锻炼可以减少疾病的传播和复发

[00:00:00] Host Amber Smith: Upstate Medical University in Syracuse, 纽约邀请您成为“知情患者”，收听播客，介绍来自纽约中部唯一学术医疗中心的专家. I'm your host, Amber Smith. 在癌症治疗期间，坚持锻炼可能不是你的首要任务，但是 there are benefits to being active. We'll hear about that from my guest, Dr. Kaushal Nanavati. 他是上州立大学的家庭医学助理教授, 他也是澳门银河平台癌症中心的综合医学和幸存者部主任. Welcome back to "The Informed Patient," Dr. Nanavati.

[00:00:37] Kaushal Nanavati, MD: Thank you, Amber. It's been a long time.

[00:00:39] Host Amber Smith: 一些健康组织有一般的锻炼建议. Dr. Nanavati，在接受癌症治疗时，有关于锻炼的权威建议吗?

[00:00:50] Kaushal Nanavati, MD: So there are, actually, 一些癌症组织根据目前最知名的证据提出了建议. And the information and evidence change, and as they do, 这些建议也会定期改变. 所以美国癌症协会是很多人寻求建议的首要组织, but, 有来自多个协会的建议.

[00:01:16] Host Amber Smith: 我们有证据表明在癌症治疗期间运动是安全的吗?

[00:01:22] Kaushal Nanavati, MD: Not only do we have evidence -- it's recommended. 对于很多人来说，他们忘记的是当你谈论癌症对一个人的生活的影响时, if we just think about, so first of all, let's go back a step. 当我们说癌症的时候，真正的意思是，它是一系列的疾病. It's a whole compendium. And so one cancer does not equate to another. And someone who has cancer, during their journey through cancer, their body goes through different stages, different phases, 所以即使他们的身体在不同的时间也能忍受不同的东西.

All of that being said, as a broad stroke general recommendation, the value of exercise, if I put it in the cancer context, three main points to really bring up. One is that it's been known, through evidence, 这种锻炼降低了患某些癌症的可能性, especially when you think about breast cancer, colorectal cancer, endometrial and gastric cancer, esophageal cancer, kidney cancer, and specifically with lung cancer, for people that smoke, exercise reduces their risk of lung cancer. So that's just the risk of getting it.

And for people who have cancer, exercise reduces the rate of recurrence, 尤其是当涉及到某些类型的乳腺癌时. So now we're talking about recurrence.

Then we think about cancer therapies. Exercise, through the literature, 已经被证明可以提高治疗的效果并且有助于减轻身体的癌症负担, whether it be reducing the spread of cancer, what we call metastatic disease. So high intensity exercise, in one study, 实际上表明它降低了癌症扩散的可能性将近72%. That's huge. Right? 高强度的活动并不是每个人都必须做的, 但很明显，在合适的条件下，合适的人会有一些潜在的好处.

然后是癌症化疗的副作用? 无论是免疫疗法还是化疗，或者只是经历癌症之旅. People experience mental fatigue, physical fatigue, emotional drain, 甚至是骨骼变薄的副作用, heart toxicity, cognitive decline, all of these things have been shown to benefit. When somebody has exercise, 实际上，他们的副作用更少，好处更多.

[00:04:03] Host Amber Smith: 我想更具体地问一下运动的类型, 但我认为，根据每个人患的癌症类型，建议可能会有所不同, or how progressed it is, or where they are in their treatment.

[00:04:18] Kaushal Nanavati, MD: So that's exactly right. And on the other hand, as a baseline, 我们可以说，任何处于任何癌症阶段的人都可以从体育锻炼中受益.

体育活动包括一些基本的活动，比如散步, riding a bicycle, going up and down the stairs, that type of stuff. And then there's more intense forms of activity. 我们认为运动分为有氧运动和无氧运动. 有氧运动是人们想到的标准的心血管运动, whether it's walking, jogging, treadmill, bikes, swimming, that type of stuff. 无氧训练与重量训练有关.

