Feb. 1, 2017

Tired of cancer

Fatigue affects almost all cancer patients, yet it's one of the least-understood or treated symptoms of the disease. University of Calgary researchers seek to understand what causes chronic fatigue and how best to treat it.

A friend once remarked that Nicole Culos-Reed was likely the only university student in the world who kept a poster of Marathon of Hope runner Terry Fox in her dorm room.

“I thought that was normal, but apparently, not so much,” says Culos-Reed, laughing. “I had his picture and my first Terry Fox Run t-shirt in my room all through university as an undergraduate, and now the shirt hangs in my office.”

As a professor in the Faculty of Kinesiology, an adjunct associate professor in the Cumming School of Medicine and a member of the Alberta Children’s Hospital Research Institute (ACHRI), she is helping lead an effort to use exercise to help improve the quality of life of both cancer patients and survivors. “The mission of my group is to change the current situation so that exercise becomes part of standard cancer care,” she says.

After his right leg was amputated due to cancer, Fox saw how much research could help patients. His Marathon of Hope run across Canada on a prosthetic leg to raise money for research was cut short in 1980 near Thunder Bay, Ont., at the 5,373-kilometre mark. Cancer had spread to his lungs, causing him to die shortly before his 23rd birthday in 1981.

“During his run, I was eight years old, and I absolutely loved him,” says Culos-Reed. “He just didn’t want to see other people suffer what he did — including kids much younger than him that he saw during his treatment for cancer — and that really hit home for me.”

She hasn’t missed a year since she took part in the first Terry Fox Run in 1981. “I also have my plaque as a 35-year participant up in my office.”


Through her research at the Health and Wellness Lab at the Faculty of Kinesiology, Culos-Reed has helped create cancer outreach programs for everyone from adults to children. These initiatives are supported through the Thrive Centre, a fitness facility for people affected by cancer, and the Thrive program, which helps cancer survivors through exercises tailored to their individual needs.

Culos-Reed is also researching cancer-related fatigue with professor Guillaume Millet, PhD, of the Neuromuscular Fatigue Lab. Patients can experience overwhelming chronic exhaustion, says Millet.

“It affects everything — their ability to have a normal life and sometimes even a social life,” he says. “They miss work, they cannot go to see their friends, and they cannot look after their kids, so that’s actually a very important problem. They stay at home, they rest and they stay in bed for long periods of time, and of course that has a huge impact on their lives.”


Such fatigue affects 70 to 100 per cent of cancer patients and is the most reported side effect, says Millet, adding about a third of survivors experience fatigue for months and even years afterwards. Yet this debilitating condition is one of the least treated, with patients often simply accepting fatigue as a fact of life, he says.

“Fatigue is a very complex phenomenon,” says Millet, who is also a member of the Alberta Children’s Hospital Research Institute and the Hotchkiss Brain Institute at the Cumming School of Medicine. “We are trying to investigate all the possible causes of fatigue, including neuromuscular origin, so how the brain could potentially be involved in fatigue.

“Nobody has done that in cancer patients. We are also using a new test that I developed to analyze fatigue resistance during exercise. There are a few studies in other diseases like multiple sclerosis or chronic fatigue, and cancer-related fatigue might be similar to these. Some people may be fatigued because they don’t sleep well, some because they are not fit enough, and some because they have inflammation and so on.”

While exercise helps fight cancer-related fatigue, no one knows why, says Millet. Using a $171,000 grant from the Canadian Cancer Society Research Institute, Millet and Culos-Reed will be studying 40 survivors who experienced different types of cancer.

After determining potential causes of fatigue in individuals, specific exercise regimens will be created to see if the condition can be eased, says Millet. “If we can understand the causes of fatigue, we think we can tailor the type of training that we are doing to the real causes of fatigue.”

Things to remember:

  • About 30 per cent of cancer survivors experience fatigue for months and even years after the completion of the treatment.
  • Unlike pain, this debilitating condition is one of the least treated.
  • This study aims to better understand the objective causes of fatigue to better treat this symptom.
  • Exercise is known to reduce the subjective fatigue of cancer survivors but the exact mechanisms of why this is the case are not known.
  • A better understanding of the objective causes of fatigue in cancer also allows tailoring the exercise intervention. This is the second aim of the study.


