Katie Schmitz - She Leads Science

In this episode of She Leads Science, Dr. Liz Joy talks with Dr. Kathryn “Katie” Schmitz, one of the world’s leading voices in exercise oncology. The conversation highlights Katie’s groundbreaking leadership in moving exercise from the margins of cancer care to an evidence-based component of survivorship. As a past president of the American College of Sports Medicine, founder of ACSM’s Moving Through Cancer initiative, and founding president of the International Society of Exercise Oncology, Katie has helped build the science, guidelines, programs, and global infrastructure needed to make exercise a standard part of oncology care. The discussion explores how physical activity during and after cancer treatment is associated with improved fatigue, function, strength, quality of life, mental health, and overall survivorship. Katie also reflects on implementation, referral systems, reimbursement, mentorship, and what it will take to ensure every person living with and beyond cancer has access to safe, effective movement support.

Transcript

SPEAKER_00 0:16

Welcome back to She Lead Science. I'm your host, Dr. Liz Joy. Today I am delighted to be joined by Dr. Katherine Schmitz, or Katie to many of us, one of the world's leading voices in exercise oncology. Katie is a professor at the University of Pittsburgh School of Medicine and a leader at UPMC Hill and Cancer Center, where she directs the Moving Through Cancer Program. Her career has helped transform the idea of exercise for people living with and beyond cancer from something that was once considered optional or for that matter even questionable into an evidence-based component of cancer care. UPMC describes her work as focused on supportive care treatments, including physical activity, to optimize outcomes before, during, and after cancer treatment. She's also a past president of the American College of Sports Medicine, serving from 2018 to 2019, and has been central to the growth of exercise oncology as a field. Katie founded ACSM's Moving Through Cancer Initiative with the bold goal of making exercise a standard part of oncology care by 2029. And now she is helping build the next global home for the field as the founder and founding president of the International Society of Exercise Oncology. Today we'll talk about her science, her leadership, why exercise oncology is ready for primetime, and what it takes to move from evidence to implementation and how one builds a field while still having enough energy to tell everyone else to exercise. So, Katie, welcome to She Leads Science. I am so happy you're here.

SPEAKER_01 1:45

Thank you so much, Liz. It's delightful to have some time with you. Excellent.

SPEAKER_00 1:51

Well, um, we have a lot to cover. So we're going to get going.

unknown 1:55

Okay.

SPEAKER_00 1:56

You have spent much of your career telling the oncology world that exercise is not just safe for cancer society survivors, but important. When you first started saying that, did people look at you like you just suggested chemotherapy patients trained for a marathon?

SPEAKER_01 2:11

Oh, absolutely. So when I first started thinking about doing some work in uh exercise and cancer, you know, the field of exercise oncology hadn't really, that wasn't a name that was used back then. Um, I went to talk to um some colorectal cancer surgeons. I was at the University of Minnesota at the time, and then they were like, you want to do what with our patients? They didn't understand. They thought it was very odd. So um, so I actually I wandered down the hall to um the office of Dr. uh Doug Yi, who is uh was the the uh longstanding director of the of the cancer center and at the time was a junior investigator. And I said, So this is what I'm thinking about doing. And he was a breast oncologist, and he said, Great, let's go for it. And uh and so my first work was in uh uh breast cancer and exercise.

SPEAKER_00 3:06

Love that, love that. Um, I think that's a great segue to uh the next question. You know, you're known for being both scientifically rigorous and very direct. A combination I personally appreciate. Um has that always been your style?

SPEAKER_01 3:23

I don't understand. What are you saying?

unknown 3:27

Okay.

SPEAKER_00 3:28

Really? That's why we worked so well together when we were leading ACSM.

SPEAKER_02 3:34

Yes.

SPEAKER_00 3:35

But I'm curious, you know, if if that's always been your style, or did did the field of exercise oncology in its natant state kind of require you to develop a little bit of that extra persuasive muscle?

SPEAKER_01 3:49

Yeah, I I was uh born into this. Um my mother was a lobbyist on Capitol Hill for the Equal Rights Amendment for many decades and worked with the uh League of Women Voters uh for women's uh rights. Um and she was um a force to be reckoned with. And so I I think I probably it's genetic.

SPEAKER_00 4:12

Yeah, a little bit of nature and nurture there, I bet. Um well, you know, definitely uh, you know, the commitment you've made to this field, you know, has led you to develop programs and guidelines and initiatives, and now an international society. Uh what keeps you saying yes to such big, big field building work? Not just the topic, but you know, the breadth of that work.

