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Research Week 2017: Leaving your comfort zone, ‘cross training’ in conducting exercise research

Research Week: Kerri Winters-Stone, Ph.D.
Kerri Winters-Stone, Ph.D., researches the use of physical activity to prevent and manage chronic disease. Her studies have shown that cancer survivors can benefit from exercise that reverses treatment-related side effects and symptoms.(OHSU)

Kerri Winters-Stone, Ph.D., has a mantra that applies to her research as well as her advice to young researchers: Get out of your comfort zone.

“It can be very comfortable to work with your colleagues and lab mates because you’re generally all on the same page,” she said. “The most challenging and the most rewarding projects I’ve worked on allowed me to collaborate with people outside my discipline.”

She says those people challenge your thinking. “And that, ultimately, drives the innovation in science.”

Exercise as therapy

Pushing the envelope comes naturally to Winters-Stone, an exercise scientist by training whose work emphasizes the importance of health and movement. A research professor in the OHSU School of Nursing and co-program leader of Cancer Prevention and Control in the OHSU Knight Cancer Institute, her expertise is in the use of physical activity to prevent and manage chronic disease. Her studies have shown that cancer survivors can benefit from exercise that reverses treatment-related side effects and symptoms.

She started her career as an expert in bone health, then began to ask bigger questions. She wondered: “Could we use exercise in the same way a clinician would use precision medicine to help people recover from their cancer treatment?”

Her first study at OHSU was a longitudinal study focused on bone health in breast cancer patients. People from all over the state participated in what was one of the first studies to show that breast cancer patients have weaker bones and fall more often after cancer treatment.

“They finished treatment, wanted to feel better, and at that point, there just weren’t resources for them,” she says.

The data Winters-Stone gleaned from that study prompted her to consider whether targeted exercise could reverse the risk of bone fractures after breast cancer treatment. Studying the effects of exercise and health wasn’t a novel idea, but in terms of cancer treatment, she found that many oncologists hadn’t considered exercise as a formal part of the treatment plan.

“At that time, it felt like all of my ideas were brand new to oncology, but really we took what we already knew from exercise science and brought it into the clinic,” she said.

A hands-on approach

For these studies, Winters-Stone and her research teams design targeted exercise programs to counteract specific treatment-related problems; and generally, people come in to supervised classes two to three times a week for six months to a year.

Winters-Stone is in the training room, observing whether study participants are responding as expected. She can see for herself how certain groups may struggle with certain exercises, and she can hear their concerns and questions first-hand. When these cancer patients receive a letter from OHSU inviting them into her exercise studies, she says for many, it’s like their prayers have been answered.

“It can be the first time they’ve ever felt like they might be able to do this type of exercise program,” she says. “Commercial or community fitness centers may not work for them, because they don’t feel up for going to a big gym.” She says many study participants tell her they feel limited by some of their lingering side effects from treatment, like pain or fatigue, and aren’t confident that they can exercise at the level of classes in those settings.

Bringing exercise to the clinic

Though her work generally takes place after patients finish cancer treatment, Winters-Stone understands the importance of knowing a patient’s in-clinic experience, what they’ve been through and what they struggle with when coming into the training room for the first time. Watching her mom undergo treatment for acute myeloid leukemia gave her first-hand access.

“Her mobility and overall function dropped to nothing,” she said. “At no fault of her treating providers, I saw how there was no good way to predict that treatment might really immobilize my mom or to help her try to keep as much function as possible when she was at home. There’s not a good tool to tip off providers about when a patient might struggle with daily functioning.”

Winters-Stone and her team are working with Brandon Hayes-Lattin, M.D., a hematologist-oncologist with the Knight Cancer Institute, on a project to use body-worn sensor devices to measure mobility in bone marrow transplant, or BMT, patients. The research team will record mobility markers for patients across their treatment to see whether or not a simple assessment can help determine whether patients may have functioning issues at home, including falls.  

The nurse manager for OHSU’s oncology unit, Malinda Burt, R.N., reminded Winters-Stone of the need to “stay grounded” in how her research will be used in the care of a patient. Burt asked Winters-Stone if they’re going to be able to use the results from this research in their practice.

“Research shouldn’t only be about seeking new knowledge,” Winters-Stone says. “You have to know how your research will translate to the real world, like the clinic. It’s really nice when you can answer questions like Malinda’s with an assured yes.” 

Long-term health

The ultimate goal of her work, Winters-Stone says, is to develop safe, targeted and effective exercise programs that translate to community settings and clinical practice so that people can make positive lifestyle choices for better long-term health.

“Cancer survivors want to be part of the recovery process,” she says. “They want a hand in the decision-making about their care, and exercise gives them that avenue for taking some control of their health and their future.”

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