As a fitness instructor, former Miss Rhode Island, competitive baton twirler and figure skater, Dawn Kirsch was in great shape when she was diagnosed with breast cancer six years ago at age 33.
Having lost her 38-year-old sister to the disease, Kirsch vowed to beat it with the aid of faith and one of her most reliable coping mechanisms.
"Exercise was my way out," says the Exton, Pa., mother of three, who had a bilateral mastectomy in 1993 and a series of reconstructive surgeries over the next two years. "Exercise helped me channel my frustrations and my nervousness, and it helped me center myself."
Kirsch spent the evening before her mastectomy sweating through an intense exercise class at the Y, which she credits with helping her get a good night's sleep. Before the surgery, she did stretching exercises.
Two weeks after surgery, she was walking a track. One month after the operation, she was taking a regular exercise class. Within six weeks, she resumed teaching her fitness classes, being careful to modify any high-impact moves.
But when Kirsch sought advice about exercising with breast cancer, she found very little. So she spoke with physicians, did research and launched her own Breast Cancer Wellness Program at the Brandywine, Pa., YMCA in 1995.
"People with cancer want to start feeling normal again," says Kirsch, whose doctors say her cancer is cured. "Exercise helps people deal with the side effect of their therapies, like weight gain from anti-cancer drugs and stiffness from surgery. And it helps them feel healthier and less depressed."
Just as the idea of heart patients exercising seemed unthinkable 40 years ago, the notion of cancer patients exercising surprises many people today. Yet Kirsch's program is one of a growing number of exercise classes geared to helping people with cancer improve the quality of their lives.
"Research is beginning to show that exercise may help prevent the disease," states "Informed Decisions," the American Cancer Society's guide to cancer diagnosis, treatment and recovery (Viking, 1997). "It also seems to help counter some aspects of cancer and to relieve some of the unpleasant reactions to its treatment."
Appropriate physical activity can help cancer patients, the book notes, by fighting fatigue, improving immunity, boosting energy, preserving lean tissue, maintaining range of motion, alleviating anxiety and heightening self-esteem.
The trend toward getting cancer patients active reflects "a whole new area of cancer survivorship," says Manhattan nutritionist Abby Bloch, chairwoman of the American Cancer Society's advisory committee on nutrition and physical activity.
"Many of today's treatment regimens are much less devastating than in the past, and clinicians are now faced with patients who are anxious to get active as soon as possible." To address this new need, Bloch's committee is developing exercise guidelines for people in various stages of cancer treatment.
"Exercise helps you believe in your own survivability," says Jeff Berman, a marathon runner who was working as an ad salesman in Manhattan when he was diagnosed with chronic lymphocytic leukemia in 1990 at 32.
"When you return to doing something you did before and build your body back up again, it makes you feel that you can do anything."
Berman has continued to run marathons--one just five months after finishing chemotherapy--and in 1993 started a support group for athletes with cancer at the New York Road Runners Club. "Here was this room full of people who weren't as worried about dying as they were about recapturing their running times," he recalls. "Just being alive wasn't good enough for us. We wanted to really live."
In 1994, Berman founded Cancer Support Services, a nonprofit corporation dedicated to helping people with cancer use exercise, nutrition and psychosocial / spiritual resources to enhance their recovery.
In September, he started Focus on Rehabilitation and Cancer Education, the 13-week program known as FORCE that teaches stress management, nutrition and exercise to cancer patients.
"Exercise prescriptions for people with cancer need to be very individualized," says Doug Kalman, director of clinical affairs at Peak Wellness, a private medical center in Greenwich, Conn., that offers exercise programs for cancer patients.
A physician's approval is essential, because cancer patients may be at increased risk for injury as a result of their disease or treatment. It's also a good idea to work with a qualified exercise physiologist to design a program that takes into account the specifics of each person's condition and sets appropriate exercise goals. For someone with cancer, Kalman says, "the goal of a strength training program isn't to make them the next Arnold Schwarzenegger. It's to help them be able to carry their own groceries."
Programs in this emerging area tend to feature both group and individualized exercise. For example, at Living for Life, an exercise class for cancer patients at the National Institute for Fitness and Sport in Indianapolis, participants warm up together, and then each person spends about 30 minutes doing an individualized cardiovascular program. Next comes a strength training portion on resistance machines, followed by 10 minutes of stretching done together.
"It's almost like a support group that meets in a fitness center," says the program's creator, Jamie Turner, who is gathering data she hopes will persuade insurance companies to reimburse "oncology rehabilitation" in the same way they subsidize cardiac rehab. "Exercise addresses the whole person, not just the cancer. And it gives people back a sense of control."
* ENCOREplus, a combined peer support group and exercise program for women with breast cancer, is offered at 37 YWCAs around the country. Call (800) 95-EPLUS or e-mail cgould@YWCA.org.
* Cancer Support Services, a nonprofit organization based in Manhattan, offers exercise, nutrition and stress management programs for cancer patients. Call (212) 628-9728 or visit the Web site: http://www.cancersupport.org.
Carol Krucoff writes a column on health and fitness issues for the Washington Post.