SPEAKER_01 4:40

Right. So um so my my training is a cross between exercise physiology and public health. And uh my undergraduate training is in economics. And so I I see things from sort of a sociological and public health vantage point. And so to me, um, the idea of getting a p-value of 0.05 in a single study just doesn't do it for me. Um, what's important to me is to change the behaviors of clinicians and societies and insurance companies and CMS, and uh to to actually change um to have a paradigm shift, the same paradigm shift we once had for exercise and heart disease. We need to have that paradigm shift for exercise and cancer. Um, everybody needs to understand that exercise is actually essential for people to have positive outcomes as they go through their cancer journey.

SPEAKER_00 5:42

Yeah, you know, that really aligns with a line that I've used a lot in my career, and that's um we have to get from discovery to delivery. Yes, right? Exactly. So much money is spent on discovery, and that's great. You know, it's it's what we've been talking about, you know, a little earlier about the discovery of new medications, you know, that are treating complex diseases. But now we have to kind of get it down the road to delivery where, you know, it's actually influencing and improving the health of people.

SPEAKER_01 6:10

Absolutely, absolutely. And that it becomes um systematic and becomes something that um uh you know isn't isn't a nice to have, but is uh, you know, considered by the clinicians who are treating cancer as an essential element of care for their patients.

SPEAKER_00 6:32

Yeah, and you know, if we both put our public health hats on, you know, having both done masters in public health, you know, it's um how do you make the right choice the easy choice?

SPEAKER_01 6:41

Yes, absolutely. Absolutely, absolutely. I couldn't agree more. And I think, you know, I think there are a variety of ways of trying to skin that cat. Um, and you know, I've been really interested in um, you know, what is the kind of evidence that gets accrediting bodies to change their minds and make exercise standard? Um, what is the evidence base that is needed for CMS to decide that exercise oncology should be uh a covered benefit? Um, what, meanwhile, is the type of advice necessary for a private insurer or an employee group to decide that exercise oncology should be a covered benefit. They're not the same. They're actually not the same. The type of evidence that's necessary, uh, we have evidence for this now for the for the accrediting bodies, really is the evidence. It actually is the evidence. I mean, the the challenge trial came out last year, it was the first randomized controlled trial to show us that exercise actually has a survival benefit for um colon cancer survivors. And, you know, and that was the impetus for the American College of Surgeons Commission on Cancer to um call for a new committee to uh start to write um a draft exercise standard for all 1,400 um cancer centers and hospitals across the United States that are accredited by ICOS COC. Um it's it's evidence and for the for the accreditation bodies. But you know, I have I have very like late-breaking news for you. Um my own institution, um UPMC, um, in March, the executive committee voted to make exercise oncology a covered benefit for breast cancer, which is remarkable. It's the first U.S. payer to uh to do this. It'll be live in January 2027. But the evidence that convinced them to do so was economic. It was not the science. It was not the benefits, it was economic. It was entirely a return on investment analysis.

SPEAKER_00 8:52

Well, I think, you know, in order for um our our science to really be relevant, um, you know, you have to be able to look at it through those different lenses. You know, what does, you know, what do other scientists need to know, you know, in order to take the science to the next level, right? What does um what do we need to do from a clinical trial perspective? What do we need to do from an implementation science perspective? Um, you know, how do we talk to, you know, like you said, to payers and then to clinicians themselves, you know, and actually get um, you know, new discoveries into routine clinical practice. And it is a journey. You know, they called it what, the 17-year blue highway from discovery to delivery. I mean, we can't we can't have that anymore. Nobody wants to pay for 17 years worth of science. You know, nobody needs to move faster.

SPEAKER_01 9:41

Yeah. We also need to be more facile as scientists because um, you know, if I see one more 12-week supervised exercise oncology intervention led by masters trained exercise physiologists showing us that, you know, we there we the the intervention is efficacious for, you know, uh patient-reported outcomes and symptoms. I'm gonna scream. I'm just gonna scream. Um, so you know, the field has to move with the evidence. So we have the evidence for survival. Now we need the evidence for the economics. There's one really beautifully done uh economic analysis in the US that's been published. We need way more than that. It's just in breast cancer. It needs to be done in other uh in other cancers as well. The field needs to recognize um where we are uh in the journey towards making exercise standard of care and pivot so that we do more in implementation science and more in economics than we have in the past.

SPEAKER_00 10:49

And certainly this affects, you know, a lot of people because in the US, about one in three adults, you know, I've read 39% of men and about the same in women, you know, will be diagnosed with cancer at some point in their lifetime. So this is important to just about everyone as cancer will strike either themselves or or their loved ones. Um, for listeners who are not um very familiar with exercise oncology, can you tell us what that is exactly?

