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“If it weren’t for this place, I’d be dead,” said a man wearing a baseball cap and
a black T-shirt.
He’s sitting in a chair at the front of the exercise room, his blood pressure being
taken by a student. “I would just sit at home, depressed.”
Another woman wearing gray leggings and a long sleeve T-shirt arrived, visibly upset.
But within 20 minutes, she was working out on an exercise bike, laughing with two
students.
This is a normal Friday morning at the Ben Nighthorse Campbell Center, the one-story
brick building home to the UNC Cancer Rehabilitation Institute (UNCCRI). The sound
of interns and practicum students encouraging their patients could easily be mistaken
for the upbeat chatter of friends as they get to work on that day’s exercises. Their
treatment is based on extensive medical training and best practices. Their goals are
both lofty and weighty — help cancer patients live better, longer lives.
However, watching the smiles widen on the faces of patients, students and staff, it’s
clear that the work done here is powerful in ways not fully explained by science,
at least not yet.
The Power of Exercise
When Carole Schneider, Ph.D., a UNC professor of Sport and Exercise Science, was diagnosed
with cancer in 1995, her treatments left her struggling with side effects like fatigue
and muscular weakness. Then, there was little research on the effect of exercise on
cancer survivors. But she and her doctor saw how the benefit of exercise directly
counteracted the toxicities of her cancer treatment.
Schneider quickly realized this area of study had the potential to greatly improve
lives. So, she enlisted the help of her colleagues Cad Dennehy, Ph.D., and Dr. Sue
Carter. With their help, they established UNCCRI in 1996 to study the role of exercise
in cancer survivors’ rehabilitation.
Today, the institute is recognized as a frontrunner in exercise-based cancer rehabilitation
and is the only facility of its kind. UNCCRI has served over 1,000 adult cancer survivors
with all types of cancer in various stages of treatment. More than 500 students participated
in this experiential learning, conducting clinical and basic research in cancer rehabilitation.
In fact, researchers at Memorial Sloan Kettering Cancer Center published a study in
2023 in the Journal of Clinical Oncology that found people diagnosed with cancer who
regularly exercise reduced their risk of dying from all causes by 25% compared with
people with cancer who did not exercise.
Exercise Oncology: Extending Life
Students at UNCCRI work directly with patients during their rehabilitation work. Buck
Covington is the current graduate assistant at the institute and a doctoral candidate
in the Exercise Physiology program. When Covington learned about the work UNC was
doing in exercise oncology, the use of exercise in addition to cancer treatments to
help patients, his entire career trajectory shifted.
“[My advisor] was telling us about [UNCCRI] and the field of exercise oncology in
general, and immediately I was enamored with the idea,” said Covington, who before
that, planned to go into a physical therapy program.
In August of 2020 when Covington first arrived at UNC, he was a doctoral student intern
at UNCCRI working with individual patients on their rehabilitation plans. Both then
and now, the institute opens bright and early at 7 a.m., with patients coming in every
hour for hour-long appointments. Students chat informally with their patients to see
how they’re feeling that day before starting their session.
Students are right there with their patients every step of the way. Students take
a completely hands-on approach in every session, from taking vitals to leading the
patients in aerobic activity and resistance training.
Patients participate in a four-phase program, with the first three phases lasting
12 weeks and the last phase lasting as long as they like. Each phase is fully customized
to each patient by their student intern. At the beginning of each phase, patients
undergo an extensive evaluation to establish their fitness baseline, which students
and researchers use to gauge fitness maintenance and progress.
Giving Hope, Gaining Wisdom
While patients reap the many benefits of exercise and a student intern to keep them
accountable, the students benefit from their patients as well.
“There does seem to be some sort of effect between having a younger population of
students who are learning and looking forward in life and more hopeful about the future,
[work] with someone who’s maybe at the end of life, or at least not looking forward
the same way we are,” said Covington.
“I think it causes a synergistic effect where we’re imparting hope on them, and they’re
imparting wisdom and guidance on us.”
Covington has personally gone above and beyond for his patients. At one point, a patient’s
health deteriorated to the point that they were no longer able to come into UNCCRI
for their treatment. Rather than allowing that to be the end of the patient’s relationship
with UNCCRI, Covington and another student went to the patient’s house multiple times
a day, five days a week for nearly a year.
“They were there up until the day he died. That’s the kind of commitment that a lot
of these kids have. It means that much to them,” said Reid Hayward, Ph.D., director
of UNCCRI.
For Clay Drake, ’90, UNCCRI has been a game changer in his cancer treatment.
When Drake was diagnosed with multiple myeloma, a type of cancer affecting the white
blood cells that produce disease- and infection-fighting antibodies, in 2016, he was
given five years to live based on the aggressiveness of the cancer. Despite that,
Drake didn’t focus on the timeframe. Instead, he decided to do everything he could
to improve his health.