So the current guidelines for exercise, 以前是每周150分钟的有氧运动然后是几次举重训练. 最新的指导方针实际上鼓励每周进行300分钟的有氧运动, 每周进行两到三次举重训练.

So, ultimately, 你最终会发现每周大约有三到五个小时或三到七个小时的锻炼时间, if you include the weight-based training, 为癌症患者和非癌症患者提供最大的价值.

[00:05:38] Host Amber Smith: 那么不那么剧烈的放松运动，比如瑜伽甚至太极呢. Do those count as movement and exercise?

[00:05:48] Kaushal Nanavati, MD: They count and have their own value, actually, 不仅仅是帮助一个人保持平衡和协调, if they've had side effects of their treatment, 但放松疗法对体内的生物化学和激素有影响. 比如深呼吸练习或练习.Some people meditate. Some people just do deep breathing. Walking in nature, as a reflective exercise. Tai Chi. Yoga. Pilates. 所有这些东西实际上都对增强免疫系统有生物化学影响, 这在很多情况下是有价值的，同时也有利于减少组织，肌肉和关节的炎症, improving flexibility.

And so overall wellbeing improves, but specifically not only the physical, but the mental, emotional, 人体的生化和荷尔蒙构成也会变得更好.

[00:06:46] Host Amber Smith: 这里是纽约州澳门银河平台的“知情患者”播客. I'm your host, Amber Smith. 我在跟中西医结合主任. Kaushal Nanavati from the Upstate Cancer Center, 我们讨论的是癌症治疗期间运动的好处.

所以让我们更具体地谈谈对刚开始锻炼的人有好处的锻炼, 这在过去并没有太多的应用现在它们被用于癌症治疗. 你会给他推荐什么类型的东西?

[00:07:17] Kaushal Nanavati, MD: Start low and go slow. Right? 当他们说这些的时候，我微笑着对那些看不见我们的人. 你知道，关键是你要做的是保持一致. 有一项研究表明，每周锻炼三次30分钟的人与每天锻炼10分钟的人相比, 每天做10分钟的人更有可能把它变成一种习惯.

So the key is really to get started. 今天早上我的想法是出发，对，开始旅程. 最重要的是迈出第一步. 所以对于那些没有经常锻炼的人来说，让它成为你日常生活的一部分. 让它成为一个不可协商的问题，这样其他的事情就会围绕这个问题进行.

对我来说，在我早上去上班之前，我有我的锻炼时间. And then if I have time later in the day, 我可能会多锻炼或晚上和我的妻子或家人去散步, et cetera. But fundamentally, 我把自我照顾的时间放在早上，因为我知道一旦一天开始, sometimes we get busy, things come up, et cetera. 但是早上的第一件事，我们可以好好计划一下. 所以我鼓励那些甚至还没有开始计划5分钟甚至10分钟的人, depending on their physical ability.

And more importantly, 我要提醒你，如果你没有经常锻炼, 确保你和你的医疗保健提供者一起工作，并确保你足够健康，可以开始锻炼. 然后他们，或者他们会帮你联系一个能指导你如何最佳锻炼的人. 在北州，我们的优势是拥有多种专业和专家. 我们甚至有一位理疗师专门研究癌症患者的身体活动. 所以我们会有越来越多的可用资源, 这让我很兴奋，因为每个人都有不同的能力. 同时，每种类型的癌症对身体的影响也不同. 这取决于它如何影响一个人与另一个人, 我们可以更具体地说明我们提出的建议的类型和人们可以采取的方法.

但我们每天都在做一些基本的事情. 只要我们运动的时间比久坐的时间多，就有价值. One of the things that exercise does, actually, which I think is fascinating biochemically, 它真的对减少癌症代谢有影响吗. So what I mean by that is, if you exercise very vigorously, 你的肌肉需要血液流动, 哪一种能把它从那些渴望它，吵嚷着争夺它的癌细胞中偷走. 所以如果你在运动，肌肉得到血液流动, the cancer cells are getting less of it, which can eventually lead to starving them out. And, 生化运动实际上在细胞内起作用，诱导癌细胞自然死亡, so that we can actually get rid of them faster. 这是我们从未想过的神奇的东西.

