Recap: Rethinking rest - cancer treatment and exercise | Dr. Jessica Scott

Summary

Podcast Summary: ZOE Science & Nutrition
Episode Title: Recap: Rethinking Rest - Cancer Treatment and Exercise | Dr. Jessica Scott
Release Date: April 22, 2025
Host: Jonathan Wolf
Guest: Dr. Jessica Scott

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Introduction

In the April 22, 2025 episode of ZOE Science & Nutrition, host Jonathan Wolf delves into a paradigm shift in cancer treatment strategies, particularly focusing on the role of exercise during and after treatment. Challenging the longstanding recommendation that cancer patients should prioritize rest, the episode features insights from Dr. Jessica Scott, a leading researcher in exercise oncology, whose work is revolutionizing recovery pathways for cancer patients.

The Evolution of Exercise Oncology

Dr. Jessica Scott introduces the relatively nascent field of exercise oncology, highlighting significant changes over the past two decades. Traditionally, the medical consensus advocated for minimal physical activity to conserve the body's energy during the taxing cancer treatment process. However, recent studies led by Dr. Scott suggest that incorporating exercise can substantially benefit patients.

Notable Quote:
"With exercise oncology, it's a fairly new field. Again, 20 years ago, the message was just rest and take it easy."
— Dr. Jessica Scott [00:55]

Key Findings: Exercise Reduces Cardiovascular Risks

Dr. Scott discusses her observational research, which surveyed a large cohort of cancer patients regarding their exercise habits. The findings revealed that patients engaging in at least two and a half hours of exercise per week experienced a 30% reduction in the risk of developing cardiovascular disease.

Notable Quote:
"If patients reported doing at least two and a half hours of exercise per week, they have about a 30% reduced risk of developing cardiovascular disease."
— Dr. Jessica Scott [00:55]

Further, her studies on adult survivors of childhood cancers demonstrated that even a modest increase of 30 minutes in weekly exercise led to a 20% decrease in cardiovascular risk, underscoring that it's never too late to start exercising.

Randomized Control Trials: Exercise Before, During, and After Treatment

Addressing the robustness of her findings, Dr. Scott elaborates on various randomized control trials (RCTs) that span the entire treatment continuum:

1. Pre-Treatment Exercise:

   • Example: In prostate cancer patients with a 4-6 week window before surgery, varying exercise doses were tested.
   • Outcome: Enhanced surgical recovery times.

2. During Treatment Exercise:

   • Focus: Breast cancer patients undergoing chemotherapy.
   • Outcome: Mitigation of cardiovascular adverse effects associated with chemotherapy.

Notable Quote:
"If you start exercising right before treatment, so we call this a window of opportunity... exercise does improve. It helps you recover from surgery a little bit quicker."
— Dr. Jessica Scott [02:37]

Shifting Medical Advice: From Rest to Movement

The conversation shifts to the evolving recommendations from oncologists regarding exercise. While 50% of oncologists in the United States now advocate for exercise during cancer treatment, Dr. Scott emphasizes that this figure is still growing.

Notable Quote:
"At least 50% of oncologists recommended exercise training in the United States."
— Dr. Jessica Scott [05:03]

Internationally, countries like Denmark and Norway have already institutionalized exercise programs as a standard component of cancer care, providing models that Dr. Scott suggests the United States can emulate with further evidence.

Defining "Exercise": Practical Approaches for Patients

Clarifying misconceptions about exercise, Dr. Scott explains that it encompasses more than intense gym workouts. Walking emerges as a foundational activity due to its comprehensive benefits, including bone strength, muscle maintenance, and cardiovascular health. For patients with reduced muscle mass or those undergoing specific chemotherapy regimens, resistance training using body weight or resistance bands is recommended to build muscle strength gradually.