Even at points when Drake’s treatment wasn’t working, or he had to spend multiple
months in the hospital, he never stopped trying to get ahead of his diagnosis. He
underwent experimental procedures, including two different stem cell transplants using
both his and a donor’s stem cells.
It wasn’t until about a year after undergoing the stem cell transplant that Drake
found out about UNCCRI, and it ended up making all the difference.
“When I first started going [to UNCCRI], I couldn’t use my left leg, but it changed
everything. We were at a point where we didn’t know what we were going to do. And
here I am, nine years later, talking about this place,” said Drake.
Drake has been a patient at UNCCRI for about eight years now and has full use of his
left leg.
He credits the structure of UNCCRI’s program with holding him accountable to exercise.
Drake and other patients know that when they don’t go into UNCCRI it doesn’t just
affect them, it affects their student interns too. Throughout their course of rehabilitation,
they develop a mutually beneficial relationship where patients gain strength and improve
their health, and the students gain hands-on experience working with patients.
Each relationship is different, with some developing a deeper bond than others. The
relationships Drake has fostered with his student interns have each been distinct.
One student, with whom he trained for two and a half years, had a particularly significant
impact on him.
“He just got a job with UCHealth in Denver. He’s going to be doing some rehab-related
stuff … and he’s going to find his way. That’s the kind of stuff that’s more powerful
to me than just the exercise piece. Certainly, the exercise is why we do it, but it’s
also about the relationships,” said Drake.
To this day, Drake and that former student keep in touch, golfing together at least
once every summer. Drake even tried helping their partner find a job when he learned
they were trying to move closer.
“I’ll do whatever I can if that’s the direction they want to go and I can help them,”
said Drake, “I will absolutely do it.”
The Science Behind the Exercise
The strength and depth of the relationships built at UNCCRI are a testament to the
culture that’s been developed from the very beginning.
Hayward has poured his heart and soul into the institute since 1998. Schnieder was
Hayward’s advisor while pursuing his master’s degree at the University of Kansas.
He was almost immediately recruited to work at UNCCRI after its inception.
Hayward’s background in cardiovascular pathophysiology, the study of disorders affecting
the heart and blood vessels, was a natural match for the institute. Many of the chemotherapy
drugs and radiation drugs cause damage to heart tissue, called cardiotoxicities. Hayward’s
expertise in that area, coupled with his understanding of the healing properties of
exercise, made him the perfect addition to the small but mighty team.
From the beginning, UNCCRI studied the effects of exercise on the cardiotoxicities
of chemotherapeutic drugs. Some of their findings show that exercise does protect
the heart from the negative effects of chemotherapy.
Exercising allows the heart to create proteins that pump the toxic drugs out of the
heart, reducing the damage they can cause. Hayward and his team found that those toxicity-fighting
proteins are not created inside tumors, but instead they add protection to the heart
without affecting the drugs’ ability to fight the cancer.
The research conducted at UNCCRI today is examining new ways to understand the correlation
between exercise and cancer recovery.
For example, one study looks at lactate, a naturally occurring chemical compound produced
by the body when cells break down carbohydrates for energy. Lactate is produced at
higher rates when oxygen levels are low, such as during exercise.
UNCCRI students are evaluating whether there is a difference in how quickly patients
break down lactate before and after their 12-week session at the institute. Finding
a difference would allow researchers and practitioners to better understand how the
program affects metabolism and how it can improve different health markers related
to cancer.
Another study is evaluating whether exercising at certain times of day impacts the
body’s ability to maximize the benefits of exercise therapy.
Since its founding, UNCCRI has produced more than 150 national presentations, journal
articles and manuscripts culminating in a published textbook. International and national
educational programs in addition to public and private consulting firms that teach
others how to implement and manage cancer rehabilitation centers have recognized UNCCRI
as a leader in the field.
Every patient who comes through UNCCRI’s program has their data, such as their cancer
treatment history and vitals, saved in the institute’s database. Saving current patient
data for future use allows students to look back and evaluate whether a certain variable
might have an impact on patient outcomes before they actually design a study around
it.
A Culture Built on Personal Care
While UNCCRI is doing incredible work on the quantifiable aspects of cancer rehabilitation,
the interpersonal aspect that so many patients emphasize has its own profound effects.
“There’s something that happens between the students and the patients. It’s something
that I can’t describe because it’s more than the sum of its parts. There’s synergy
there that happens with them,” said Hayward.
The hands-on work that students do with patients results in innumerable positive health
outcomes. But it’s the relationships they build that keep patients coming back.
The community fostered at UNCCRI has a profound impact on the lives of both students
and patients, giving students invaluable career experience and patients the ability
to take aspects of their health into their own hands, literally. The powerful connection
and care patients experience from students and staff at UNCCRI plays a vital role
in forging a transformative rehabilitation experience. UNC
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