November 7, 2025 • 24 mins
Could exercise be just what the doctor ordered for recovery during chemotherapy? In this episode of “The UMB Pulse,” explore this novel approach to cancer recovery withIan Kleckner, PhD, MPH, associate professor at the University of Maryland School of Nursing and director of the SYNAPSE Center. Kleckner shares how exercise can alleviate symptoms of chemotherapy-induced peripheral neuropathy and improve the quality of life for cancer survivors. Through his research, Kleckner investigates how movement can reduce inflammation, enhance brain and body coordination, and empower patients to reclaim their lives.
Chapter Markers
00:00 – Introduction
00:00:17 – Cancer Treatment & Neuropathy
00:01:37 – Guest Introduction: Dr. Ian Kleckner
00:05:06 – Understanding Neuropathy
00:09:38 – Research Findings: Brain & Exercise
00:13:33 – Exercise Intervention & Clinical Trials
00:19:08 – Practical Advice & Takeaways
00:23:31 – Conclusion & Credits
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Jena Frick (00:04):
You are listening to the heartbeat of the University of
Maryland, Baltimore, the UMB Pulse.
Dana Rampolla (00:17):
Cancer treatment saves lives, but it can also leave
lasting reminders, tingling, numbness,even pain in the hands and feet.
For some survivors, just walkingacross the room or buttoning a
shirt can be a daily challenge.
It is called chemotherapy inducedperipheral neuropathy, nerve damage
caused by certain cancer drugs.
(00:39):
It affects nearly two thirdsof patients who receive those
treatments, and for many the symptomscan last months or even years.
Charles Schel (00:48):
At the University of Maryland School of Nursing, Dr.
Ian Kleckner exploring a new ideathat exercise, simple movement
might help the brain and bodyrelearn how to work together again.
His research asks a powerfulquestion, can movement itself
be medicine for cancer patients?
Dana Rampoll (01:09):
On this edition of the UMB Pulse, I sat down with Dr.
Ian Lerner to learn how his teamis using exercise to help cancer
survivors move and feel better again.
If you enjoy stories like this one, besure to like, follow and subscribe to
the UMB Pulse so you will never miss anepisode about discovery and innovation
(01:29):
at the University of Maryland Baltimore.
Now here's my conversationwith Dr. Kleckner.
Ian, thank you so muchfor joining us today.
I have a lot of questions for you.
Ian Kleckner (01:43):
Yeah, thank you for having me.
I'm really excited to be here.
Dana Rampo (01:46):
And tell me a little about your, your, hypothesis that
exercise can be used as medicine?
Ian Kleckner (01:53):
Yeah.
So, one of the, I think, cool ideas, anew idea and exercise oncology is this
idea that, exercise can help people.
Get comfortable being uncomfortable.
We know that patients with cancer duringtheir treatment have symptoms like
fatigue, distress, pain, and so forth.
And exercise can reduce the intensityof those symptoms for many patients,
(02:18):
but sometimes it will not reducethe intensity of those symptoms.
But even still, it canhelp people feel better.
And so, as an example, we have data froma couple of our studies showing that.
Patients with pain or fatigue whenthey exercise, the intensity of
those symptoms might not go down,but they interfere less with what
(02:42):
the patient wants to do on that day.
And so those people who are exercisingare able to do the things they want to do.
Those symptoms don't interfereas much, even if those symptoms
are at that same level.
So for example.
If you had a patient in a clinic whocame in with seven outta 10 distress,
which is really severe, very highlevel of distress, if that patient were
(03:06):
randomized to the exercise group andregularly exercising, that distress
would interfere only a four out of 10.
But if the patient was not exercising,that distress would be a six outta 10.
So they're still experiencing someinterference where the distress
is getting in the way of whatthey want to do, but if they're
exercising, it gets in the way less.
(03:28):
And so that leads to the idea thatexercise helps people feel comfortable
being uncomfortable, and that exercisecan help people live the lives they wanna
live, even with the symptoms they have.
Because the unfortunatetruth is, although.
we would love to prevent cancer.
