#Exercisumab
I love the “exercise is medicine” space and could not have asked for a better ASCO 25 drop than the CHALLENGE Trial. Discussion flourished immediately after the exciting results were reported on Sunday and the paper is already available.
Monday brought more discussion, including thoughtful critiques from some of my favorites on Twitter. The Sensible Medicine post from Cardiologist John Mandrola and Twitter thread from Oncologist (and elite Tweet artist) Timothée Olivier are required reading for anyone interested in this study.
This phase III, randomized controlled trial showed that patients who enroll in a structured exercise program have improved overall and progression-free survival compared to control patients. They just received information about healthy lifestyle.
Oncologist Bishal Gyawali delivered the Tweet I was waiting to see:
We all know he is right.
Twitter coined exercise-as-a-drug, Exercisumab, as early as 2014 when Karan Chhabra, a bariatric surgeon, quipped about its effectiveness in lowering LDL. Bishal actually first invoked the term in oncology way back in 2018:
I enjoy the satire because the American Healthcare System’s relationship with exercise is, well… it’s not like the relationship with pharmaceuticals.
Hippocrates hypothesized the health benefits of exercise and prospective scientific experiments have since supported this hypothesis. It’s now 6 years old, but here is a nice summary table of some benefits offered to patients with cancer:
Schmitz et al., https://pmc.ncbi.nlm.nih.gov/articles/PMC7896280/
Despite these findings, gyms and trainers are not usually covered by insurance and access to physical therapy and other clinical exercise professionals is poor. Even though physicians generally agree it’s important, we aren’t really trained to prescribe exercise and it’s often left out of patient discussions.
The CHALLENGE Trial finally gave oncologists that phase III OS benefit to pay attention. With that attention, comes critiques! In addition to Mandrola’s and Olivier’s pieces above, you can find a lot of good commentary on Twitter.
John Mandrola offers a suggestion about implementing the CHALLENGE Trial protocol across a nation’s cancer centers.
I too believe that any widespread, costly intervention should follow the same rules as drugs or devices.
The problem is there is no Exercisumab. Exercise can’t be packaged, advertised, and sold to physicians and their patients.
The incentives in oncology research are a barrier to multiple, histology-specific exercise trials in oncology. We may not get them.
This discussion is important and whether exercise “fights cancer” remains up for debate. I just don’t want clinicians to lose sight of the big picture.
Exercise is a component of a healthy lifestyle that can take many forms and protocols tested in studies vary widely. Many are less intensive than those used in the CHALLENGE trial and offer significant benefits for common symptoms associated with cancer.
We also know that less than 50% of healthy American adults follow aerobic exercise recommendations and less than 25% follow aerobic + strength recommendations.
Whether it improves cancer control or not, incorporating an exercise prescription into clinical counseling is a no brainer.
You should prescribe Exercisumab today.
Physicians can prescribe exercise to their patients today. No pharma rep, hospital administrator, or infusion center required.
In 2021, Schmitz et al. published a call for “clinicians to assess, advise, and refer patients to either home-based or community-based exercise or for further evaluation and intervention in outpatient rehabilitation”.
It’s really helpful and contains a number of resources to help you get started. For example, check out this useful triage guide below. The paper also includes a sample exercise prescription (i.e. EIM ExRx).
If you want more, the American College of Sports Medicine has an entire website dedicated to Exercise is Medicine with a special section on cancer. The Moving Through Cancer website has a ton of resources, including a registry of community exercise programs designed for patients with cancer. Just search your zip code.
Physical therapists will see your patients that need supervised exercise for fatigue, gait instability, and deconditioning, all common diagnoses in patients with cancer. You can find local therapists through the APTA registry.
Finally, Oncology Unscripted recorded a podcast for patients all about exercise that’s available on the usual podcast platforms. Please feel free to share that with your patients.