Dr. Kerry Courneya

So these patients who have low muscle mass or lose muscle mass when they're going through these difficult treatments tend to have the worst outcomes.

So it's prompted a lot of research now into the resistance training angle versus the aerobic exercise angle.

Yeah, I don't think they know all the mechanisms right now of why that's going on, but they've attempted to address it mostly with nutritional interventions and supplement types of interventions, but not had great success.

There is some research looking at exercise and strength training seems to have modest benefits.

But I think ideally we'd want to intervene earlier and prevent patients getting from that cachexic state because then things, you know, progress very rapidly once you get into that cachexia and it's very hard to reverse it at that stage.

But if we can prevent it up front and delay it, I think that would be a really important benefit.

And there is, and of course that feeds into the whole obesity paradox, right?

Which is obesity is a risk factor for getting a chronic disease, but it actually helps you live longer after a chronic disease.

So we've seen that in a few of the studies, say with lung cancer, that once you're diagnosed with lung cancer, patients who are actually larger, more obese, have a little bit longer survival.

And I think it gets into this idea of the reserves that you've built up and sort of this rapid decline that's going to occur.

I think the obesity angle may be important, but it's probably even more important with the muscle mass, right?

The larger amount of muscle mass is going to help you live longer, you know, as cancer sort of takes this toll over the course of months or years.

Yeah.

And the research shows there's no necessary link between that.

There is this phenomenon we call sarcopenic obesity.

So there's high rates of obesity, but those people have fairly low lean body mass as well.

So there's different kind of phenomena.

phenotypes, if you will, of the obesity.

And you're right, the real issue we want to look at in obesity is how much muscle mass versus how much fat mass and look at kind of that fat to lean ratio.

And that's really the more important factor.