Rewiring Relief: How Exercise Heals the Body and Mind After Cancer

Could exercise be just what the doctor ordered for recovery during chemotherapy? In this episode of “The UMB Pulse,” explore this novel approach to cancer recovery with Ian Kleckner, PhD, MPH, associate professor at the University of Maryland School of Nursing and director of the SYNAPSE Center. Kleckner shares how exercise can alleviate symptoms of chemotherapy-induced peripheral neuropathy and improve the quality of life for cancer survivors. Through his research, Kleckner investigates how movement can reduce inflammation, enhance brain and body coordination, and empower patients to reclaim their lives. 

Chapter Markers

 00:00 – Introduction
 00:00:17 – Cancer Treatment & Neuropathy
 00:01:37 – Guest Introduction: Dr. Ian Kleckner
 00:05:06 – Understanding Neuropathy
 00:09:38 – Research Findings: Brain & Exercise
 00:13:33 – Exercise Intervention & Clinical Trials
 00:19:08 – Practical Advice & Takeaways
 00:23:31 – Conclusion & Credits

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Chapters

• 0:00 Introduction
• 0:17 Cancer Treatment & Neuropathy
• 1:37 Guest Introduction: Dr. Ian Kleckner
• 5:06 Understanding Neuropathy
• 9:38 Research Findings: Brain & Exercise
• 13:33 Exercise Intervention & Clinical Trials
• 19:08 Practical Advice & Takeaways
• 23:31 Conclusion & Credits

Transcript

Jena Frick: 0:04

You are listening to the heartbeat of the University of Maryland, Baltimore, the UMB Pulse.

Dana Rampolla: 0:17

Cancer treatment saves lives, but it can also leave lasting reminders, tingling, numbness, even pain in the hands and feet. For some survivors, just walking across the room or buttoning a shirt can be a daily challenge. It is called chemotherapy induced peripheral neuropathy, nerve damage caused by certain cancer drugs. It affects nearly two thirds of patients who receive those treatments, and for many the symptoms can last months or even years.

Charles Schelle: 0:48

At the University of Maryland School of Nursing, Dr. Ian Kleckner exploring a new idea that exercise, simple movement might help the brain and body relearn how to work together again. His research asks a powerful question, can movement itself be medicine for cancer patients?

Dana Rampolla: 1:09

On this edition of the UMB Pulse, I sat down with Dr. Ian Lerner to learn how his team is using exercise to help cancer survivors move and feel better again. If you enjoy stories like this one, be sure to like, follow and subscribe to the UMB Pulse so you will never miss an episode about discovery and innovation at the University of Maryland Baltimore. Now here's my conversation with Dr. Kleckner. Ian, thank you so much for joining us today. I have a lot of questions for you.

Ian Kleckner: 1:43

Yeah, thank you for having me. I'm really excited to be here.

Dana Rampolla: 1:46

And tell me a little about your, your, hypothesis that exercise can be used as medicine?

Ian Kleckner: 1:53

Yeah. So, one of the, I think, cool ideas, a new idea and exercise oncology is this idea that, exercise can help people. Get comfortable being uncomfortable. We know that patients with cancer during their treatment have symptoms like fatigue, distress, pain, and so forth. And exercise can reduce the intensity of those symptoms for many patients, but sometimes it will not reduce the intensity of those symptoms. But even still, it can help people feel better. And so, as an example, we have data from a couple of our studies showing that. Patients with pain or fatigue when they exercise, the intensity of those symptoms might not go down, but they interfere less with what the patient wants to do on that day. And so those people who are exercising are able to do the things they want to do. Those symptoms don't interfere as much, even if those symptoms are at that same level. So for example. If you had a patient in a clinic who came in with seven outta 10 distress, which is really severe, very high level of distress, if that patient were randomized to the exercise group and regularly exercising, that distress would interfere only a four out of 10. But if the patient was not exercising, that distress would be a six outta 10. So they're still experiencing some interference where the distress is getting in the way of what they want to do, but if they're exercising, it gets in the way less. And so that leads to the idea that exercise helps people feel comfortable being uncomfortable, and that exercise can help people live the lives they wanna live, even with the symptoms they have. Because the unfortunate truth is, although. we would love to prevent cancer. People still get cancer and although we would love to perfectly prevent all of their symptoms, people still get symptoms. So what we can do is just try to help people live their best lives with the situation they're currently in. And new evidence suggests exercise can do that. The other cool thing is that we were not trying to do that with our exercise intervention. It just happened to be that way. And so the next big idea is about can we make an exercise intervention that does that on purpose, that helps people feel like they can live the lives they wanna live alongside their symptoms. I think in the far future, I hope to dissolve the false distinction between physical exercise and psychological exercise. if we can dissolve that boundary the patients are gonna benefit.

