Exercise and cancer treatment; high-intensity interval training and cancer risk; diabetes and pancreas transplants: Upstate Medical University's HealthLink on Air for Sunday, Dec. 29, 2024

Host Amber Smith: Coming up next on Upstate's "HealthLink on Air," an integrative medicine doctor goes over the benefits of exercising during cancer treatment.

Kaushal Nanavati, MD: ... People experience mental fatigue, physical fatigue, emotional drain, and even the side effects of things like bone thinning, heart toxicity, cognitive decline, when somebody has exercised, they actually experience less of the side effects and more of the benefits. ...

Host Amber Smith: An exercise physiologist shares research on high-intensity interval training and its effect on cancer risk.

Carol Sames, PhD: ... You kind of get bang for your buck with HIIT. It doesn't take a whole lot of time. You can do it in your home. You don't need stuff. Body weight, a chair, a wall. And there is tremendous value because you can add strength-training to this type of workout. ...

Host Amber Smith: All that, some advice about people with diabetes and pancreas transplants, plus a visit from The Healing Muse, right after the news.

This is Upstate Medical University's "HealthLink on Air," your chance to explore health, science and medicine with the experts from Central New York's only academic medical center. I'm your host, Amber Smith.

On this week's show, an exercise physiologist shares research on high-intensity interval training and its effect on cancer risk. Then, a transplant surgeon discusses whether people with diabetes may consider a pancreas transplant. But first, an integrative medicine doctor goes over the benefits of exercising during cancer treatment.

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air."

Maintaining an exercise routine may not be your top priority during cancer treatment, but there are benefits to being active. We'll hear about that from my guest, Dr. Kaushal Nanavati. He's an assistant professor of family medicine at Upstate, who is also the director of integrative medicine and survivorship at the Upstate Cancer Center.

Welcome back to "HealthLink on Air," Dr. Nanavati.

Kaushal Nanavati, MD: Thank you, Amber. It's been a long time.

Host Amber Smith: Several health organizations have general exercise recommendations. Dr. Nanavati, are there authoritative recommendations about exercise while undergoing cancer treatment?

Kaushal Nanavati, MD: So there are, actually, several cancer organizations that have recommendations based on the best-known current evidence. And the information and evidence change, and as they do, the recommendations do periodically change as well. So the American Cancer Society is kind of the premier organization that a lot of people look at for recommendations, but, there are recommendations from multiple societies.

Host Amber Smith: Do we have evidence that it's actually safe to exercise during cancer treatment?

Kaushal Nanavati, MD: Not only do we have evidence -- it's recommended. And for many people what they forget is that when you talk about some of the impact that cancer has on a person's life, if we just think about, so first of all, let's go back a step. When we say cancer, what that really means, it's a family of conditions. It's a whole compendium. And so one cancer does not equate to another. And someone who has cancer, during their journey through cancer, their body goes through different stages, different phases, and so even their body at different times will be able to tolerate different things.

All of that being said, as a broad-stroke, general recommendation, the value of exercise, if I put it in the cancer context, three main points to really bring up. One is that it's been known, through evidence, that exercise reduces the potential for onset of certain cancers, especially when you think about breast cancer, colorectal cancer, endometrial and gastric cancer, esophageal cancer, kidney cancer, and specifically with lung cancer, for people that smoke, exercise reduces their risk of lung cancer. So that's just the risk of getting it.

And for people who have cancer, exercise reduces the rate of recurrence, especially when it comes to things like certain types of breast cancer. So now we're talking about recurrence.

Then we think about cancer therapies. Exercise, through the (medical research) literature, has been shown to actually enhance the benefit of the treatment and also benefit in actually helping to reduce the cancer burden on the body, whether it be reducing the spread of cancer, what we call metastatic disease. So high intensity exercise, in one study, actually showed that it reduced the potential for spread of cancer by nearly 72%. That's huge, right? And high-intensity activity isn't something that necessarily everybody does, but clearly there's some potential benefit for the right person in the right condition.

And then the idea of side effects of cancer chemotherapies, right? Whether it's immunotherapy or chemotherapy, or just going through the cancer journey. People experience mental fatigue, physical fatigue, emotional drain and even the side effects of things like bone thinning, heart toxicity, cognitive decline, all of these things have been shown to benefit. When somebody has exercise, they actually experience less of the side effects and more of the benefits.

Host Amber Smith: I want to ask you a little more specifically about the types of exercise, but I'm assuming maybe the recommendations are different depending on what type of cancer a person has, or how progressed it is, or where they are in their treatment.

Kaushal Nanavati, MD: So that's exactly right. And on the other hand, as a baseline, we can say that anyone at any stage of any type of cancer can benefit from being physically active.

