27. Exercise Is Cancer Medicine | Anna Schwartz

Meet the woman who helped create the field of exercise oncology. Anna Schwartz, PhD, NP, isn't just a world record-holding cyclist and cancer survivor – she's the researcher whose groundbreaking work proved exercise is medicine for cancer patients. From being told by a mentor, "nobody's studying this" to co-authoring the first exercise guidelines for cancer survivors, Dr. Schwartz's journey is remarkable.

Here's what'll shock you: exercise reduces your risk of getting cancer by 10-15%, and lifestyle interventions account for 80-90% of disease prevention. That means most cancers could be prevented through movement and healthy choices. We dive deep into why 90% of cancer survivors experience fatigue and how exercise beats any medication for treating it. Plus, for those already fighting cancer, exercise can reduce recurrence by 30-50%.

Whether you're looking to prevent cancer, currently battling it, or supporting someone who is, this episode delivers actionable strategies. Dr. Schwartz shares details about her free Cancer Exercise app that adapts to any fitness level – from bedridden to elite athlete.

Get ready for real talk about why providers hesitate to discuss exercise with patients, how to bridge the gap between patients and exercise specialists, and why movement truly is medicine.

More from Anna Schwart, PhD, NP:

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Email: DrAnna@DrAnnaLSchwartz.com

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ACSM's Essentials of Exercise Oncology

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Transcript

Bill Jollie (00:00)
How can exercise help prevent cancer?

Anna Schwartz (00:03)
Well, a lot of cancers are affected by overweight and obesity. And certainly cancer is directly related to inflammation. And overweight and obesity actually further contributes to that. So that's like stacking on the pile. Exercise helps to reduce inflammation. And it helps to manage body weight. And so we see that it reduces

the risks for cancer by 10 to 15%. And we know that lifestyle interventions reduce a huge amount of disease. know,

account for 80 to 90%, of disease, morbidity and mortality in this country. Yeah, it's phenomenal.

Bill Jollie (02:53)
Hey everyone, it's Jollie here

Move Eat Give. Thanks for joining us today. We've got Dr. Anna Schwartz with us. Dr. Schwartz, thanks for joining us.

Anna Schwartz (03:00)
Thank you for inviting me. This is great.

Bill Jollie (03:02)
Yeah, you are quite welcome. You've been on my radar to have on the podcast for some time. We first crossed paths some years ago, and I'm excited to get to know you better

I'm going to read a bio here and it's pretty darn impressive. it's a little longer, but she's had an incredible career. for all our listeners, bear with us for just a second, but this is important to get all this stuff out. Dr. Anna Swartz is a global trailblazer in exercise oncology and integrative health whose groundbreaking research and personal triumphs as a world-class athlete and cancer survivor have redefined what's possible in cancer survivorship care. She currently serves as chief

executive officer of Coleman Health and executive director of the Strength for Living programs. Dr. Schwartz's distinguished academic career includes serving as professor and associate dean of research at Northern Arizona University and holding the prestigious Charlotte Peck Lineman endowed chair to the University of Nebraska Medical Center. With over three decades of experience, her innovative research has been continuously funded by the National Institutes of Health, Department of Defense and other major

agencies resulted in hundreds of peer-reviewed publications and seven authored books. Her revolutionary work has fundamentally changed clinical practice standards. Literally. She's co-authored the landmark American College of Sports Medicine meeting that developed the first exercise guidelines for cancer survivors, collaborated with YMCA USA and Livestrong to create the groundbreaking Livestrong at the YMCA program, and created the award-winning Cancer Exercise app.

Anna Schwartz (04:25)
Bye.

Bill Jollie (04:36)
As a member of the American College of Sports Medicines Moving Through Cancer Task Force, she continues her mission to make exercise oncology accessible globally. Dr. Schwartz's unique perspective is both

Anna Schwartz (04:44)
Thank you.

Bill Jollie (04:48)
A healthcare professional and cancer survivor has shaped the Strength for Living program, an elite research-proven system that fuses cutting-edge hormone optimization, precision nutrition, strategic exercise, stress masters, and longevity science into a personalized blueprint for cancer survivors and high achievers seeking extraordinary health and performance. Dr. Schwartz is a fellow of the American Academy of Nursing, reflecting her significant contributions to nursing

Anna Schwartz (04:53)
you

Bill Jollie (05:16)
science and healthcare innovation. So with that, let's see here. You've helped start an entire field of medicine. Not many people can say that. You're a world record holder in cycling. Again, not many people can say that. You're a cancer survivor. You hold an endowed chair in research. You authored an exercise guidelines for cancer survivors and you made a really cool app. So

Anna Schwartz (05:23)
Yep.

Mm-hmm.

Bill Jollie (05:40)
Where did this drive come from? This passion for exercise.

Anna Schwartz (05:44)
Yeah. So I've always had this desire. I've had this fascination ever since I was a little kid of pushing the limits of human performance. And, and that got me really into exercise, but the exercise piece really came after my, or during when I was diagnosed with cancer and I was at the absolute lowest point in my life. And I realized that, you know, if I'm going to die or if this is radically going to change,

my life, my ability to function, I've got to start doing anything, you know, kind of the bucket list things. This was before we talked about bucket lists, but, and one of my dreams that I got in my head when I was a kid, probably about nine years old was, wouldn't it be neat to ride my bike across the United States? And, ⁓ and so I set out to make that, you know, try and make that a reality. And, and that got me into, you know, cycling and then

Bill Jollie (06:18)
Yeah.