SPEAKER_01 11:17

Sure. Exercise oncology is a field that is interested in the use of uh movement uh of a variety of types. It could be rehabilitation, it could be um, you know, physical activity, it could be formal structured exercise for cancer prevention, for addressing uh the types of outcomes that would be of interest to somebody who is currently undergoing treatment, as well as for uh individuals who are long past their treatment. So there is something called the cancer control continuum, right? Which goes all the way from primary prevention through treatment and then survivorship. And the types of outcomes that we would be interested in, um, and thus the types of interventions that would be appropriate vary according to where somebody is on their cancer control continuum. Um so there's, you know, there's there's a lot of interest now in prehabilitation and the concept of you know getting people to be more physically active, particularly before they go in for a surgical intervention. Um, and then of course rehabilitation after they're done with their surgery, um, and then exercise uh interventions, largely very structured supervised interventions during treatment, and then we can come back to the community and programs like Live Strong at the YMCA when people are done with their treatment.

SPEAKER_00 12:44

Got it. So there's a lot of different audiences for this message, right? Um, you know, definitely um we've we've already talked about administrators and payers, but the oncologists themselves as well as their patients. I think um we saw the same, so I suspect we saw we're gonna see the same thing with them that we saw in um cardiologists and um patients who experience heart disease, that um they don't engage in regular physical activity out of fear. You know, the doctors are afraid to refer, you know, because they're afraid their patients can have a heart attack or some, you know, some type of cardiac complication. And the patients are afraid to get off the couch that if they exert themselves, they're going to have a heart attack. So I'm I'm curious, you know, when you're talking with oncology clinicians, you know, what are, you know, um, what are some barriers that they're facing? And then what are some of the benefits that patients might experience that get their attention? Is it around, you know, fatigue, function, treatment intolerance, quality of life, survival, recurrence, mental health? I mean, I think all those things are benefited by exercise, probably in everyone. Um yeah. So barriers and and what are the benefits, you know, that that kind of are influencing the clinical care delivered by the oncology um community.

SPEAKER_01 14:15

Okay. So at first, there is survey evidence that tells us that the grand majority of oncologists agree that exercise is something that their patients should be doing. Um and so uh, you know, those surveys were arguably uh biased towards more academic centers. Um, and so I can't tell you what this, you know, oncologist that is in a you know solo practice in Gary, Indiana thinks. But um, you know, I think uh in general, it is the impression of the literature that um most oncologists have heard the message that exercise is going to be good for their patients. The problem is when they actually go to say something about exercise, the first thing is they don't know what to say. They don't know, they don't understand what to say. So I know, Liz, that you're very familiar with the Ask, Ask Advise Connect. You know, there's there's a variety of ways that we've taught uh primary care clinicians to talk to their patients about exercise. And so that's great, that's wonderful, that's good, we can certainly do that. Um, the complication in the oncology uh setting is that um uh you have a great swath of capability of those patients. And so there is a real need for some kind of assessment or triage to understand um, you know, where what this patient needs. Some of the oncology patients seen by a clinician will need to be seen by rehabilitation specialists, will need to be seen by a physical therapist, some can be seen by an exercise specialist with some training in oncology, and some are really fine to go out and play pickleball tomorrow, and that's fine, and they should, and that's great. But um, who's who? And on what basis do you decide this? And so I'm glad to tell you that um there are about three or four different validated triage tools that have been developed in exercise oncology that can be used. Um, the one that I use most frequently is called Exceeds, and we've developed a short form version of it that's about six to eight questions, depending on how you count questions. Um, and uh we've embedded it within our electronic medical record. And so uh every time somebody comes in for an infusion visit, they are asked these screening questions, and then my staff knows, aha, this person needs to be referred to physical therapy. Um, the other thing that I've just um uh just said to you is that it's my staff that's doing that, not the oncologist. And so um what we really want, we want the oncologist to say, hey, uh we we think it's really important that you exercise. Um Ray Scalise is going to come talk to you about exercise. I really want you to do what he tells you to do, right? That's all we really want the oncologist to do. We don't want the oncologist to ask all of the screening questions. That's a bad use of their time. We don't want them uh doing the behavioral counseling. That's an extremely poor use of their time. Um they have, you know, 60 minutes worth of things they need to cover in the 15-minute visit that they have with the patient. You know, it's not all that different than what I hear about primary care being, you know, the the 15-minute hour. Isn't that a isn't that a phrase that gets to be able to do that? Yes, exactly. So yeah, so I think it's very similar in oncology. And so we want them to say, this is important. Somebody's gonna talk to you. I want you to do what they tell you, right? And then we want to pass it off to somebody who actually knows um how to do the triage process and can then do the appropriate referrals. So um we need to set up lots and lots of different ways of trying to do this. This is actually implementation science, uh, cancer care delivery research. Um, there are people who believe that the only person who can actually get the patient to do the exercise is the oncologist. Um, there are other folks who think, hmm, we're getting people to do things pretty well with an exercise physiologist talking to the patients directly. Um, so there's some question, and those are those are testable hypotheses. But we definitely need the oncologist to say something. Um, but what they say and how much they say is is is a real question. And you ask me another question. You ask me um what they're interested in. What kind of you know results are they interested in? Oh, survival, survival, survival. I mean, challenge. I I can't tell you how many of my colleagues have emailed me to say, have you seen this? You know, they're very, very excited about the results of the challenge trial. Um, you know, it's not that it's not nice to have improvements in quality of life and body composition and lymphedema and and you know, various different symptoms and function. Those things are nice to have, but that's exactly the point. It's nice to have. What an oncologist cares about is is my patient gonna live? And is there anything I can do to help my patient live?

