By Pat Carragher - November 28, 2022
As Amanda Brunson approaches the track, the beating summer sun doesn’t seem to faze her. It’s July in Florida and it’s already 85 degrees by 10 a.m. It doesn’t matter.
“It brings back memories,” she says.
Brunson, a born and raised Floridian, ran 13 years of competitive track. Going for a run in 88% humidity is nothing new for her.
As a group of football players prepares for the upcoming season on the track’s infield, Brunson is running circles around them only breaking a minor sweat.
The run on this particular day is just for fun though. She places her hands down on the ground in a sprinter’s pose. There are no starting blocks to work with so she uses her imagination. With 13 years of muscle memory on her side, her feet find their position. If you’ve ever spent five minutes with her, it would be easy to see that this is about as still as she gets. Once she starts moving there’s no stopping her. On or off the track, she’s constantly in motion. Walking, talking, moving, dancing. It’s as if there’s a constant soundtrack that she’s swinging side to side to.
If there’s anything that could slow her down, she’s yet to see it.
Cancer tried twice.
Cancer failed twice.
“I was running track in college when one day my shoulder was really bothering me,” Brunson said. “I had chest and back spasms that took my breath away. I went to see a doctor, but I was told I was pushing too hard while working out and just needed to take it easy.”
Weeks later, the pain was getting worse. On top of that, she started noticing bruises and pink rashes all over her body. This time she found herself racing to the hospital.
“When my bloodwork came back, the ER doctor tugged on my foot to wake me and told me, ‘I think you have leukemia.’ ”
Brunson was diagnosed with acute lymphoblastic leukemia (ALL). What followed was three and a half years of chemotherapy, bone biopsies and spinal taps, but she kept moving. Brunson found herself in remission and was back on the track working toward an Olympic tryout. She managed to finish her senior year and graduate from the University of Central Florida despite an intense chemotherapy regimen.
Just when things were starting to look up, her ALL had recurred. Brunson found herself back at the starting line less than two years after her first bout. She underwent another round of intensive chemotherapy, but this time her doctors called for an allogeneic bone marrow transplant.
“Treatment was harsh but I tend to keep in shape,” Brunson said. “I knew being in shape during treatment would help tremendously. I really like to work out. Just because I had cancer at the time, I didn’t want to let it stop me. It honestly pushed me more.”
Brunson’s bone marrow transplant was successful. The treatments took a toll on her body, though. She was especially weak after her transplant. Despite going back and forth from the hospital because of fevers and other complications, she still found a way to push through.
“I would still go for walks whether it was just in my room or down the hallway,” Brunson said. “I was still walking, and then I was encouraging other patients who were in the same wing to come walk with me.”
EXERCISE’S ROLE IN THE CANCER JOURNEY
It was Brunson’s inpatient nurses at Moffitt Cancer Center whom she credits for pushing her to get up and move even if that was the last thing she felt like her body could do.
“I remember my nurse telling me that I would get out of here faster than if I just sat in bed,” Brunson said. “Even for the weeks at a time when I was in inpatient treatment, I was still active. I would work with resistance bands in my hospital room, and I would just go for walks in the hallway.”
Brunson’s nurses were on to something when they told her to stay active during her treatment. A growing amount of research shows that regular exercise can greatly improve physical and mental health during the cancer journey.
Nathan Parker, PhD, is one of the leading experts in this field. Currently serving as an assistant member in Moffitt’s Department of Health Outcomes and Behavior, Parker first took an interest in the subject as a graduate student studying public health and kinesiology. A graduate research assistantship with Matthew Katz, MD, in the Department of Surgical Oncology at The University of Texas MD Anderson Cancer Center led to a chance to explore what the world of exercise had to offer for patients.
“Dr. Katz became really interested in his older patients who were coming into clinic and approaching pancreas surgery,” Parker said. “These incredibly complex operations require patients to be in pretty robust order to handle these procedures and come out on the other side with the quality of life and the function that they had before.”
What started as interest then turned into opportunity.
“I started to learn and realize that there is a huge role for exercise research in cancer treatment and survivorship,” Parker said. “I worked with clinicians to design a home-based exercise program because we had patients coming from far and wide for surgery. We were trying to gradually increase their aerobic exercise, mostly walking, and we gave them guidelines for intensity and how much they should be doing each week.”
They were also given a set of resistance tubes and received instruction on how to do specific exercise movements along with guidance on how to increase resistance when they felt up to it. The initial study results came as a bit of a surprise.
“What we found was that most patients walked like crazy,” Parker said. “They were very motivated to walk and far surpassed our recommendations for aerobic exercise, but they really struggled to meet the strength training aspect.”
Follow-up interviews found that many of the participants felt they lacked the confidence to feel like they were training effectively, as it was the first time many had embarked on a formal strength training program.