Physical activity includes basic things like going for a walk, riding a bicycle, going up and down the stairs, that type of stuff. And then there's more intense forms of activity. We think about exercise in terms of aerobic and anaerobic activity. So aerobic is the standard cardiovascular stuff that people think about, whether it's walking, jogging, treadmill, bikes, swimming, that type of stuff. And the anaerobic stuff relates to things like weight-based training.

So the current guidelines for exercise, which are -- it used to be that 150 minutes of aerobic exercise per week and then a couple of sessions of weight-based training. The latest guidelines actually encourage up to 300 minutes of aerobic exercise per week, along with two to three sessions of weight-based training per week.

So, ultimately, you end up looking at somewhere around anywhere between three to five or three to seven hours of exercise per week, if you include the weight-based training, to give the biggest kind of value for people who have cancer and for people who don't.

Host Amber Smith: What about less vigorous things like relaxation exercises like yoga or even tai chi. Do those count as movement and exercise?

Kaushal Nanavati, MD: They count and have their own value, actually, in terms of not only helping a person with things like balance and coordination, if they've had side effects of their treatment, but relaxation therapy has an impact on the biochemistry and hormones in the body. And so things like deep breathing exercise or practice.Some people meditate. Some people just do deep breathing. Walking in nature, as a reflective exercise. Tai chi. Yoga. Pilates. All of these things actually have an impact biochemically in boosting the immune system, which is valuable in many instances and at the same time also have a benefit for reducing inflammation in tissues and muscles and joints, improving flexibility.

And so overall well-being improves, but specifically not only the physical, but the mental, emotional, biochemical and hormonal constitution of a person's body actually gets better as well.

Host Amber Smith: This is Upstate's "HealthLink on Air" with your host, Amber Smith. I'm talking to Director of Integrative Medicine Dr. Kaushal Nanavati from the Upstate Cancer Center about the value of exercise during cancer treatment.

So let's get a little more specific about exercises that would be good for someone who is maybe new to exercise, that hasn't really done a whole lot of activity in the past, and now they're in cancer treatment. What types of things would you recommend for that person?

Kaushal Nanavati, MD: Start low and go slow, right? And I'm smiling as they say that for those that really can't see us anyway. You know, the key is what you want to do is be consistent. There was a study that was done that showed that people who exercise 30 minutes three times a week versus people who did 10 minutes a day, the ones that did 10 minutes a day were more likely to make it a habit.

So the key is really to get started. This morning my thought was to embark, right, to begin the journey. The most important thing is taking that first step. So for those people that haven't exercised regularly, make it a part of your routine. Make it a non-negotiable so that everything else works around that.

For me, before I go to work in the morning, I have my exercise time. And then if I have time later in the day, I may exercise more or go for a walk in the evening with my wife or my family, et cetera. But fundamentally, I get my self-care time in in the morning because I know that once the day gets going, sometimes we get busy, things come up, et cetera. But first thing in the morning, we can actually plan for it. So I encourage people who haven't started to even plan for five or even 10 minutes, depending on their physical ability.

And more importantly, I will put the caveat that if you haven't exercised regularly, make sure you work with your health care provider and ensure that you're healthy enough to begin exercising. And then they, or they can connect you with somebody who can guide you on how to optimally exercise. At Upstate, we actually have the advantage of having multiple specialties and specialists available. And we even have a physical therapist who is specifically now focused on physical activity in cancer patients. So we're going to have more and more resources available, which I'm really excited about, because everyone has different ability. At the same time, every cancer type has a different impact on the body. And depending on how it's impacting one person versus the other, we can be More specific about the types of recommendations we make and the approach that people can take.

But there are fundamental things we all do during the day. And as long as we're more active than we are sedentary, there's value. One of the things that exercise does, actually, which I think is fascinating biochemically, is it actually has an impact on reducing cancer metabolism. So what I mean by that is, if you exercise very vigorously, what happens is your muscles need the blood flow, which kind of steals it away from those cancer cells that are starving for it and clamoring and competing for it. And so if you're exercising and the muscles are getting the blood flow, the cancer cells are getting less of it, which can eventually lead to starving them out. And, biochemically exercise actually works inside the cells to induce natural kind of cancer cell death, so that we can actually get rid of them faster. So that is amazing stuff that we don't even think about.

Host Amber Smith: What about athletes who are used to working out at a high level? Do they ever have to take it down a few notches?

Kaushal Nanavati, MD: So the best answer in medicine that we always teach our students is, "it depends."

So it depends, Amber. And what I mean by that is that it depends on the person, depending on what type of cancer they have. In many instances, they may have to take it down a notch, especially if they're experiencing fatigue, bone pain, if there's stress on their heart because of the treatment or the therapy that they're getting, if they're having impact on their cognitive function, et cetera. Or it's metastasized somewhere else, let's say, to the bone or muscle.