Notable Quote:
"A lot of our programs are walking because it targets so many systems... But there are certain patients who have low muscle, so... it's important to try and incorporate some of that resistance training."
— Dr. Jessica Scott [06:06]

Tailoring Exercise Programs to Individual Needs

Dr. Scott underscores the importance of personalizing exercise regimens based on individual fitness levels, cancer types, and treatment stages. For instance:

• A 60-year-old woman with breast cancer might begin with 20-minute walking sessions, gradually increasing to 60 minutes per week.
• A 25-year-old man with testicular cancer could start with a higher capacity, incorporating both walking and resistance training to match his fitness level and recovery goals.

Notable Quote:
"It's about starting where you are and then you can move a little bit and it makes a big difference."
— Dr. Jessica Scott [09:11]

Timing of Exercise: During vs. Post-Treatment

Addressing whether exercise should commence immediately upon diagnosis or be adjusted based on treatment stages, Dr. Scott highlights findings from recent trials. Exercising during and after chemotherapy resulted in the most significant improvements in overall health, including reduced fatigue and fewer physiological side effects.

Notable Quote:
"We just finished a trial... exercising during and after chemotherapy... was associated with the greatest improvements in overall health."
— Dr. Jessica Scott [09:35]

Final Thoughts: Embracing Movement for Better Health

The episode concludes with a reaffirmation of the core message: movement is beneficial at every stage of cancer treatment and recovery. Dr. Scott emphasizes that even minimal physical activity, such as a five-minute walk, can yield substantial health benefits, aligning with general health advice but tailored to the unique challenges faced by cancer patients.

Notable Quote:
"It's never too late to start. It's just, you know, try and get out for a five-minute walk. It's that movement that is really beneficial."
— Dr. Jessica Scott [11:00]

Conclusion

Jonathan Wolf wraps up the episode by encouraging listeners to engage with ZOE's resources for continued health improvement. The discussion with Dr. Jessica Scott sheds light on a transformative approach to cancer treatment, advocating for the integration of exercise as a key component of patient care and recovery.

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Key Takeaways:

• Exercise Oncology is Growing: Moving away from the "rest is best" mantra towards incorporating strategic physical activity during cancer treatment.
• Significant Health Benefits: Regular exercise can significantly reduce the risk of cardiovascular diseases in cancer patients.
• Personalized Exercise Regimens: Tailoring exercise programs to individual needs enhances effectiveness and patient compliance.
• Global Variations: Some countries have already adopted exercise as a standard part of cancer care, providing blueprints for wider adoption.
• Start Anytime: Whether before, during, or after treatment, initiating exercise contributes positively to recovery and overall health.

Recommended Action:
For cancer patients and survivors, consult with healthcare providers to design an appropriate exercise regimen that aligns with personal health status and treatment plans.

Transcript

[Host]

Hello and welcome to Zoe Recap, where each week we find the best bits from one of our podcast episodes to help you improve your health. Today we're talking about the relationship between cancer treatment and exercise. For years, the standard advice for someone going through cancer treatment has been simple, just rest. The belief has long been that the body has to slow down and conserve energy to cope with the intensity of the treatment. However, recent research is challenging this long held notion. What if your body doesn't need to slow down? What if it actually needs to speed up? Today, I'm joined by Dr. Jessica Scott, whose groundbreaking research is reshaping our understanding of the best path to recovery for cancer patients.

[Interviewer]

Tell me about what your research has discovered about exercise and cancer.

[Dr. Jessica Scott]

Yeah. So with exercise oncology, it's a fairly new field. Again, 20 years ago, the message was just rest and take it easy. So one of the first layers of evidence that we looked at was observational. So this is taking a large number of patients and asking them, how much exercise do you do? And what we found with that is that if patients reported doing at least two and a half hours of exercise per week, they have a about a 30% reduced risk of developing cardiovascular disease. So that's a pretty big number. And that suggests that exercise is really beneficial.

[Interviewer]

So just to make sure I got that right, you're saying that you did this big survey effectively, and you saw that for patients who were doing two and a half hours or more exercise a week, there was actually a 30% reduction in cardiovascular disease. So a really big reduction.