“It was new to most people,” Parker said. “Everybody’s pretty familiar with aerobic exercise, but getting into a structured strength training program isn’t something that a lot of people stick to without guidance and support, especially at the onset. We started to think about ways where we could take an in-person exercise program, which is the gold standard, and bridge that to the comfort and convenience of homebased training where more patients would want to and be able to participate.”
That’s where technology comes in.
A BREAKTHROUGH OVER ZOOM
Fast forward to 2022. Video conferencing was something once reserved for the workplace, but nearly three years into the COVID-19 pandemic, Zoom calls have become second nature for almost everyone.
Now, with that technology on his side, Parker is launching another exercise study. This time technology will allow him to offer a personal trainer in the comfort of a patient’s living room with Zoom, an iPad and a Fitbit.
“We call it ‘tele-resistance training’ because we meet with the participants via Zoom,” Parker said. “We use tablets or smartphones and try to position the devices in the right spot where we can see the patients’ bodies to make sure that they’re doing the exercises properly. It’s also important for them to see us if they need some examples or to mirror what we’re doing.”
The National Cancer Institute-funded study will be open to 100 patients who have advanced, upper gastrointestinal cancers. According to Parker, muscle loss is a major concern due to the older age of patients with these diagnoses.
“The cancers themselves and the treatments that patients undergo, they can take a toll on body composition in a number of different ways,” Parker said. “Metabolic changes can lead to the deterioration of healthy body tissues. Chemotherapy and other treatments can cause fatigue and other side effects that make people less physically active and more sedentary. Both the cancer and treatments can cause nutritional issues where patients aren’t getting the calories that they need to maintain their muscle mass.”
Parker’s study will focus on the feasibility and acceptability of the exercise intervention in this clinical population, with exploratory outcomes including maintenance of muscle mass and fitness measured pre- and post-intervention. Patients in the intervention will be given a set of resistance tubes as their primary form of strength training.
“We’re using resistance training or strength training exercise for mitigating muscle loss or regaining lost muscle,” Parker said. “The goal of the training is to help keep patients as robust and strong and fit as they can be during chemotherapy. Keeping them strong and better able to tolerate their treatments might improve treatment outcomes, help them keep their energy levels up, reduce fatigue and improve quality of life.”
Nathan Parker, PhD, MPH, put together a routine of six resistance training exercises targeting major muscle groups to help maintain strength and muscle mass during cancer treatment. These exercises can be done from the comfort of a patient’s home using a basic set of resistance tubes with handles and a door anchor strap, plus a chair for balance and support.
Donneisha Smith, a research coordinator at Moffitt, was Parker’s first hire to join his new research team, called the MPROVE (Moffitt Promotes Resilience in Oncology Via Exercise) Lab. Smith recently became a certified exercise trainer while pursuing a Master of Health Administration at the University of South Florida. The MPROVE team will keep close track of participants’ sets and repetitions, helping patients safely increase their workload and progress their program as sets at a given resistance become easier.
“We use our beautiful new exercise lab to do baseline and follow-up testing, giving us objective data to evaluate how fitness changes over the course of the program and chemotherapy,” Parker said.
For the next three years, Parker will track a number of patient-reported outcomes like quality of life, fatigue and peripheral neuropathy. These can all worsen with chemotherapy, but the belief is that exercise can help to alleviate some of the side effects.
But how do you tell a patient who is experiencing nausea, fatigue and neuropathy that they need to move more and start a strength training program?
“It can definitely be a hard sell for some people,” Parker said. “But there are far more for whom it registers quickly, revealing striking motivation. Exercise can give patients something within their control at a time when everything feels out of control, empowering them to improve their trajectories and outcomes.”
‘FIND LITTLE GOALS TO SET’
Amanda Brunson is now in full remission seven years after hurdling over ALL a second time. Looking back, she knows that her drive to be active during her treatments made a big difference in the long run, even if she couldn’t feel it at the time. Her advice to newly diagnosed patients who may be facing an uphill battle is simple: Listen to your body.
“Whether it’s just a walk or riding a bike to stay active, just listen and be as active as you can,” Brunson said. “Find little goals to set and put them on your chart. It helps tremendously with your mental health.”
Today, Brunson says she’s in remission, cancer free, back in shape and giving back to the cancer community. You can catch her volunteering for Be The Match, Ronald McDonald House, Livestrong, and as a peer advisor for Moffitt’s Adolescent and Young Adult Program. That’s if you can catch her.
“Young adults dealing with cancer have become a deep passion of mine to help, but also to help cancer patients and survivors in general,” Brunson said. “I want to use my own cancer experiences and turn my pain into purpose. To reach out and be what I needed when I was in active treatment.”
This article originally appeared in Moffitt’s Momentum magazine.