Definitely I think across the spectrum from the sedentary person to the person who's an experienced athlete or a competitive athlete, fundamentally we have to make sure that what they're doing is not increasing stress load on their body, on their heart, and on their skeletal structure as well. And then give them a green light as to the degree of intensity, frequency, duration, all those things they can do. But that doesn't mean that they can't be active and doesn't mean that they still can't compete and / or engage in activity as they're able to tolerate and as is dictated by the type of cancer they have.

Host Amber Smith: Does it matter whether the person exercises indoors or outdoors?

Kaushal Nanavati, MD: So if they're exercising, I'm smiling, right? Because they're already doing the thing. Outdoors and indoors, in terms of what the evidence suggests, as long as they're doing it, there's value.

We know that there's benefit to daylight, in terms of mood, cognition, attention and feelings of joy. At the same time, if it's February in Syracuse, then you've got to be careful as to what the weather is outside as well.

So, it is variable. At the end of the day, doing the exercise is where the greatest value is. And then the environment should be one that supports somebody's sense of joy, versus stresses them out. And that's the way they can kind of figure it out as to what works best for them.

Host Amber Smith: I've heard that oncology treatments can weaken the immune system, so do you have any concerns regarding group exercise classes, where the person would be surrounded by other people who are exercising?

Kaushal Nanavati, MD: Yeah, actually that is something to consider, and that is something to pay attention to because the potential for infections such as viral infections, et cetera, is higher, especially if you're sharing equipment or it's not cleaned properly from user to user. Then we have to be careful.

Also, oftentimes when you're in physical exercise environments with groups, not everybody is necessarily practicing optimal hygiene. And even if they are, if they have a cough or they have a cold, then the potential for risk is higher for a cancer patient, especially if they're on some type of immune-suppressing treatment.

And so they do have to be careful about that. And yeah, sometimes you love that emotional support, and the support of a group can be uplifting. And at the same time, in terms of exercise itself, you still have to be careful.

Host Amber Smith: Well, on that note, are there things to watch out for so that you're not overdoing it or is there anything risky about this, just to be aware of?

Kaushal Nanavati, MD: I think the most important thing one has to gauge is, 1, their ability,and 2, pair that with their health providers' recommendations, specifically their oncology team and their primary care providers, since between the two of them, their health is assessed, not just in terms of their cancer diagnosis, but their overall health in the context of their life, in terms of their goals.

And so that becomes the important thing. You know, people will hear exercises good for you, and then just start doing it. But, you know, when you jump start the system, sometimes there's a little bit of stress that comes with that. So, taking a gradual approach to increasing it, but being consistent.

There's a great quote by (actor) Denzel Washington that talks about dreams are just dreams, but in order to achieve those dreams -- I'm paraphrasing -- it requires discipline. It requires consistency. And I think when it comes to physical exercise, the key is consistency, just as it is with nutrition. And I do have to put a plug in that exercise and nutrition go hand in hand. So when people do better with both, it enhances their overall well-being and clearly creates an environment that gives them better opportunity to have an anti-cancer environment within their body as well.

Host Amber Smith: We talked about sort of the ideal amount of time being three to five to seven hours a week, kind of spread across the week. But what about the person who's battling fatigue and struggling just to get through the day sometimes? Do you have any advice for that person?

Kaushal Nanavati, MD: Yeah, actually it is exercise, because what happens is when it comes to cancer-related fatigue, we know that people that exercise actually have improved energy. And so, they may not start with an hour a day. But what they can do is start with two minutes or five minutes, get up to 10 minutes.

We also know from other studies that if you get 10 minutes of cardiovascular exercise, aerobic exercise that's actually good for your heart. We also know that people that tend to exercise more consistently actually have improved energy.

So, it's kind of like, if I don't do it, I'll remain tired, but if I do it, I might be tired in the moment, but over time I'll actually have better and better energy, improved stamina, and that actually helps in the long term.

Host Amber Smith: Is there a value to building in a rest day where you don't do aerobic stuff, or you don't do weight training, you just sort of let your body rest?

Kaushal Nanavati, MD: That depends on the person and depends on the intensity of what you're doing. If you're going for walks every day you can go for walks every day. If you are going to be doing a power-lifting competition, or you're going to be doing something engaged competitively or training for a marathon, then you have to kind of do what's right for your body, giving moments of rest. Especially when you do longer endurance or strength-based, more intense activities, then your body does need time to recover, depending on how intensely you're doing it. For people that are doing moderately intense activity and/or low-intensity activity, generally speaking, they can remain consistent throughout the week.

Host Amber Smith: At the beginning of this interview, we talked about the benefits really of adopting an integrative approach that combines medical treatment with exercise, and you also brought up nutrition. Do we understand, in the body, what it is that is happening that helps reduce the spread of cancer, potentially, or reduce the risk of cancer? What is happening, like, at a cellular level?