Dana Rampolla: 4:40

Well, before we jump into what your actual research is, I unfortunately, my dad passed away a few years ago from lung cancer, and part of what he was experiencing was something called neuropathy as he was reaching the end of his life. And I think that when we think about cancer, you know, we're all familiar with side effects like nausea, losing our hair, those sorts of things. But what exactly is neuropathy?

Ian Kleckner: 5:06

Yeah, that's a great question. And um, yeah, I'm sorry about your dad. It's, you're in good company 'cause a lot of people have, you know, seen their loved ones lost to cancer and, seen their loved ones experience the side effects of cancer treatment. So what is neuropathy? Neuropathy means nerve damage. And so when those nerves get damaged, you can imagine like if it were an electrical circuit, now it's not conducting the signals that it was used to conducting through your whole life. So you might have a loss of sensation. You might touch something and you don't feel anything at all, or you might have unusual sensations like pins and needles, even if you're not touching anything at all. Or you might have sharp shooting or hot burning pain, for no particular reason that you can be aware of.

Dana Rampolla: 5:56

And do you usually see that throughout your chemotherapy treatments or more so at the end or afterwards?

Ian Kleckner: 6:03

It can depend upon what type of chemotherapy is used. So sometimes the chemotherapy can cause neuropathy right away. So a patient will sit down for their chemotherapy infusion and have sensitivity to cold immediately for the next few hours. And you might have other people getting neuropathy that builds over the weeks of chemotherapy. So if a person, a woman with breast cancer gets chemotherapy for three months with a taxane based drug like Paclitaxel, that neuropathy could build over the course of those 12 weeks and get worse and worse and worse and worse and worse, um, in a dose dependent manner. Sometimes there's this thing called coasting. And coasting is when a person's neuropathy symptoms get worse after they've finished their chemotherapy.

Dana Rampolla: 6:56

And so it really can just be different. Based on all kinds of factors. Maybe the type of medication, maybe the, just how your body itself reacts to it.

Ian Kleckner: 7:05

Yeah, I think mostly it's different based on the type of medication., Okay. And um, also, I don't think that people have good explanations for how that is happening, so that's a bit of a mystery. How is it that some of them have a fast onset or a slow onset or a delayed onset?

Dana Rampolla: 7:28

Interesting. So tell us a little bit then about what it is that you are researching and how it might help something like neuropathy.

Ian Kleckner: 7:37

Yeah. So, I'm the director of my lab, which is called the Cancer Control Mind and Body Lab. And the mission of our lab is to understand how the body and brain produce subjective feelings like symptoms and try to use that knowledge to help patients with cancer feel better. We have two main goals. One is to test the effects of exercise on symptoms that patients with cancer have with a special focus on chemo induced peripheral neuropathy and fatigue and distress. And then the second thing we do is to look at how the brain is involved in those processes. How does the brain process that information from the body? How does the brain make the symptoms that we have as perceptions and how does exercise affect the brain and how can we use that to help us feel better? So, in a nutshell, we wanna know how is it that you feel, what you feel, and then how can we help you feel better? So, the types of things that we're doing are all about helping patients with cancer and their symptoms. The number one symptom we focus on is chemo induced neuropathy, or CIPN chemotherapy induced peripheral neuropathy.

