yeah.
Chris Fitzmaurice 38:22
I mean, of course, from a simplicity, simplistic aspect of it, we would like to frame it in that way where it's just like, You know what? You were just diagnosed with this cancer right now we want to send you. We want to send you through the prehab phase before we do surgery in the next, I don't know, two months, three months, you know. So this, there's a, there's a great time phase to, you know, to to prep up, basically to, as I like to say, you're kind of, like, training for a marathon type of aspect, in terms of, like, for the treatment. But a lot of the times, it's, it's, it's even different, you know, because sometimes they may be on, when we think of multi, multi modal interventions, you know, sometimes they will already be on, you know, the they'll do radiation before they receive the surgery, or, you know, or they maybe they will have both chemo, chemotherapy and radiation before they have the therapy, you know, you know. And maybe they, they are doing the exercise while they're going through the treatments. Or maybe the exercise portion is, is, is is completely isolated from the from the time points that they're on those different treatment modalities. So what I do know now through the research, practitioners are trying to do a better job. Or, you know, almost in a way of treating exercise, like it's its own treatment phase. It's a part of its own phase of treatment, you know, instead of just being an adjunct to it, you know, it's a vital component, you know. So, so, you know, depending on the the scenario for for the cancer survivor, ideally they want to try to push as much prehab as much as possible. So again, more better the prehab, the better the outcome, like in the end. But of course, it doesn't always work like that. Sometimes you only have two weeks or something to to to have the person to get enough exercise before they don't go into treatment.
Peter Williams 40:49
So, but what I think quite, what's quite exciting about this, and again, for anyone in the UK, forgive me, because I'm not really up to speed with with this. But what we're saying here isn't it? Is that it is another treatment strategy. That's how, certainly, the work that you've done with the with the health services that you're in is that it's just another part of the pre treatment strategy.
Chris Fitzmaurice 41:14
And we're definitely, I can see us going stronger and better in that direction. You know, just because more emerging research is coming out within that given area, because there's one time point where exercise on call, or exercise physiologists in oncology, they were primarily working with patients in the post cancer treatment, like setting, they didn't do anything during or whatever, or or maybe there's more prehab stuff, but now, just the evidence is so robust, it's almost like exercise is being is is being inserted in all the different continuums of the of the cancer phase.
Peter Williams 41:57
But It completely makes sense, even from a from a financial perspective, if you get people fitter, they're better in surgery, they recover quicker. So, you know, eat on all of those aspects, and, you know, longer less, stay in hospital, all of those fit so as I said, Yeah, I don't, I don't know how well developed it is in the UK. It's certainly probably more developed as a, as a, an associated strategy. Well, certainly you've experienced it quite a bit more. Can we? Can we? Can we give us, maybe some sort of real world experience for you about what are the lessons that you've learned from developing exercise oncology programs in sort of in clinic. Can you can you run some examples of how that would work? How does it work in a multi disciplinary team who talks to what you know? Where do you sit? How accessible it is in us again, I don't know how accessible it is in UK, it's, I certainly don't think, I think we talk about it, but I don't know. I'm sure there's some really good, probably UK centers that have it very high up on the list. But what's, what's your experience? How does the team work? How does it all fit together? Yeah.
Chris Fitzmaurice 43:22
So, so I would say, I'm just in my experience, but I would imagine, for many other people, is, of course, you know, at the end of the day, you're working with the team and and, you know, with that team, it's, it's, it's almost like you have to to establish a great level of trust, you know, you know, you need to establish a great buy in, in terms of, like, you know, what exercise can do, you know, because, like, for example, not all oncologists, but there's a lot of oncologists out there that are still kind of wary about having their patients doing exercise. This is it's gotten much better than what it was 20, years ago, but it's it's trying to, basically to create a a culture and a better understanding and a better level of trust within teams, for example, of just what exercise can do, how it can be impactful for them. You know, you know, getting them to understand, like the oncologist, for example, look, I understand that you are nervous or sorry your concern about your patient from exercise, but think of it, the exercise is going to help them to to handle the effects of the chemotherapy that you're prescribing for them. So the things that you're prescribing exercise is going to allow. To for, for them to to deal with it better, and in return, it's going to make you look better, you know. Because you know you're, you're, you're the, the essential leader of, of, of all of this, you know. So it's getting them to understand the value in a sense, of what exercise does at that level. But then, of course, the value of what it does holistically for the clinic or like within the entire like hospital. So so yeah, so depending on the space and the setting that individuals like working with, it's really doing a good job in terms of building that trust, that communication, that dialog with with your team and and just letting letting it go from there
Peter Williams 45:55
you're one of the things that we talked about before we came on her is that quite soon you're going to go, you're going to do your PhD, you're going to go back into academia around exercise, oncology and your posts are amazing that you put out what is the direction of research that you what interests you in this area? I mean, obviously there is no doubt. Again, I think if I go back 25 years, exercise was always the poor cousin, and now it's the sort of King of everything, particularly in chronic disease, because the data, the data is the data, and the data is always so impressive when we see it. What direction? What? What is the interest for you, what is it the specific interests in exercise oncology, that sort of gets you really motivated and interested in
Chris Fitzmaurice 46:50
great question. I mean, I have, I have several different ones. So holistically, I want to do whatever I can to contribute with many others to making exercise the standard level of care holistically, but then more specifically, that for the exercise is a is a standard of care for for cancer survivors, I want to be one of many to help to contribute to the body of knowledge to that and In terms of when we get down to the the intricacies, or the exact specifics of what, what is passionate to me, I'm, I'm really, I'm, I'm really big in in in the in the effects of what strength training does for for cancer survivors. So so trying to do more research in terms of what type of impact, what types of impacts that it does for cancer survivors, in terms of what it does for the mental health, what it does for them on the molecular level, and just how it impacts their their overall mortality. So I'm really, really interested in those specific areas.