People still get cancer and although wewould love to perfectly prevent all of
(03:50):
their symptoms, people still get symptoms.
So what we can do is just try to helppeople live their best lives with
the situation they're currently in.
And new evidence suggestsexercise can do that.
The other cool thing is thatwe were not trying to do that
with our exercise intervention.
It just happened to be that way.
(04:11):
And so the next big idea is about canwe make an exercise intervention that
does that on purpose, that helps peoplefeel like they can live the lives they
wanna live alongside their symptoms.
I think in the far future, I hopeto dissolve the false distinction
(04:31):
between physical exerciseand psychological exercise.
if we can dissolve that boundarythe patients are gonna benefit.
Dana Rampo (04:40):
Well, before we jump into what your actual research is,
I unfortunately, my dad passed awaya few years ago from lung cancer,
and part of what he was experiencingwas something called neuropathy as
he was reaching the end of his life.
And I think that when we think aboutcancer, you know, we're all familiar
with side effects like nausea, losingour hair, those sorts of things.
(05:03):
But what exactly is neuropathy?
Ian Kleckner (05:06):
Yeah, that's a great question.
And um, yeah, I'm sorry about your dad.
It's, you're in good company 'causea lot of people have, you know, seen
their loved ones lost to cancer and,seen their loved ones experience the
side effects of cancer treatment.
So what is neuropathy?
Neuropathy means nerve damage.
And so when those nerves get damaged,you can imagine like if it were an
(05:29):
electrical circuit, now it's notconducting the signals that it was used
to conducting through your whole life.
So you might have a loss of sensation.
You might touch something and youdon't feel anything at all, or you
might have unusual sensations likepins and needles, even if you're
not touching anything at all.
Or you might have sharp shooting orhot burning pain, for no particular
(05:53):
reason that you can be aware of.
Dan (05:56):
And do you usually see that throughout your chemotherapy treatments
or more so at the end or afterwards?
Ian Kleckner (06:03):
It can depend upon what type of chemotherapy is used.
So sometimes the chemotherapycan cause neuropathy right away.
So a patient will sit down fortheir chemotherapy infusion
and have sensitivity to coldimmediately for the next few hours.
And you might have other peoplegetting neuropathy that builds
(06:25):
over the weeks of chemotherapy.
So if a person, a woman with breastcancer gets chemotherapy for three
months with a taxane based drug likePaclitaxel, that neuropathy could build
over the course of those 12 weeks and getworse and worse and worse and worse and
worse, um, in a dose dependent manner.
(06:45):
Sometimes there's thisthing called coasting.
And coasting is when a person'sneuropathy symptoms get worse after
they've finished their chemotherapy.
Dana Rampolla (06:56):
And so it really can just be different.
Based on all kinds of factors.
Maybe the type of medication, maybe the,just how your body itself reacts to it.
Ian Kleckner (07:05):
Yeah, I think mostly it's different based on
the type of medication., Okay.
And um, also, I don't think that peoplehave good explanations for how that is
happening, so that's a bit of a mystery.
How is it that some of them have a fastonset or a slow onset or a delayed onset?
Dana Rampolla (07:28):
Interesting.
So tell us a little bit then about whatit is that you are researching and how
it might help something like neuropathy.
Ian Kleckner (07:37):
Yeah.
So, I'm the director of mylab, which is called the Cancer
Control Mind and Body Lab.
And the mission of our lab is tounderstand how the body and brain
produce subjective feelings like symptomsand try to use that knowledge to help
patients with cancer feel better.
We have two main goals.
One is to test the effects ofexercise on symptoms that patients
(08:00):
with cancer have with a specialfocus on chemo induced peripheral
neuropathy and fatigue and distress.
And then the second thing wedo is to look at how the brain
is involved in those processes.
How does the brain processthat information from the body?
How does the brain make the symptomsthat we have as perceptions and how
(08:21):
does exercise affect the brain and howcan we use that to help us feel better?
So, in a nutshell, we wanna know howis it that you feel, what you feel, and
then how can we help you feel better?
So, the types of things that we'redoing are all about helping patients
with cancer and their symptoms.