Dana Rampolla: 8:46

Interesting. And Ian, what made you start wondering if movement itself could help people feel better?

Ian Kleckner: 8:52

We know that exercise is generally healthy and that it helps people feel better, and personally, I've been exercising. Vigorously for, you know, almost 30 years. And I've experienced its benefits, As a scientist, I got into science because I was curious about how the body worked. And then I was curious how the mind worked. And so for me, it was very natural to try to study whether exercise was helpful for a clinical problem. And cancer is one of the biggest clinical problems that we're facing in the world right now.

Dana Rampolla: 9:28

So you noticed that research focused on damaged nerves, not so much on the brain. Talk a little bit about how the brain fits into the story.

Ian Kleckner: 9:38

When we think about how do people have symptoms and how do they have the symptoms they have? For me, it is natural to ask, well, what is the brain's role in that process too? So when I got into cancer research over a decade ago, I came from psychology and neuroscience where I thought a lot about. What the brain was doing to help us feel what we feel. And when I got into cancer research, I knew I wanted to look at chemotherapy induced neuropathy because I was so curious. What does the brain do when the peripheral knowledge, when the information from the body is altered, what does the brain do? And of course people in cancer research know that the brain is important, but it is more often associated with chemo brain, meaning cognitive impairment. I can't remember where I put my keys. I can't concentrate, and things like that. And we all know that chemo brain, you know that common phrase, um, but. People usually say it refers to cognitive function and not necessarily emotional function or pain or distress or other things that the brain also it plays a key role in. So that's kind of where I got started and what I was really excited about

Dana Rampolla: 11:03

When you say exercise can retrain the brain, what's really happening inside the body when someone moves?

Ian Kleckner: 11:11

What exercise has a lot of effects upon the body, and it is called a pleiotropic intervention, meaning it has multiple effects. And so I'm gonna tell you about three things that I think are important, that what exercise does to the body and to the mind. Number one is anti-inflammation. We know that exercise has a really strong anti-inflammatory effect, and inflammation is the body's molecular level process for healing injuries. So it's an important part of the body, but when inflammation is too much and too long, that is not good. It can make you feel tired. It can make you feel achy, like when you have the flu. And, exercise can reduce inflammation. So it can reduce inflammation in the periphery, in the muscles, in the nerves, in, in your brain too. And so the first way that exercise can help is through reducing inflammation. The second way that exercise could help is by allowing you to train how to move your own body. People with chemo induced neuropathy can have nerve damage to their feet that prevents them from maintaining their balance. Exercise and walking regularly and doing balance exercises will help the brain use the information it does have access to in order to maintain your balance. The third part I would say is psychological level stuff like improving your feeling that you can help yourself. when someone starts exercising, they prove to themselves, I can do this. I can have some control over my health, my life and get some independence back. And so the knowledge that they are helping themselves can feel better and their worry can go away., Their pain can go away. And we have data showing that people who worry less about their pain will exercise more.

Dana Rampolla: 13:14

So when you work with your patients, uh, you're working in the lab with them and you're giving them different things to test and try, and then you see what their reaction is or how do, how do, how does your research actually work on a day-to-day basis?