Peter Williams 48:05
Well, I'm really interested there. So can we dig in a little bit more? Is there anything more specific on that? Is it because? Is it because myokine production? Is it to do with keeping muscle mass? What? What is it in particular that that really interests you on that side, or is it the just the bigger picture of, well, it's really difficult to say. Is it, is it the sort of whole picture about people feel good from lifting weights, or so? Is it, is there anything sort of very specific that you want to look at? Or is it,
Chris Fitzmaurice 48:38
I would say, definitely more of the aspect with the with the exokines, because, because that's such a a new area. I mean, I just heard of exokines for the I mean, Myokines, anything kines . I know it's so many words for it, but I've just been hearing about it for the first time just a couple of years ago. And just the fact that this is so much to do with that so much direction to go and jet in those areas, specifically, that's that's an area that I am in in am curious enough to do more research and and I'll even say, even though I know this is What I want to do. I'm still, I'm still figuring out what other specifics I may want to do, but I know it's, it's definitely in the in the world of exercise, oncology,
Peter Williams 49:32
okay, Chris, I'm going to get you to summarize, for people who are listening on this side, and it usually, sometimes it's like, what is the top five pieces of advice that you could give to someone who may have cancer, going through treatment, or there's someone listening in who may know someone who is going through cancer and struggling, what would be your. Top Five. And again, you probably say this to patients that you're dealing with all the time. What's your top five tips as far as why people should engage with exercise when they're going through their cancer journey, and why? Absolutely.
Chris Fitzmaurice 50:18
Um, you know, I'm used to hearing like a top three, but I can go along with that. So I can definitely say one of the top things is, is trust the process, you know. And I say that because, you know, many It's an unfortunate issue. You know, cancer is it's, it's the number one, or is the number is the second cause of death? Like many people are getting cancer and it's increasing, so it's almost like it's a normal thing and, and I would say, almost everybody in this world, whether if they know somebody, or if they have is some type of association, they are linked to cancer somehow. Yeah, and just when you, when you, when I say, trust the process, just know that you're going to mean you're going to be in good hands. You got people who care about you and love you. Speak with them really get as much help and support that you can, so that you have the strength and and the courage to to fight this thing. So, so that's, that's one thing I say the other, the other thing is, is always set the intention. And when I say set the intention, of course, I want people to go and to go to exercise, but nothing's perfect. No, there's going to be days where they can't do it, but, and I always say, You know what? Just set the intention that you're going to at least try, even if it means you miss out the entire week. But if you always set the intention, there is going to be a day that you know what, I'm going to do this, or I'm going to do some preliminary step to get me to move more, even if it means me to get in the car, you know, you know, to drive to the gym, but I don't, don't work out, but at least I get in the car To with the with the intent to go to the gym. So always maintain and set, set the the intention. There. Three, start slow, you know. So, you know, I rather somebody start exercise for the very first time in six months from now, as opposed to right now. And you only do it for five days, and then this is like you stop for good. So, so if it means taking forever to start, but whenever you start, you are you're setting the the guideline for yourself that, you know, hey, I'm going to stay consistent with this. I'm going to gradually build up, or even if it means if you get knocked down a little bit, but hey, you're, you're, you have all the tools, you have the resources to where it's like, you know what? I'm getting better at this. I'm going to stay along with this, and I'm just taking it slow one day at a time. Or was that three? Or was that four?
Peter Williams 53:27
That was three, mate. And I think they are all, I think, I think they are lessons for life. Those three, aren't they? Is that? You know, consistency is key, and many of us, it's a little bit like, you know, you know, I spent my whole life pretty much training and with, with lots of people that in my my social group, training, and a lot of your sessions are just pretty crappy. They're not, you're not breaking records on them, but we you turn up, and that's everything. And because a lot of it's two, two sets, you know, two steps forward, one step back, two steps forward, one step back, and yes, you know, you know that this is something that you're going to need to do for the rest of your life. So there's no rush, absolutely no rush. I think it's that. It's that question of this is what I should be doing for the rest of my life. So there isn't really too much rush. And the amount of time that it can take for me to get better, it doesn't really matter. Just consistency is key for me. On all of this. It goes with, goes with everything on that. Chris mate, it's obviously, this is a, I think, a field of medicine that is going to explode. This is the exciting thing, I suppose, with exercise, because of everything we about it, it is becoming that sort of key intervention we would love to have you. On again, mate, in a couple of years. If you've done your PhD and now you're professor of exercise and ecology at the University of Miami, that would be, that'd be fantastic. How's the weather there this morning?
Chris Fitzmaurice 55:12
Oh, it's perfect. Believe it or not, record breaking it last week and the week before it I mean, it got down because of the cold front, it got down to, like, the low 40s and high 30s,
Peter Williams 55:26
right? Wow, yeah,
Chris Fitzmaurice 55:30
yeah, it never gets cold down here, but, but, but, but that time it definitely did. But actually, I kind of enjoyed it, because I'm originally from North Carolina and and we know we have the four seasons, obviously, and it's like, it's good to feel for that short period, of course, to feel that type of like cold, because it's just hot throughout the entire year.
Peter Williams 55:52
It's a good city, though. Mate, I've been here a couple of times. So really enjoyed my time, buddy. Thank you so much for your time. Really informative. Everyone is going to love this one. So I really appreciate you giving your morning up for us. Really appreciate it absolutely.
Chris Fitzmaurice 56:10
Thank you so much for having me. This was this was a great experience.