Kaushal Nanavati, MD: A ton of stuff, I'll tell you. Everything from impact on dopamine to immunoglobulins, to actually impacting cellular structures that lead to kind of advanced cell death and slow down the progression of cancer, slow down the spread of cancer, what we call metastatic disease, what we call proliferation or growth of the cancer.

There are multiple, multiple enzymes and hormones and chemicals that are affected, including what we call cytokines and the VEGF (vascular endothelial growth factor) protein that some people have heard of, something called mTOR, (mammalian target of rapamycin) multiple, multiple enzymes that get affected.

In fact, the other thing that ends up happening is, it actually has an impact even on the blood supply to cancer cells and reducing that, as I mentioned, with higher intense activity. So, everything from regulating the metabolism of cancer, how much it gets for nourishment, to regulating the immune environment in the body to keep our immune system stronger, to reducing the cancer risks, as I mentioned, to reducing the cancer-related side effects. And all of that, combined, is happening simply by staying physically active on a consistent basis.

Host Amber Smith: Well, this is really good to know and very important information. I appreciate you making time for this interview.

Kaushal Nanavati, MD: I really appreciate it because I agree that this is really the stuff that puts the power back into a person's hands to be able to navigate their living experience, even with a diagnosis of cancer, recognizing that you want to be, you want to live like you're living, and you want to have the best quality of life moving forward, regardless of the diagnosis, to the best of your ability.

Host Amber Smith: My guest has been Dr. Kaushal Nanavati, an assistant professor of family medicine at Upstate, who is also the director of integrative medicine and survivorship at the Upstate Cancer Center. I'm Amber Smith for Upstate's "HealthLink on Air."

Can high-intensity interval training workouts reduce cancer risk? Next, on Upstate's "HealthLink on Air."

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air." High-intensity interval training (HIIT) workouts have been popular in recent years, not just because people like concentrated workouts, but because of the health benefits, which are still being understood. My guest is exercise physiologist Carol Sames, and she'll explain. She's an associate professor of physical therapy and physician assistant studies at Upstate.

Welcome back to "HealthLink on Air," Dr. Sames.

Carol Sames, PhD: Thanks so much, Amber.

Host Amber Smith: I want to start by asking you about a specific study in the Journal of the American Medical Association's journal JAMA Oncology. It said that people who moved fast for at least three minutes a day significantly lowered their risk of 13 types of cancer. How can that be?

Carol Sames, PhD: So essentially what these investigators did was they used data that came out of the UK Biobank study, and they prospectively looked at individuals. And these cancers are actually related to either low levels of physical activity, higher levels of obesity or sedentary behavior. And what they found was that these very short, brief bouts of intense -- we would call it higher intensity activity -- reduced their risk for these 13 cancers.

Host Amber Smith: So what counted as higher intensity? Or, what kind of activities are we talking about?

Carol Sames, PhD: So things like moving up the stairs really quickly or fast walking, but again, for brief periods of time. About 92% of all of these bouts were a minute, and then 97 were up to two minutes. So just, those really brief types of moving quickly for just a very brief period of time.

Host Amber Smith: So did the movement have to happen all at once, or could there be like three one-minute bursts, versus one three-minute burst?

Carol Sames, PhD: There were multiple bursts because they actually used a minimum of 3.4 to 3.6 minutes. So in that case, you were looking at multiple bouts of these quicker activities. So maybe I'm in the basement, and I live on a two story house, and I'm going up those basement steps and then walking quickly to the next set of steps and getting to the top of the steps. And that would probably take about a minute.

Host Amber Smith: Did the risk drop more if there were more fast movements?

Carol Sames, PhD: So they did say that. They actually said that if they were between 3.4 to 3.6 of these vigorous minutes, they had about a 17% to 18% reduction in the cancer risk compared to no vigorous minutes at all. And then they saw that 4.5 minutes was associated with a 31% to 32% reduction in those 13 physical activity-related cancer incidences.

Host Amber Smith: So which are the cancers that appear to have this protective effect, or which ones really aren't covered by this?

Carol Sames, PhD: So here's where it becomes interesting because you have a combination of lack of physical activity, and that's a risk. You also have increased percentage of body fat, or body composition. We sometimes call it obesity. And then you have sedentary lifestyle. And those three are intricately woven together. They're not separate.

So generally, think of it if I am not active, if I'm inactive, I probably engage in sedentary activity, and then there's a chance that maybe I have gained some weight. And usually when you're talking about gaining weight, it usually tends to be fat mass. So it's very difficult to tease out that these are only what we call the physical activity-related cancers or low physical activity. They're really all three intricately designed and interwoven.

But the cancers were bladder, breast, rectal, colon, head and neck, myeloma, myeloid leukemia, endometrial, esophageal, upper stomach, renal, lung, liver. But, we also know that there's some other cancers that are associated with obesity specifically and/or sedentary behavior. So, that's also important to understand.

