Transcript Disclaimer – Please note that the following transcript has been machine generated by an AI software and therefore may include errors or omissions.

Robin Daly
Hello, welcome to the Yes To Life show . I’m Robert Daly, host of the show and founder of the UK charity Yes To Life, that’s just begun celebrating 20 years of advocating for integrative medicine as a far better way to meet the many needs of those with cancer in body, mind and spirit. Today, the show is going to be focusing on the role of exercise in health, and particularly, of course, in cancer. Exercise appears to have come from left field just a few years ago and to have turned the ideas about how to physically care for those with cancer on their head. But of course, the back story is of a long leading, fueled by a few dedicated scientists and practitioners. Ad one of those is Dr. Stephanie Otto from Aaln University Comprehensive Cancer Centre in Germany, who specializes in exercise oncology, a term that I’ve never heard before and possibly not in use here in the UK at all, but sounds like one to adopt. Stephanie, welcome to the Yes To Life show.

Dr Stephanie Otto
Hi Robin, thank you very much, nice to meet you and thanks very much for the invitation to talk to you and to have some conversation.

Robin Daly
Absolutely, my pleasure. After connecting with you recently, I’m excited to meet you and to hear more about your lifelong interest in exercise and oncology. I think we’re talking something like 30 years, is that right, or more?

Dr Stephanie Otto
Yeah, that’s right. I’m working in the exercise oncology field since 1990. So it’s 35 years now. 35. It’s quite a long time. I’m in that field. That’s right.

Robin Daly
It wasn’t even really a field back then, was it? I mean, it must have only been you doing it. It just wasn’t even a discipline then, was it? You mean the beginning, the very beginning? Yes, in the 1990s, we knew about exercise and oncology.

Dr Stephanie Otto
that was strange because of course also my work as a sports scientist, it’s a very new field in medicine and we’re just developing many, many things. And in the 1990s, it wasn’t developed anything, it’s just with exercising and I started work with cancer patients in a rehabilitation clinic and that was a big center with patients. It was an in-house rehabilitation, so they stayed for four up to six weeks in the center. And I did my diploma as well, that was a second study with cancer patients in Germany. And yeah, what did we do? We just did movements and gymnastics and yeah, we tried to have better outcomes on the range of motion, for example, that have been, I think 80, 90% that have been breast cancer patients. they have been done with that treatment, so that was finished and we did some re-creating therapy, we did a lot outside, we did a lot of hiking, biking as well, mountain biking, skiing, walking. Later we started with Nordic walking, with this stick walking and also we did a lot and the swimming, we had a wonderful swimming pool and we exercised a lot in the water. Water therapy was amazing, especially for breast cancer patients. So many people asked us, what are you doing there? Yes. It’s dangerous, don’t move when you are sick and when you’re suffering from cancer, you should rest. Why do you exercise? And we said, OK, what are you doing over there, guys? You medical doctors, you are treating them not much better with the chemotherapy. Or with radiation therapy. that was quite different from nowadays. The cancer patients look very strange. They had black breasts or they looked like have been at the butcher’s, not at the theater before. So that was a strange situation. And we said, what else, whatever are you doing with the patients? That’s not better. And nobody could say we probably could develop metastasis by doing exercise and sports.

Robin Daly
Yes, that was the worry, wasn’t it?

Dr Stephanie Otto
Yes. They have been very afraid that we could do anything harm to the patients. But at the end, they saw they have been improving and they have been getting better from day to day. And when they left the hospital or the rehabilitation center, they gained so much energy. They felt so well. And that was for them, of course, a very big gain in quality of life again. They felt like, oh, I’m still a human being.

Robin Daly
Right. Amazing. Well, you know, as you say, the sort of doctrine previously was that you’re supposed to keep quite still in bed and just not do a damn thing. It was all too dangerous to move the tools. So I’m kind of interested in how anybody got the idea in the first place that that was not the right thing and that it would be good to start moving. Do you know who was the real pioneer who brought that idea in?

