Emerging research indicates that exercise not only can help prevent a wide range of chronic and acute diseases, but also can enhance outcomes and help prevent recurrence. Rusk Rehabilitation at NYU Langone Health is pioneering the use of this powerful tool, and working to develop protocols and policies for its widespread adoption.
A New Prescription for Cancer Survivors
In October 2019, an international roundtable of experts convened by the American College of Sports Medicine published new guidelines on the integration of exercise into cancer treatment. The report—entitled “Exercise is medicine in oncology: Engaging clinicians to help patients move through cancer”—recommended a minimum of thrice-weekly aerobic activity and twice-weekly resistance exercise for most patients and survivors, citing a growing body of scientific evidence supporting “the prescription of exercise to improve cancer-related health outcomes.” The co-authors issued a call to action to healthcare providers and policymakers to help make exercise assessment, advice, and referral a standard practice in clinical oncology.
Among the report’s co-authors is Jonas M. Sokolof, DO, clinical associate professor in the Department of Rehabilitation Medicine and director of the division of oncological rehabilitation at Rusk Rehabilitation. Since launching the division in 2018, Dr. Sokolof has worked to make exercise oncology central to its therapeutic approach. “We’re trying to shift the paradigm,” he explains. “Exercise is typically prescribed to cancer patients only to mitigate specific impairments—for instance, arm pain after mastectomy. Yet research indicates that it can affect outcomes including depression, anxiety, sleep, overall physical functioning, even mortality and survival. Our approach is to use exercise to support the optimal health of all patients living with or beyond cancer.”
Rusk Rehabilitation is one of the first rehabilitation departments in the country to establish an oncology rehabilitation services program. “We’re fortunate to have a direct line to NYU Langone’s Perlmutter Cancer Center, a National Cancer Institute–designated Comprehensive Cancer Center,” Dr. Sokolof notes. Rehabilitation physiatrists meet regularly with the cancer center’s survivorship coordinator and medical oncologists to collaborate on building the program and developing appropriate exercise prescriptions for individual patients.
Attacking the Cancer–Cardiovascular Disease Continuum
“You can think of cancer and cardiovascular disease as part of the same spectrum,” observes Jonathan H. Whiteson, MD, associate professor of rehabilitation medicine and vice chair for clinical operations and medical director of cardiac rehabilitation at Rusk Rehablitiation. These diseases share many common biological pathways, such as inflammation and oxidative stress, along with common risk factors, such as smoking, sedentary lifestyle, and obesity. In addition, cancer patients often experience weight gain and deconditioning—and some cancer therapies can damage patients’ arteries and hearts. According to a 2019 scientific statement by the American Heart Association (AHA), such factors may contribute to a 1.3- to 3.6-fold increased risk of cardiovascular-specific mortality in long-term cancer survivors.
As survival rates for cancer continue to improve, the problem of cardiovascular comorbidity is becoming increasingly urgent. To address it, the AHA statement (endorsed by the American Cancer Society) calls for cardio-oncology rehabilitation to become a standard part of cancer care. This emerging approach adapts techniques from cardiac rehabilitation—including exercise, nutritional management, and lifestyle counseling—to reduce cancer patients’ cardiovascular risk. “More than two dozen clinical trials have shown that exercise can compensate for the declines in cardiac health associated with cancer treatment,” Dr. Whiteson says. “The challenge is translating the science into clinical practice, and getting it covered by insurance.”
Rusk Rehabilitation is at the forefront of these efforts, helping to develop cardio-oncology protocols that can be implemented on a wide scale. In September 2019, Dr. Whiteson and Dr. Sokolof led an Innovative Leadership session on this topic at the annual meeting of the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) in Portland, Oregon. “There’s a lot of trench work to be done,” Dr. Whiteson says, “but we’re beginning to move this model into the mainstream.”
Building a Community of Pioneers
Dr. Whiteson is also leading other efforts to collate, review, and disseminate evidence for exercise-based rehabilitation therapies. He recently established an Exercise as Medicine member community within the American Academy of Physical Medicine and Rehabilitation (AAPM&R). The group, which has more than 700 members, is collecting published scientific data on the topic in a digital reference library for consultation by clinicians.
In November 2019, Dr. Whiteson led an educational session on prescribed exercise at the AAPM&R annual assembly in San Antonio, Texas, covering areas including brain injury and immune function. “Aerobic exercise, in particular, can be used to treat a broad variety of disease,” he explains. “For instance, there’s data to show its value in neuro-recovery following stroke. It boosts the immune system to fight off infection and rid the body of damaged or malignant cells. And, of course, it enhances strength, stamina, and pulmonary function. Aerobic exercise should be incorporated into the whole continuum of rehabilitative care, from the acute setting through outpatient and into the community.”