The Benefits of Exercise with CLL and COVID-19

[AussieNeil]

With CLL being a relatively rare cancer, it is often hard to find studies specific to our cancer. Often we are reliant on studies from more common cancers, where the challenge is determining their relevance to CLL. Of interest is this analysis of 1,340 patients enrolled in the Diet, Exercise, Lifestyle, and Cancer Prognosis Study (DELCaP)

Physical activity tied to lower recurrence and mortality in patients with breast cancer

Major finding: Patients meeting the minimum guidelines (≥150 minutes of moderate-intensity RPA/week) vs. being inactive before and 1 year after diagnosis had a 41% lower risk of recurrence and 49% lower all-cause mortality.

Of direct relevance to CLL is the finding that "Exercise can also reduce insulin levels and insulin resistance, create an anti-inflammatory environment, and condition the body’s response to oxidative stresses, all features that can favourably affect carcinogenesis."

Note the disclosures: The study was supported by the Breast Cancer Research Foundation, the Roswell Park Comprehensive Cancer Center, and the National Cancer Institute. The authors reported relationships with multiple pharmaceutical companies and/or research organizations. (My emphasis).

So here, despite the study being supported by pharmaceutical companies, we have a very impressive report of a massive reduction in both cancer recurrence and all cause mortality (both nearly halved), in patients meeting the minimum guidelines of ≥150 minutes of moderate-intensity exercise per week.

More:

An exercise pill would be prescribed to every cancer patient worldwide and viewed as a major breakthrough in cancer treatment

healthunlocked.com/cllsuppo...

Cancer and exercise do mix

theconversation.com/cancer-...

Health Check: in terms of exercise, is walking enough?

theconversation.com/health-...

Further health benefits associated with exercise:

Cardiorespiratory fitness in middle age was associated with reduced risk of depression and cardiovascular mortality in older adults, a retrospective cohort study found.

Exercise and Chronic Lymphocytic Leukemia (CLL) - Relationships Among Physical Activity, Fitness, & Inflammation, and Their Impacts on CLL Patients

ashpublications.org/blood/a...

High levels of midlife fitness were associated with a 16% lower risk of depression (HR 0.84, 95% CI 0.74-0.95) and a 61% lower risk of death from cardiovascular disease (HR 0.39, 95% CI 0.31-0.48) in adults over age 65 without a diagnosis of depression, reported to Benjamin L. Willis, MD, MPH, of The Cooper Institute in Dallas, and colleagues in JAMA Psychiatry.

medpagetoday.org/psychiatry...

COVID-19/CLL specific (Yes exercising now is more challenging, but per the below, well worth it):

Exercise may help reduce risk of deadly COVID-19 complication: ARDS

theconversation.com/exercis...

How to stay fit and active at home during the coronavirus self-isolation

theconversation.com/how-to-...

While we wait for a coronavirus vaccine, eating well, exercising and managing stress can boost your immune system

theconversation.com/while-w...

Regular exercise has long-term benefits for immunity – it’s important to stay active

theconversation.com/regular... In fact, acute and chronic exercise of almost any type has been found to improve the way people respond to vaccines. theconversation.com/exercis...

For older people and those with chronic health conditions, staying active at home is extra important – here’s how

theconversation.com/for-old...

Updates with reference to replies below:-

Impact of exercise on the immune system and outcomes in hematologic malignancies paper

healthunlocked.com/cllsuppo...

Being overweight/obese is a major risk factor for an adverse outcome with a COVID-19 infection:

medicalnewstoday.com/articl...

healthunlocked.com/cllsuppo...

mnn.com/health/fitness-well...

Thank you  avzuclav and  cajunjeff .

This is an Unlocked post, so others with CLL can find our community: healthunlocked.com/cllsuppo...

Neil

[Hidden]

Thank you for the very useful information...

That photo' took me right back to Cowes in Philip Island... Why? I have no idea..

[Ernest2]

Hi Neil, many thanks for that.

Hope you are getting on ok with recovering your fitness.

Best wishes,

Ernest

[avzuclav]

This was published last month by the excellent CLL research team at Duke University:

"Impact of exercise on the immune system and outcomes in hematologic malignancies"

ashpublications.org/bloodad...

[may04cll in reply to avzuclav]

Excellent , thanks

[AussieNeil Partner Administrator in reply to avzuclav]

Excellent paper thanks! I found it very interesting to read that there is evidence that exercise has been found to improve the function of white blood cells even if the counts are unchanged. It is well recognised that white cell blood counts only partially reflect our degree of immune function. It's reassuring to read specific positive results of exercise for T and Natural Killer cell cell function, given we know that CLL does adversely impact on their function in reducing our response to infections and vaccinations and the activity of Natural Killer cells against cancer cells.