The number one symptom wefocus on is chemo induced
(08:41):
neuropathy, or CIPN chemotherapyinduced peripheral neuropathy.
Dana Rampolla (08:46):
Interesting.
And Ian, what made you startwondering if movement itself
could help people feel better?
Ian Kleck (08:52):
We know that exercise is generally healthy and that
it helps people feel better, andpersonally, I've been exercising.
Vigorously for, you know, almost 30 years.
And I've experienced its benefits,As a scientist, I got into science because
I was curious about how the body worked.
(09:13):
And then I was curioushow the mind worked.
And so for me, it was very naturalto try to study whether exercise
was helpful for a clinical problem.
And cancer is one of the biggestclinical problems that we're
facing in the world right now.
Dana Rampolla (09:28):
So you noticed that research focused on damaged
nerves, not so much on the brain.
Talk a little bit about howthe brain fits into the story.
Ian Kleckne (09:38):
When we think about how do people have symptoms and how
do they have the symptoms they have?
For me, it is natural to ask, well, whatis the brain's role in that process too?
So when I got into cancer research overa decade ago, I came from psychology and
neuroscience where I thought a lot about.
(09:59):
What the brain was doing tohelp us feel what we feel.
And when I got into cancerresearch, I knew I wanted to
look at chemotherapy inducedneuropathy because I was so curious.
What does the brain do when the peripheralknowledge, when the information from the
body is altered, what does the brain do?
(10:22):
And of course people in cancer researchknow that the brain is important, but
it is more often associated with chemobrain, meaning cognitive impairment.
I can't remember where I put my keys.
I can't concentrate, and things like that.
And we all know that chemo brain,you know that common phrase, um, but.
(10:44):
People usually say it refers tocognitive function and not necessarily
emotional function or pain ordistress or other things that the
brain also it plays a key role in.
So that's kind of where I got startedand what I was really excited about
Dana (11:03):
When you say exercise can retrain the brain, what's really happening
inside the body when someone moves?
Ian Kle (11:11):
What exercise has a lot of effects upon the body, and it is
called a pleiotropic intervention,meaning it has multiple effects.
And so I'm gonna tell you aboutthree things that I think are
important, that what exercisedoes to the body and to the mind.
Number one is anti-inflammation.
(11:31):
We know that exercise has a reallystrong anti-inflammatory effect, and
inflammation is the body's molecularlevel process for healing injuries.
So it's an important part of thebody, but when inflammation is too
much and too long, that is not good.
It can make you feel tired.
It can make you feel achy,like when you have the flu.
(11:54):
And, exercise can reduce inflammation.
So it can reduce inflammation inthe periphery, in the muscles, in
the nerves, in, in your brain too.
And so the first way that exercise canhelp is through reducing inflammation.
The second way that exercisecould help is by allowing you to
(12:15):
train how to move your own body.
People with chemo inducedneuropathy can have nerve damage
to their feet that prevents themfrom maintaining their balance.
Exercise and walking regularly and doingbalance exercises will help the brain
use the information it does have accessto in order to maintain your balance.
(12:37):
The third part I would say ispsychological level stuff like improving
your feeling that you can help yourself.
when someone starts exercising, theyprove to themselves, I can do this.
I can have some control over my health,my life and get some independence back.
(12:59):
And so the knowledge that theyare helping themselves can feel
better and their worry can go away.
, Their pain can go away.
And we have data showing thatpeople who worry less about
their pain will exercise more.
Dana Ramp (13:14):
So when you work with your patients, uh, you're working in
the lab with them and you're giving themdifferent things to test and try, and
then you see what their reaction is orhow do, how do, how does your research
actually work on a day-to-day basis?
Ian Kleckne (13:28):
So for our clinical trials where we are looking
at the effects of exercise,we have a really great team,
including, uh, Mr. Javier Rosales,who is our lead coordinator.
He's been with me for, um,over two years and he has a
background in exercise science.
He screens and recruits people, from the oncologist's clinic.
(13:50):
And so they say yes, then they join ourstudy and they will be randomly assigned
to either get an exercise interventionor a non-exercise intervention.