Ian Kleckner: 13:28

So for our clinical trials where we are looking at the effects of exercise, we have a really great team, including, uh, Mr. Javier Rosales, who is our lead coordinator. He's been with me for, um, over two years and he has a background in exercise science. He screens and recruits people, from the oncologist's clinic. And so they say yes, then they join our study and they will be randomly assigned to either get an exercise intervention or a non-exercise intervention. And so the exercise intervention was developed by my mentor, Dr. Karen Musin at University of Rochester Medical Center, who I mentioned before. So the exercise intervention is daily walking. And daily resistance exercise with stretchy bands. So Javier will teach the people how to do the exercises. There are 16 upper and lower body exercises done with resistance bands. Javier will meet with them for like an hour in the beginning of the study and show them how to do all the exercises, Correct form, how to choose the right resistance level, how many sets and repetitions to do. And then he'll also talk about their daily steps and a walking goal for them. So we give everyone, an activity tracker and it tracks their daily steps and we build their exercise prescription on how many steps they tended to be walking in the beginning of the study. that number will increase over the 12 weeks of the intervention. So by the end, they're doing not 5,000, but maybe 8,000 or 9,000 steps per day. And by the end, they're not doing their lower intensity exercises with a resistance band, but they're doing a higher. Resistance level, they're doing more repetitions, We check in with people every week or two on the phone and just give them the rah rah, you know, coaching and you can do it. And how's your stuff going? What barriers are you facing And helping them solve their own barriers.

Dana Rampolla: 15:28

That sounds great. I mean, just intuitively you would think if you're doing stuff, you're getting up, you're moving, you're going to feel better, you're going to have a better mindset, which hopefully would help you get through all of it. What about the person who's, who may not been, may not have been very active before, or the person who says, I'm afraid, like my feet don't feel right, I'm, it's not connecting with my brain. I'm afraid I'm gonna fall. Maybe they're elderly and then they could have other complications. How do you kind of work with those people?

Ian Kleckner: 15:58

Yeah, so all of the people on our exercise studies are currently not exercising.

Dana Rampolla: 16:04

Okay.

Ian Kleckner: 16:05

A lot of them might have been former exercisers, but after their diagnosis and treatment, they stop, and the exercise study is a great way to start that up again. Or they might not have been active at all. And, and the cancer diagnosis is a teachable moment. American College of Sports Medicine has created guidelines for how much a patient should exercise after they got a cancer diagnosis. And the rule is start low and build slow. Most people are walking every day, even a little bit, and we just say, try to add a little bit more. And if they're not familiar with how to exercise, we show them. those are basically the things that we do with people who are not um, regular exercisers, I should say. Yeah.

Dana Rampolla: 16:52

Okay. And then does that daily walking kind of help rebuild that brain and body sink?

Ian Kleckner: 17:00

so I mean, I'm assuming that that's part of the mechanism. I think that the resistance exercise is playing a really big role because although everyone on our studies, has already been walking, you walk to the bathroom, you walk to the kitchen, you've walked to your bed, whatever. Most people are not doing resistance training, and so the addition of resistance training is probably more different than the increase in walking, if that makes sense. And so if I were to guess, I would think that the resistance exercise is playing an important role, but any exercise is good. So I, I don't want people to think that they need to do this perfect type of exercise to get a benefit. Any exercise is good.

Dana Rampolla: 17:51

Yeah. And that was going to be my next question. What, what one should I start with or a person start with if they're going through treatment or recovery? any data on how if people have been active before chemotherapy, that maybe they have had fewer side effects later, and if so, why do you think that would be?

Ian Kleckner: 18:11

So there are many more studies suggesting that people who are more active, before or during their cancer treatment have less severe symptoms. people who are more active before their treatment starts, those people have less severe symptoms during the treatment, which suggests that the moving of the body actually helped them. And I would come back to those same three things I mentioned in the beginning. exercise can reduce inflammation. Exercise can help the brain make use of the information it does have from the body. And exercise can help improve people's self-efficacy and the belief that they can help themselves and it helps them worry less about the symptoms that they do have.

Dana Rampolla: 18:57

Can you picture that at some point, movement might be prescribed like a medicine for treatment? Yes. Or is essentially what you feel like you're doing now, I guess. Right.

Ian Kleckner: 19:08

Yeah, definitely. in exercise science, we do call it an exercise prescription.

Dana Rampolla: 19:13

Okay.