I can personally attest to the benefit of exercise with respect to quality of life (QoL) and fatigue. Chris Dwyer (CLLCanada) also reported finding that going for a walk reduced his fatigue, so it was interesting to read "Reviewing the literature in hematologic malignancies found that small studies show improved outcomes in areas such as QoL and fatigue, but larger randomized trials are needed to better understand the benefits of exercise."

Neil

[avzuclav in reply to AussieNeil]

Another interesting article for CLL & exercise:

"Because CLL has not been linked to obesity the way some other cancers have, the effect of exercise is little studied in this disease. Collaborating with Assistant Professor of Medicine Danielle Brander, MD, and Medical Instructor Andrea Sitlinger, MD, Bartlett found some surprises. First, they conducted physical functional testing in 140 people with CLL. Then they compared immune system cells from the 10 most fit patients with cells from the 10 least fit. “We found that the fitter people have a completely different immune system than the unfit people. They have different levels of circulating factors that can affect their leukemia cell biology,” Bartlett says. And, when he incu­bated the blood plasma of the patients with tumor cells, the blood from the fittest patients slowed the growth of the tumor cells better than blood from other patients. These preliminary findings won Bartlett a young investigator award from the American Society of Hematology to continue this work."

dukecancerinstitute.org/don...

[Mldeterm in reply to avzuclav]

That's a fantastic paragraph!

[delseyn]

Good stuff, thanks Neil.

[studebaker]

Thank you Neil. I love the photo, it brought back memories when we visited Australia

and I said it then and say it now my impression was “What Magnificent Country” and the ocean and beaches.

As you can see I am jealous 😊

🤗Dana

[cajunjeff]

Good stuff here Neil. I intuitively believe there are many health benefits to diet and exercise. I never much thought about exercise helping my immune system, that's great to know.

I have kind of a problem solving test I go through, certainly not original to me. I try to figure out if action on my part can impact the problem. If I cant change anything, like being stuck at home mostly, I try not to worry about it.

I do think I can improve my chances with my cll and with covid by being in good shape and eating right. Although I did not consider myself that overweight at 195 when the shutdown started, I was surprised to see on some tables I would be considered 15 to 20 pounds overweight. Since I was stuck at home I embarked on a serious (for me) daily exercise program which includes walking about 4 miles a day, some yoga, some pilates and some light weight training.

My goal was to drop a pound a week. After four weeks I had dropped only one pound I was quite frustrated and blamed a lot of it on ibrutinib and my metabolism. Then I decided I was fooling myself and if I wanted to lose weight I had to make more profound diet changes. I put down the chips. No more toast with my eggs. Smaller servings. A bowl of celery or an apple for a snack instead of chips or pretzels. It was either cutting chips and bread or my two glasses of wine at night, the wine won out.

Its been hard, I wont lie, but I am at 184 today, that's 11 pounds less. I am out of my fat jeans and into the middle size ones. I would like to get to 175, I'll take 180. I have more energy and look forward to my workouts. I am not much of a vegetable fan, but I like to cook and I am learning to incorporate more veggies in my diet and how to season and cook them to add flavor. My chili is loaded with fresh onions, peppers and corn.

I don't think I have been 175 since my college days. I had dropped to 180 with my hemolytic anemia, but I was weak and unable to work out during that time and that is definitely not the way to lose weight. . At a pound a week, the weight loss goal many say is reasonable, I have nine weeks to get to 175. I am more likely to pick the chips back up if I get to 180. Friday and Sunday nights are my guilty pleasure nights, pizza and pop corn on Friday, fried chicken and fries tonight.

Thanks again for posting this. Knowing that exercise may improve my changes with covid could be the extra motivation I need to get to my ideal weight.

[AussieNeil Partner Administrator in reply to cajunjeff]

Thanks Jeff, for sharing how your personal efforts to improve your weight have been successful, despite lockdown challenges. You reminded me that I meant to note that one of the major risk factors for a poor COVID-19 illness outcome is being overweight: abc.net.au/news/2020-05-08/...

"...data out of China has found that obese and overweight patients were five times more prevalent in the numbers of deaths, while a number of studies across the world have confirmed the risk.

Research from the UK's Intensive Care and National Audit and Research Centre showed almost three-quarters of patients admitted to intensive care were obese or overweight.

A study from New York University found obese COVID-19 patients who were under 60 were almost twice as likely to need treatment in the ICU."

