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GRAHAM: Coming up on Catalyst - targeted exercise programs may double
your chance of surviving cancer.

JONICA: By the time you hit my age, odds are you've been touched
by cancer - either yourself, or someone close.

By age 85, every second Australian
will develop it. But what if I were to tell you
there's a medicine that may double
your chance of survival and cause your own body
to attack the cancer?

It's exercise,
but not as you know it.

I'm here at a clinic
where, in a groundbreaking move, people are being prescribed
specific targeted exercises designed for their own tumour
and treatment on the same day as they get
their chemo or radiation.

MAN: The evidence is so strong now that the cancer patients
deserve this medicine. You've literally, this minute,
come from chemo? Yep. Straight from the hospital
to here.

In this program, we'll show you what professionally prescribed
exercise is doing for a group of Australians
with cancer...

Best thing I ever did. It made me feel better. I felt
better at the end of each session. ..and present startling new research that reveals the secret
of how it works. MAN: The muscles
are producing chemicals, and they're actually
destroying tumour cells. The trial is still ongoing, but the early results
are so impressive, the doctors think
it will be a game-changer.

This is our exercise medicine clinic
here at the cancer care centre. As far as I know, this is
a world first, to have that close to the actual chemotherapy,
radiation therapy suites. The man behind
this audacious new program, which includes a gym built inside
the cancer treatment centre, is Professor Robert Newton... So, you had radiotherapy today?
Yeah. ..director of the renowned
Exercise Medicine Research Institute here in Perth, Western Australia. A lot of our research is actually
driven by the oncologists, because they're right working
with the patients and they see what's happening. And they came to us and said,
"Look, why are we actually waiting "until these patients
are SO deconditioned "and they're feeling SO unwell, "and then we try
and rehabilitate them? "Wouldn't it be a way better,
much more effective approach "if we actually intervene
with the exercise "at the same time that
they commence their therapy?"

At the time, this team were already
at the forefront of providing exercise programs
for patients once they'd finished
cancer treatment - with good scientific reason. We now have a growing number
of research studies showing that if people hit a certain
level of physical activity - which is relatively modest,
to be honest - then they'll more than double their
chances of surviving their cancer. In other words,
they halve their risk of dying. But the idea to start
the exercise program at the same time as starting
punishing cancer treatment, well, that's still pretty radical.

It was a little bit of
a step into the unknown, because chemotherapy,
as most people would know, is a very difficult journey
for the patient. And to put exercise on top of that -
you know, is that a good idea? Will they tolerate it?
Will it be safe? What about the muscle strength?
How are you going with the gym work? To actually go against that mould and say to people,
"Right, up you get. "You're having chemo today.
That's fine. "Now we want you to get
on an exercise bike, "and now I want you to start
doing some weights," because it is,
you know, a new concept, yeah, of course
we're all nervous about it. OK, two more reps, Margaret,
and then you can have a rest. So, push, push, push, all the way... Convinced, though,
they had a great team of oncologists
and exercise physiologists on board, they began.

One of their first recruits
was Natalie. I was diagnosed with breast cancer
on 11 February...last year.

It was already spread through
my milk ducts in my breast, on my left breast. It was quite serious
and it was quite advanced, so we needed to get on top of it
quite quickly. Hello. There you go. You OK? Alright, you ready?
Yep. I've got a four- and a six-year-old,
and a busy husband at work. And it just turned our lives
upside down. Absolutely upside down.

Natalie knew to brace herself
for heavy-duty chemo, but she never expected
to be asked to exercise. At the time, I wasn't
very fit and healthy anyway, so why not try it, you know? And so I did. I went along
pretty much straightaway, as soon as I started chemo. Joined up, got a phone call,
had to commit.

It works like this. On chemo or radiation days, patients book in here
to the in-house exercise clinic.

In between, three times a week, they come here to Exercise Medicine
HQ at Edith Cowan University... You've had that reconstruction,
so we don't want... ..all under the direction of a team
of expert exercise physiologists. Effort, you breathe out... When I first met Natalie, she was... ..struggling quite hard
with her chemotherapy. It was hitting her hard. But she's such an awesome woman - determined to exercise
whenever she could.