Dr Stephanie Otto
I think who talked at first or who was the one who thought at first about exercise with cancer patients, that’s a very long time ago. Right. We all don’t know about it. I read about there was an Indian, probably a medical doctor of the Ayurvedan medicine, and he was living around 600 years before Jesus Christ’s birth. he was talking about, let the people with such cancer, or I don’t know if he talked about the real cancer illness, but he mentioned that they do exercise to get better, to feel better. And not to get boring. And I felt that’s so funny. And at the end, it is what it is. It is pushing your mind to anything else, to be in another situation and environment to gain energy and to forget about the disease. that was the first one who mentioned exercise might be good. Later, there have been some more, of course, Hippocrates, a big philosopher from Greece. He was also talking a lot about exercise and just to give people only good nutrition, only good food is not enough. They have to move to do exercise for a better feeling and a better constitution and performance. Then later, there have been some observations from the military doctors and also from the big nurses health study, they found out that people who moved a bit more also concerning their employment, probably the ones who delivered some parcels or whatever, these ones who are delivering the post, they have been quite much in a better situation. They have been much more strong. So they thought about that might be a reason for it. And then from these epidemiological studies, it was developing further. And my first advisor, the rehabilitation director of the center, he was very convinced and he was very innovative in his thinking. In 1990, we had the psychologist already in the rehabilitation center. Yeah, that’s quite a long time ago. we had social care, we had the nurses specialized. And with me as a sports scientist, and also a physiotherapist, and later we started to add some more therapists like dancing and more different moving from the Asian part like Tai Chi Chuan or Qi Gong. That was not, yeah, I think it was the middle of the 1990s. And also music therapy, dancing therapy, art therapy, we did a lot in this field. that was very, very good to get the patients much more energy and much more comfort and much more quality of life. And we did also some studies over there and some observations, of course. And yeah, but the field developed differently. The rehabilitation, this insurance which paid for this rehabilitation for the patients, they got more structured from year to year. At first, they didn’t say anything what we have to do with the patients. So we just went out and moved a lot. But later on, they wanted us to have a structure, gymnastics and all that things. And that was, yeah, destroyed some very good treatments because we didn’t have the time anymore to do that, what we have been convinced about that help with nations.

Robin Daly
you’re seriously into the science of exercise and cancer, lots of publications that have your name to them. And so, yeah, I’m kind of interested in the direction of that science, what your key findings, if you like of that period, what you feel you’ve contributed to the science of exercise and cancer.

Dr Stephanie Otto
So my first study was just to show that we could improve quality of life. Like most of the studies in the early 2000s, we had a lot of exercise oncology studies with the outcome of the quality of life and feasibility. Of course, that was also my finding. We had improvements in quality of life and also in the range of motion because we did a special treatment with physiotherapists and all together with this recreational therapies to improve that in four weeks in this in-house setting. That was the first study and it was also with a goal to refer them back to work. That was a back to work concept as well. that’s very important still, and we still don’t have the best concepts, but we have some good ones in Germany to let the patients start slowly, little by little to get back to work, but it’s not solved everything because it’s not in all environments, so easy to get them back. But that’s only one part in exercise oncology science. I did some more research also, again, concerning BRCA mutation carriers, for example. That’s the breast cancer gene, a very, very big gene, which is a tumor suppressor gene, which is mutated in some humans. And yeah, it can lead to breast cancer. But also in men, they can be affected as well. If they have BRCA 1 or 2 mutation, they can get colorectal cancer or, at the end, prostate cancer. There are some different cancers as well. And so that’s not a very big group. But if they are affected, they have a very high risk to get cancer. Like Angelina Jolie, we remember her, a very high, high risk to get breast cancer. So in this phase, many women still think about to get the bilateral mastectomy of both breasts. And that’s a big suffering, of course. So I was thinking about what can we do by exercising, by doing training, and especially high intensity training. Do we have an effect on the systemic part of the body, not only to have them good on mind and improvement in quality of life? So that, of course, was the second outcome as well. And so we measured. We did some measurements, including muscle biopsies before and after a six week treatment. We had three times a week. We had endurance training and two times strength training. And they had to do high intensity interval trainings with 80% of the highest volume. And at the end, we had improvements on the protein level of the tumor suppressor gene of this BRCA1 gene. And that was really amazing because it was a small group. It was a pilot trial with 16 patients. it was a randomized control trial. We had some patients who had to be dropouts concerning some upcoming problems. But at the end, we could show in this very small group a high significant difference between or impact on this BRCA1 gene function. So if the protein is upregulated after the training, the function of the protein is better. So the tumor suppressor function was improved in this group after the six week training. So yeah, amazing to see. And yeah, of course, also these very personal stories around a man, for example, never exercised in his life. And he was just working on a building site. And he improved so much that he could sleep at the end.

