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Soraya Casla, from Segovia, 36 years old and with a doctorate in Physical Activity and Sports Sciences, began a little over a decade ago to investigate the benefits of physical exercise in cancer patients and discovered that, despite the evidence about its influence on increasing survival, preventing relapses and improving quality of life, in Spain it was not considered another therapeutic weapon.
She travels halfway around the world (United States, Canada, Denmark and Australia) to complete her training as a specialist in oncology practice and, upon her return to Spain, in 2015 she begins to complement patient treatments with personalized programs.
Today she directs a specialized center and has just published
Ante el cancer, muévete
(Vergara, 2024).
Ask.
How did the Exercise and Cancer project come about?
Answer.
It was born after realizing that there was no real answer on oncological physical exercise for patients.
During treatments, they experience a series of side effects for which it has already been shown that the most effective for all of them is physical exercise.
But it must be specific, adapted and individualized.
That, in Spain, did not exist.
After developing several international assistance projects and seeing how they worked in other countries, hospitals and institutions, I was encouraged to develop my own project to reach patients, train, inform and research and make it as accessible as possible.
Q.
What benefits does physical exercise provide for people with cancer?
A.
Increases survival and reduces the side effects of treatments.
Many times we relate it to nausea and fatigue, which they are, but what we see is that the treatments also have a subsequent impact: they promote or open the door to the development of other cardiovascular diseases, hypertension problems, obesity, diabetes. … They are diseases that can develop with a sedentary life and over the years, but they appear, increasingly, in young people.
Exercise improves these side effects and, in the long term, we also reduce the risk that cancer and other diseases may reappear.
Soraya Casla, researcher and specialist in oncology practice.
Q.
This conclusion is supported by a clinical study.
A.
With Miguel Martín [professor of Medicine at the Complutense University of Madrid and head of the Medical Oncology service at the Gregorio Marañón university hospital] we developed one of the first trials in which more than 200 patients participated for four years.
When we published it there was a lot of reluctance because it was believed that they could only do things of a very low intensity.
We show that exercise that mixes high intensity and moderate intensity improves all physiological aspects: increases muscle mass, improves the ability to produce energy and the circulatory and cardiovascular system.
And it was tolerated by patients both during chemotherapy and after.
Q.
Is there a general pattern or is each cancer and each patient different?
A.
There is an exercise protocol that we individualize based on the patient's level, the moment of the illness and the side effects or functional limitations.
A patient who has exercised all his life, even if he is undergoing treatment, must continue.
Other people who have never done physical exercise have to start by walking for five minutes.
The time of illness is also taken into account.
They are not the same recommendations for a person who is undergoing chemotherapy, radiotherapy, hormonal treatment or who has already finished.
This requires us to be trained and informed to know what the physiological changes are and how we have to adapt the intensity of the program to them.
And finally, specific functional limitations are considered.
It is not the same as having your entire breast and lymph nodes removed or having a bag because you have had colon cancer or having abdominal surgery.
These circumstances generate more specific limitations.
In the book, I provide concrete recommendations based on all these aspects so that everyone can have access to real and scientific information about what the benefit of exercise is and what they can do.
Walking can be the beginning, but not the end
Q.
Is walking not enough?
A.
Many studies tell us that walking alone does not generate the changes we need.
It is very important to start there when you are healthy, because it helps you maintain your health, but, when we have to recover, we need a much more complex strategy that, in the case of cancer, is not only at the metabolic level;
We also need to generate new neural connections, which are lost due to treatments, and improve functionality and mobility.
A guide must be developed as complete as possible.
Walking may be the beginning, but not the end.
You have to gradually increase it and include strength and balance cardiovascular exercise so that it is complete and really improves health in a comprehensive way because the deterioration due to treatments is much more global.
It is also important to maintain motivation.
When a person comes to the center, we want to surprise them every day.
Q.
How many times and for how long should you exercise per week?
A.
The ideal, according to the World Health Organization, is three days.
Each of the sessions should last between 35 minutes and an hour and a quarter.
We usually do between 50 and 75 minutes, taking into account breaks, gentle exercises and stretching.
Q.
Before or after treatment?
A.
People who start doing physical exercise before the treatments tolerate them better and the side effects are fewer: they get much less fatigued, have much less nausea and diarrhea, and less need to stay in bed due to excess fatigue.
Q.
And once it is overcome?
A.
You have to continue exercising.
People who exercise during treatments and stop afterwards tend to return to the levels they had before or just after chemotherapy, below normal.
It is necessary to remain active to maintain long-term benefits and prevent diseases and physiological changes.
One of the most problematic side effects is heart failure, which can occur as early as 10 or 15 years.
People who exercise can reduce the probability of suffering from it by up to 40%.
More information
Physical exercise, key to the treatment of breast cancer
Q.
Does it increase survival?
A.
Patients who do physical exercise after diagnosis increase their survival by between 30% and 40%.
The chance of getting cancer again or developing second tumors and also other heart conditions or diabetes or metabolic problems is reduced.
Physical exercise helps them live longer and better.
It has been demonstrated in cancers with the highest incidence, such as breast or colon.
In the rest of the tumors, it's not that it doesn't happen, it's that we don't know if it happens because we don't have such long or high-quality studies.
Q.
What is the sequence from exercise to benefits?
A.
High intensity, which can be achieved with strength or cardiovascular exercises and has cardiac benefits, we mix them with others for nerve regeneration, which is also very important.
When you introduce high intensity, the cell realizes that it is not able to keep up with the body, it adapts and begins to mobilize a series of enzymes and proteins to generate energy in the mitochondria.
This can only be achieved with high intensity blocks.
But the body needs to maintain those energy factories and teach them to produce it.
If you don't use them, they will be charged.
There, moderate intensity plays an essential role, because it is the type that helps and promotes functional mitochondria.
When they work well, they help preserve muscle, also improve peripheral irrigation and increase fat expenditure.
This prevents other diseases.
Walking briskly for an hour every day helps prevent tumors.
But the exercise we do on a daily basis, in our work or when traveling, is not worth it.
It has to be extra
Q.
Exercise helps during and after cancer.
Does it also prevent it?
A.
Physical exercise has been linked to the prevention of up to 26 types of tumors, but you have to meet the recommendations of the World Health Organization, that is, doing a minimum of 150 minutes of moderate exercise per week.
But high intensity is not so important here.
Even walking briskly for an hour every day helps prevent tumors.
But the exercise we do on a daily basis, in our work or when traveling, is not worth it.
It has to be extra, that is, go out every day to walk for 30, 40 or 50 minutes and do another type of activity that complements it.
Q.
Why is exercise not included in cancer treatment protocols?
A.
In 2010 I had to go abroad to learn about oncology practice because there was nothing here.
But I think the perception of health has changed a lot and currently there are more and more oncologists who recommend physical exercise.
In fact, many of my patients come to me because their physical therapists, oncologists or oncology nurses have recommended that they do physical exercise during and after treatments.
But we must continue training and informing and supporting both patients and clinicians.
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