[00:10:15] Host Amber Smith: 那些习惯于高水平锻炼的运动员怎么办? Do they ever have to take it down a few notches?

[00:10:22] Kaushal Nanavati, MD: 所以在医学上，我们总是教给学生的最好答案是，“看情况。."

So it depends, Amber. 我的意思是这取决于个人，取决于他们患的是什么类型的癌症. In many instances, they may have to take it down a notch, especially if they're experiencing fatigue, bone pain, 如果他们的心脏因为治疗或他们正在接受的治疗而有压力, 如果它们对认知功能有影响, et cetera. 或者转移到其他地方，比如说，骨头或肌肉.

当然，我认为从久坐的人到经验丰富的运动员或竞技运动员都是如此, 从根本上说，我们必须确保他们所做的不会增加他们身体的压力负荷, on their heart, and on their skeletal structure as well. 然后根据强度给他们开绿灯, frequency, duration, all those things they can do. 但这并不意味着他们不能活跃也不意味着他们仍然不能竞争或参与活动因为他们能够忍受这是由他们所患的癌症类型决定的.

[00:11:31] Host Amber Smith: 一个人在室内还是室外锻炼有关系吗?

[00:11:36] Kaushal Nanavati, MD: So if they're exercising, I'm smiling, right? Because they're already doing the thing. Outdoors and indoors, in terms of what the evidence suggests, as long as they're doing it, there's value.

我们知道日光对情绪、认知、注意力和愉悦感都有好处. At the same time, if it's February in Syracuse, 然后你还要注意外面的天气.

So, it is variable. 在一天结束的时候，做练习才是最大的价值所在. 然后，环境应该是一个支持人们的快乐感, versus stresses them out. 这样他们就能找到最适合自己的方法.

[00:12:19] Host Amber Smith: 我听说肿瘤治疗会削弱免疫系统, 你对集体健身课程有什么顾虑吗, 这个人会被其他正在锻炼的人包围吗?

[00:12:33] Kaushal Nanavati, MD: Yeah, actually that is something to consider, 这是需要注意的，因为潜在的感染，比如病毒感染, et cetera, is higher, 特别是如果你共用设备，或者用户之间的设备没有得到正确的清洁. Then we have to be careful.

Also, 通常当你和一群人在体育锻炼环境中, 并不是每个人都必须保持最佳的卫生习惯. And even if they are, if they have a cough or they have a cold, 那么癌症患者的潜在风险就会更高, 特别是如果他们正在接受某种免疫抑制治疗.

And so they do have to be careful about that. 是的，有时候你喜欢这种情感上的支持，一个群体的支持是令人振奋的. 与此同时，就运动本身而言，你仍然要小心.

[00:13:23] Host Amber Smith: Well, on that note, 有什么要注意的，这样你就不会做得太过火了，或者有什么风险吗, just to be aware of?

[00:13:33] Kaushal Nanavati, MD: 我认为最重要的是要衡量, 1, their ability,and 2, 将其与医疗服务提供者的建议结合起来, 特别是他们的肿瘤团队和初级保健提供者, since between the two of them, their health is assessed, not just in terms of their cancer diagnosis, 而是他们生活中的整体健康状况, in terms of their goals.

And so that becomes the important thing. 你知道，人们会听到对你有好处的运动，然后就开始做. But, you know, when you jump start the system, 有时候会有一点压力随之而来. 所以，采取循序渐进的方法来增加它，但要保持一致.

演员丹泽尔·华盛顿曾说过一句名言:梦想只是梦想, 但为了实现这些梦想——我转述一下——这需要自律. It requires consistency. 我认为，当涉及到体育锻炼时，关键是要坚持，就像营养一样. 我必须强调运动和营养是齐头并进的. So when people do better with both, 它提高了他们的整体健康，显然创造了一个环境，让他们有更好的机会在他们的身体里有一个抗癌的环境.