Anna Schwartz (06:37)
and then racing. And it really completely changed my life as much as the cancer did, I think. And so the combination of the two things at the same time, you know, completely changed my body, my mind, and my outlook on life and what I could achieve and do. Yeah.

Bill Jollie (06:54)
Wow, that's incredible. So,

type of cancer did you have and when did that happen?

Anna Schwartz (06:58)
I had non-Hodgkin's lymphoma. was diagnosed when I was 24. And I just felt like, you know, what am I going to do next? You know, it's just such a devastating diagnosis when you're that age. think, I mean, cancer's devastating at any age and just overwhelmingly shocking. But when you're really young, think it really, just makes you wonder about what's going to happen and what your opportunities are going to be in life.

⁓ So I was, became highly motivated to, to just live, you know, I called it dancing on the edge. I felt like I was dancing on the edge of between life and death. And, and I just wanted to just grab everything and do everything I could in life. Right. Exactly. Yes. That's, that's it.

Bill Jollie (07:25)
Yes, sir.

Nothing to lose, right?

Yeah, that's incredible. So, I mean, pretty much everybody I've talked to that that's that's

A cancer survivor has said their life afterwards is completely different. Sometimes people fall down into this horrible hole and can't climb over, but more times than not, and I think we're seeing more more folks, there's just so much hope out there and so much support out there for cancer survivors that, you know, it's not just about living, but it's about thriving. yeah, I love that.

Anna Schwartz (08:11)
Right. And really finding

that purpose and making a difference. And for me, for a while, it was all about cycling and setting the next world record. And then when I failed at one of my world record attempts, I really stepped back and I thought, what is really important in life and what can I do to make a difference? And ⁓ that's when I got involved in, I decided I really want to study cancer and exercise because

This is such an untapped area. Nobody had really been studying it. And I actually wanted to go and do a PhD in exercise physiology and study cancer and exercise. And I moved from Florida to Arizona to do that. And I got here and the person that was going to mentor me said, I can't support this. I don't know anything about cancer. And nobody's done any research in this area. And I was just.

I was like beyond devastated. I didn't know what to do. And I marched across campus and I told the nursing people, this is my situation. And they like, would you like to be a nurse practitioner? So I wound up becoming a nurse practitioner, which in the end has been a fantastic combination with my PhD because I've had a clinical practice and my research work. And then I wound up going to University of Utah where

They were fully able to embrace what I was doing, knew it was very cutting edge, and ⁓ I had just phenomenal support to pursue my research and have an amazing career.

Bill Jollie (09:34)
wow. That's cool. So, OK, so we got to we can't just skip over the world record because you might be the first world record holder I've had on here. So so tell us a little bit about that. What what was the what was the the world records in?

Anna Schwartz (09:41)
That's funny.

⁓ So I've set world records at a 24-hour distance in cycling, so ultra cycling. When I finished my ride across the United States, my friend Susan Nudarangelo, who is a really big name in ultra marathon cycling, said, you're the only person I've ever met who could break my record, and I think you should go do it. And I just thought, this woman is crazy. Who does this? Well, of course, she'd planted the seed, and the seed started to sprout. And I thought, well, how do I train for this?

Bill Jollie (10:07)
wow.

Anna Schwartz (10:16)
and you know, my background in exercise physiology was, I was fascinated and it was just when heart rate monitors were coming out and I got one from polar and you know, it, just really changed, you know, technology changes, training. And, ⁓ so I set my first 24 hour record, and I rode 418 miles and, and at that same time I was running cycling coaching and training camps.

in Florida and in Virginia. And we did climbing camps in Virginia. And one of the people I was training, you know, doing one-on-one coaching with, didn't say a thing that she was trying to break my record, that her goal was to break my record. And then I opened the newspaper one day, you know, those things we used to read. And it said, you know, Mary Burns breaks Anna Schwartz's 24-hour record. And I was like, that's...

Bill Jollie (11:01)
What?

Anna Schwartz (11:02)
Yeah, exactly. How rude.

mean, you should have told me and I would have supported you in it. And so then I was like pissed and I'm like, I'm going to go break her record. but then between then I set ⁓ a tandem, a 24 hour tandem cycling record with my tandem partner, Betsy King, who was, had done the tour to France many times and is a really famous female cyclist.

⁓ so we, we set a record of 435 miles, but I still wanted to break Mary Byrne's record just because of the way it was done. was just ugly. And so, and so I, another year later went and set that record and rode 436 and a half miles. and Betsy was like, man, you broke our tandem record. But I had a really good support team. So, you know, that makes a huge difference.

Bill Jollie (11:46)
wow. Yeah, that's incredible. I love cycling. those those kind of distances are yeah, that's that's something good. It takes a lot of drive to make that. OK, so that those so we're talking about like the early 90s, right? And then when did you go to Utah?

Anna Schwartz (11:47)
Yeah.

Yeah.

Correct, yeah.

I went to Utah in, I think it was 1993. Went up there, had a fellowship, got heavily funded with NIH, Department of Defense, Oncology Nursing Society research money, and just dove in head first. I was probably like the nerdiest. I was so excited to be able to do this research that I just, I mean, I was so passionate about what I was doing. And, you know, just everything to

the doors just kept opening to more and more opportunities. So it was incredibly exciting and fun time.

Bill Jollie (12:33)
But I think...

You're a world-class athlete. You're an exercise physiologist. You're a nurse practitioner, so you have the clinical side. And you already had the PhD when you got to Utah? got it. OK. So just having so many different perspectives.