Lack of exercise can have a profound effect on cancer survivors, says Culos-Reed, whose mother is a breast cancer survivor and who has lost family members to the disease. “Patients are overwhelmed, physically and emotionally, when they are put into the cancer system, with numerous appointments for treatments.”

“Everybody’s activity level goes down, no matter if they were very fit or not, and with that comes the loss of the benefits that physical activity would normally provide. We see some of the commonly reported symptoms, like fatigue, get worse, and we see other things like higher levels of depression, anxiety and stress.

“People are thrown into a system that is very good at treating their cancer, but that doesn’t focus on wellness and definitely doesn’t focus on the ‘after.’ You’re cured, you leave the cancer centre and there’s nothing standard in terms of getting people to move back into healthy living.”

Culos-Reed has helped spark programs such as Yoga Thrive, which provides training to yoga instructors about holding yoga classes for cancer patients and survivors. About 300 instructors have taken part from countries ranging from Canada and the U.S. to France, the U.K. and Australia.

“The health care system isn’t going to deliver all these wellness programs, because it’s already overtaxed,” says Culos-Reed, who is also a member of the faculty’s Arnie Charbonneau Cancer Institute and a researcher with the Department of Psychosocial Resources at the Tom Baker Cancer Centre.

“Instead of saying we need dedicated cancer care fitness facilities, we just go out to fitness partners in the community and train them. We have trained City of Calgary staff who ran our prostate program, for example, and the YMCA staff who ran our breast cancer program.”

The university is helping launch a pilot project in January called the Alberta Cancer Exercise (ACE) program in partnership with the City of Calgary Recreation, YMCA, Alberta Health Services and the University of Alberta, says Culos-Reed.

“It’s about building exercise into standard cancer care. We will have a certified exercise physiologist who will be at the Tom Baker Cancer Centre in Calgary and at the Cross Cancer Institute in Edmonton,” she says. “They can help screen patients and prescribe exercises that are best for them and then lead them to the right community resources.”

Culos-Reed is also the national lead for the TrueNTH Lifestyle Management program in Canada for Prostate Cancer Canada and funded by the Movember Foundation, a global initiative seeking to provide supportive services for men with prostate cancer and their support persons. The Health and Wellness Lab created the TrueNTH Lifestyle Management Program, which helps prostate cancer survivors through everything from nutrition to physical activity, she says.

The years of research and fundraising that go into creating such programs are worth it, says Culos-Reed. “People say: ‘You are the ones who gave us our lives back, because I didn’t have this quality of life before and I have it now because of the physical activity program and that support.’”

Things to remember:

  • Any movement is beneficial – some is better than none.
  • Tailoring physical activity to address cancer survivor needs will enhance the potential benefits.
  • Cancer-related fatigue is a common side effect associated with treatment – and physical activity is a promising tool to address it.
  • Physical activity may provide physical and psychological benefits – including reductions in stress, anxiety and depression.
  • Guidelines for cancer survivors are the same as for the general healthy adult Canadian population. But even mild activity may provide benefits, and we need to consider survivors’ current activity and health status in order to individualize their exercise prescription.

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Nicole Culos-Reed is a professor in the UCalgary's Faculty of Kinesiology, an adjunct professor in the Cumming School of Medicine, and a member of the Alberta Children’s Hospital Research Institute (ACHRI) and the Arnie Charbonneau Cancer Research Institute. Her research is on physical activity for cancer survivors, and focuses on utilizing a multidisciplinary perspective to understand and improve the quality of life of cancer patients and survivors. View her publications

Guillaume Millet is a professor at the University of Calgary’s Faculty of Kinesiology. He also heads the Neuromuscular Fatigue Lab within the Faculty’s Human Performance Laboratory. His research interests lie in the areas of exercise physiology, neuromuscular function and fatigue. View his publications

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