Finding joy in movement

Most people will have heard the phrase “exercise is medicine” before. It’s something of deep interest to Dr Stacey Reading, senior lecturer in Exercise Sciences at the Faculty of Science and director of the University’s Health and Rehabilitation Clinic. Since 2019, he has been studying the benefits of exercise for women living with incurable breast cancer. 

It all started after speaking to women at a meeting hosted by Sweet Louise, a charitable organisation that supports women living with incurable breast cancer.  Stacey had been invited by his wife, who works for the charity, and word got out that he was a specialist in exercise rehabilitation. Many of the women explained that physical activity and exercise rehabilitation were not included in their disease management plans. “I asked them, ‘What does your oncologist say?’ It turns out there was no exercise programme to support them – nothing,” he says.

Further investigation revealed that, while there is research on the impact of exercise on cancer survivors and those undergoing current treatment, very little work has examined whether exercise is helpful for patients with cancer that cannot be cured. 

In New Zealand, there are approximately 850 women living with metastatic breast cancer, and 350 new cases are identified each year. The median length of survival ranges between six and 48 months, depending on the type of breast cancer and whether it is a new diagnosis or recurrent disease. On average, 20 percent of women will live for five years after diagnosis, and ten percent will live for ten years or more. Once a woman is diagnosed with metastatic disease, treatment shifts from a curative focus to one focused on prolonging life and helping patients live comfortably and more fully.

This is where exercise can have a positive effect on patient well-being. Stacey created the METs programme, short for ‘Meet, Exercise, Talk and Socialise’, to examine how movement can improve quality of life for women with incurable breast cancer. “There is no evidence that exercise will increase life. None,” he states. “The point of the METs programme is to help these women live their best life now. We aim to give them a safe space and knowledgeable staff to guide them so they can exercise safely for their condition and learn that their bodies are still capable of doing great things.”

More than 80 women have participated in the programme since its inception, attending the Health and Rehabilitation Clinic for supervised exercise sessions delivered over six months. Participants are asked to choose a goal they hope to accomplish through the programme. Some choose everyday goals, such as building mobility and strength to get up and down off the floor and play with their grandchildren, or being able to play a favourite sport again. Others choose to work towards a specific event, like one patient who wanted to complete an Outward Bound course with her daughter – which she did.

Each woman is paired with a clinical exercise physiology student, who gathers medical background data and conducts a one-on-one function assessment to carefully develop a targeted exercise plan. This individualised approach is crucial, Stacey notes, as participants have different needs according to factors such as age, fitness level and illness progression. Students work closely with participants to teach them movement mechanics and adapt plans as needed. 

The benefits of this dynamic are two-fold: it helps participants exercise safely, and it provides students with valuable experiential learning that prepares them to enter the workforce. “It’s a partnership,” Stacey explains, adding that for some patients, student involvement encourages them to attend sessions. “They say, ‘Well, I have to show up for my student; they need me for their studies’.” Many participants have cited the student’s encouraging, respectful and caring approach as a positive aspect of the programme. Likewise, in student feedback surveys, this practical aspect of their course is consistently the most highly rated. 

Support from The Hugh Green Foundation has been critical in getting the METs programme off the ground and enabling women to participate for free at a time when their financial burden is overwhelming. “A significant barrier for these women is cost,” Stacey explains. “Many of them have spent all their savings trying to cure their cancer. The Hugh Green Foundation made it possible to break that barrier. Their funding has been absolutely instrumental in helping us learn the challenges they face and how we can help them.”

Lorraine Mentz, CEO of the Foundation, explained the importance of supporting the METs programme: “The Hugh Green Foundation is focused on making a difference in the lives of those who need it most. We are proud to support the invaluable work of the METs programme. This initiative plays a crucial role in empowering women in our community during times of need, and we commend the team for their dedication and impact.”

The programme is helping Stacey and his team learn more about the difficulties faced by its participants. An often-reported symptom is cancer-related fatigue, or “fatigue on steroids”, as he calls it. This affects individuals across the cancer spectrum, and there are no effective pharmacological treatments yet.

Exercise is emerging as a moderately effective treatment, but the mechanism of effect is not well understood. Stacey and his team have identified that the capacity of the heart, lungs and muscles to deliver and use oxygen during exercise is 25 percent lower in women living with metastatic breast cancer. This reduced function correlates well with the severity of their cancer-related fatigue symptoms. This finding raises the exciting possibility that using exercise to improve aerobic fitness may help reduce patient fatigue symptoms. Feedback gathered so far shows women feel more energised, less fatigued and have greater strength, endurance and balance while completing the METs programme.

The value of social interaction is another significant finding that improves well-being. “‘Meet, Exercise, Talk, Socialise’ – each of these things matters,” says Stacey. “Exercise gives us a reason to show up, to ‘meet’, but it’s as much about mental and social well-being as it is physical, because living with cancer can be so isolating.” Again, feedback was positive: women detailed feeling more confident and independent, enjoying a sense of unity with other participants, and experiencing an overall improvement in mental health. 

With The Hugh Green Foundation’s support, Stacey and his team are also looking to the future and hope to refine further research topics that could help more women. As with any medicine, exercise must be prescribed for specific conditions and at appropriate doses. Stacey hopes to expand their work to develop best-practice recommendations for exercise plans and evidence-based exercise prescription guidelines. “Continued work is needed to  understand what kind and how much exercise will safely build physical capacity to reduce fatigue.” He now has two PhD students leading research projects based on these long-term aims.  

In the meantime, the METs programme continues to run, shining a light on the need for women with incurable cancer to live with joy and dignity. Like anyone suffering from a chronic health condition, they deserve to feel motivated, valued and fulfilled. As Stacey says: “They’re not a disease. They’re a wonderful person trying to live their best life.”