Another three reps. It's the exercise physiologist's job to tailor the program for each cancer
patient's special circumstances. Keep that breath going.
It's really important. Natalie got some really bad
peripheral neuropathy in her feet, so it really hurt to walk. So, obviously, the treadmill was
out of the question, and so we moved her
onto a recumbent bike. Still, as Natalie was
one of the first, many were understandably nervous about whether it would
ultimately prove too much, including Natalie's kids. They didn't think I should do it.
They were a bit scared. 'Cause I looked so frail
and I looked so bald and I looked different. I was getting my gym gear on
and dropping them off to school, and off I'd go, and they'd... .."You're going to gym AGAIN, Mum?
After chemo?" "Yeah."

But when they'd see me come home, still going
and not laying on the couch and not having some of those
symptoms that typical patients get, I think they could see the benefit. That's it. Good. Natalie often dragged herself in, but by the end of a session, she'd be feeling so much better
than when she came in. And that's a huge change in an HOUR,
let alone over six months. MAN: Drop it middle stump.
Middle stump.

And as time went on, everyone started
to see the benefits. And believe it or not, it did -
it made me feel better. I felt better at the end
of each session. I walked out with that extra bit
of energy, little bit less fatigue. The nausea was curbed,
or kept at the same level. Three-quarters of the way through
her punishing treatment, Natalie even managed
a four-kilometre fundraising walk. It was hard and I was tired. Nobody wanted me to do it,
my husband including. He said, "You're just gonna...
It's just gonna be too much." And I just...I just did it. And it was amazing
that you could do it. PROF ROBERT NEWTON:
Everyone, including her oncologist, were very surprised with how well
Natalie went through her treatment, because she was going through particularly hard
chemotherapy regimens to try and kill this cancer.

But it wasn't just Natalie
that was doing well. DR ANDREW DEAN:
I'm probably surprised by how good
people's blood counts are. I'm surprised by their wellbeing, by how well they feel on chemo. Anecdotally, all the patients
on the exercise program seem to be getting less of the
expected side effects of chemo - particularly less nausea and fatigue. WOMAN: I can be very fatigued, but if I make the effort
and have even the walk, then it lifts my energy. You just can't go slow, can you? MAN: It's been pretty good,
actually. The chemo's not as bad as I thought
it was going to be. Come in. This is where
our DEXA scanner is. Now, I just want your head
at this end here, and your feet at that far end,
please. But the evidence
that blew the clinicians away came from this machine - the DEXA, which was used to track
the fat, muscle and bone composition of each of the patients in the trial.

So, how much decline do you
typically see in muscle mass when people go on chemo? Somewhere between 10% and 15%,
depending on the length of duration that they're actually
undergoing chemotherapy. That's the normal. That's expected. Yet in the 38 patients who have
gone through the exercise program, that muscle wastage was
almost completely blocked. Some even gained.

If we take Natalie, for example,
she's actually - which is quite astounding -
increasing her muscle mass... Over the course of chemo?
..over the course of chemotherapy. And that's just
a really fantastic outcome, because it not only improves
their health and function, but it likely improves
their capability to complete the full course
of chemotherapy. That means they're much more likely
to survive. We're really excited about this. I believe it will actually change
the management of cancer patients.

To understand quite how
extraordinary this is, let's visit someone who had
a very different experience of chemo. This is Science Show 2065.
Hello. I'm Robyn Williams... This is Robyn Williams, known to
ABC Radio National listeners as the legendary voice
of The Science Show - and, in the interests
of full disclosure, he's also my long-term partner. Are you ready for your trip
down memory lane? I think so. 18 months ago, Robyn was told he had
two large tumours in his bowel. Do you remember when that was? Oh. Dancing.
Yeah. (CHUCKLES) That was the day after
you got your diagnosis. The next day, the treatment
steam train started. Gradually, you stop feeling
like yourself. Your body is not yours to control. (CHUCKLES) You kind of...
get smaller. Literally smaller, of course, because the effect of the chemo
was for me - surprisingly, for them as well -
devastating. I was then with a colostomy bag,
and I was losing weight. Along with the weight loss came
damage to the peripheral nerves, which meant he kept
bumping into things, and a rapid loss of Robyn's ability
to run, which he'd previously done daily. At one point, I remember I couldn't
even walk around the block. How much weight did you lose
in the end? I was just over 85 kilos
when I started, and I was 59...under 59 at the...if you like,
the base of the experience. I was a walking cadaver. Yeah. That's why I took a photo! Robyn was hospitalised for five weeks and his chemo had to be terminated
two months early - though, Radio National listeners
will be pleased to note, he still insisted on making
The Science Show. The first ever
computer programmer... I did things from the hospital bed.
We never missed a program. Robyn's experience
was particularly bad, but it does help show why the fact the patients on the exercise trial
are maintaining their muscle mass is so significant. A scientific paper is currently
being prepared. The benefit, in terms of muscle
mass, is absolutely extraordinary, because we know that there's
no pharmaceutical intervention that can actually stop
that decline in muscle mass. The only thing which will do that is highly targeted,
prescribed, tailored exercise. It certainly appears as though
something here is working, which begs the question - how?