Dr Stephanie Otto
He never could, he could never sleep all night long. He woke up several times and he had so many problems to sleep well. But after this treatment, he could sleep without any breaks or stops. And that was perfect for him, much more quality of life.

Robin Daly
Absolutely. Because it’d make a massive difference. That’s right. And your overall health.

Dr Stephanie Otto
Yes, yes, that’s really it. And we also did some more studies, exercising, also high intensity training during chemotherapy. So that was a pretty up try with most of them breast cancer patients, had also similar outcomes with outcomes on anti-inflammatory cells, for example, and also roskavengers and all these anti-oxidantic improvements. And at the end, we had, of course, improvements in quality of life. But in the follow up study, we found out it was not that what we would have liked to see, that they attend over a long period to that training, they didn’t, they fell down again, they, they lost some of their performance again, after one year. So it’s very important to have, I think, for the cancer patients, to get them treatments over longer periods and always to recheck them again, you can’t just leave them alone. They need regular consultations, and they need check-ins and also checks on the body, on the performance. Like you can do it with the gold standard VO2 max, but that’s not always possible. And that costs a lot. You can do that also with very simple measurement methods, assessment tools, like hand ripped sprains, for example, or stand up tests. That’s very easy to measure, but it should be implemented in the regular medical checkups. That’s one of my my biggest goals that the cancer patient get a regular checkup, like a medical checkup, together with his performance checkup, let’s call it that way. And also to avoid, for example, sarcopenia. Many, many cancer patients are suffering from sarcopenia or at the end cachexia. That’s a very, very big problem. And they can’t bear the chemotherapy or radiation therapy, they get fatigued, but not only fatigued and bad quality of life, they have really, yeah, hard, they suffer a lot from this inflammation, from less muscle, muscle mass, and at the end from less muscle function. And you need the muscle function and the muscle is like a pharmacy, I always say it’s a whip organ in the body like fascia as well. these organs are completely underestimated, because they have so many, so much power. They have a pharmacy with so many functions. If you contract a muscle, it releases so many cells, immune cells, and anti inflammatory cells and all these processes, which the body needs to be well, to be balanced and homostasis.

Robin Daly
Yeah, very interesting.

Dr Stephanie Otto
Yeah, and I miss all these, yeah, measurements and functions and yeah, rehabilitation tools to avoid that the patients decline by the therapy. So we always wait until it’s worse.

Robin Daly
Yeah, so you’re talking about preventing these bad side effects. Yeah. Very interesting. I’ve never heard anybody speak about muscles in quite that way. It’s not to say it’s your subject.

Dr Stephanie Otto
right. I love investigating muscles and that function. Of course, we have this, this body composition part. How much muscle mass do we have? But we know nowadays, it’s not only to have a big muscle mass. You also and that’s the outcome of the latest, the recent outcomes of the sarcopenia group. There is a group. Meanwhile, a group of the all over the world, they met and found out that muscle function is the most important thing. And yeah, but who looks after that in old people in the elderly, in the patients with chronic diseases like cancer or several other diseases. So it’s very important to look and to find out where’s the problem before they get worse in such situations where you can’t have them anymore. If the patient is already suffering from Caixexia, it’s such an inflammatory environment, you almost can’t help them anymore. So we have to prevent that prevention is the key education, the next key prevention, education, in all levels, between all groups, the all health professionals, also the patients, the relatives, the care givers, in all fields, and also the politicians because they don’t even know how important it is to improve knowledge at the end to improve educational standards, and to get some standards for diagnostics, for treatment, and to implement these standards in regular therapy.

