Inspired by her own fitness journey, an M Health Fairview cancer physician explores a strength-training “prescription” for her patients
Rounds of chemotherapy and a bone marrow transplant to treat leukemia had turned 51-year-old Greg Miller into a shadow of his former self.
The regimen worked. Miller was cancer-free. But he didn’t feel anything close to normal. An avid hunter and cement contractor, Miller was used to spending his days on the move. Unfortunately, the cumulative effect of his treatments had zapped his physical and mental strength.
“I couldn’t take stairs. I couldn’t step on a ladder,” he recalls. “I’d walk across grass that was uneven and I’d fall over.”
Miller was ready to try something new. He heard M Health Fairview hematologist Shernan Holtan, M.D., speak at an event about her idea for a strength-training study for bone marrow transplant and chemotherapy recipients.
“I thought, ‘I want in,’” Miller says.
Holtan’s strength-training study idea stemmed from her own fitness journey. Six years ago, she was living in another state, working long hours as a clinician-researcher treating patients with blood cancers like lymphoma and leukemia. Her professional life was taking a toll on her personal well-being: She was constantly tired and just not feeling like herself.
When she moved to Minnesota at the end of 2013, she signed up for a gym membership with the goal of “maybe doing the elliptical a few times a week.”
That was before she met Jason Sweetnam, a fitness coach at Life Time Fitness. He suggested she follow his strength-training program for one month. She loved it. And she kept getting stronger—so much so that she ended up setting a national powerlifting record for her age group, performing a 308.6-pound squat in a 2019 competition. She calls the accomplishment a “crazy accident.”
“I had no idea how much better I would feel,” says Holtan, who is also an associate professor of medicine at the University of Minnesota Medical School and a Masonic Cancer Center member. “As I continued to make progress of my own, I heard my patients complain about the same symptoms I had myself.”
Holtan had a thought: “Could strength training help my patients feel better?” She brought the idea to Sweetnam, who agreed to help her test her theory.
The two designed a clinical study that took the form of a 12-week exercise program for patients who had undergone cancer treatment. The enrolled patients were considered frail, Holtan says, meaning they were frequently fatigued, unable to complete even simple physical tasks, and otherwise in search of the day-to-day normalcy they knew before their treatment.
“If strength training could help someone regain their independence, that’s incredibly meaningful,” she says. “It’s not about weight loss. It’s about muscle gain. We thought this program could really change people’s lives.”
Hitting the gym
A few months after hearing Holtan speak at Marrow on the Move, a fundraising walk/run that supports the U of M Medical School’s Adult Blood and Marrow Transplant Program, Miller had enrolled in the study and was at the gym meeting with Sweetnam for the first time.
The pilot study group included Miller and three other patients, as well as their training partners— family members or friends who also participated in the exercise program and served as a control group for Holtan’s research. Miller’s wife, Sandy, was his partner.
Sweetnam customized people’s exercise plans to their abilities and starting strengths, but two elements of the program were universal: All participants learned seven basic strength exercises and were challenged to either do more repetitions or lift more weight each time they went to the gym.
“Progression is the magic ingredient,” Sweetnam says. “Whether you’re healthy or have gone through something traumatic, it’s all about progression over time.”
For three months, the Millers and the other study participants worked out once a week as a group and at least once a week on their own. Sweetnam provided ongoing one-on-one guidance as well as tips for navigating the gym. By the end of the study, which was funded by money raised at Marrow on the Move, the results were undeniably positive, Sweetnam says. Not just in how much weight each person could lift (“at least a 200% improvement for everyone,” Sweetnam says) but in how much better they felt.
“When you lose your strength, you lose your independence, and you lose yourself,” Greg Miller says. “Exercise just helps your life all around. I take the stairs all the time now. Walking is a lot easier. I just feel better.”
It wasn’t just the cancer survivors who benefited from the program, Holtan says.
Sandy Miller agreed to be Greg’s exercise partner with the assumption that she’d be a “cheerleader more than anything else.” After the Millers went through the study’s initial baseline health screening, Sandy received a call from Holtan about the results.
“I thought, ‘Oh, gosh, what’s wrong with Greg now?’” she remembers. “And Dr. Holtan goes, ‘This isn’t about Greg, it’s about you. You have diabetes.’”
Sandy was stunned. As Greg’s primary caregiver, she knew she was prioritizing her husband’s health over her own, but she had no idea hers had deteriorated so much. No longer just Greg’s cheerleader, Sandy entered the strength-training program with a newfound personal motivation. The results were literally life-changing.
“In 12 weeks, she reversed her diabetes,” Holtan says.
Both Millers continue to work out about three times a week, using the lessons they learned from Sweetnam and Holtan.
“It’s hard to pull yourself off the couch, but when you know it makes you feel better, you do it,” Sandy says.
Holtan and Sweetnam are overseeing a second round of the study this year to collect more data on the possible benefits of strength training for cancer survivors and their partners. Ultimately, Holtan hopes exercise will become an integral part of posttreatment recovery, deliberately prescribed to promote physical and mental resiliency and to help patients get back to a more normal life after the rigors of cancer care.
But based on her own experience, as well as Sandy Miller’s, Holtan knows strength training holds powerful potential for everyone, not just cancer survivors.
For people who are interested in strength training, Holtan recommends seeking out a coach, someone who can help you understand your limits and thoughtfully prescribe your exercise “dosage,” she says.
“Everyone should have a coach like Jason,” she says of Sweetnam, who remains her trainer. “Just like I carefully prescribe chemotherapy at personalized doses, you should have a coach who can help personalize your workouts to achieve your goals.”
And once you’ve started, she says, stick with it.
“If you’re not careful,” Holtan says with a laugh, “you just might set a national record.”