Anna Schwartz (12:36)
Thank

No, I went to Utah and did a PhD.

Bill Jollie (12:53)
It was just, your life was just kind of funneling into exercise oncology. I mean, you were kind of destined to do this.

Anna Schwartz (12:57)
Exactly. Yeah. I

was definitely destined. And when I first finished nursing school, I worked in a bone marrow transplant unit, which was really cutting edge at that time. And so between that and then my own diagnosis and then starting to cycle and just pulling all these things in together. And I think having my own experience with cancer really helped me to understand symptom management.

when I was working with patients and then ultimately with developing exercise interventions that could be doable for people during treatment. And yeah, so it's, it has been a blended life, but everything, all roads seem to be leading to Rome. Yeah.

Bill Jollie (13:34)
Yeah.

So let's talk about like your first published paper in this new field of exercise oncology. What was the body of evidence like up until that time?

Anna Schwartz (13:48)
So,

yeah, so that's a great question. So there had been one study that had been done by an exercise physiologist before me, before I started, and she had done a really high intensity exercise program, like interval training kind of program for people when they were on treatment and found that it reduced nausea. And granted, this was in the time when we didn't have all the antiemetics that we have now that are so effective. And so,

That was pretty much it. There hadn't been any other studies. I mean, I dove in head first. I did a survey of cancer survivors who responded to a little ad that I put in or a little call for participants in, it was in Bicycling and Runner's World and Runner's Magazine and all these different sports magazines. And it was amazing the people who responded, all these celebrities.

big time news anchors, and they all wrote their personal stories in there. And it was incredible. So that was one of my early papers. When I very first started doing this work, I was just a budding researcher. And my mentor said, you need to really focus on fatigue because that's the biggest problem cancer patients have.

And I said, well, exercise helps that. And she's like, well, nobody looked at that. We don't even have a good measure of fatigue. So I actually had to step back and develop a fatigue scale, a cancer fatigue scale. So I developed the Schwartz Cancer Fatigue Scale, which is now used all over the place. And it's a short six-item measure that we could.

look and see, you know, do we change fatigue levels with exercise? And yes, we do. Exercise is one of the best things for fatigue.

Bill Jollie (15:31)
I didn't know it was called the shorts. That's cool. That's neat. Yeah. Very familiar with that. Okay. let's, talk about fatigue for a minute because, ⁓ 90 % of cancer survivors get cancer related fatigue. And like you said, there's, there's no medicine that works better than exercise. Why?

Anna Schwartz (15:33)
Yeah. Yeah.

Right.

Bill Jollie (15:50)
Yeah, just tell us why. Why is exercise so good for fatigue? Because it seems counterintuitive for a lot of people.

Anna Schwartz (15:56)
It's

incredibly counterintuitive for patients. I've had so many patients who've just looked at me like I had two heads when I've told them you need to get up and move. And they're like, get out of here, please send somebody else in. But I think, you know, I don't think we really understand the actual mechanism of why fatigue helps. I think there's a cellular activation. You know, I think you could look at the cellular level and say, ⁓ well, you're activating all these different pathways.

And there's probably some truth to that. But I think, ⁓ when you move, you know, it helps your endorphins. It increases your serotonin. It, it affects you so in so many different levels physiologically that, ⁓ that you, feel better. And certainly I knew from my personal experience, the more I followed medical advice, which was to rest more, the worse that I felt. And, ⁓ and we know that when people rest a lot.

They get weaker. And I think that's probably the number one mechanism is that when you go home and you rest a lot, you become debilitated. So when you get debilitated, it gets harder and harder to do things. It gets, you know, if you sit at home for a week and then you say, I've got to go grocery shopping, you're going to be exhausted grocery shopping because you haven't moved. You haven't used your muscles. You're getting weaker, physically weaker and debilitated. And so fatigue and weakness are the two most common side effects.

that cancer patients complain about. And it's really from going home and taking care of themselves and resting more.

Bill Jollie (17:23)
So fast forward to like the first time y'all came together for the guidelines, that first round table. When was that? Like 2010 or was that before that?

Anna Schwartz (17:34)
Mm-hmm.

Um,

they were published in 2010. We, all got together, um, in 2009, I guess, in St. Louis. And, um, it was, it was a really small group of people. were an international group. Um, and there were very few papers to, to review. I think there might've been, I don't know, 30, 40 papers to review. Um, and when we got together, and so we didn't actually write

we wrote recommendations for exercise because there wasn't enough data really. Although it was screamingly obvious if you were in the midst of doing the research, scientists were very conservative. So we made recommendations. And then spring forward 10 years later in 2019 when we had a much larger group of people that we convened, Dr. Katie Schmitz led that and... ⁓

And we had thousands of papers to review. It's just phenomenal how in 10 years, the field just has grown exponentially and continues to grow exponentially. I just met with somebody yesterday at University of Florida, whose her training is as a cardiovascular exercise physiologist. But she said, I've been touched by cancer so many times, I want to go into cancer. And so that's her new passion.

Bill Jollie (18:35)
Yeah. Yeah.

That's exciting. Yeah, we've had some of your colleagues on here, Katie Schmitz and Sami Mansfield and kind of yeah, there's there's there's Katie's book. I need to get your book on my on my shelf too. So yeah, that'd be fun. OK, so so we talked about cancer related fatigue and I'm just thinking I've talked to people trying to figure out like why some people get not not cancer related, but why some people get a like a runner's high.

Anna Schwartz (19:00)
Yeah.