Host Amber Smith: Do I understand correctly this study focused on people who don't exercise and how they compared with people who exercise regularly?

Carol Sames, PhD: All the individuals in this study, actually five and a half years before they started collecting the data, they had all filled out a questionnaire and said, "We're not active," OK. So that's always, that's a limitation of the study. You don't know if people might have become more active in that five and a half years. But they wore what we call a wrist accelerometer, which is like having a Fitbit or an Apple watch on, and it tracks movement and the speed of that movement, and so, they were looking at people who had these fast minutes compared to people who didn't have these fast minutes.

Host Amber Smith: Previously you and I have talked about the benefits if someone doesn't want to do sweaty workouts of doing less strenuous activities like walking. But this study is different because it's all about the benefits of bursts of vigorous activity, right?

Carol Sames, PhD: Specifically with a reduction in these cancer risks, yes.

So, this study was about 96% Caucasian individuals. So this study would need to be replicated. This is looking at relationships or associations. This is not an experimental design where they looked at cause and effect. So that's always important to understand.

So when you get this type of results, you want to see this replicated with different populations, to just really see: Is this a stronger relationship? And then kind of go from there. So this is a first step, and I think it really does line up with some of the research that we've seen in sedentary behavior because what we have found with sedentary behavior is that if you just get up every hour for one to two minutes, compared to just sitting all day for eight hours, you actually reduce some of the metabolic risks. Insulin sensitivity improves, glucose levels come down, so you can kind of see how these two might be conjoined at some point, in terms of sedentary behavior.

You know, one of the big concerns now is sedentary behavior, sedentary lifestyle. So if I got up this morning, and I rode my stationary bike for 30 minutes, and then I come to work and I sit for eight hours straight, that 30-minute stationary bike burned off calories and had some good cardiovascular benefits. However, if I sit for eight hours straight, there's some negative metabolic things going on that we need to address. So, sedentary lifestyle or sedentary behavior is considered a separate risk factor from physical inactivity, not achieving the guidelines.

There are two different ones. So that's something that people really need to understand because I think it's easy to say, I got my work in, I did my exercise, I'm achieving the guidelines, but now I'm sitting all day.

Host Amber Smith: Well, it is a little alarming because there's a lot of jobs that that's what you do. You're pretty much seated all day.

Carol Sames, PhD: That's probably a good reason to, if you're able to, just stand. And some of the research is, you know, we're not talking (about) having to stand and walk for 15 minutes every hour, but just for a couple of minutes seems to negate some of those poor metabolic outcomes. More research, again, more replication is needed, but the research is leading in that line that it is a separate risk factor, compared to not achieving the physical activity guidelines.

Host Amber Smith: Well, focusing back on cancer a little bit, do researchers have an understanding of what is happening in the body during these bursts of activity or during these short spurts of exercise that help protect us from developing cancer? Do they know why that's happening?

Carol Sames, PhD: There's some models and some theories, and so when we move quickly, we need muscle to move, and so that muscle has to contract and that muscle requires energy, or we're not going anywhere. And so what happens is that we have glucose that's stored in our muscle. And so when we move, we immediately have our energy there and we're able to move. They're thinking that that is what's occurring to keep insulin sensitivity at a normal level, versus a reduction of insulin sensitivity.

We also know if there's not a lot of movement, you start a chain of inflammation and inflammatory proteins. And if we are not moving for periods of time, we get like chronic inflammation. And that's a real hot topic now in the research world because chronic inflammation just leads to all kinds of bad things, oxidative stress, DNA damage -- actually our DNA, it becomes damaged. And we know that individuals who gain weight, that is linked to chronic low-grade inflammation.

And so, adipose tissue actually produces pro-inflammatory substances. So at least being active kind of is a way of stopping some of that bad inflammation that can occur when we're not moving.

Host Amber Smith: This is Upstate's "HealthLink on Air," with your host Amber Smith. I'm talking with exercise physiologist Carol Sames about the value of high-intensity interval training in reducing cancer risk.

Let me ask you to please define high-intensity interval training and how it compares with something called vigorous intermittent lifestyle physical activity.

Carol Sames, PhD: So that vigorous intermittent activity that this study looked at is very short bursts. These are not longer bursts. They're intermittent, so they're occurring at multiple times during the day. So that is distinctly different from high-intensity interval training.

High-intensity interval training is activity that is at a higher intensity. That's similar between the two of them. But generally it is set up that you're trying to achieve at least a minimum of an 85% of a heart rate max intensity -- so it is higher intensity -- that you're doing it, an activity for say, 20 or 30 seconds, and then you're doing something that is lower intensity for a rest period. And then you're doing another bout of high intensity, and then something lower intensity. And generally the goal is to try to do about 20 to 30 minutes of that high-intensity interval training. Now, people don't necessarily start there, but that is the general idea.