[00:14:55] Host Amber Smith: 我们说过理想的时间是每周3到5到7个小时, kind of spread across the week. 但是对于那些与疲劳作斗争，有时只是为了度过一天而挣扎的人呢. Do you have any advice for that person?

[00:15:14] Kaushal Nanavati, MD: Yeah, actually it is exercise, 因为当涉及到癌症相关的疲劳时, 我们知道锻炼的人实际上有更好的能量. And so, they may not start with an hour a day. 但他们能做的是从两分钟或五分钟开始，逐渐增加到十分钟.

我们也从其他研究中知道，如果你做10分钟的心血管运动, 有氧运动对心脏有好处. 我们也知道，坚持锻炼的人实际上精力更充沛.

So, it's kind of like, if I don't do it, I'll remain tired, but if I do it, I might be tired in the moment, 但随着时间的推移，我的精力会越来越充沛, improved stamina, and that actually helps in the long term.

[00:16:01] Host Amber Smith: 在不做有氧运动的休息日锻炼身体有什么价值吗, or you don't do weight training, you just sort of let your body rest?

[00:16:12] Kaushal Nanavati, MD: 这取决于个人以及你所做事情的强度. 如果你每天都去散步，你就可以每天都去散步. 如果你要参加举重比赛, 或者你要做一些有竞争性的事情或者马拉松训练, 然后你必须做对你身体有益的事情, giving moments of rest. 特别是当你做更长时间的耐力或力量为基础的更激烈的活动, then your body does need time to recover, depending on how intensely you're doing it. 对于正在进行中等强度活动和/或低强度活动的人, generally speaking, they can remain consistent throughout the week.

[00:16:53] Host Amber Smith: At the beginning of this interview, 我们谈到了将医学治疗与运动相结合的综合疗法的好处, and you also brought up nutrition. Do we understand, in the body, 正在发生的事情有助于减少癌症的扩散, potentially, or reduce the risk of cancer? What is happening, like, at a cellular level?

[00:17:18] Kaushal Nanavati, MD: A ton of stuff, I'll tell you. 从对多巴胺的影响到免疫球蛋白, 影响细胞结构从而导致细胞晚期死亡并减缓癌症的发展, slow down the spread of cancer, what we call metastatic disease, 我们称之为癌细胞的增殖或生长.

There are multiple, 多种酶，激素和化学物质都会受到影响, 包括我们所说的细胞因子和一些人听说过的血管内皮生长因子蛋白质, something called mTOR, (mammalian target of rapamycin) multiple, multiple enzymes that get affected.

In fact, the other thing that ends up happening is, 实际上，它甚至对癌细胞的血液供应也有影响，并减少了这种影响, as I mentioned, with higher intense activity. So, 从调节癌症的新陈代谢, how much it gets for nourishment, 调节体内的免疫环境，使我们的免疫系统更强大, to reducing the cancer risks, as I mentioned, to reducing the cancer related side effects. 所有这些，结合起来，都是通过持续的体育锻炼来实现的.

[00:18:34] Host Amber Smith: 这是非常重要的信息. I appreciate you making time for this interview.

[00:18:40] Kaushal Nanavati, MD: 我真的很感激，因为我同意这真的是把权力放回到一个人的手中，能够驾驭他们的生活经历, even with a diagnosis of cancer, recognizing that you want to be, you want to live like you're living, 你想要拥有最好的生活质量, regardless of the diagnosis, to the best of your ability.

[00:19:02] Host Amber Smith: My guest has been Dr. Kaushal Nanavati, 北州大学家庭医学助理教授, 他也是澳门银河平台癌症中心的综合医学和幸存者部主任. “知情的病人”是一个关于健康的播客, science, and medicine, 由锡拉丘兹上州医科大学为您带来, New York, and produced by Jim Howe. 在upstate找到我们之前的剧集.edu/informed. If you enjoyed this episode, 请在Spotify上对“知情患者”播客进行评分和评论, Apple, YouTube, or wherever you're listening. 我是主持人安珀·史密斯，感谢大家的收听.