Bill Jollie (19:13)
And I know I feel like so much better. I definitely get the runners high. Like it helps me just keep a clear head. My mental health suffers when I don't exercise for a long time. I had surgery earlier this year and I couldn't exercise for a while and I could feel my mental health suffering.

Anna Schwartz (19:22)
Mm-hmm.

Yeah.

Bill Jollie (19:31)
It makes a lot of sense that all those chemicals, neurotransmitters and hormones and all kind of stuff that aid, that help with that runner's high, help with a lot of other things too. So outside of fatigue, weakness, what else does exercise do to fight cancer?

Anna Schwartz (19:43)
Mm-hmm.

Yeah, you know, it definitely, so during treatment, helps with depression, anxiety, improves your quality of life. You know, we're seeing more and more that improves your body composition and your bone density. You know, some of this stuff is like such, you know, we're getting to know it so much. It's like a no brainer. Well, of course, you know, and you just said all these things that it helps you, it helps you with your focus and your concentration and just having a better outlook on life.

We also know that exercise really reduces your risks, not from a prevention perspective, if you're trying not to get cancer, it reduces your risks for getting cancer, which is huge. And we're now seeing some really fantastic new research that shows, for cancer survivors, we want to really prevent recurrence and development of second cancers. And exercise is very strong in that department.

⁓ like stronger than most medications are. So exercise really is medicine in prevention, management of tolerance of cancer treatment, and then in preventing recurrence and development of second cancers. ⁓

Bill Jollie (20:55)
So let's

talk about prevention first because when I talk about the benefits of exercise, a lot of folks don't...

realize this. And it's not just for cancer, but it's for a lot of other chronic diseases that we face. my line I usually say is you insert exercise anywhere along the cancer continuum and you have dramatic improvements. People who exercise get significantly less cancer. Cancer survivors going through active treatment have significantly fewer side effects. Cancer survivors that exercise happen to live longer than those that don't. That is not a well-known

idea because I was talking to somebody the other day highly educated and I was telling my own personal cancer story from from 13 years ago with leukemia and how a triathlon helped save my life and catch my diagnosis so early and I was talking about sitting in the infusion chair for the first day watching poison drip into your veins the chemotherapy and I was just you know I felt I was kind of wallowing in my self-pity feeling really

upset with myself that I let myself get in this position and she's like well you know like you didn't actually cause yourself to have cancer.

Anna Schwartz (21:58)
Mm-hmm.

Right.

Bill Jollie (22:07)
So American Cancer Society says something like 42 % of cancers can be prevented. I think it's probably much higher than that. We just don't have the research yet to back that up, but there's 18 million, I think, cancer survivors right now. So even if it's only 42%, that's a lot of cancer survivors that we could try to prevent if we changed behavior. So let's start there.

Anna Schwartz (22:12)
Mm-hmm.

That's a huge number. Yeah.

Bill Jollie (22:32)
Like How can exercise help prevent

cancer.

Anna Schwartz (22:35)
Well, a lot of cancers are affected by overweight and obesity. And certainly cancer is directly related to inflammation. And overweight and obesity actually further contributes to that. So that's like stacking on the pile. Exercise helps to reduce inflammation. And it helps to manage body weight. And so we see that it reduces

the risks for cancer by 10 to 15%. And we know that lifestyle interventions reduce a huge amount of disease. know,

account for 80 to 90%, of disease, morbidity and mortality in this country. Yeah, it's phenomenal.

And the most important, most powerful,

piece of that is as exercise and being physically active to reduce blood pressure and cardiovascular disease and cancers. yeah, exactly. And then you add nutrition on, and I think we've covered, pretty much covered the gamut. Of course, stress has something to do with it too, yeah. And then when you look at the other side, when people have survived cancer and they don't want to have a

Bill Jollie (23:25)
And you throw nutrition on there, of course.

Yeah.

Anna Schwartz (23:40)
you want to reduce the risk for recurrence and development of secondary cancers. In the colorectal cancer ⁓ setting, we've seen reductions of 30 to 50 % in those patients who exercise. So it is really a powerful drug. I mean, if it were a drug, if we could put it in a little pill, we would change the healthscape of Americans and of the world, really. ⁓ We haven't figured out.

Bill Jollie (24:04)
There was just a really

big study that just came out, one of the most robust studies we've had. So yeah, can you speak to that?

Anna Schwartz (24:13)
Exactly.

Yeah, you know, that was done by my colleague, Kerry Cornea and other colleagues around the country. And they looked at different exercise programs. And I'll probably misspeak on this because I'm not, you know, I'm not, wasn't one of the study people, but they saw in the group that exercised reductions in recurrence and improvement in survival.

⁓ And they followed these people, think it was like seven or 10 years. was, it was a really remarkable study. So yeah, I mean, yeah. And, and I mean, this was a huge contribution. It's very hard to do these long-term studies like this with, you know, following one person over that amount of time. So it was.

Bill Jollie (24:47)
Just adding to the body of evidence, yeah.

Yeah.

So you mentioned there's, so I think right now we can show that there's 13 different types of cancers that are related to obesity and overweight and sedentary behavior. Do you think it's more than that? And again, we just don't have the data to prove it yet.

Anna Schwartz (25:18)
You know, I think we'll

probably find out that it's more, that it is more than that. And there's certain subtypes that are, you know, more, there's definitely genetic, ⁓ you know, SNPs that, that increased your, ⁓ your, your propensity to getting cancers, ⁓ and it's environmental exposures. Absolutely. You know, there's so many toxins in the world now, you know, and, and hormone disruptors in, you know, the plastics that we're exposed to all the time that increase our risks for cancer.