The activities that can be included in high-intensity interval training can be anything. They can be strength-training activities. They can be things like walking, or you could potentially, if you had a stationary bike, you could hop on your bike and go for 30 seconds and get off and do something that is lower intensity.

It could be functional things. As we get older, functional exercise is really important because it's the stuff that enables us to live independently. So, picking things off the ground, getting out of a chair, all of those kinds of activities, maybe even climbing the steps. So, higher-intensity interval training is just a longer period of time. Usually 20 to 30 minutes is what we're aiming for. And, at a higher-intensity heart rate, at least 85% of maximum heart rate.

And this vigorous, intermittent lifestyle, physical activity is really just trying to capture things that you might be doing in your every day that you do for very brief periods of time.

Host Amber Smith: So would a person who does a half hour long HIIT workout get the same reduction in cancer risk as someone who runs to catch their bus?

Carol Sames, PhD: Ultimately the person who's doing 20 to 30 minutes of a HIIT workout, there's so many other benefits involved than just me running to catch my bus. I'm assuming if I'm running to catch the bus, it's probably not taking more than 30 seconds. You know, something that's, maybe it's a minute, but it's very short.

There is value there. But if we're looking at, like, total benefits, that 20 to 30 minutes of HIIT is going to be strength training, potentially, depending on how you have set up. It could be core strength. It's cardiovascular in nature. And we know that cardio respiratory fitness has a strong impact on reduction of risk of cardiovascular disease. So the better my fitness level, the lower my risk is of developing cardiovascular disease. And you know, when we talk about cardiovascular disease specifically, coronary artery disease, that is the No. 1 killer of adult Americans. So, there are other benefits that are going to occur with that longer duration, higher intensity activity.

People think that high-intensity interval training is only for like athletic, high fit people. And it's not. You can set up a HIIT workout for somebody in a chair. Do you know what I mean? Like it doesn't, you don't have to have this high level of fitness to do a HIIT workout. So, if somebody is really low fitness, it doesn't take a whole lot of activity to get to 85% of their maximal heart rate, because just standing up out of a chair could be it, right?

I think what happens is we kind of associate this HIIT workout, this high-intensity interval training with individuals that are highly fit. And that's a problem because you kind of get bang for your buck with HIIT. It doesn't take a whole lot of time. You can do it in your home. You don't need stuff. Body weight, a chair, a wall. I don't need a lot of stuff. And there is tremendous value because you can add strength-training things to this type of workout. And we certainly know older adults absolutely need to do strength training three times a week. And it should include power activities. So that's like getting out of a chair. That is going up your stairs.

Host Amber Smith: Upstate's "HealthLink on Air" will be right back, after this short break, to learn more about how high-intensity interval training workouts can help reduce cancer risk.

Welcome back to Upstate's "HealthLink on Air." This is your host, Amber Smith. And my guest is Carol Sames, an exercise physiologist at Upstate. We've been talking about high-intensity interval training and how research is showing it can reduce the risk of cancer.

How do HIIT workouts compare with other things like swimming or pickleball -- pickleball's a popular sport right now -- or Rollerblading?

Carol Sames, PhD: So pickleball really is short bursts. I mean, that is a perfect example of something that could actually be high-intensity interval training because you're playing so long for a point, you're moving around kind of very quickly.

Swimming and Rollerblading could be set up as something that is higher intensity, or it could be something that's set up where you're just doing a continuous moderate intensity activity. So it just depends on how you set that up.

If I'm swimming, I could do intervals, right? Where I say I'm going to swim a half a lap fast, as fast as I can go, whatever that is. And the next half lap -- slow. And rollerblading, you could do the same thing. I'm going to roller blade quicker to the next light pole, and then I'm going to go easier. So those two activities could be set up to be a HIIT type of a workout, at least interval-training workout, just depending on what your goals are.

But pickleball, that is bursts; that is, it's like soccer or basketball, those kinds of activities where there's a burst and then a little bit of a rest, a burst, and then a little bit of a rest.

Host Amber Smith: Is there a concern that people might overdo it with this, with the bursts like that?

Carol Sames, PhD: So certainly the selection of your activities and the intensity that you go for those activities could be too much for an individual, not just too much cardiovascularly, but even for the musculoskeletal system. So if we have somebody that maybe is of lower fitness, we might not want to have them doing a lot of hopping and jumping types of activities because they haven't been doing that activity, and that's tough on the musculoskeletal system.

So, how would I know that it was too much? Well, I'm not recovering. So if I'm attempting maybe two days later to do another one, and I'm just, I'm tired, I have a lot of muscle soreness. You know, when somebody has been inactive, and they start to move, they're going to have some muscle soreness, OK? But it shouldn't be so much muscle soreness that I'm struggling to go downstairs or upstairs or walking. That's an indication that what I have done is a little too much for my current fitness level. So, everybody has it in them to do too much. This is not a short race. This is about health, and this is long. We're playing the longevity game here. So we want to be active every day.