SPEAKER_00 19:06

And I assume, I'm gonna assume, but I don't know if that same thing is true with patients. Is survivorship the reason why they're willing to engage in regular physical activity during the course of their um cancer experience? Or is it um quality of life and some of those other symptoms that that many experience?

SPEAKER_01 19:28

Yes, some some of all of the above. Um, so you know, and um anxiety and depression is extremely common as people are going through their cancer treatment and afterwards. And we know that exercise, I mean, this isn't special to oncology, exercise is very good for uh anxiety uh symptoms and depression. Um, and so um some people find that um having something to focus on other than their cancer is very good for their anxiety and depression. Um, and so um we also know that for uh certain populations, there are certain symptoms that are motivational. So, for example, for breast cancer patients, all of the side effects that come with taking aromatase inhibitors are really, you know, a downer. And uh we know that exercise is really helpful with those symptoms. And so um we know that exercise is excellent for bone density as well. And so, you know, there's some real challenges with bone density in in several different cancer populations, not just breast. And so, so there are um examples where uh symptoms rise to the level of a motivational um uh you know factor. Um, but uh overall I would say yes, survival is is uh what's on everybody's mind. And having the challenge trial results, I I you know, people are using the challenge trial results and extrapolating that to other cancers at this point. You know, I have clinician colleagues who are writing the challenge trial results in to uh grants about melanoma. So that's it's exciting news.

SPEAKER_00 21:05

Yeah, it is really exciting. I I want to go back to um the comment around um you know, the oncologist seeing the patient in the exam room, they're probably do not have access to a physical activity vital sign unless they're in certain healthcare systems. Because certainly, you know, a pre-diagnosis physical activity habit is going to help someone, you know, as they are experiencing cancer, you know, to uh engage in physical activity because they've already recognized the benefits, right? So, you know, I see a physical activity vital sign um as being a really important tool, you know, for the oncologist to kind of understand, you know, what they're currently doing and and and using that as a stepping stone to more of a conversation around physical activity. So it seems like that would be uh important. Um, and obviously. You know, has been successfully integrated in a lot of different health systems and electronic health records. The second thing is the something that I think is unique to cancer is the cancer care navigator role, right? Which is pretty well defined. I mean, when I have had, you know, worked in different systems, you know, the role is pretty similar, right? It's really helping people to access the resources, you know, that they that is going to help them be successful in their treatment, um, but also to manage the the symptoms and side effects of their treatment. Um, but I wonder if if there's work going on to kind of redefine that cancer navigator role, you know, or or to at least provide them with additional um knowledge and skill so that they could help with that, you know, physical activity exercise triage. You should see somebody in physical therapy first. You know, you could actually transition right into um physical fitness. You know, you could be um doing self-directed physical activity on your own safely. So um can you share anything about that?

SPEAKER_01 23:11

Sure. So I have two thoughts based on what you've said. The first is um at UPMC, we are actually going to use the um the navigators as a way to uh navigate breast cancer patients into the uh moving through cancer program that we'll we offer here that will be covered by by UPMC. Um so um so you're spot on. I think that you know, systems that use cancer navigators, um this is this is an excellent use of the cancer navigator. Um so and that's already in place, and everybody sees that as sort of a no-brainer, right? So um that said, um uh what I will also say is that those cancer navigators exist at the mothership. And you know, UPMC Holland Cancer Center is in 80 locations, and um there are not cancer navigators at all 80 locations. And so, you know, 85% of cancer care is delivered in the community in places where there are not are no advanced practice practitioners, there are no APPs, there are no nurse practitioners, there is nobody who is a cancer navigator. They have chemo nurses, they have, you know, lab people, they have the doctors, and then they have the um you know the front desk staff. And that's kind of what they've got, you know. So so then the question becomes all right, how are those places, which is where most of cancer care care is happening, how do those places do it? How do we how do we make it the easy thing to do, as you mentioned earlier? How do we make it the obvious thing to do? And um, I think um, you know, automating things and doing things with telehealth is really going to help us with those. And, you know, getting people connected is gonna be the big hurdle with the locations outside of the mothership.

