Prof. Dr. Karen Steindorf
Interview of October 1, 2013 from Dr. Andreas Lauenroth
Prof. Steindorf, you are leading the research group Exercise and Cancer at the National Center for Tumor Diseases (NCT). What exactly do you research?
We have two large research areas here, one focuses on how a physical active lifestyle can possibly lower the risk of cancer and the other on how activity, as a concomitant therapy, can be helpful for cancer patients to cope with the disease, and therefore possibly lower the risks of recurrence of the disease or even lower the risk of dying. Additionally we are intensively researching which biological mechanisms are responsible for the positive effects of physical activity and sport therapy.
What role does activity play in the prevention of cancer?
That physical activity can contribute to the lowering of cancer risks, has been well researched on the basis of large epidemiological studies. Today we assume, that 15% of all cancer cases could be avoided by sufficient physical activity. We ourselves carried out a study for breast cancer, that showed that in Germany alone, 6000 postmenopausal breast cancer cases per year could be avoided by being more physical active.
Has activity as medication, been underestimated in the treatment of cancer patients?
That surely is the case. For a long time the assumption was, that patients should take it easy, because the disease and therapies are very challenging and burdening. We more and more understand now, that this leads to a vicious circle. Today we know, that through physical activity one can actively contribute to coping with the disease, as well as better life quality and fitness of the patients. That of course is very beneficial for managing everyday life.
Furthermore there is evidence, that the therapies are better tolerated by physically active patients. That of course is very important because chemotherapy cycles can be completely finished and there are less therapy dropouts due to side effects. But for this, further scientific studies are necessary.
How does physical activity affect the psychological state of the patients?
That is another focus of our work in Heidelberg. We are currently conducting several studies with the emphasis on psychological components like life quality and fatigue. Also the handling of depression can be noticeably improved by physical activity and is very helpful for the self-image and wellbeing. It makes it possible to feel your body again, to get a closer relationship with it and to contribute to the therapy.
Is it possible to reduce the risk of becoming ill of certain forms of cancer through physical activity ? Do you have an example?
That is the case in large, common tumours. We see those effects in colon- or breast cancer for example, with stronger effects in postmenopausal breast cancer. It also reduces the risk of lung cancer, pancreatic carcinoma and cervical cancer and the list of influenceable cancer forms increases. The attainable risk reductions lies between 20-30%. On the other hand, there are forms of cancer that cannot be associated to a risk reduction through physical activity e.g. colorectal cancer.
Which physical activities are especially recommended for cancer patients?
It basically depends on the condition of the patient and the training goal. That has to be individually set. Basically all forms of sport are suitable, there is no special cancer sport where we say it is especially effective.
When there is still a wound healing process, patients shouldn’t choose a contact sport. On the other hand, it is very important that they choose a sport that they enjoy so a continuous training can be achieved. Therefore, every form of sport that is or was fun before is suitable. That applies to endurance- as well as weight training. We actually recommend a combination of both.
Additionally, a goal can be to train certain muscles with special forms of weight training, to specifically better those e.g. occurrence of metastases or a reduced bone density. And sport in a group has a social component that, next to the physical effects, has psychological variables like a better life quality.
Does the form of cancer matter?
Partially yes. Especially immunocompromised patients should not be active in a group sport right away. On the basis of individual conversations with experts, a decision should be made. After a thorough physical examination we offer a wide variety of physical activities for cancer patients, from nordic walking to rowing to weight training here at the NCT. So we offer a wide range of activities.
When you recommend a physical activity, how often and intense should the training be?
That also depends strongly on the condition of the patient. We start exercising during chemotherapy, so the individual condition has to be considered. Basically, the goal is to exercise just as a normal, healthy person should. Recommended are 30 min daily in moderate activity and reachable by just walking fast for example. Of course you cannot expect this level from a freshly operated patient. But what we observed is that it could be worth it to start exercising right after the diagnosis and before the operation, so they can go into the therapy phase with a good fitness level.
When would you advise cancer patients not to exercise?
Surely immediately after an operation. The wound healing process should be nearly completed, so we are talking 6-8 weeks. Then there are contraindications like strong bone metastases or conditions in which even a healthy person would not exercise, like any febrile disease or other infections and dizziness. It doesn’t make sense to exercise under those circumstances.
We also advice cancer patients to wait 24-72 hours directly after a chemo- or radiotherapy before the next exercise period.
Where can persons concerned get physical active and does health insurances take over any costs?
There are already a few sport clubs that offer specific activities for oncological patients as well as here at the NCT . We surely have a certain flagship position here. But we also know how important it is for cancer patients to have those exercise opportunities close to their place of living. That’s why we are building a network of local sport clubs and partners to establish and link competence throughout the whole region. Starting point can be sport clubs as well as fitness studios. But you should keep a closer eye on the oncological competence. In the long run, the goal is to have nationwide offerings but we are far from that in Germany.
The covering of the costs is not guaranteed as much as we would like. There are possibilities but those are temporary. For some patients there is the possibility to have 50 exercise units paid for but this offer does not apply for weight training. Weight training cannot be prescribed to oncological patients even though our studies show how important it is. There is definitely some convincing to do with potential payers but I think we are well on our way.
That is a justified question because there is just not a lot of time for a fulltime working mother of two with an interesting but challenging job. So I have to integrate physical activity into my everyday routine as much as possible. Built in is the daily ride to work on the bicycle. That is 16km daily. In the summer I like to swim and when possible I jog now and then. Of course I would like to do more, especially because I research all day how good physical activity is.
Karen Steindorf studied statistics and theoretical medicine in Dortmund and Sheffield, UK, from 1985-1991. During her doctorate, which she finished in 1994, she worked at the DKFZ Heidelberg as well as the American Cancer Institute. After several years working for the pharmaceutical industries, she returned to the DKFZ in 1999 and habilitated at the medical faculty of the Heidelberg University in 2007 in the fields of epidemiology and medical biometry. She currently leads the research group exercise and cancer at the DKFZ and NCT.
In her free time she likes to read, cook and eat, likes to spend time with her family in nature and travels exciting places and countries.