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When Joyce Nishi was told she had breast cancer in late 2017 following a routine mammogram, she knew what she needed to do.

The hospital pharmacist from Medicine Hat required surgery and underwent four cycles of chemotherapy and a year of intravenous biologic therapy. Just last month she finished treatment and is now considered cancer-free.

But through her personal journey, Nishi also learned there’s more to recovery than the prescribed medical routines many patients endure.  As a person who has had cancer, Nishi is now also a graduate of a specialized program that takes a holistic approach to battling the disease, focusing on aspects of both physical and mental wellness. 

Dr. Nicole Culos-Reed, PhD, has spent the last two decades working on the idea that building a program of both exercise and wellness into the journey of the cancer survivor can allow them to experience a positive environment with others who are also dealing with the disease. She conducted various studies on the benefits of yoga and/or physical activity (exercise programs) in breast, head and neck, brain, lung, and prostate cancer survivors. In all of them, she found that participants who took part in group-based class delivery tended to stick with the programs, get benefits, and for many, continue to stay active beyond their initial wellness program.

Two years ago, working in partnership her colleague at the University of Alberta, Dr. Margie McNeely, PhD, they received funding from Alberta Innovates to launch a five-year pilot, The Alberta Cancer Exercise program, or ACE.  It’s a province-wide initiative that brings trainers and cancer survivors together twice a week for 12 weeks for fitness and wellness sessions that are delivered in a community-based group setting.

“This program is so important because the evidence clearly shows that exercise should be part of standard cancer care,” Culos-Reed says. “There are huge potential benefits and really, no drawbacks to being physically active.

“Cancer survivors deserve support for wellness within their illness journey,” she continues. “This support ensures a healthier cancer survivor, and ultimately, less burden on our health-care system. ACE is a program to which all cancer survivors should have access,” she says, “in order to optimize quality of life.”

Hundreds have already participated

Working with McNeely and now with additional funding from the Alberta Cancer Foundation, Culos-Reed has developed ACE across the province, with multiple program locations operating in Calgary and Edmonton, as well as sites in Red Deer, Lethbridge, Medicine Hat, Fort McMurray and, coming later this year, Grande Prairie.

Two years into the five-year funded program, there are more than 1,500 cancer survivors in the database for the program, which runs four times a year. Registrants’ costs are covered by the funding, and after the initial 12-week program, participants are able to register and self-pay for the ACE maintenance program.

“This has been extremely popular, as we’re seeing approximately 70 per cent of our ACE’ers uptake into a maintenance program or transition into another fitness program in their community,” says Culos-Reed.

“Maintenance is so important, as we are trying to support long-term behaviour change in our cancer survivors. We want them to build the habit of being physically active.”

Reaching survivors where they live and work

Programs such ACE are particularly important to people living in rural and remote communities, as they typically don’t have access to the same support resources that are found in larger centres. Organizers match the program to local sites and personnel, and support them by providing the ACE training to allow them to directly deliver the classes to cancer survivors and support persons.

ACE relies on these community partnerships with fitness facilities and cancer support services to deliver the program. Instructors in the communities are provided training through online and on-site methods.

“We can very economically deliver and support exercise classes, and don’t need to reinvent the wheel,” explains Culos-Reed. “By providing a cancer-specific exercise setting, we are helping to build a community that supports wellness in cancer survivorship — one that recognizes the unique needs of this population and can address such needs in an exercise setting.

“This results in a cancer survivor who is healthier and has a better quality of life. Ultimately that translates to less burden on our health-care system.”

Joyce Nishi heard about the program from a friend who works in oncology and who highly recommended it; she also saw a poster advertising the program at the Margery E. Yuill Cancer Centre in Medicine Hat. The program was held at a nearby family leisure centre.

Nishi says her profession and her understanding of the need to learn more about the disease were key factors in her decision to sign up. “As a health-care worker, the benefits of research and the need to do research also motivated me to join the ACE program.”

The future of the ACE program

“For exercise to become part of standard cancer care in Alberta,” says Culos-Reed, “we must be able to show that we can deliver a sustainable model across the province. We also must be able to provide access to these exercise resources where cancer survivors live — not just where they get treated — if we want to support long-term behaviour change.

“ACE is doing this by partnering with local fitness facilities, training those fitness professionals to deliver our safe and effective ACE program, and then supporting cancer survivors by continuing to offer fee-based cancer survivor-specific classes.”

Nishi agrees and says the benefits of the ACE program are not just physical, but also social and mental. “The program provided structure and motivation,” she says.  “I knew I had to get to the program even on days when I felt tired or lazy.”

Nishi’s advice for anyone who has the opportunity to participate? “This is one of the best choices you can make for your health and well-being, and I am very grateful for all the support from our local leaders and all the participants.”

Interested in this topic?

•  about Dr. Culos-Reed’s research into improving the quality of life for cancer patients