SPEAKER_00 24:53

Yeah, you know, as you were talking, I was thinking exactly the same thing that this is this is where our acceleration during the pandemic to, you know, to being able to connect to people virtually, you know, if there's I hate to say the term silver lining, because how could there be? But, you know, it did accelerate um virtual uh resources and services. And um boy, it seems to me like that's a a great application of it, you know, to connect people with uh the a cancer navigator with that knowledge and skill that can help connect them to um community-based or healthcare-based um resources to be physically active because we know the the benefit. But you're right, it's it's not gonna happen otherwise. You know, the collegists are too busy, you know, they're probably not seeing their primary care physician, you know, directly related to their cancer care. Um they probably don't have exercise physiologists in their clinics. I mean, you know, so how do we connect them?

SPEAKER_01 25:51

Yeah. So I I have another, there's kind of an elephant in the room um in the middle of all of this, and that is that um uh not everybody is willing to exercise um as they're going through their cancer. And right, um, so you know, we we actually have developed a behavioral um triage that uh is secondary to our um our medical triage. And um the outcomes are um we have colloquially calling them, we call them um willing, wobbly, and no way. Um and so we have patients who we talk to and we say, Hey, we have this exercise program for you. And they say, Where have you been all my life? This is fantastic. I can't wait to get home and use these resistance bands. Um and then we have the the wobblies, right? And they're the ones who are like, Well, I don't know, did you say my doctor told me to do this? I I don't know, I'll do, I'll do some of this, you know. And uh and then the no ways are the ones that are like talk to the hand, you know, no way, I'm not, I'm not doing this. And the truth is that there is some kind of Venn diagram, Liz, between um the clinical picture of the patient, and they might be dealing with peripheral neuropathy or fatigue or uh nausea, you know, or pain or any number of symptoms. Um so there's the clinical picture, and then there's the um behavioral picture and you know their readiness for exercise, and that's a reality, right? Um, but then there's also the reality of you know, cancer is a heavy, heavy load for people. And, you know, they might be dealing with financial toxicity and not know whether they can afford their next infusion. Um, they might have travel um uh challenges in getting to their treatments. Um they might be dealing with um loss of their job or you know, fear of loss of their job. Um, there might be housing instability, there might be food instability, there might be any number of other issues that they are dealing with that are real and uh that you know have to be put into the Venn diagram of whether somebody is ready for uh accepting a referral to an exercise program. And so, you know, that's why when when people ask me the question, well, how do you define standard of care? You know, I I would put it somewhere between 40 and 50 percent of patients doing an exercise program. I don't think it's a hundred percent. Um, I don't think it's the same as chemotherapy. Um I don't think that would be a fair comparison. Um, but you know, based on all of those, you know, Venn diagram circles touching each other, um I think if we can get half the half the population of cancer actually connected to a program and doing something, that would be a huge success.

SPEAKER_00 28:45

Uh yeah, for sure. I mean, it you know, I I listened to the way you're describing this, and I mean it's not that different from what we we recommend to our primary care, you know, providers. Right. It's using an expert framework, screening, brief intervention, referral to treatment. It's you know, using evidence-based behavior change with, you know, the trans theoretical model, and you know, you don't give an exercise prescription to somebody who's in pre-contemplation, you know, or they just shut the door in your face. Um, you know, and for somebody who's in contemplation preparation, you use the six A's, right? And you kind of systematically go through that. And I can tell you that every primary care provider is trained on that. Um they are all trained on that. I think the challenge is that it is time consuming, right? Yes, it is. And, you know, um, you know, an office visit is crowded. It's crowded with, you know, the physician's agenda, the patient's agenda, the patient's family's agenda. You know, it's it's hard to kind of get through all that, and yet it's so important in order for that person to be successful.

SPEAKER_01 29:49

Well, what I get to with my oncologist colleagues is I'd like you to tell me what other supportive care intervention has the survival benefits that have been documented for exercise oncology. If you can find something else, then you can tell me why you need to spend more time on that than on exercise within your encounters with your patients.

SPEAKER_00 30:14

Yeah, such a good point. And we can say that about a lot of things. Um I know, you know. Um uh especially uh with the um, not to get us too off track, but with the uh aging baby boomers and dementia prevention. You know, we've spent probably billions of dollars on uh medications that so far have not proven to be nearly as effective as exercise, but I digress. Um so Katie, you know, I'm super excited because the American College of Sports Medicine annual meeting is here in Salt Lake City next week. And uh you and I, both past presidents of ACSM, we will be there um busy from Tuesday until Friday. Um as I mentioned in your introduction, you were president of ACSM uh from 2018 to 2019. Um and I, you know, that's where, you know, during that time is I think when you were um really developing moving through cancer, which became part of exercises medicine, which I have the honor of leading. Um and one of the things that we're trying to do with exercises medicine is, you know, move discovery into delivery. Yeah. Um and you know, that's a challenge across science, across healthcare. Um, but I think it's also probably a challenge for professional societies that, you know, we really have to move to having a real world impact for the members and for the communities they serve. And um, just gonna ask you very directly, one direct gal to another, uh, what do you think ACSM is doing well in this regard? And, you know, how do they need to evolve?