Robin Daly
Yeah. Okay. Well, thank you. I say it’s kind of a new angle on things for me. So I was thinking that with exercise, I mean, one of the things that’s very clear is just how broad the range of effects, it has positive effects on the immunity, on information, toxicity, your outlook, your mood, you know, all sorts of things, your muscles, of course. But I was kind of interested, is there anything known about directly how exercise can affect cancer itself or tumors?

Dr Stephanie Otto
Yeah, that’s a quite good question. And it’s very difficult to talk about that topic. We have some signs of that. There are several animal studies, of course, some rodent studies or mice studies. And there are some signs that it might be due to exercise. We have an improvement in animal studies. We can see that there is an improvement in the natural killer cells, for example, which attack the cancer cells and also viruses and some other cells. And so they get bigger, they get, yeah, the quantity and the quality of the cells rise and improves. But it’s not all shown in humans. Yeah, there are some small studies, and we really need big studies. And that’s on my heart to find out that much more about that. This basic science to find out how do the immune cells function? What can we do to have a better function, to prevent cancer, but also at the end to treat cancer? Right. And one of my field, which I like very, very much is the fascia field. Fascia is a connective tissue in the body. because everything runs over this connective tissue, every cell in the body is covered with a connective tissue. And it’s like if you cut an orange in the middle, and you look into this orange, you see every so many parts are covered with this kind of skin. If you have a piece of chicken meat, for example, and to lift this white skin, that’s fascia, that’s this connective tissue. we need this connective tissue to transport information, for example, it’s connected with the neurologic system, it’s connected with the blood system, with the muscle, with the tendons, with the bones, everywhere with the organs at the end. So it’s all one system. And it has a very important role in the body, which is too much underestimated. environment of, yeah, probably tissue, which is almost getting worse, probably which is almost a tumor is developing. I can imagine that we can have some influence on this micro environment of the tumor. But how can you show that? It’s not so easy. No, you can’t just say that we need a lot of investigations, a lot of studies in that. But we know what what we know already is that the environment of a tumor is stiffness, it’s very stiff tissue, for example, a liver tumor is very hard, like a stone.

Dr Stephanie Otto
Yeah, this is blocked. That’s blocked tissue. That’s not elastic, like usually a tissue is elastic and it’s sliding, it’s guiding, it’s moving very well, all these layers of the tissue that are different layers of the super pressured tissue with some fat, the fat under the skin. And then you have step by step, layer by layer and go into the deeper fascia of the muscle, for example. all these layers should move well. But in the surrounding environment of the tumor, nothing is moving well anymore. It’s all blocked. It’s like it’s hard, it’s not elastic anymore and not moving anymore. So no information can go into and out of this region anymore. So you have not this anti-inflammatory response and all this toxicity can rise and you have the problem with hypoxia and yeah, that’s all this developing in the worst case.

Robin Daly
So are you thinking that exercise is a means of kind of loosening all of this tightness and stiffness up and bringing life to the area?