[Dr. Jessica Scott]

Yeah. So that's the first line of evidence showing that is really important. And we also did a study showing that it's not too late to start exercising. So typically in an observational study, you ask the exercise question at one time point. And in a study looking at adult survivors of childhood cancers, we asked the questionnaire at two time points, and we found that in individuals that increased their exercise even by just 30 minutes a week, they also reduce their risk of cardiovascular disease by about 20%.

[Interviewer]

Are there any randomized control trials around this?

[Dr. Jessica Scott]

There are plenty of randomized trials around this.

[Interviewer]

Tell us about it.

[Dr. Jessica Scott]

Yeah, so we kind of span the continuum. So we've got trials looking at if exercise is beneficial before you start treatment, exercise during treatment, and then exercise after you've finished treatments. And what we've shown is if you start exercising right before treatment, so we call this a window of opportunity. So you've been diagnosed and depending on the cancer type. So for example, in prostate cancer, you have a four to six week window before you go in for surgery. And in that trial we tested different doses of exercise. So how, what's the volume of exercise? And does that improve some of the surgical outcomes? And exercise does improve. It helps you recover from surgery a little bit quicker. More recent one, we also looked at exercise during breast cancer treatment and this was for women that were receiving chemotherapy. So again, that pretty toxic regimen that is challenging to get through. And with this study, we found that exercise during and right after, right after treatment was really important in offsetting some of the cardiovascular changes that happen during treatment.

[Interviewer]

Now, I think quite a lot of people listening to this either who've had cancer and are living as a survivor after that or maybe undergoing treatment, you know, around the world. And the listenership to this podcast is really almost every country in the world is amazing. May be thinking, you know, my oncologist didn't tell me to exercise. You know, in fact they told me to rest. Do you feel that in general this advice of doing no exercise is still quite common? Or actually, are you seeing that there's been a sort of a big shift? Because you're saying that 20 years ago, like, you know, nobody had this feel. This is very new research.

[Dr. Jessica Scott]

Yeah, I think at least in the seven years that I've been in the field, there's been a shift. So I think it's much more common to say recommend exercise or there is less of an inclination to recommend, don't do anything. I think at least 50%. There was a recent survey that said at least 50% of oncologists recommended exercise training in the United States.

[Interviewer]

So that's a pretty big shift. It's a big shift, but not yet. It sounds like you are hoping that it's going to end up at a higher number than 50%.

[Dr. Jessica Scott]

Yeah, exactly. And again, it's very different in countries around the world. So in Denmark and Norway, it's standard that if you receive a diagnosis, you can get an exercise program or go to an exercise center.

[Interviewer]

Is that right? So there it's completely the norm. So you really see a difference from country to country.

[Dr. Jessica Scott]

Today it's completely different. And that's where we're trying to get in the United States is that similar and we just need the evidence showing that exercise is beneficial.

[Interviewer]

I think the natural. Next thing I want to ask is you've used the word exercise a lot and I'd like to understand what that means because I feel that whenever I speak to scientists, like what they mean by exercise can mean something very different from what most people listening to this is which is going. That sounds like going to the gym or going for a run. Is that what you mean?

[Dr. Jessica Scott]

A lot of our programs are walking because it targets so many systems. Walking is great for your bones, for your muscle, for your heart. So it's a great way to target as many systems as you can at one time. A bigger bang for your buck. But there are certain patients who have low muscle, so there's certain types of chemotherapy or certain history where you're starting out with not as much muscle mass as you might need. And that's where it's important to try and incorporate some of that resistance training. A lot of the work can be done depending on the level that you start with is with, with body weight exercise. So a lot of it is doing standing up and sitting down in a chair that is a squat. And then as you get a little bit stronger, you can add some resistance bands. So these are the stretchy bands that add a little bit of resistance. And the goal is to gradually build up your muscle size and your muscle strength.