Also, we need to bear in mind that improving our fitness even with little to no change in our weight does provide health benefits. That's because we increase our muscle weight while reducing our fat cell weight. That means a higher metabolic demand to maintain our musculature over that required by fat cells - so some leniency for guilty food pleasures. Fat cells are also associated with inflammatory response which is thought by some to drive our CLL. Chris Dwyer/CLLCanada starts off his profile with the comment "CLL Regression - 2009 to 2012 drop ALC 136K to 42K EXERCISE!!" Chris concurrently incredibly reduced his weight and the benefits encouraged him to keep up his walking regime even under very challenging circumstances.

Wishing you success with your weight loss goals.

Neil

[cajunjeff in reply to AussieNeil]

Obesity and hypertension, which often go hand in hand, appear to be big covid risk factors as you say. I have no idea if my immune system would protect me if I get covid, but I am definitely operating under the assumption that the more fit I am, the better chances I have.

It’s a small silver lining being stuck at home. I have more time to work out working from home. And I haven’t been to a restaurant in 10 weeks where I would be more likely to overeat.

Unfortunately ibrutinib raised my blood pressure enough to need meds. I think losing ten pounds dropped it 5 points or so. So there is another benefit of losing weight.

[64lusso in reply to cajunjeff]

Dang Jeff, you sound like me. By any chance are you 5'8"? I am and around Thanksgiving last year I had to almost hold my breath to tie my shoes!! I knew that if I didn't do something I would gain 10 pounds between Turkey day and the first of the year so I quit sugar, no deserts candy or anything that was mostly based on sugar as the main ingredient. While it didn't help me lose weight I didn't gain any either but after about two weeks I felt I had much more energy. I started the year at 205lbs and am now down to 180 but I would like 175 to be the most I ever weigh in my life so shooting to lose at least 10 more lbs. I'm walking 5 miles at least 3 times a week, eating smaller quantities and drinking less alcohol--however no where near as disciplined with myself as I would like to be! Regardless I am making progress and hope to continue.

FWIW, 11Q, mutation status unknown, complex Kariotype (sp?) AHIA in early 2017, BR starting April of 2017 along with Ibrutinib since then. My last bone marrow biopsy showed no detectable disease and I haven't had so much as a mild cold the last two years and will be 69 in August.

Jay

[Miller1960 in reply to cajunjeff]

Good for you, sounds like you've really made some healthy life choices.

[Mystic75]

Thanks Neil for taking the trouble in posting this. Great post to save!

[kablea]

Many thanks Neil for this information. For those of us inclined to exercise, having our lifestyle legitimized really helps. I am 73 and my running mileage has just exceeded 70,000 miles. I don't proselytize because I realize how hard it is to exercise when you are not driven. When I cycle to hospital for my appointments, I am the only one in cycle gear. It is essential to reduce ones vehicle to emergency transport and let the body take you everywhere. Walking is probably the best exercise but it needs, occasionally, to be at something like four miles per hour. That speed pushes the cardio-vascular system. If you can walk uphill then all the better. It helps, I think, to simply enjoy exercise and not worry too much about the fitness element. The more you do the better the muscles respond.

[oilraguk]

Hi, the University of Bath (UK) is planning a series of studies on the benefits of exercise to CLL Patients.

Three studies as I understand it, covering patients on W&W, in treatment, and post treatment. As I said the studies are in the planning stage and will probably not commence until 2021 earliest.

[GrapeGrower1]

Excellent post excellent pic!

[barger1951]

That is great validation. I have been exercising through diagnostics (9 years before start of treatment), during treatment (ibrutinib) and after treatment. I have been in remission (3 years) and feel it is not coming back as I continue to get stronger and numbers continue to improve. Something told me to keep exercising even when I felt like death warmed over. Cheers, Barger1951

[jbctx]

Thanks Neil, another really interesting post!!!

regards, John

[Hidden]

Thank you!!! I exercise daily, with weights, 5 lbs., some exercise bands for the arms and legs that my husband attached to the wall for me, and weather permitting we walk about 1/4 mile or more a day. Trying my best to stay as healthy as possible with CLL. Not always easy, as you know.

[janvog in reply to Hidden]

See my comment below about indoor walking treadmill >>>

[Miller1960]

🏋️‍♂️🧘‍♀️🏃‍♀️anything you do to improve your spirit will help in more ways than we know. Sometimes just getting going is the toughest part. This week I'm feeling extremely fatigued but will set a goal to get out at least 3x for my 10,000 steps.

Happy Victoria day to all my Canadian Cll friends.

[janvog]

The large muscles of the thighs absorb the cancer medicine along with the digestive system. The practical solution: Walk every day. Get yourself a "walking tread mill" - only for normal walking (with elevation feature) indoors to avoid dressing for outdoors, heat, rain, pollution, dogs, traffic, cold. Walking treadmills are small, cost less then $500, with side support for hands. You can watch TV while walking.