One likely mechanism
is pretty straightforward - it's all about blood flow.

One of the troubles
of getting chemo into a tumour is that tumours often have
a really poor blood supply. But exercise increases blood flow, potentially allowing more chemical to get inside the tumour,
where it's needed. That's why I believe that the
greatest effectiveness of exercise is when you actually exercise
either immediately before or after the actual session of receiving
the chemotherapy. Because either before or after,
you're still influencing the circulation of blood
into the tumour. So you have to be delivering
more of the chemotherapy agent, targeting the specific cancer cells.

But the science gets
way cooler than that. In the last three years, some fascinating discoveries
have been made about what exercise does
to the immune system.

Our bodies are making potential
cancer cells all the time, but our immune system regularly
finds them and destroys them.

Crucial to our tumour defence force
are so-called 'natural killer cells'. They're one of the only cell types that can recognise threats
generated by our own bodies and call in an attack.

It's one of life's great mysteries why some cells slip past our defences
and begin to grow.

So, our own immune system is still one of the best ways
to fight the cancer. The trouble with chemo is, at the same time
as it's poisoning our tumour cells, it's also wrecking our immune system.

Which brings us to
a small but remarkable study conducted in Sweden
and published in 2013.

A group of 10
average, healthy young men were exercised on a bike
for 60 minutes.

Their blood was taken before
the exercise and also straight after. The before and after bloods were then
spun down to extract the clear serum and poured over laboratory lines
of prostate cancer cells to see if they would grow. Incredibly, the serum taken
straight after exercise suppressed the cancer cell growth by 30%.

PROF NEWTON: That particular study
is landmark, because what it has done is it's
woken up the scientific community to say, "There is something produced
during exercise systemically." So, the muscles
are producing chemicals which are going
to all parts of the body and they're actually destroying
tumour cells.

Then, in early 2016,
another study in Denmark gave us an even clearer picture
of what's going on. The study involved mice with cancer. They were split into two groups. One was given unlimited access to
a running wheel, the other was not. And just to be thorough,
the researchers tried this experiment in five different kinds
of mouse cancer models, from lung cancer
to liver cancer to melanoma.

You can see clearly here
what happened. These are from the lung cancer mice. The black stain is cancer. Look at the difference
when they've exercised. Across all five experiments, exercise reduced tumour growth by:

Then, when they looked
inside the tumour cells, they saw this - the tumours of the exercising mice were chock-full
of natural killer cells. Now, that's amazing. What is changing in the body
through exercise that makes these
natural killer cells more active, be able to seek out the tumour, and then attach to the tumour
and destroy it?

The result would be striking enough, but the Danish researchers
went much further. They were able to demonstrate
HOW exercise did it - what sort of signal it was releasing to make the natural killer cells
attack the cancer.

First signal - adrenaline. Adrenaline, produced during exercise, actives the natural killer cells
to be released into the bloodstream. They're now primed for surveillance
and looking for a target. That information then comes
via the muscles. Exercise causes muscles to release a
chemical signal called interleukin 6.

Interleukin 6 not only seeks out
the tumour cells directly, informing them to cease and desist, it also tells the natural
killer cells what to target.

There are many other
physiological mechanisms involved, but this study shows so clearly exactly how exercise can up-regulate
the immune system and make it better
at fighting cancer. PROF NEWTON: The exciting thing is
that it's actually the body generating its own chemotherapy,
if you like. It's generating its own
anti-cancer drugs.

But is all exercise the same, or can some treat specific cancers
better than others?

Lee has prostate cancer. LEE: Well, I was put on
an anti-testosterone drug, that, of course, depleted
my testosterone down to nothing. What normally happens there is, from a man's perspective,
you grow boobs, you put on weight,
you become lethargic.

PROF NEWTON: The problem with
anti-androgen therapy - whilst it's fantastic for slowing
the progression of prostate cancer, it does have a lot of side effects, and one of the key ones is that it actually causes
a dramatic loss of bone. And so these men
rapidly become osteoporotic - they develop osteoporosis. So, we had to do something
to try and address that.

