By Tara Loader Wilkinson
Veteran mountaineer Petra Thaller does not easily accept defeat – especially from cancer.
In 2014, the German mother-of-two, then aged 53, was hiking the Carstensz Pyramid – also known as Puncak Jaya – which at 4,884 metres (16,024 feet) is Indonesia’s highest peak.
She found it odd that she felt so tired on the climb. At one point, while crossing a river, she hurt her breast, which immediately swelled up and felt tender and sore.
On her return to Germany, her doctor found five malignant tumours in her breast. Treatment was aggressive: lymph node removal, chemotherapy, a mastectomy and then radiotherapy.
Less than two years later, while still in treatment, two small nodules – diagnosed as “precancerous” – were found in her other breast.
Although no treatment was required at that stage, she felt as if she was back at square one, she says over Zoom from her home in Munich, Germany.
Her doctor supported her decision to have that breast removed and reconstructed as well.
Thaller kept her life as normal as possible.
“I think being ‘a patient’ often makes people sicker, psychologically. When people say, ‘I’m ill, I’m suffering,’ it doesn’t make you feel better,” she says.
“A lot of the time I barely thought about it. I said to my kids, ‘Don’t treat me as if I am ill.’ I went shopping, cooked, was a single mum, carried on working. It’s my way of doing things.”
To stay alive and thrive, stay active
An incredibly fit person, Thaller continued to live an active life: running, mountaineering and swimming with her children, and not slowing down in her job as the publisher and editor-in-chief of an outdoor sports magazine.
During her cancer journey, Thaller was surprised at others’ lack of awareness that outdoor physical activity was a good complement to prescribed treatment for cancer survivors.
In 2015, wanting to help others, she set up Outdoor Against Cancer (OAC), which went on to become an international NGO. She began holding free weekly training sessions in a park, along with mountain hikes and night hikes in public spaces, all designed for cancer survivors.
Later, she trained trainers to hold their own sessions.
Through OAC, Thaller began to get the word out about the importance of structured exercise and physical activity for cancer survivors to a broader audience in Europe, speaking at summits, conferences and other events.
She leans on science to support her message.
She joined forces with exercise physiologist Rudolfs Ceseiko in 2023, who shares her commitment to preventing cancer or its recurrence through physical activity and exercise. He is now OAC’s exercise expert and adviser.
On his Facebook page, he notes that “there are more than 30,000 studies on the valuable importance of physical activity in oncology [cancer], including our own research”.
4×4 training boosts physical and mental health
Ceseiko’s master’s degree studies in Norway focused on so-called 4×4 training. He had started leading these types of outdoor sessions for cancer patients in rehab camps in 2017.
The 4×4 training method is high-intensity interval training consisting of a six-minute warm-up, followed by four intervals of four minutes of higher intensity training, interspersed with three minutes of active recovery.
The method significantly improves maximum oxygen uptake, or VO2 max, the maximum amount of oxygen your body can use during intense exercise, Thaller says.
The higher this is, the better your health. It is a good predictor of your risk of getting diseases like heart disease, type 2 diabetes or certain cancers.
The risk of cardiovascular disease and early death is lower in people with high VO2 max compared with those with low VO2 max. People who can raise their VO2 max over time will lower their risk of disease.
This is why 4×4 training “can be a highly effective method for improving cardiovascular and metabolic health”, says Thaller.
Ceseiko is one of OAC’s regular hosts for the free training sessions.
“It must be emphasised that these activities not only promote physical health, but also improve mental well-being if they are done regularly and structured,” he says in a Facebook post.
“If you are plagued by fear, ignorance, depression, powerlessness, anxiety or you want to know how you can help yourself with physical activity medicine, feel free to join 4×4 outdoor classes.”
Thaller is a keen believer in the healing power of nature, which is why all of OAC’s classes are held outdoors, usually in public parks.
“One of the most important aspects for cancer survivors is maintaining quality of life and mental stability, and reducing fatigue. Being outside helps with that. A better state of mind also helps people better tolerate chemotherapy and radiotherapy.”
In 2018, Thaller wrote a book in German with sports scientist Dr Thorsten Schulz about her journey, called Outdoor Against Cancer: How Exercise and Sport in Nature Help Fight Cancer – Faster Recovery, Better Quality of Life, Better Prognoses.
Schulz researches the links between cancer and sports at the Technical University of Munich in Germany, and oversees the OAC coach training programme that is part of the university’s sport and health for life programme.
OAC now has a presence in 18 countries – including Morocco, Spain, Portugal, Austria and Latvia – and has 800 certified trainers.
Exercise links to improved cancer recovery well documented
From her own experience, and that of hundreds who have been helped by the OAC method, Thaller was already convinced that exercise helps cancer sufferers. Scores of studies support this.
A 2021 report in the British Medical Bulletin, titled “Why exercise has a crucial role in cancer prevention, risk reduction and improved outcomes”, reviewed 180 studies on the effects of exercise and physical activity on cancer.
It noted that “a physically active lifestyle and, particularly, supervised exercise rehabilitation programmes after cancer are linked to an improvement in many common adverse effects across multiple types of cancer”.
It concluded: “The importance of physical activity before, during and after cancer treatments is being appreciated as emerging evidence indicates that exercise improves several common side effects associated with cancer therapies and correlates with an improved overall survival and a lower probability of relapse.”
‘Exercise can prevent cancer recurrence, death, better than drugs’
A landmark study published in June in The New England Journal of Medicine adds persuasive evidence to the growing pile.
Researchers recruited 889 mostly late-stage colon cancer patients who had started chemotherapy after having had surgery.
Half were assigned to a group that took part in a three-year structured exercise programme, working with coaches twice a month to help them reach a goal of three to four 45- to 60-minute walks each week. The others were given health education, including on the value of exercise and nutrition.
It found that the exercise programme was linked to significantly longer disease-free survival and longer overall survival.
The results were presented at the annual meeting of the American Society of Clinical Oncology (ASCO) in Chicago, in the US state of Illinois, in late May.
Dr Julie Gralow, ASCO’s chief medical officer, said in a release: “For the first time in the history of medicine, there is clear evidence that exercise can prevent cancer recurrence and death better than many of the drugs currently prescribed to patients.”
Dr Pamela Kunz from the Yale School of Medicine and an ASCO expert in gastrointestinal cancers added: “Post-treatment exercise is both achievable and effective in improving disease-free survival. Exercise as an intervention is a no-brainer and should be implemented broadly.”
Thaller’s mission is to expand OAC’s work to help do just that. She stresses the importance of patient empowerment in taking charge of their own well-being.
“It’s not just the fight against cancer, it’s about enhancing health to contribute to society. We are all responsible for our own health. It’s not just the doctors’ task. You have to save your own life.”
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