So I think if we can clean up our environment and our food chain, that would further reduce a lot of people's exposure to carcinogens.

Bill Jollie (25:53)
Yeah, sure. So can you talk about what are the guidelines right now? What are the recommendations for cancer survivors?

Anna Schwartz (26:00)
Yeah, the recommendations are

kind of during treatment, the recommendations are at least 90 minutes of exercise per week, and ideally two to three days a week of resistance training. For cancer prevention and for cancer, long-term cancer survivors who are out of treatment, we recommend at least 150 minutes of aerobic exercise a week, building up to at least 300 minutes a week.

and then adding on two to three days of resistance exercise. you know, most people think of exercise and they think of just doing aerobic exercise, but it's so important to do the resistance exercise. And I think we're beginning to have a better understanding of not just in the cancer arena, but in, people in general, particularly with aging, that resistance exercise is really key because once you hit about 50, you are.

radically, you at a very fast pace, you're losing muscle mass unless you're doing something proactively to maintain that. And so many people, when they do aerobic exercise, it's a good exercise, but it's not enough to maintain their muscle mass. And so lifting weights or pulling on a, you know, a resistance band is incredibly important. ⁓

Bill Jollie (27:10)
So

what about like from a physiological basis? Can you keep, I mean, we can get really, really nerdy, but we don't have to. you share just like what's going on at a, like a cellular level or, you know?

just help explain why besides just kind of muscle wasting and saving muscle mass, but what else is going on in that ⁓ resistance training helps with cancer prevention?

Anna Schwartz (27:38)
So the resistance

training, you know, not only builds your muscles, but it also, and I usually have a little pencil or pen and I invariably break it. But when you, when you put force on your muscles, so like when I contract my muscles, see my little muscle there, I'm actually bending the two ends of the bone. So it's stimulating the bone to make more bone. it's, you know, losing bone mass happens to both men and women.

And we don't talk about it as much. We don't talk about osteoporosis and bone loss in men very much, but it's a real problem for men. And then you add on like treatments for a lot of different cancers that are bone wasting, or you have a man who's got prostate cancer who now are going to ablate his testosterone. So he's going to have really rapid bone loss. And so resistance exercise helps to maintain your bone mass.

and can actually build it back up. And because you're using your muscles to bend either end of your bone basically and stimulate them. The other way to do it is with jumping, but most adults don't really like to jump very much because we hurt as we get older. But jumping really does ⁓ build your bone mass also.

Bill Jollie (28:46)
This is amazing since, like I had heard of plyometrics, but I never really dove into it until I had my surgery that was from doing, you know, a long trail run early, early last year. So I decided at 53 and coming off a significant ankle surgery, I needed to like do everything I can to get back to, to training and, and, and, and start preparing for.

Anna Schwartz (28:51)
Okay.

Yeah.

Bill Jollie (29:11)
you know, continue to be active into my 60s, 70s, and 80s and 90s, right? So, a neat thing with plyometrics is there's a lot of jumping involved. And ⁓ it's pretty fascinating, not just for, you know, not just for speed, but gosh, just the, yeah, just talk about that a little bit more, would you?

Anna Schwartz (29:21)
Mm-hmm.

Yeah, plyometrics is really, one of those exercises that kind of gets everything all at once. It gets your heart rate up. So you're getting a good aerobic workout. You're working on your explosive power because you're jumping and then you're getting that landing. That's really helping to build your bones and your, it takes a lot of strength. really build your strength when you're jumping around like that. And that's how your power gets built. Yeah. And it's fun. It's like being a kid.

Bill Jollie (29:51)
And it's And it's Okay,

so you can't just start jumping or plyometrics or, you know, do a long distance. So cancer hits folks of, that are all across the exercise spectrum. Some people that have, that haven't exercised in 30 years. And then some are, you know, world-class athletes get cancer sometime.

Right now, I tell folks that like one of my missions in life is to ensure every single cancer survivor is referred to an exercise specialist as part of their individual cancer survivorship plan. The problem is our health system hasn't caught up with that goal. We're getting closer, but we still have a long way to go.

If somebody is seeing an oncologist, maybe they're in the rural setting or maybe they're just oncologist doesn't have the resources or knowledge yet. How do we bridge that gap, that knowledge gap?

Anna Schwartz (30:50)
That's what we're really working on right now is trying to, Katie Schmitz and Anna Campbell and I just published a book called Essentials of Exercise Oncology, which is the first textbook for undergraduate students to really start getting the next generation educated as they come out of college. But that's, your goal is my goal is to try and get every cancer survivor to an exercise program or into exercise rehabilitation. And this

this changing the whole paradigm across the medical system is really a challenge because physicians are like, I'm too busy. And then you've got like medical assistants who bring patients into the clinic who don't really have the educational background. so, figuring out how to insert that and create the easy buttons so that it's very easy for someone to get referred into exercise oncology programs.

One of the things we've done with the Moving Through Cancer Task Force, which is initiative of the American College of Sports Medicine, is we've put together a list of all, worldwide list of all the different exercise and cancer programs that are available in all the cancer exercise specialists. So that that's readily available. All people have to do is go to the Moving Through Cancer website.

and they can find that whole registry of people. And it's not just people, it's also virtual programs and like my Cancer and Exercise app is on there. But it takes a village and a lot of voices to really change patterns of care and to get people into the programs that they need to.

and really get triaged into the right one because some people don't need a physical therapist. They just need to know how to exercise properly and what they can do and need some guidance, you know, ⁓ from a trainer. ⁓ And then some people are able to, yeah, exactly. And then some people are able to use, you know, just pick up like my Cancer and Exercise app, which is tailored to each individual user by the type of treatment they're getting, their type of cancer.

