I thought I was doing so little, but I saw it meant so much.

Meetings with breast cancer patients made the newly-minted oncology nurse Yvonne Wengststromm feel that she had found the right profession at the beginning of the 1990s. But pretty soon she realized that it would take more than empathy to improve care in depth.

I understood that research was what was needed. It can generate knowledge that can provide both tools and a mandate to influence, she says.

Since then, she has had one leg in research, at the Institute of Neurology, Medical Science and Society, the Carolingian Institute, and the other in clinical work at the University Hospital of Carolina.

It's a perfect combination. It keeps me up to date on current clinical research issues and helps me understand how solutions can be implemented in care. I may never be enough, but it's worth it, Yvonne Wengstrom laughs.

Would relieve symptoms

Questions have always been about how to alleviate symptoms in patients with cancer, both from the disease and from treatment.

In my early research, I evaluated the possibility of supporting patients'self-care by means of special nursing receptions. But after a few years, I thought we were stomping, I was frustrated. She says there were so few interventions to take.

At the same time, they received more and more questions about exercise and cancer from patients: can one train at the same time as receiving treatment? Is it dangerous? How do you train?

Back then, we always recommended calm and rest, we said in principle that it was not good to train in the context of ongoing treatment, says Yvonne Wengstrom.

But then studies began to emerge that indicated that, on the contrary, it could be something positive with physical activity. In 2009, Yvonne Wengstrom had returned from a three-year period as a professor in Scotland. Strengthened by new knowledge, she began to set up a working group with specialists in other fields such as physiology and molecular biology. It became the backbone of a research group with the ambition to be able to answer patients'questions.

Study gave answers

Ten years later, the results of their research show that patients with breast cancer have everything to gain from prioritising their exercise. In a study called OptiTrain, which started 2013, the effects of two training programmes were studied: high-intensity interval training combined with either strength training or conditioning training twice a week during the 16-week period of chemotherapy. The monitoring group received a general recommendation to train but was not allowed to take part in the specific training programme or the support given to the other women. Measurements of activity levels showed that the control group had exercised less.

Both training groups stated that they had better quality of life and they indicated fewer symptoms such as pain. They were also less ill and returned to work earlier after the illness period. We also saw a clear mitigating effect on the difficult form of fatigue affecting many cancer patients, called fatigue. The training groups were also hospitalised to a lesser extent than the control group during the chemotherapy period. Yvonne Wengstrom tells us that the best effect was achieved by women involved in combination training.

Precisely because of the effects of training, Yvonne Wengstrom's research team has not responded, but the training seems to counteract the negative effects of treatment.

Cell toxins break down cancer cells but also other healthy cells in the body. Training, on the other hand, builds up the body, among other things we saw that the muscle cells got bigger, and that more small blood vessels were formed in contrast to the control group, she says. We are currently analysing blood samples from patients to see if training can affect the inflammatory process during and after the chemotherapy. We are also studying whether and how much impact inflammatory markers have on cancer-related fatigue, fatigue, on which it is not yet known, she says.

The effects of training on the tumour itself have not been studied by Yvonne Wengstrom in her research.

The prognosis seems to be improved as soon as possible by training according to other research, but what's causing it is unclear. There are studies in mice as well as in people indicating that increased blood circulation can make the distribution of chemotherapy more effective, she says.

The effects of training are:

In long-term follow-up, Yvonne Wengstrom's research team has also seen that the positive effects of training during treatment remain both one and two years after treatment has been completed. This can be explained, among other things, by the fact that the practice of training i s maintained.

Once the patients have discovered how well they're doing with their training, many will continue.

Today, around 800's, there are international studies on training and various forms of cancer carried out in over 50000 patients. Everyone can train, it's never too late to start and the side effects are no worse than exercise pain. The best effect was those who had never trained before. Well, that sounds easy. But is it really so obvious to prioritise exercise in the midst of the physiological and psychological crisis of cancer treatment?

Cancer patients have the same barriers to training as everyone else. There's no time, no strength, no motivation. In our study, we had a training psychologist and a nurse who encouraged the patients to get to the training and it helped many times. In the same spirit, we are currently developing an app that will create its own avatar, which will hopefully provide corresponding support.

But Yvonne Wengstrom also mentions something she calls the teachable moment. In an existential crisis, which is a life-threatening disease, a learning window often opens up when we feel extra strong motivation to make lifestyle changes.

The patient feels that he wants to take good care of himself and wants to know everything about how it should be done. It is important that health care is ready to support and coach the patient so that physical activity can be a priority, she says.

This requires training for both the public and health professionals, something that Yvonne Wengstrom set in motion on several fronts. It is a question of raising awareness in general of the positive effects of training, but also a little more specific issues relating specifically to cancer and training.

Yvonne Wengststromm is currently trying to introduce support for training for large-scale cancer patients in healthcare.

It is time to offer training as part of cancer treatment to all patients, she says.

Successful implementation will require politicians, too, to understand the benefits of this at the social level so that resources can be allocated. But it's on an individual level that Yvonne Wengstrom finds her own motivation.

It's nice to see how training makes women happier, stronger and brighter. It can mean so much to be able to experience health even though you are sick.

Text: Cecilia Odlind. Previously published in Medical Science No 32019.