SPEAKER_01 31:51

Yeah, so um I think that ACSM has stepped nicely into the policy realm and works very um uh collegially with uh the Physical Activity Alliance and all of the efforts that the Physical Activity Alliance has has started and is putting forward to try to get uh CMS to you know to cover um exercise training for a variety of different um clinical populations and a number of other uh another initiatives. The place where I think uh ACSM has an opportunity is to be um become facile with um uh uh relationships with um uh other advocacy and accrediting organizations and become more facile with um um uh any kind of uh policy efforts. Um so you know the process right now for if I write a national coverage determination application to CMS and I want ACSM to um sign on to that um uh the amount of time that it takes um to get through that process is um uh uh uh longer than uh the policy window allows. Um and so you know when um moving through cancer goes to try to get sign-on for things, um, we have to account for extra time with ACSM because of the way that the organization moves the ball down the field. Um so I think that there are opportunities to be more uh facile. I think that there are opportunities for ACSM to partner with accrediting bodies and other professional organizations. Um and um and I think you know, I've I uh being the direct gal that I guess I am, um I have, you know, kind of um um stripped the gears of ACSM on more than one occasion when I've said, look, you know, we need to do this now. Um and uh and you know I've managed to push things through, but I think I think there's an opportunity for streamlining.

SPEAKER_00 34:16

So I'm I'm guessing um with the need for speed um in this space, um, that that was probably some of the impetus um behind your really leading the development of the International Society of Exercise Oncology. Can you talk a little bit about that group and what it's doing?

SPEAKER_01 34:36

Sure. So um so the International Society of Exercise Oncology um grew out of um uh you know our efforts and our interest to raise the profile of exercise oncology. And um I I want to make sure that I give credit where credit is due. Um ACSM gave us space uh for a pre-conference in Boston in 2024 in order for 200 people from six continents to come together to have a very meaningful discussion about whether it was time to form a new society or whether it was better for us to um work within ACSM. And um uh the group uh overwhelmingly voted to uh form a new society that would be a sister to ACSM. Um I am remain quite committed to the success of ACSM. I'm coming to the meeting, I'm presenting at the meeting. Um and you know, there's a lot of of uh exercise oncology content um at the ACSM meeting, and you know, I'm you know, have like lots of running between things in hallways um in order to get to every and everything that's being offered, which is great. Um, but we felt that um uh ACSM um was not able, because it serves so many different constituencies, to allow for the growth of the kind of programming that we were looking for in um meeting. Uh and so we have formed this new organization. We have um, you know, I'm the founding president and we have a board, and uh, we're having our first inaugural meeting in Heidelberg, Germany, um, July 22nd and 23rd. Um we had um over 400 abstract submissions um for our inaugural meeting, um, which tells me that we will have at least 400 people at the meeting. So um, you know, that's that's good. Um, and you know, we our our meeting venue can't hold more than 750, so you know, so we'll see how many we end up getting. Um we have um formed committees around a webinar. We have a monthly webinar series um that is specific to exercise oncology, including, you know, everything from you know basic science through implementation science and policy. Um we have an early career uh committee that is uh doing a special webinar series giving voice to postdocs and doctoral students uh in exercise oncology. We have a communications committee that is um uh putting out a regular newsletter and is helping us to um you know focus our our website um to uh make sure that we're um getting the word out to our membership. Um and then um we have uh a newly forming um workforce committee as well. Um this is this is a huge issue. If we are able to get um third-party peer coverage for exercise oncology, um our workforce is not ready. Um the average fitness trainer in the United States and internationally can spell cancer, um, but you know, may not know a whole lot about peripheral neuropathy and when it's time to pass the patient off to the physical therapist. Um, so um so we need to develop our workforce, and um, doing so is um probably specific um to um to country or region, um, but there are a lot of commonalities within those specifics as well. And so we're we're interested in um furthering the cause of making exercise standard of care in the setting of oncology. We're interested in furthering the science of exercise oncology, and we're interested in the practice. Um our meeting uh is very welcoming to those who are um carrying out the work of actually seeing patients uh as they're going through their cancer journey and helping them with their with their exercise um uh instruction. So um so we're um we're seeing ourselves as uh, as I said, as a sister to ACSM. There is a natural tie um to the cancer sig um at uh ACSM. Um current chair of the cancer sig is Monique Potiampai, who was once my postdoc and is my colleague here. Um and so she and I talk a lot about um the uh sisterhood between ISEO and ACSM, uh cancer SIG. So um, you know, we just we felt like we'd we'd kind of um the community um was was outgrowing what ACSM could offer us in um in focus. Um, not that ACSM has done anything wrong. This is just an outgrowth of a field that is um that is exponentially growing.

