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Alicia Morgans: Hi, my name is Alicia Morgans and I'm a GU Medical Oncologist at Dana Farber Cancer Institute in Boston. I'm so excited to have here with me today, a good friend and colleague Dr. Christina Dieli- Conwright, who is an Associate Professor of Medicine at Harvard Medical School, and also working with us here at the Dana Farber. Thank you so much for being here with me today.

Christina Dieli-Conwright: Thank you so much, I'm so excited to be here.

Alicia Morgans: Well, wonderful to have you here to talk about something that is so important to so many patients who have prostate cancer, and of course, the loved ones who think about them, and who hope that they can be healthier as they go through the process of dealing with their cancer. So let's start by talking about exercise in general, which is an area of expertise and an area of research interest for you. Why is exercise actually important to people who have cancer?

Christina Dieli-Conwright: Absolutely, that's a fantastic question. And I think the importance of exercise is really multifactorial. I think we all know that exercise is good for us. It's healthy for us. We know we should be doing it, or at least be thinking about doing it, but the benefits of exercise, really from the time of diagnosis and of course, before diagnosis in the prevention space, but from the time of diagnosis throughout the rest of our lives really is critically important for many, many factors.

There is really strong evidence to support exercise as improving quality of life, not only just quality of life in general, but also mental health, so reducing anxiety and depression but also helping to manage fatigue, pain, even improving sleep, all the way to more physical attributes, such as improving fitness, improving the ability of us to carry out activities of daily lives or, excuse me, activities of daily living such as simply standing up from a chair or sitting down, even physiologic improvements such as helping to regulate risk factors related to diabetes and heart disease, blood pressure, and of course, bodyweight management, which is where a lot of work in this area tends to be focused in on. So there are really multifactorial benefits of exercise that make it critical to participate in throughout the timeframe of diagnosis through survivorship.

Alicia Morgans: Well, I think that's it is great and I so appreciate that you have such an interest and a passion for not only counseling people about why it's important to think about exercise and physical activity when dealing with cancer, but you are so proactive, designing trials and really pushing the envelope in ensuring that we think about it, especially at the teachable moment when people are diagnosed, and I think to have that opportunity to think about new habits and patterns that they can engage in. And I know when people who have prostate cancer see me in the clinic, they are often asking in those early visits especially, "Doc, what can I do on my own? What can I do on my part that does not involve medicine, that does not involve radiation or surgery to try to do something for my prostate cancer?" What would you say to these people who really want to engage?

Christina Dieli-Conwright: Yeah, that's a great point. And it's also great that patients are coming to you inquiring about this. The great thing about exercise is there really is no wrong way to go about starting to do it per se, of course, within reason, assuming that the physical goal is not too ambitious. And simply what we like to advise people on is to start with something to just get started, something is going to be better than nothing. A lot of us are familiar with the exercise guidelines for cancer survivors, which is 150 minutes of moderate to vigorous exercise, aerobic exercise per week, 75 minutes at a higher intensity per week. And I like to really take the focus off the total volume of minutes and really focus on just getting people up and moving, whether that be something simple, such as just standing up and down out of a chair if they are completely sedentary and really dislike exercise, or maybe do not have the time or do not know what to do, to maybe even starting with partnering up with a friend or a family member or doing some group exercise, just starting with something and even in little amounts either throughout the day or during the week can actually have a pretty big impact.

In fact, there is even a greater body of evidence showing now that reducing sitting time or reducing the amount of time we spend sedentary can actually be pretty impactful for cancer survivors on reducing cardiovascular disease risk, and just overall for adults on reducing disease risk. So we're even trying to investigate that now and sort of not necessarily steering away from focusing on the total volume of exercise one should do, but also integrating into the approach of directing patients to reduce sedentary time in order to help promote them to be active as well. So I think the bottom line really starts with something that you could be consistent at, you're not fearful of, that you feel comfortable with, and then just stick with it.

Alicia Morgans: I love that sort of whole time approach, so reducing sedentary activity in addition to increasing more aerobic activity because when things are prescribed in these small snippets and they don't address the lifestyle of the individual between those 150 minutes, I think that we can be a lot less impactful or effective in that work. I mean, that's just my gestalt though. I am not an exercise researcher like you, but I love that you are thinking about it more holistically and kind of approaching it from several angles. And one of the interests, I think of the Prostate Cancer Foundation as an organization that of course is interested in cancer research related to men with prostate cancer and especially advanced prostate cancer, they are very interested in the work that you are doing and in the ideas that you're coming up with in terms of moving this field forward. Are there specific research projects or ideas that you are hoping to move forward in the context of the Prostate Cancer Foundation or otherwise that we can look out for as clinicians and hope to see results from at some point?

Christina Dieli-Conwright: Sure, absolutely. So one of the focuses we've been examining on and hope to really continue in this area is helping in reducing exercise, to help to reduce risk factors related to heart disease, not simply for prostate cancer survivors on ADT but broadly. And so we've done some preliminary work in that area with some success. And so now, but it's been with clinical exercise, so supervised with us in an exercise clinic. So now we are really interested in using more remote-based platforms to disseminate that exercise that we can broaden our audience to a larger population, rather than those who might just be in the Boston area.

Additionally, to that, we do have a passion for minority patients with prostate cancer. So we have a number of trials we are designing and hoping to get funded soon that will actually specifically target black men with prostate cancer and Hispanic men with prostate cancer, similarly, to reduce the risk of heart disease. And those will be remote-based exercise interventions, but with supervision from my team, so that they are still getting the one-on-one attention needed to help emphasize the exercise technique, exercise prescription, and really ensure that they are doing exercise in a manner that will actually reduce the risk for cardiovascular disease.

Alicia Morgans: That's fantastic, and I look forward to working on some of those projects with you and would love to give you just a final minute, I guess, to give us a summary to the listeners on what your message would be in terms of exercise for their patients and the future of exercise research for men with prostate cancer.

Christina Dieli-Conwright: Absolutely, sure. I think the final message is to take whatever time you have in the day, large or small, and use it to get moving a little bit, whether that be just a simple walk up and down a set of stairs, or whether that be walking a dog or doing some exercise with a friend, any bit counts and getting out and doing it is very, very helpful. And I think the same message can come from the Medical Oncologist to their patients is to start with something. Obviously, there is going to be patients who are very highly motivated and are ready to jump into something like CrossFit or other high-intensity exercises, and that's great too, but really not to be discouraged by sort of the big, bad world of exercise and needing a lot of time to do it. Simply pick something that's fun, enjoyable, and do it in small doses. To be consistent at it, I think is a good message to take home.

Alicia Morgans: I could not agree more. And if you fall off the wagon from exercise and you take a few weeks off, just start slowly and get back into it. It is the exercise over time that is so important. So thank you so much for your work in this field and for inspiring all of us to get moving a little bit. We appreciate it.

Christina Dieli-Conwright: Great, thank you for having me.