We're not going to, in one day of high-intensity interval training, negate maybe all of the poor health choices I've made in the past. So I think that's important for people to understand. And you can start at any point in your life. So that's also important to understand.

Host Amber Smith: This is Upstate's "HealthLink on Air," with your host Amber Smith. I'm talking with exercise physiologist Carol Sames about the value of high-intensity interval training in reducing cancer risk.

Aside from reducing cancer risk, let's talk about some of the other medical benefits that have been associated with interval workouts. Not to be confused with the benefits of exercise in general, but for instance, do HIIT workouts have an effect on our immune system?

Carol Sames, PhD: They would, just like general benefits. So, absolutely. And we want to make sure that we're not overdoing it because if you overdo workouts, you actually, you impair your immune response. So that's why it's really important to understand, like, is this too much for me?

As I just mentioned, HIIT workouts improve cardiorespiratory fitness at a greater level than just more moderate intensity activity. And we now are seeing research that suggests that that provides greater risk reduction for cardiovascular disease. So that is a benefit.

The other benefit is what, when you do higher-intensity activity, you burn more calories per unit time, so, say, per minute. So they become efficient. That is a tremendous benefit for people who are time pressed. You know, all of us have 24 hours, but we fill it up differently. And so if I only have 20 minutes, I can get kind of bang for my buck.

The other advantage of a HIIT-type training, versus a continuous cardiovascular activity is, I can put those components that I need. Say I'm really weak in my hip flexors, I can add some hip flexor activities in there, or core, or I can add activities into my HIIT workout that I really need to work on.

If I want to work on quad strength, I might try going up and down the stairs a couple of times. So that's very beneficial. But the average person doesn't want to do a HIIT workout, probably, every day because that really could put them, possibly overtraining, where they're not recovering

Host Amber Smith: Well, Dr. Sames, I really appreciate you making time for this interview and telling us about HIIT training.

Carol Sames, PhD: Thank you so much, Amber.

Host Amber Smith: My guest has been exercise physiologist Dr. Carol Sames. She's an associate professor of physical therapy and physician assistant studies at Upstate. I am Amber Smith for Upstate's "HealthLink on Air."

Host Amber Smith: Here's some expert advice from transplant surgeon Matthew Garner from Upstate Medical University. How can a person with diabetes know if they need a pancreas transplant?

Matthew Garner, MD: You really can't. You have to come see us. Because it is so challenging to be able to determine whether or not you would benefit from one that I can't even expect most kidney doctors to have a good explanation of that.

What I can tell you is that if you have renal failure, if you're being referred for a kidney transplant, and you also have diabetes, you should be seen at a center that does both pancreas and kidney transplants. Because you want someone to look at you from the perspective of, could this person be a pancreas candidate? The answer to that may very well be no. And that's OK. Because ultimately what we want to do for you is to give you the best treatment we can. And for some patients, that is doing a pancreas transplant. For other patients, it's to say, "look, that's a too high risk surgery for you because it is a much bigger operation, so that what we're going to do instead is just work with your endocrinologist to get better glycemic control after the kidney transplant."

But if you go to a center that just does kidney transplants, there's not a good way to then get a pancreas transplant. And it is a little easier to get the kidney and the pancreas done at the same time than to do the kidney first and the pancreas later. We can do that. But it's a little bit more complicated because every time you do a surgery, it places that kidney transplant at a little bit of risk. And that risk is easier to tolerate when it's all at once. When you do it afterwards, and then the kidney doesn't work because of a problem, that's a tough pill to swallow. So we will do it if need be, because there are some patients that still benefit from that. But we preferentially try to do both at the same time to avoid that.

Additionally, you get a kidney and a pancreas from the same donor, the immunological burden on the patient is lessened, because they only have tissue from one donor as opposed to from two donors.

Now the way that we describe diabetes can be a little confusing. So in general, we refer to Type 1 diabetes as someone who produces no insulin. They have had destruction, usually from an autoimmune process, which is the body attacking itself. They no longer produce insulin of any kind.

Type 2 diabetes is more characterized by insulin resistance. What insulin resistance is, when your body gets used to producing a lot of insulin. This is more common in people that are overweight, but it can happen to people that are of normal size as well. And what that resistance means is your pancreas needs to produce more and more insulin in order to achieve the same effect. And at a certain point, the engine is running as fast as it can. It's making as much insulin as it can. And yet it's not making enough in order to control the blood sugar, and you get diabetes. And then you have to take additional medicines or potentially even insulin to supplement that.