Dr Stephanie Otto
Yes, at the end, it’s exercise which works well in the facial tissue, in this connective tissue, and we need a good tissue at the end. If we want to be good in performance and also in sports, we need a good tissue. These elite sports men, for example, they can only give their best when the function of the fascia is well. Ask all these elite sports men, they will tell you the same. It needs a good function to develop energy and a good performance, but at the end, it’s also very important for all these mechanisms behind this immune function and this anti-inflammatory function and also the metabolism and the body needs to have a very good function of the fascia and the muscles and all these environments to have a homostatic situation. if that’s not functioning, you overload the stress excess. As well, you have the environment of the tissue which is misfunctioning. You also might get some mitochondrial problems. The mitochondrial function might get worse, so you have not a good transport of oxygen. And you also might have a problem with the HPA excess. The stress excess is overloaded. You don’t have any heart rate variability due to the misregulation between the simpaticus and the parasympaticus. So the autonomic nervous system isn’t functioning anymore. And that’s because the vagus nerve isn’t functioning anymore. The vagus nerve, the tense nerve of the brain, the most important one because it’s the biggest one and it’s connected to the whole body and all organs. If it’s not working out well, you can see it. You don’t have any heart rate variability. And if you don’t have the heart rate variability, the body is lacking of its own, I would say of its own help. There’s no balance, no homostasis as well. And you have more inflammation, higher inflammation. And it has also been shown in cancer patients. For example, patients in leukemia which get stem cell transplantations, there is a study which could show that these patients which are suffering a lot after stem cell transplantation, allogeneic transplantation, when they have probably a lot of complications after the transplantation and also probably get the GBHD, this graft-versus-host disease where they don’t accept the donor cells. That might be the reason before that they did have any heart rate variability from the beginning, from their diagnosis. And I checked, I rechecked all my patients which had many complications later on in their survivorship or in their palliation situation. I rechecked their echocardiography and I found out that most of them, 20% of them, didn’t have any heart rate variability as a sign that their vagus nerve function wasn’t well, that their autonomous nervous system didn’t function well, and so there’s a misregulation as well. I have some cases which I treated with fascia treatment and vagus nerve stimulation and they developed from one day to the other vice versa in a completely different situation.

Robin Daly
Once they look like those sort of treatments, what are you actually doing? I don’t know what a vagus nerve simulation looks like.

Dr Stephanie Otto
Yeah, what’s the biggest stuff? How can you treat it? So, can you do some boxing too? It is. No, it’s really amazing. It’s so easy that you can’t imagine that will help this system. The most important system or functioning for the vagus nerve to stimulate it is to breathe well. It’s only breathing. For example, this box breathing is very common. It’s like you breathe in, you just count until four. You breathe in, you hold the breathe until four again, you exhale until four, hold again four, inhale four, hold four, exhale four, hold four. So, like in box. And this breathing method is very well to get balanced. That’s one part. You can do a lot of breathing techniques. You can do yoga. You can do all these mind body therapies, massage therapies, stretching, yoga, tai chi chuan, chi gong. All these mind body muscle releasing techniques or anti-stress treatments. And also, you can make use of your voice if you do singing, for example, or like you take some water in your neck and you goggle. It’s a very good thing because the vagus nerve is running through your neck.

Dr Stephanie Otto
and you can do eye movements. A lot of eye movements stimulate the baggage nerve. Yes, and I also treat with some techniques which I make use of for the superficial fascia. I have some that are so-called cuppings. It’s a cupping method with, yeah, you put it on, and develop a vacuum, and then you treat the body, and you go along the muscles over the body, and I do it in the front and the side parts, because there the baggage nerve is running. To release the muscle tone and to have a better fascia function, I do some massage techniques as well, and then the function is better, the baggage nerve works better, and immediately it shows a different situation for the patient. You have very fast response of the body.

Robin Daly
this is the most fascinating talk about exercise. It’s gone in directions I never imagined. We’ve actually used up the time already. It’s been so interesting. Thank you so much, Stephanie. I feel like we could talk a lot more. There’s plenty of other things I haven’t asked you at all, but really interesting. what a great, you’re scraping the service of a very deep and subtle science, which is destined to help us an awful lot once we understand this stuff properly, it seems. Fantastic. Thank you so much for telling us about it and for all your great work contributing to the area.

Dr Stephanie Otto
Yeah, thank you so much. That would be, yeah, we could fill the whole evening, I think, talking about. Of course, I would love to. And it was amazing to, to talk to you, Robin. It was wonderful to me. Thank you very much.

Robin Daly
Thanks so much, Stephanie.

Dr Stephanie Otto
Take care. Bye bye.

Robin Daly
The human body is such an incredible thing, isn’t it? The more you look, the more you find. It’s so interesting to learn about the complex multiple roles of muscles and fascia. Thanks for listening today. I hope you want to join me again to meet my guest in next week’s Yes to Life show.