[Interviewer]

So that all sounds a lot less scary in a way than the resistance training. So I feel there's some branding to be done here, Jessica.

[Dr. Jessica Scott]

That's probably true. Yeah.

[Interviewer]

So that's really interesting. You're saying even that this really makes a difference to these side effects.

[Dr. Jessica Scott]

100%. It's all about starting slow and continuing on and building.

[Interviewer]

So imagine that we have two people. One is maybe a six year old woman with breast cancer and another is maybe a 25 year old man with testicular cancer. And they both have sort of an average, average level of fitness for their age. Just to make that practical, understanding how might their recommended exercise program differ, if at all?

[Dr. Jessica Scott]

Yeah, I think the overall program would not differ that much between the two. I think their prescribed doses of exercise may differ. So the six year old woman with breast cancer may start at a lower level of exercise. For example, she may start with just doing a 20 minute bout of walking exercise and then start with 60 minutes a week of exercise and gradually try to build up from there. Whereas the younger testicular cancer individual, he may want to do start a little bit longer. So he may have a little bit higher capacity and he may be interested in doing resistance training at the same time. So again, it's trying to tailor the exercise program to the different levels and the different interests.

[Interviewer]

And this is about being realistic about where you are rather than like having some, you know, which I think is often what scares people about exercise. Right. It's this theoretical idea of like this amazing activity you can do, whereas you're just saying start where you are and then you can move a little bit and it makes a big difference.

[Dr. Jessica Scott]

Exactly. That's the key, is look at your levels, where you're at, what are you doing previously and start there and try and build up.

[Interviewer]

Should your exercise program start the second that you get this diagnosis? Should it be changing after treatment versus during treatment? How do you think about that?

[Dr. Jessica Scott]

It's a really interesting question as well, of. Because patients are receiving this very tough treatment. Should they wait and then start exercise after they've gone through a couple of cycles, or should they exercise during and after? And we just finished a trial looking at that exact question. And what we found was that for women receiving chemotherapy for breast cancer, exercising during and after chemotherapy, so a total of about 32 weeks, that was associated with the greatest improvements in overall health, both in terms of how patients reported feeling so less fatigue, less side effects from themselves. And then what we measured physiologically, it was better to exercise during and after. So basically start as soon as you can and then, and then keep going.

[Interviewer]

So in many ways, I feel like this advice is quite similar to when you just talk about exercise in terms of health for somebody who's not, you know, living with cancer or some other disease, which is the best time to start is today and the best time to stop is never. And is that that's what you're actually seeing even when you're dealing with like these horrible treatments or, you know, recovery is. Is it in a sense, as simple as that, Jessica?

[Dr. Jessica Scott]

Yeah, it's. That's what we've seen is, you know, it's never too late to start. It's, it's just, you know, try and get out for a five minute walk. It's that movement that is really beneficial.

[Interviewer]

I think that is fascinating because, you know, we've discussed on, on other shows this idea that I've certainly been brought up to believe that, you know, when your parents get to a certain age, then suddenly like, you should take their bags away from them and make them rest and not do anything. Very good. And I've been told by various scientists, oh, well, actually the best thing you could do is probably give them your bag to carry up the stairs if you really want them to live to 90. Now, I understand that here you're not as extreme as that and needs to be within the constraint of what you're able to do. But fundamentally you're saying even in this, you know, really quite extreme situation, actually if there is the capacity to do some more. And when you say exercise this, you know, again, this is sort of walking around amazingly, actually, that can be helping you, you know, is remarkable and shows, I guess, like this big swing away from, I think, a lot of the advice that we live through in the 20th century.

[Dr. Jessica Scott]

Exactly.

[Host]

That's it for today's recap. If you want to continue your health journey with Zoe, why not try our membership? Zoe is your daily coach to better Health for Life. Click the link in the show notes to get started today. And don't forget to follow Zoe science and nutrition in your favorite podcast player so you never miss an episode. See you next time.