Bill Jollie (32:36)
and just have somebody tell them it's okay.

Anna Schwartz (32:50)
And it follows the ACSM guidelines. So it just, you know, it's very individual for different people, which makes it a little more complicated too, because everyone needs a different prescription. It's not one size fits all.

Bill Jollie (33:02)
Yeah, so let's focus on the patient here and your app, because I've actually taken time to go through your app and it's really easy. You created an e-app and then after that, let's talk about the healthcare provider, the APP, like PA slash nurse practitioner or an oncologist. So let's focus on an individual patient right now, because odds are,

they aren't talking to an oncologist at a cancer center that has ⁓ an exercise physiologist on site. We're getting more, but odds are they're not. So you created this really neat app. So why don't you tell us about that

Anna Schwartz (33:35)
Right. Right.

Yeah, so I created the app because I saw exactly this problem. People don't have access to cancer and exercise programs and they don't know what to do. I mean, I would always tell patients you need to do this, this and this, but they would say, you're the first person who's ever told me what to do. And I know this is a problem everywhere and I know that most places don't have exercise programs for patients. So I created the app based on all of this, you know, all of these thousands of data points that I had.

and created algorithms based on someone's level of fitness, their fatigue. It adapts every day to the user. So if you have a lot of fatigue today, you'll have a lower exercise prescription than if you feel better tomorrow. And the prescription is really individualized based on what your baseline, how you perform on the baseline tests. And so it begins to ramp up over time.

using exercise physiology principles. So some weeks it's harder, some weeks it's easier to try and, you know, bring you up to the best that you can be over time. And a funny story, I was going to say a funny story about this was when I was developing it, the app developer or programmer is a pretty fine triathlete. And he said, you've got two programs here. And I said, no, really, I have really an infinite program here. And you have to figure out how to program this.

Bill Jollie (34:40)
So is this, go ahead, no, no, no, tell your story.

Anna Schwartz (34:59)
And then once he did it, he started testing it and he said, Hey, this even works for me at my, you know, as an elite athlete. And I said, that's the, that's what I wanted. You know, I want something that would take somebody from being bedridden and get them stronger, but also be helpful for a young guy who's super fit and trying to maintain their fitness. Yeah.

Bill Jollie (35:18)
So

even before someone goes to your app, should they talk to their provider? Make sure there's no limitations they need to be aware of?

Anna Schwartz (35:25)
You know,

that's a real struggle. think for the vast majority of people, they can exercise. We all walk every day, don't we? So why would I ever tell someone not to walk? And the biggest problem in our country right now, and probably worldwide, is inactivity. So why would I put up that barrier? I want people to pick up that app and be able to go. And if they can't walk very far, in the six minute walk that the app starts with,

Bill Jollie (35:32)
Yeah.

Anna Schwartz (35:50)
it's going to totally titrate the exercise program down.

Bill Jollie (35:54)
I think that's important.

It doesn't matter again, if it's been 30 years and you're a novice and beginner and have no experience and you're out of shape, it doesn't matter. Or if you're an elite level endurance racer, it adjusts for you.

Anna Schwartz (36:10)
Right, It adjusts.

Yeah. So it gives you, and there's a whole library in there of how to do the different resistance exercises. So if you've never done them before, you know, you'll know how to do them. And it gives you, you know, it starts you off at a very basic level ⁓ because, pardon me.

Bill Jollie (36:27)
So sounds really expensive.

I said your app sounds really expensive.

Anna Schwartz (36:32)
it was really expensive to develop it. It's been, ⁓ no, actually right now it's, it's free. yeah. yeah, I really want people to use it and it right now it's being used by people all over the world, which just blows my mind. I'll get emails from people, you know, all over the place and, researchers in different countries that want to use it or, or, or tweak it in different ways. ⁓ so I'm really hoping.

Bill Jollie (36:34)
no, no, no, I mean to use for the the user. Yeah, I was setting you up.

Yeah,

really is easy to use. So you've a good job.

Anna Schwartz (37:00)
Yeah, that was my goal because

most people, know, so many cancer survivors are older and they may not be comfortable with using apps and I wanted it to be really easy to read if they had a hard time visually or whatever. So.

Bill Jollie (37:12)
Yeah. So,

So let's turn to the, to the providers. So PAs, NPs, MDs, DOs, they're very hesitant about initiating this discussion with patients because I've had, I've had oncologists tell me like,

Anna Schwartz (37:16)
Mm-hmm.

Bill Jollie (37:28)
Of course I know my patients should be exercising. Of course I know it's good for them. But as soon as I ask, tell them that they should be exercising. You know what the first question is going to be? ⁓

Anna Schwartz (37:39)
What do I

have to do?

Bill Jollie (37:40)
What do I do? And I don't know what to tell

them. And I don't have time. So I do before, before I let you get started here, you use the term easy button. And that's what I use with folks all the time. Like we don't expect our providers to know everything there is to know about radiation or everything there is to know about surgery or nutrition. That's why you hit the easy button and refer it out.

Anna Schwartz (37:52)
Mm-hmm.

Right, exactly.

Bill Jollie (38:03)
That's all you got to do. You just

got to have a plan in place. talk to us about providers. How do we bring providers up to speed and get them comfortable?