Ian Kleckner: 19:14

And the largest body, a governing body for exercise science. The American College of Sports Medicine has a movement called Exercise is Medicine. And so we do talk about that in the field of exercise science, using exercise as a prescription. However, you don't see doctors necessarily write a prescription for exercise, although some of them do, and they write it on their prescription pads, and it's been shown to help improve adherence to exercise and help people exercise more when a doctor writes it down on a piece of paper. Um,

Dana Rampolla: 19:49

it's official, right? You have to do it.

Ian Kleckner: 19:51

Yeah. Doctor's orders. Yeah. I think that exercise, I think that using. If any means we can to help people exercise more, will be helpful. And if that means writing it down and calling it a prescription, that sounds great. And, if it means, you know, sending them an app that helps track their exercise, that sounds great. If it means meeting weekly or twice a week with a physical therapist, that sounds great. you know, people know that exercise is helpful. And I think part of the problem is that they maybe have a hard time doing it or prioritizing it in any way. We can do that. That that sounds great.

Dana Rampolla: 20:35

Right. I know just on a healthy day it's hard to prioritize it, you know, when you're balancing work and kids and family and whatnot. So even more so when you're, when you're ill. one last takeaway, Ian, what if you could tell every survivor one thing about hope, healing, or movement, what would that be?

Ian Kleckner: 20:56

I would say probably keep moving. just keep it simple. Keep moving. You know, everyone, you know, I, I'm also a Buddhist and so I do really like those principles from Buddhism. I think they're very useful. Um, there are phrases , that come about across multiple, cultures and things. Marines say pain is weakness, leaving the body. Bodybuilders say, no pain, no gain. And Buddhists say, no mud, no lotus, because the lotus, the beautiful lotus flower grows out of the mud. And there is a lot to be said about keeping moving and to understand that everyone will experience pain. Everyone will experience some suffering and, we might not want that, but can we keep moving and trying to live the life we want to live? And how do we make meaning out of what we have, regardless of what cards we've been dealt.

Dana Rampolla: 22:01

Right, right. Well, I think you've inspired me to, to get off of here and go get a little exercise in today. would, would your, is your feeling also, and I think I know the answer to this, but that exercise throughout your life really does, I mean, certainly anything can happen. We're exposed to a lot of different environmental and, and biological influences, but generally speaking, it sounds like your prescription is to exercise no matter what. Right.

Ian Kleckner: 22:29

Yeah, I think there's always something that we can do and definitely there are people who are bedbound or in other situations, they might not be able to do the exercise that they see on TV or the types of exercise that I've even mentioned here, but. I would say work with an expert, work with a physical therapist or somebody who can help you figure out what can you do that gives you meaning, that helps move your body, and, that tries to leverage those three things we talked about, anti-inflammation, helping the brain make use of the information it does have and helping you realize that you're helping yourself.

Dana Rampolla: 23:10

Well, I love the example you gave about yoga not being created for that purpose, but yet that is what it's, it's doing for many. So thank you for, for sharing with us and for all that you are doing, and we will definitely try to stay connected to hear what's ahead in the future.

Ian Kleckner: 23:26

Yeah, thank you so much. It's great to talk with you.

Charles Schelle: 23:31

Dr. Kleckner's work reminds us that recovery isn't only about medicine, it's also about movement, mindset, and the body's ability to heal itself. At the University of Maryland School of Nursing, his team is helping survivors rediscover strength, confidence, and control. By asking the question, can you rewire the brain to provide some physical relief?

Dana Rampolla: 23:57

Our thanks to Dr. Kleckner for sharing his insight and to you for joining us for this episode of the UMB Pulse. If you enjoyed today's conversation, tap that like button, subscribe to our channel, and follow the pulse wherever you listen to podcasts so you can never miss a story about discovery and innovation at the University of Maryland, Baltimore. And we'll see you next month on the Pulse.

Jena Frick: 24:25

The UMB Pulse with Charles Schelle and Dana Rampolla is a UMB Office of Communications and Public Affairs production edited by Charles Schelle marketing by Dana Rampolla