Kate Cracknell talks to Erin Ercoline, executive director of ThriveWell, about its DIVA exercise and nutrition programme for breast cancer patients

What is ThriveWell, and when was it set up?
ThriveWell Cancer Foundation is an organisation that’s dedicated to finding a cure for cancer by funding cancer research, providing patient support and offering programmes to improve the quality of life for patients and their families. Its motto is: “Empowering cancer patients and survivors to thrive.”

It’s based at The START Center for Cancer Care in San Antonio, Texas, US. However, although ThriveWell was established in 2007 by one of START’s medical oncologists, Dr Amy Lang, it operates as a standalone charity.

Why was ThriveWell created?
ThriveWell was essentially set up in response to a number of scientific studies that demonstrated the importance of exercise and nutrition in the battle against cancer – specifically breast cancer.
In 2005, a Harvard study showed that 92 per cent of women who exercised between three and five hours a week were alive 10 years after their breast cancer diagnosis, compared to 86 per cent of women who exercised less than one hour a week.

In December 2006, the WINS Trial (Women’s International Nutrition Study) showed that women with early stage breast cancer who followed a low-fat diet had a 24 per cent reduction in recurrence or new primary breast cancers compared with women who ate as usual.

More recently, a WHEL Trial (Women’s Healthy Eating and Living study) showed a 50 per cent reduction in mortality for breast cancer patients who exercised an average of 30 minutes a day, six days a week, and ate at least five servings of fruit and vegetables a day.

These results exceed those of many conventional cancer therapies, but few patients are aware of the data. Drawing on these findings, as well as her own extensive research into breast cancer, Dr Lang therefore decided to set up ThriveWell to help bring the benefits of healthy living to people suffering from this disease.

How does ThriveWell work?
We offer a range of services for cancer patients in the San Antonio area. Hospital treatment can be expensive, and for eligible adults we offer assistance to cover co-insurance costs of chemotherapy or radiation treatments. We also pay for and co-ordinate transportation services for cancer patients to and from their treatments. In addition, we fund cutting-edge research into cancer treatment and undertake a campaign of public advocacy to try and accelerate progress towards the cure of cancer.

Running alongside this, we have a specially created DIVA programme (Deriving Inspiration and Vitality through Activity) at four sites in the San Antonio area, offering exercise and nutrition classes for breast cancer patients and survivors.

Tell me more about DIVA
The goal of the DIVA programme is three-fold: to give survivors a sense of control over their wellbeing, to provide them with the tools and the motivation to continue wellness activities on their own, and to give them the confidence to be proactive in maintaining a healthier lifestyle.

All DIVA classes are available free of charge to people at all stages of the disease, including afterwards. We have some participants who’ve been free of cancer for 20 years – ThriveWell is funded by grants, and by individual fundraising and support, and there is never any charge for the classes.

In terms of exercise, participants can choose from a range of classes, from aerobics to strength training, and from yoga to tai-chi – DIVA focuses in particular on forms of exercise that enhance the wellbeing of both mind and body. The classes are also designed to be fun, helping people to focus on the positive aspects of their lives rather than purely on their physical, and often all-consuming, symptoms.

In addition to boosting survival rates, benefits of exercise for breast cancer patients include reducing the risk of lymphedema, improving self-image and reducing many of the side-effects of hormone therapy and chemotherapy.

Nutrition classes and even one-to-one sessions are also available, offering specific dietary guidance based on the latest research findings – the importance of protein and omega 3 fatty acids in a cancer patient’s recovery process, for example, as well as the benefits of a low-fat diet and incorporating vitamin D, calcium, phytonutrients and antioxidants. These classes are run by qualified dieticians.

The exercise classes are run by normal fitness instructors who want to be involved – albeit they are vetted to ensure they’re properly qualified, and with the right sort of people skills to properly manage this special population group. They need understanding and empathy, and also need to know how to tweak exercises for individual participants if necessary. We work with a local organisation called Forte Rehabilitation and Wellness Center to ensure all instructors are suitably qualified for our requirements.

The classes take place at sites which have either donated studio time, or to whom we pay just a small fee. Although DIVA is also open to men, as they too can suffer from breast cancer, at this point all participants are women.

How do you prescribe appropriate activities?
A 2010 study published by the American College of Sports Medicine Roundtable on Exercise Guidelines for Cancer Survivors states: “Exercise training is safe during and after cancer treatments and results in improvements in physical functioning, quality of life, and cancer-related fatigue.” We also know from the wealth of scientific research already available that staying physically active is highly beneficial for breast cancer patients.

However, given that our instructors aren’t medically trained – and as we don’t have any scientific outcomes from our own work just yet – we do stress that participation is down to the individual’s choice. We don’t make specific recommendations on which classes people should do – this is something they should discuss with their oncologist.

Do you have any plans to evolve the DIVA programme further?
San Antonio is a huge city, and we would love to roll the programme out to more sites so that everyone has access to DIVA classes within their neighbourhood. We need more sites.

Within that, there’s also a great opportunity for health clubs to get involved, perhaps offering some of their studio time to host DIVA classes and promoting those classes in their own marketing. They don’t need to have specialist knowledge to do this, as we are able to provide the instructors and the programming, and it will bring in new audiences to their gyms.

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