Anna Schwartz (38:10)
Yeah, so I think, well, a lot of the stuff that we've done through the ACSM is to develop, you know, like tear sheets that they can give is either there's one version where they can give it as a prescription and write in, you know, just check the boxes of, you know, lift two days a week and walk for, you know, work up to walking 300 minutes. You know, that seems like incredibly easy because, you know, we're used to writing, you know, prescriptions and things.

There's also just like informational sheets that they could have in their clinic for patients. And then certainly, you know, knowing about the registry and then becoming familiar with people in their community who can be that resource and that referral. I think once somebody, a clinician makes a connection in the community with somebody who has some cancer and exercise knowledge, they can use that, you know, that person to refer to.

⁓ and say, need to go see, Jolly, you need to go see, you know, so and so and get your cancer exercise fix. So.

Bill Jollie (39:10)
So

really, providers do this all the time with resources in the community. They're always networking, trying to figure out who to send a patient to for this or that. That's really how easy it is, right? It takes a little time up front, but you just have to reach out and get a network.

Anna Schwartz (39:15)
great.

Exactly.

You know, women with breast cancer, they're at risk for getting lymphedema, which is when their arm gets swollen. And we refer people to lymphedema specialists all the time. I mean, that's just standard of care. And if you don't attend to their swollen arm, then that's, know, you're not really, you're not practicing very well. And so you refer to a PT or an OT, you know, somebody who specializes in that.

that can help the patient manage that because I don't have time in clinic to go through everything. It's not my expertise. So I refer them out. so we just need to get the volume of educated trainers and physical therapists and OTs in the community so that they can lead the charge and so that there are more programs to refer people to or individual providers that can.

can help patients with that.

Bill Jollie (40:12)
Yeah, so not everyone has access to a YMCA, but you helped create Livestrong at the YMCA. ⁓ I don't know if it's free, but it's very low cost. Yeah, sure. yeah, and there's plenty of...

Anna Schwartz (40:17)
Mm hmm. Right.

It's very low cost and they do a lot of scholarships. Yeah.

Bill Jollie (40:30)
resources for exercise physiologists, exercise specialists, even trainers to go out and get certified, right?

Anna Schwartz (40:36)
Yeah. There

are lots of educational programs and we just, ⁓ Anna Campbell just completely changed the, ⁓ and upgraded the American College of Sports Medicine certification. So it's very doable. It takes time. There's, you have to have a lot of, you know, there's a lot of modules. But cancer is a complicated disease and it's, it's not one disease. There's so many intricacies and then so many different effects of

of cancer treatment. So a trainer really needs to have a pretty good knowledge base, but that program provides all of that.

Bill Jollie (41:08)
Even if you're in a very rural setting, if there's an oncologist or somebody that's motivated, allied health professional in a cancer center, like it just seems, you just need a spark. You need to reach out to somebody that an extra, a local physical therapy or something. And even if they're not trained, like the two of y'all working together,

to improve your knowledge would be a very powerful team to help an entire community.

Anna Schwartz (41:30)
Exactly.

It's hugely powerful. even in a really rural area, there needs to be at least somebody who has that knowledge. And I think we're really focusing on workforce development. I think in five years, it's going to be a very different conversation because there'll be a lot more people out there with interest and understanding and the clinical knowledge of

of how to get people into a safe exercise program.

Bill Jollie (41:59)
So putting your, ask you to put your nurse practitioner hat on for a second. Nurse practitioners and PAs, APPs seem best suited to kind of own this so far for a cancer center.

Anna Schwartz (42:12)
think we do.

We tend to spend a little more time educating the patients and really pushing them into more of the lifestyle changes that will make a difference for them. Again, it's a huge, when you think of what these people come out of school with, their background, is really poorly developed, shall I say, in...

with exercise. mean, nurses don't come out of nursing school or nurse practitioner training or PA training with a strong background in, in exercise, whether it's for rehab of cancer or cardiovascular disease or arthritis or any of that. And, ⁓ I personally think there needs to be a whole module at the advanced practitioner level about exercise and chronic disease. because it's just so, it's so critical. There should actually be exercise for

disease prevention and chronic disease. But that's the disease prevention thing. We just keep pushing that out, even though we have so much knowledge about disease prevention and we just, we don't seem to value that. We only value the treating the problem. We don't want to see you until you have a problem, ⁓ which is just backwards. ⁓

Bill Jollie (43:18)
Yeah.

It's completely backwards. I think we'll get it fixed. It's going to take a little bit. I think I've got one more question before I put it back over to you. So let's talk about prehab for a second. So we've learned a lot about...

prehabilitation. So rehab afterwards and prehab is actually before you start treatment. So somebody gets diagnosed. Sometimes it's critical. You have to get started with treatment right away, whether that's a medicine or a radiation or surgery. But sometimes you do have a little bit of time, even if it's only three weeks. Can you talk about the benefits of prehab going into treatment?

Anna Schwartz (44:00)
Yeah, prehab is incredibly

important. Even in three weeks, you you think of somebody, we've really seen this in the lung cancer setting where prehab is you get diagnosed with lung cancer and you know, you're not very functional. Your lungs aren't functioning very well and a lot of them are pretty debilitated and you get them to exercise and they get stronger before they get, go to surgery. And so they're going to do better post surgery. They're going to tolerate the chemo better.