And so the exercise interventionwas developed by my mentor, Dr.
Karen Musin at University of RochesterMedical Center, who I mentioned before.
So the exercise interventionis daily walking.
(14:13):
And daily resistanceexercise with stretchy bands.
So Javier will teach thepeople how to do the exercises.
There are 16 upper and lower bodyexercises done with resistance bands.
Javier will meet with them for likean hour in the beginning of the
study and show them how to do allthe exercises, Correct form, how to
choose the right resistance level,how many sets and repetitions to do.
(14:36):
And then he'll also talk about theirdaily steps and a walking goal for them.
So we give everyone, an activity trackerand it tracks their daily steps and
we build their exercise prescriptionon how many steps they tended to be
walking in the beginning of the study.
that number will increase overthe 12 weeks of the intervention.
(14:58):
So by the end, they're doing not 5,000,but maybe 8,000 or 9,000 steps per day.
And by the end, they're notdoing their lower intensity
exercises with a resistanceband, but they're doing a higher.
Resistance level, they're doing morerepetitions, We check in with people
every week or two on the phone andjust give them the rah rah, you
(15:19):
know, coaching and you can do it.
And how's your stuff going?
What barriers are you facing Andhelping them solve their own barriers.
Dana Rampoll (15:28):
That sounds great.
I mean, just intuitively you wouldthink if you're doing stuff, you're
getting up, you're moving, you'regoing to feel better, you're going to
have a better mindset, which hopefullywould help you get through all of it.
What about the person who's, who maynot been, may not have been very active
before, or the person who says, I'mafraid, like my feet don't feel right,
I'm, it's not connecting with my brain.
(15:50):
I'm afraid I'm gonna fall.
Maybe they're elderly and then theycould have other complications.
How do you kind of work with those people?
Ian Kleckne (15:58):
Yeah, so all of the people on our exercise studies
are currently not exercising.
Dana Rampolla (16:04):
Okay.
Ian Kleckne (16:05):
A lot of them might have been former exercisers, but
after their diagnosis and treatment,they stop, and the exercise study is
a great way to start that up again.
Or they might not have been active at all.
And, and the cancer diagnosisis a teachable moment.
American College of Sports Medicinehas created guidelines for how
(16:26):
much a patient should exerciseafter they got a cancer diagnosis.
And the rule is start low and build slow.
Most people are walking every day,even a little bit, and we just
say, try to add a little bit more.
And if they're not familiar withhow to exercise, we show them.
those are basically the things thatwe do with people who are not um,
(16:49):
regular exercisers, I should say.
Yeah.
Dana Rampolla (16:52):
Okay.
And then does that daily walking kind ofhelp rebuild that brain and body sink?
Ian Kle (17:00):
so I mean, I'm assuming that that's part of the mechanism.
I think that the resistance exerciseis playing a really big role because
although everyone on our studies, hasalready been walking, you walk to the
bathroom, you walk to the kitchen,you've walked to your bed, whatever.
(17:21):
Most people are not doing resistancetraining, and so the addition of
resistance training is probablymore different than the increase
in walking, if that makes sense.
And so if I were to guess, I would thinkthat the resistance exercise is playing an
important role, but any exercise is good.
(17:44):
So I, I don't want people to thinkthat they need to do this perfect
type of exercise to get a benefit.
Any exercise is good.
Dana Rampolla (17:51):
Yeah.
And that was going to be my next question.
What, what one should I start withor a person start with if they're
going through treatment or recovery?
any data on how if people have been activebefore chemotherapy, that maybe they
have had fewer side effects later, andif so, why do you think that would be?
Ian Klec (18:11):
So there are many more studies suggesting that people who are
more active, before or during their cancertreatment have less severe symptoms.
people who are more active beforetheir treatment starts, those people
have less severe symptoms during thetreatment, which suggests that the
moving of the body actually helped them.
(18:33):
And I would come back to those same threethings I mentioned in the beginning.
exercise can reduce inflammation.
Exercise can help the brainmake use of the information
it does have from the body.