There is a term that some people use called diabetes 1.5, which is not an official term because it is kind of confusing. What that effectively refers to is a Type 2 diabetic, someone who does make insulin and had insulin resistance, but doesn't really make much insulin anymore. So when your pancreas gets to the point where it has to work as hard as it can to make insulin because you have insulin resistance, what can happen to that over time is, in layman's terms, it sort of gets tired. It burns out. And so the amount that it can produce, just like an engine, you run too hard and too fast. It produces less and less insulin.

So sometimes we see patients who have Type 2 diabetes, and their insulin production is so low they are basically functioning like a Type 1 diabetic. And that's really important because when we put in a new pancreas it produces insulin normally, but it's just a normal pancreas. It's not a super pancreas. It's not going to produce any more insulin than your old pancreas could at its best. So if you are a Type 2 diabetic, that still produces a lot of insulin, well, even if I put in another pancreas and it's working at full volume, that may still not be enough for you. Then I've done this surgery, and you're still on insulin, you still have diabetes. I haven't really helped you. So we try to avoid doing that.

On the other hand, if you're the sort of person who was a Type 2 diabetic, saw that you were, lost weight, got some of your other diabetes under control, but still has it, and when we test you, we find that you don't make much insulin, now you're the sort of person that even though you're a Type 2 diabetic, you're kind of behaving like a Type 1. And that's a person because your problem, even though initially was insulin resistance, now it's more of a production problem. You're not making enough insulin. So what we do is we can put a pancreas into that person, and that extra insulin it produces is now enough to sort of make up for what was lost. And, you can take someone and correct their diabetes.

Now those patients will have a higher rate of recurrence, obviously, because they do have some of that insulin resistance that a Type 1 diabetic doesn't usually have. But in careful patient selection, you can find people that can still benefit from that. But in general, the average Type 2 diabetic will not benefit from a pancreas transplant.

Host Amber Smith: You've been listening to transplant surgeon Matthew Garner from Upstate Medical University.

And now, Deirdre Neilen, editor of Upstate Medical University's literary and visual arts journal, The Healing Muse, with this week's selection.

Deirdre Neilen, PhD: Eric Machan Howd teaches professional and technical writing at Ithaca College. His new collection of poetry, "Universal Monsters," has just come out from the Orchard Street Press. He sent us a beautiful celebration of a man's life, told through a series of nautical images. Here is "The Sailor's Hitch":

The first time he came home

from surgery he found it difficult

to rise out of the waterbed. His stomach

muscles, though tightly woven,

were severed to get at what darkness

was swimming inside of him, so he brought

some old rope out of the cellar, looped

one end around the post at the foot

of the bed, and formed the other

into a handle. Each morning, he'd pull

himself up out of the mattress,

far enough to swing his feet over the edge

and push off toward the window, the fresh

air of springtime, the distant smell of salt water.

He grew up with sand between his toes, his soles

hard callused from pounding beach

and boardwalk. He tied himself

to the tides and shore, to the silent

father who returned home from war,

to the tired mother who punished

with her glance, to the beached whale

of his youth that appeared above the fold

of the Sunday issue

of the Asbury Park Press,

to anything that was anchored.

He knew the best knot for every

situation: the binding half-hitch,

the fishing line's blood knot

the secure icicle hitch, the strong water bowline. He knew

how the barrel hitch was best

for suspending objects, how the slip

knot was not a noose, and how the monkey's

fist needs to be stuffed into crevice to root

the climber's line. He knew of pull

and slack and broke his back

on roof's edge hauling bundles

of shingles from ground to pitch with tow line.

He fished for the end of the rope with boat

hook to pull his family to dock

mooring after a day, swimming and steel

gray Atlantic waters and hitched to the salty

ends to the slip's corroded horn cleats.

He eventually let his boat go

and dug an in-ground pool, bought a water

bed, and moved closer to Shark River

Inlet, the place where grown-ups warned

their children not to swim with tales

of teeth, the whites of rolled back

eyes, and breeding. He always wanted

to see the darkness inside of the whale

and regretted not using his pocket-knife

to open the one he found on Bradley Beach

as a child, to discover what was beneath skin

and fat and muscle. By the time Hospice came,

he had tied his rope to the living room recliner,

and as he died he reached up

as if to pull another rope we could not

see -- to pull himself up to the ceiling

as he cried Mommy, Daddy, and struggled

to get closer, to pull himself toward the knot,

hand over hand toward his darkness, his light.

Host Amber Smith: This has been Upstate's "HealthLink on Air," brought to you each week by Upstate Medical University in Syracuse, New York.

Next week on "HealthLink on Air" breast cancer surgery options.

If you missed any of today's show, or for more information on a variety of health, science and medical topics, visit our website at healthlinkonair.org.

Upstate's "HealthLink on Air" is produced by Jim Howe, with sound engineering by Bill Broeckel and graphic design by Dan Cameron.

This is your host, Amber Smith, thanking you for listening.