Seven years ago,
Professor Newton's team took a group of men
who were on anti-androgen therapy and prescribed them
three different types of exercise.

One group of participants
did aerobic exercise only. Another group did aerobic exercise
plus resistance training. The third group did
resistance work plus jumping.

Impact training. Lee was assigned this treatment. So, this was quite radical, to have men in their 70s
and some in their 80s actually doing jumping, bounding
and skipping.

I didn't want to do it to start
with. I thought, "Nah, strike." Anyway, I decided that
I'd go ahead and try it. It was the best thing I ever did. How was that?
That was hard. (BOTH LAUGH) To everyone's surprise, for the men who were doing
aerobic and resistance, it didn't help
the osteoporosis at all. They still lost 3% of their
bone mineral density in six months. But in the jumping group,
the bone loss was prevented.

This is actually Lee.
So, this is his data. And what we see here - his bone density has actually
improved to 1.170. Legs, then arms. Legs... LEE: It gave me a new lease of life. I met a whole bunch
of fantastic people. I got healthy. I got fit. Probably the best thing that ever
happened to me, getting cancer - strange as that may sound.

It was only the combination
of resistance exercise and the impact loading that totally obliterated
the bone loss. So, it was a world first
and an outstanding outcome. It also showed clearly
how important it is to know which exercise to prescribe
for each condition.

The results of this study, presented at the Australasian
Prostate Cancer Conference in 2011, were so significant,
they changed the national guidelines for prostate cancer treatment
in the US and Australia. It was SO positive... If we hadn't have all gone
on that journey, we would never have met
and formed the friendship. And we would never
have gone to the gym! And we wouldn't...!
(ALL LAUGH) Text message, "Where are you?!" As Natalie
and her fellow survivors show, it does seem we're on the cusp
of a turning point - a shift away from some
vague recommendation to exercise toward a more sophisticated, targeted exercise prescription for cancer patients.

And while Rob's team will likely be
one of the first in the world to publish their findings on
exercise during cancer treatment, at least two other teams we're
aware of, in Sweden and Denmark, are running similar trials. There are also
individual oncologists here who are starting to prescribe it, and more trials are under way of patients with different
types and stages of cancer. PROF NEWTON: The evidence
is so strong now that the cancer patients
deserve this medicine. It's a very powerful medicine. It actually increases their survival
and it has no side effects. So, what we need now is for actually the medical and health
professions to embrace it and actually make it
an integral component of the overall management
of the cancer patient. NATALIE: Go, mister! Whoo!

Natalie, having just finally been
given the all clear, can only agree. I just know it did.
I just know it helped. It helped me bounce back. It helped
me get back on my feet quicker, too. Yeah. Absolutely. It meant everything. You know. It's my life. (LAUGHS) Good boy, BB. It is a great result for Natalie. However, at this point,
we do need to stress this is a limited and ongoing
scientific trial. Anyone with cancer should seek
professional medical advice before embarking on
an exercise program. I'd advise someone with cancer
who'd like to exercise, who doesn't have access
to a program such as this, find an exercise physiologist. When you have cancer,
you need an exercise physiologist. They know about the drugs and all the different things
that can be going on in your life when you're having
serious chemotherapy.

And even after chemo is over,
exercise can be crucial, as I experienced firsthand last year
with my own partner, Robyn Williams. This is the day
I dragged you into hospital. Oh! Not exactly Mr Atlas, really,
is it? (CHUCKLES) Months after his treatment finished, Robyn still wasn't recovering
from the fatigue and nerve damage until finally he tracked down
an exercise specialist... Are we there yet? ..started his own targeted program and turned things around. That's great. And working on rotating.

When Robyn first did this exercise, he was literally
falling flat on his face.

Weight training, treadmills,
you name it. Boxing, even! Me!
Hadn't done that since I was 13! That's the way.

Everyone's cancer experience
is different, but appropriate exercise
before, during or after treatment seems to substantially improve
our odds. And that's two months later.
The zombie rises. Long may the remission last.

Captions by Ericsson Access Services

GRAHAM: Next time on Catalyst, we take a look back
at an exercise program that's hard work,
takes very little time, but could have huge health benefits
for us all. The more rapid and intense you do,
it seems the better outcome. For more information
on tonight's story, go to our website.

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