SPEAKER_00 39:47

Yeah, for sure. Well, there's a lot there. Um uh for the listeners, SIG stands for special interest group. So this is uh these are people within the ACSM membership who have interests in um exercise oncology or cancer in in general, and um and they're very multidisciplinary. You know, it includes exercise physiologists, you know, masters to doctorate, you know, researchers, practitioners, dietitians, mental health professionals, clinicians of all different shapes and sizes. So the the SIGs are just a great way to kind of understand, you know, what people are doing, what they're interested in, you know, what they need. Um, yeah, I think uh the cancer sig has been you know very active.

SPEAKER_01 40:32

Very active and has grown, grown a great deal. So yeah.

SPEAKER_00 40:37

Okay, well, um we are we're coming to the end of our time together, but I have a couple of questions, and then of course, there's the famous rapid fire. So um first I want to ask you about mentorship because you know, the podcast is She Lead Science. Um, obviously your career isn't just an incredibly strong example of that. Um, and now you're, you know, certainly still doing a lot. Um, but in order for all of us to sustain our impact, right, we need to mentor the people who are going to come after us. Um, so I'm curious, you know, how do you mentor people who want to work at the same kind of intersection that you have had, you know, between science, clinical care, implementation, and policy?

SPEAKER_01 41:21

Yeah, so um these folks find me. Um, you know, I get emails frequently from people who are at this intersection and who are interested in moving things forward. And um, you know, I I like to invite folks that are interested to be a part of the Moving Through Cancer Initiative through ACSM. Um and um I have a lot of you know brief calls with people in order to kind of understand what it is that they're looking for, who they are, and you know, how we can work together to move things forward for them and for the field. Um most of the people who are working and doing all of the sort of the day-to-day work of the Moving Through Cancer Initiative are junior faculty and postdocs. Um, this I see as an excellent opportunity for them to be able to move the agenda forward, get a great publication, um, make a presentation, um, start a new project, and have the guidance of some senior folks. Um, so it's extremely important that I do myself out of a job, Liz. It's extremely important that I, you know, there will, there will never be an exact replica of me, but there should be a lot of, you you used this term earlier, uh, mini me's, you know, there should be a lot of of um uh, you know, people who um understand this field in part because um I've had the uh honor and privilege of getting to intersect with them.

SPEAKER_00 42:54

Yeah, and it's um if it while we're on the topic of kind of the future, um I have two questions for you. Um you can answer both or or pick one. Uh one being, what is the most exciting science in exercise oncology right now? And maybe said differently, what are the most important unanswered questions?

SPEAKER_01 43:14

Yeah, so the very most important unanswered questions right now, in my opinion, looking at the field in general, is the economics, understanding the return on investment. I think that that's going to get us much farther with getting insurance coverage. I have proof of this with UPMC. Um, so I think the economic analyses are where we need to be heading. Um, and uh the most exciting science, meanwhile, um, I think that there is incredible work happening um in animal models that's helping us to understand the mechanisms that underlie what we've already demonstrated with with randomized controlled trials, and that is exercise does improve survival. And so why? The question then is why? We will never have those answers from human trials that follow people all the way to survival. That's untenable. But we can get those answers in animal models. So I think if if uh if I if I had the opportunity to talk to doctoral students who are considering what direction to go, I think animal work and exercise oncology is extremely fundable right now from NIH and understudied.

SPEAKER_00 44:39

Well, of course, you know, it's really hard to get you know patients to run on a wheel all night long, right? Like so hard. They just don't want to do it, no matter how much you coach coach them.

SPEAKER_01 44:50

Or prod them or shock them with an electric prod. Yes.

SPEAKER_00 44:57

Okay, well, we're moving into our rapid fire section of the conversation. So, first, what's your favorite way to move? I am a weight training girly. Ooh, love that. Me too. Me too. Uh, most underrated exercise for cancer survivors. Walking. Love that. Most Americans, as you know, meet the physical activity guidelines for Americans through walking. So glad to hear that. One thing you wish oncologists would say more often. Please get off the couch.

SPEAKER_01 45:32

Share, share the credit.

SPEAKER_00 45:36

And last but not least, a woman in science you would love to have coffee with. Margaret Sanger. Okay, say more.

