Soraya Kasla, oncology exercise specialist: “Physical activity increases survival rate by up to 40%” | Health and wellness

Soraya Casla, 36, from Segovia, who has a PhD in physical activity and sports science, began researching the benefits of exercise in cancer patients just over a decade ago and found that, despite existing evidence of its effect on increasing survival, preventing relapses and improving quality of life, in Spain it was not considered just another therapeutic weapon. He traveled the world (USA, Canada, Denmark and Australia) to complete his training as a specialist in oncology practice, and upon returning to Spain in 2015, he began complementing patient treatment with personalized programs. Today he runs a specialized center and has just published Move in the face of cancer (Vergara, 2024).

Ask. How did the Exercise and Cancer Project come about?

Reply. It came about after the realization that there was no real answer to cancer exercise for cancer patients. During treatment, they experience a number of side effects, for which exercise has already been proven to be the most effective for all of them. But it must be specific, tailored and individualized. This was not the case in Spain. After developing several international aid projects and seeing how they worked in other countries, hospitals and institutions, I was asked to develop my own project to reach patients, educate, inform and conduct research, and make it as accessible as possible.

TO. How does exercise benefit people with cancer?

R. Increases survival and reduces treatment side effects. Many times we associate this with nausea and fatigue, but we see that the treatment also has a downstream effect: it promotes or opens the door to the development of other cardiovascular diseases, hypertension problems, obesity, diabetes. These are diseases that can develop with a sedentary lifestyle and over the years, but they are increasingly appearing in young people. Exercise reduces these side effects, and in the long term we also reduce the risk of cancer and other diseases coming back.

TO. This conclusion is confirmed by a clinical study.

R. Together with Miguel Martin (Professor of Medicine at the Complutense University of Madrid and Head of the Department of Medical Oncology at the Gregorio Marañon University Hospital), we designed one of the first studies in which more than 200 patients participated over four years. When we published this, there was a lot of resistance because it was thought that they could only do very low intensity things. We show that exercise that combines high and moderate intensity improves all physiological aspects: increases muscle mass, improves the ability to produce energy, and improves circulatory and cardiovascular function. And this was tolerated by patients both during chemotherapy and after.

TO. Is there a general pattern or is each cancer and each patient different?

R. There is an exercise protocol that we customize based on the patient’s level, time of illness, and side effects or functional limitations. A patient who has been exercising all his life, even if he is undergoing treatment, should continue. Other people who have never exercised may start with a five-minute walk. The time of illness is also taken into account. These are not the same recommendations for a person who is undergoing or has completed chemotherapy, radiation therapy, hormonal treatment. This requires that we be trained and informed to know what physiological changes are and how we should adapt the intensity of the program to them. Finally, specific functional limitations are addressed. This is not the same as having your entire breast and lymph nodes removed, or having a sac removed due to colon cancer or abdominal surgery. These circumstances give rise to more specific restrictions. In the book, I make specific recommendations based on all of these aspects so that everyone can have access to real and scientific information about the benefits of exercise and what it can do.

A walk may be the beginning, but not the end

TO. Walking isn’t enough?

R. Many studies tell us that walking alone does not bring about the changes we need. It’s important to start with this when you’re healthy because it helps you stay healthy, but when we need to get better we need a much more complex strategy that, in the case of cancer, doesn’t just work at the metabolic level. ; We also need to create new neural connections that are lost as a result of treatment, as well as improve functionality and mobility. The guidelines should be designed to be as complete as possible. A walk may be the beginning, but not the end. You have to gradually increase it and include strength and cardiovascular balance exercises to make them complete and truly improve your health holistically, because the deterioration caused by treatment is much more global. It is also important to maintain motivation. When a person comes to the center, we want to surprise him every day.

TO. How many times and for how long should you exercise per week?

R. The ideal, according to the World Health Organization, is three days. Each lesson should last from 35 minutes to an hour and a quarter. We typically work out for 50 to 75 minutes, including breaks, light exercises, and stretching.

TO. Before or after treatment?

R. People who start exercising before starting treatment experience better exercise and fewer side effects: they are much less tired, experience much less nausea and diarrhea, and are less likely to have to stay in bed due to excessive fatigue.

TO. And when will this be overcome?

R. You must keep training. People who exercise during treatment and stop after treatment tend to return to the levels they had before or immediately after chemotherapy, below normal. It is necessary to remain active to maintain long-term benefits and prevent disease and physiological changes. One of the most problematic side effects is heart failure, which can occur as early as 10 or 15 years of age. People who exercise can reduce their chance of developing this disease by up to 40%.

TO. Does it improve survival?

R. Patients who exercise after diagnosis increase their survival rate by 30–40%. You are less likely to get cancer again or develop secondary tumors, as well as other heart disease, diabetes, or metabolic problems. Exercise helps them live longer and better. This has been demonstrated in the most common cancers, such as breast or colon cancer. In other tumors, it’s not that it doesn’t happen, it’s that we don’t know if it happens because we don’t have the same long-term, high-quality studies.

TO. What is the sequence from exercise to benefit?

R. High intensity, which can be achieved through strength or cardiovascular exercises and which benefits the cardiovascular system, we mix with other exercises for nerve regeneration, which is also very important. When you introduce high intensity, the cell realizes that it is unable to keep up with the body, it adapts and begins to mobilize a number of enzymes and proteins to produce energy in the mitochondria. This can only be achieved with high intensity blocks. But the body needs to support these energy factories and teach them to produce it. If you don’t use them, they will be charged. This is where moderate intensity plays an important role because it is what helps and promotes mitochondrial function. When they work well, they help preserve muscle while also improving peripheral irrigation and increasing fat consumption. This prevents other diseases.

Walking briskly for an hour every day helps prevent swelling. But the exercise we do every day, at work or while traveling, is not worth it. This should be extra

TO. Exercise helps during and after cancer. Does this also prevent this?

R. Exercise has been linked to the prevention of up to 26 types of tumors, but you should follow the World Health Organization’s recommendations of at least 150 minutes of moderate exercise per week. But high intensity is not so important here. Even brisk walking for an hour every day helps prevent tumors. But the exercise we do every day, at work or while traveling, is not worth it. This should be supplementary, that is, going for a walk every day for 30, 40 or 50 minutes and doing another activity that complements it.

TO. Why isn’t exercise included in cancer treatment protocols?

R. In 2010, I had to go abroad to learn about oncology practice because there was nothing here. But I think the perception of health has changed a lot and now more and more oncologists are recommending exercise. In fact, many of my patients come to me because their physical therapists, oncologists, or oncology nurses have recommended that they exercise during and after treatment. But we must continue to educate, inform and support both patients and doctors.

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