They're just, their outcomes are going to be better. And this is true for, you know, for anyone with cancer. If you can start to, if you're not an exerciser and then you get diagnosed, if you can get launched into that, by God, I'm going to be as strong as I can before I start all this treatment, it's going to make a big difference. And then if you can maintain it throughout, it makes a huge difference. You know, I think, I think about like, ⁓ knee replacement surgery. And if, if you can,

do really intense leg strengthening exercise before a knee replacement or a hip replacement, your recovery and your outcomes are going to be so much, your recovery is going to be so much faster and your outcomes are going to be better. And it's the same with cancer. I mean, you're going to tolerate, we know that when you exercise during treatment, certainly if you start exercising before your start, you have to go to surgery.

you have a better tolerance for treatment. You're more likely to get the full dose of chemo. And yeah, it's huge. You say, well, so what if I get the full dose? Well, so what? That means you're much more likely to reach that cure. And so it means a lot.

Bill Jollie (45:23)
I was going to point that out. Yeah, that's a huge thing. Yeah.

I

remember... so this is is old-fashioned chemotherapy when I when I got it back in 2012. But you know the full dose was six cycles of bendimustine rituxan. Doesn't really matter what it is. There's countless meds out there now. But like the full cycle was... or the full dose... the full regimen was six cycles.

every 28 days. But I remember my oncologist saying, you know, the average was only about three of those cycles because it was it was so harsh. ⁓ I think this becomes even more important. It's important to everybody, but even more important for for for our older patients, because those are the ones that have the problems tolerating medications. More even more so.

Anna Schwartz (46:03)
wow. Right.

Bill Jollie (46:19)
Yeah, so go ahead.

Anna Schwartz (46:19)
Yeah, very definitely. And it's hard to

get old people to exercise when they've never exercised in their life. Really hard to move the needle. And that's what I'm always saying. Some movement is more important than none. And just getting up off at the couch and walking around the dining room table can help you. So.

Bill Jollie (46:29)
Yeah.

There's,

I get such a smile on my face. I'm starting to see more and more examples of folks in their eighties.

doing sprinting and weightlifting. Oh my gosh, I don't remember her name. I follow her on Instagram. She's in her early 80s. I don't know if she's 83 or 84, but I don't think she started lifting until she was 63. And now she's like world record holder and winning all these...

Anna Schwartz (46:51)
Mm-hmm.

well.

That's cool.

Bill Jollie (47:08)
contest because like, you she's the oldest one out there, but she's still like doing the Olympic lifts and I mean, knocking it out in her early eighties. So it is literally never too late to start.

Anna Schwartz (47:11)
Yeah.

That's awesome.

It's never too

late. Our bodies are meant to move and it's just, it's the most important thing you can do for yourself. Yeah.

Bill Jollie (47:26)
That's a pretty fantastic place to stop. So let me ask you, is, we covered a lot today and I feel like we could have kept talking to you for a while. Is there anything else you want to share with folks?

Anna Schwartz (47:31)
Mm-hmm.

I think it's just the most important thing you can do whether you don't have cancer and you want to prevent it or whether you're a cancer survivor or a person living with cancer, movement is medicine. It's the most important thing you can do. It really is.

Bill Jollie (47:51)
I love that. So you mentioned moving through cancer, American College of Sports Medicine. ⁓ What's the name of your app again?

Anna Schwartz (47:58)
My app is Cancer Exercise. My book is Cancer Fitness. It was written in 2004, but it's as relevant now as it was then. ⁓ Nothing is, you know, we had a lot more data now than when I wrote that book, but everything in the book is still pretty relevant. ⁓ Yeah. And then I have a program called Strength for Living for cancer survivors and for people who are really interested in optimizing their health.

Bill Jollie (48:03)
Okay.

Very good.

Alright, so I did think of one more question, what's the best way to follow you or get a hold of you?

Anna Schwartz (48:29)
⁓ I'm Dr. Anna L. Schwartz at Dr. Anna L. Schwartz. I have a practice page that's Dr. Anna L. Schwartz, www.drannalschwartz.org or the Cancer Exercise app, which has information about the app and also another email for me.

Bill Jollie (48:48)
Gotcha. So the last question I just thought of like what do we still need? What are we still lacking in cancer research?

Anna Schwartz (48:55)
there's still a lot that we have to learn. We have to really understand like the cellular mechanisms of things because we always want to know. And if we can understand the cellular mechanism of things, the mechanisms are everything. If you can understand the mechanisms, you understand why you can really focus interventions better. We need to have.

insurance reimbursement, we're working on trying to get Medicare coverage right now. That's going to be a very long drawn out process. But that's key to get people, know, cancer survivors healthy again and strong and functional. So it's really, really important. And so many people do need the specialized care of a physical therapist or an occupational therapist. That's, you know, a ⁓

a step above what an exercise trainer can do. And we need to build this workforce so that we've got the volume of people across the United States and around the world who can help cancer survivors regain their vitality and their zest for life. Yeah.

Bill Jollie (49:56)
Yeah, I

fully believe that we'll get there. I don't know if it's gonna be, you know, 10 years. I think we'll make great strides just in the next five years, but we'll get there.

Anna Schwartz (50:05)
We, this field

is growing so fast. It's just exploding. So I think we're going to see changes really quickly. It's really, it's such an exciting time. Yeah. Yeah.

Bill Jollie (50:12)
Damn. It is exciting. ⁓

This is fantastic. Well, thank you so much for spending time with us today. ⁓ This has been a lot of fun. So with that, Dr. Schwartz. All right. Have a good one. Thanks.

Anna Schwartz (50:20)
Thank you for the invitation.

Great. Thank you.