SPEAKER_01 45:45

Um she, like me, was interested in this intersection of the science and the practice and the policy and making it happen uh real time. And so she created Planned Parenthood. And um, that is the way that most women in America get their reproductive care.

SPEAKER_00 46:07

Love it. Well, Katie, thank you. Thank you not only for joining us today, but for the extraordinary way you have helped build the field of exercise oncology. Your work is such a powerful example of what happens when science does not stop at a publication or a p-value. You know, it becomes guidelines and programs, it becomes policy, movement, and and most importantly, it becomes care that helps people live better during and after cancer. And you've really helped change the question from is exercise safe for cancer survivors? to how do we make sure every person living with and beyond cancer has access to safe, effective, and evidence-based support? And and that is science leading to action. And that is exactly what She Lead Science is about. And to our listeners today, if you enjoyed this episode, please follow, rate, and share it with someone who believes that movement belongs in medicine. Thank you so much, Katie. Thank you, Liz. Okay, we're done.

SPEAKER_01 47:08

That was so fun. That was so fun.

SPEAKER_00 47:11

Awesome.

SPEAKER_01 47:12

Yeah.

SPEAKER_00 47:12

Oh my God, I wish I you did such an amazing job answering the, you know, and I'm like scrolling through my questions, going, okay, which one next? Which one next? How do I segue? How do I move from talking about mentorship to the future of cancer?

SPEAKER_01 47:27

Yeah, no, I think you did great. That was really fun. That was thank you so much. That was it was it was an honor to get, and I and I love spending time with you.

SPEAKER_00 47:36

So well, likewise, likewise. I, you know, um, I think we did extraordinary things actually during our tenure at ECSM. We moved um, we moved things along in ways that others didn't have the courage to do. Yeah, and um, that was so important for the organization, painful, but important. Yeah, yeah, and um, and there's there's still work to be done. Um, and um, but this is like this was fabulous. I'm like, I can't tell you, I'm so psyched that we could have this conversation. I think you did a great job of thank you talking about how it was, you know, important. And I tried to like, you know, ground some of it for people who may not understand, like, I don't know about exercise and cancer, but you know, like you know, we made it the norm for you know cardiac care. Hello, cardiac rehab, and still only 10% of people who are eligible actually, you know, get referred and go. Jesus. Yeah, it's 10 10 of people on Medicare. 10%. Yeah, it's horrible. That is horrible, anyways. AHA is trying to do something about that, but I don't know why it's not working. Anyways, uh, I'm gonna let you go. Uh, so let me tell you, I will um from our conversation today, I'll do a description of um what we of you and uh what we were talking about. Um, I grabbed a picture off the web that you know that um one that uh unless you want to send me a new one, a new headshot. I always use the one of your big smile. I love that one. Okay, all right, um, and uh that will go to LinkedIn, it goes to Facebook, um, public, and then I have a listserv of almost 200 people that it gets sent out to. And then um and you'll are you on that, are you on that listserv? Have you been getting the notice notifications? Yes, okay, okay, so you know you'll get this. Feel free to forward it on to everyone in the International Society of Exercise Oncology. Yes, um, I will tag you on LinkedIn.

SPEAKER_02 49:38

Yeah.

SPEAKER_00 49:39

And um, so uh, anyways, I'll get all that done today. So it'll all be up later today.

SPEAKER_01 49:47

And I'll and I'll wave at you while I run past you next week.

SPEAKER_00 49:51

I know, right? It'll be like that for me too. I uh and my two presentations are both on Thursday as well. Oh it's a busy, it's a busy day.

SPEAKER_01 50:01

Yeah, Thursday's a crazy day. Thursday's a crazy day. And then Friday, I'm doing the the um the the walk. The the hike? The hike, yeah.

SPEAKER_00 50:10

Oh nice.

SPEAKER_01 50:11

I just thought you know it'd be nice to get out, you know.

SPEAKER_00 50:14

Yeah, yeah. I do that hike uh with regularity. Um it's nice. Um, I don't I I don't even remember. Is it early in the morning?

unknown 50:23

Yeah.

SPEAKER_00 50:24

When is it? Yeah. Yeah, I'm I might do it. We'll uh we'll see if I can drag Robin out there and do it with me.

SPEAKER_01 50:31

Oh, please. Oh, please. Oh, I can't wait to see her.

SPEAKER_00 50:36

Yeah, yeah, yeah, yeah. She's she's coming in on uh Tuesday and she's staying up at our house. And um, and so I'm gonna go back and forth, you know. Um and um, but you know, she and Jim are good friends, and so she can hang out here too. Okay, okay, awesome. Okay, cool. All right, all right. Well, I'll see you in a few days. See you soon. Okay, bye.