And exercise can help improve people'sself-efficacy and the belief that they can
help themselves and it helps them worryless about the symptoms that they do have.
Dana Rampo (18:57):
Can you picture that at some point, movement might be
prescribed like a medicine for treatment?
Yes.
Or is essentially what you feellike you're doing now, I guess.
Right.
Ian Kleckner (19:08):
Yeah, definitely.
in exercise science, we do callit an exercise prescription.
Dana Rampolla (19:13):
Okay.
Ian Kle (19:14):
And the largest body, a governing body for exercise science.
The American College ofSports Medicine has a movement
called Exercise is Medicine.
And so we do talk about that inthe field of exercise science,
using exercise as a prescription.
However, you don't see doctorsnecessarily write a prescription for
(19:36):
exercise, although some of them do,and they write it on their prescription
pads, and it's been shown to helpimprove adherence to exercise and help
people exercise more when a doctorwrites it down on a piece of paper.
Um,
Dana Ramp (19:49):
it's official, right?
You have to do it.
Ian Kleckner (19:51):
Yeah.
Doctor's orders.
Yeah.
I think that exercise, I think that using.
If any means we can to help peopleexercise more, will be helpful.
And if that means writingit down and calling it a
prescription, that sounds great.
And, if it means, you know, sendingthem an app that helps track
(20:12):
their exercise, that sounds great.
If it means meeting weekly ortwice a week with a physical
therapist, that sounds great.
you know, people knowthat exercise is helpful.
And I think part of the problem isthat they maybe have a hard time doing
it or prioritizing it in any way.
(20:32):
We can do that.
That that sounds great.
Dana Rampolla (20:35):
Right.
I know just on a healthy dayit's hard to prioritize it, you
know, when you're balancing workand kids and family and whatnot.
So even more so whenyou're, when you're ill.
one last takeaway, Ian, what if you couldtell every survivor one thing about hope,
healing, or movement, what would that be?
Ian Kleckner (20:56):
I would say probably keep moving.
just keep it simple.
Keep moving.
You know, everyone, you know, I, I'malso a Buddhist and so I do really
like those principles from Buddhism.
I think they're very useful.
Um, there are phrases , that come aboutacross multiple, cultures and things.
(21:18):
Marines say pain isweakness, leaving the body.
Bodybuilders say, no pain, no gain.
And Buddhists say, no mud, no lotus,because the lotus, the beautiful
lotus flower grows out of the mud.
And there is a lot to be said aboutkeeping moving and to understand
(21:39):
that everyone will experience pain.
Everyone will experience somesuffering and, we might not want that,
but can we keep moving and tryingto live the life we want to live?
And how do we make meaning outof what we have, regardless of
what cards we've been dealt.
Dana Rampolla (22:01):
Right, right.
Well, I think you've inspiredme to, to get off of here and go
get a little exercise in today.
would, would your, is your feelingalso, and I think I know the
answer to this, but that exercisethroughout your life really does, I
mean, certainly anything can happen.
We're exposed to a lot of differentenvironmental and, and biological
(22:22):
influences, but generally speaking,it sounds like your prescription
is to exercise no matter what.
Right.
Ian Kleck (22:29):
Yeah, I think there's always something that we can do and
definitely there are people who arebedbound or in other situations, they
might not be able to do the exercise thatthey see on TV or the types of exercise
that I've even mentioned here, but.
I would say work with an expert, workwith a physical therapist or somebody
(22:50):
who can help you figure out whatcan you do that gives you meaning,
that helps move your body, and, thattries to leverage those three things
we talked about, anti-inflammation,helping the brain make use of the
information it does have and helping yourealize that you're helping yourself.
Dana Rampolla (23:10):
Well, I love the example you gave about yoga not being
created for that purpose, but yet thatis what it's, it's doing for many.
So thank you for, for sharing with usand for all that you are doing, and we
will definitely try to stay connectedto hear what's ahead in the future.
Ian Kl (23:26):
Yeah, thank you so much.
It's great to talk with you.
Charles Schelle (23:31):
Dr. Kleckner's work reminds us that recovery
isn't only about medicine, it'salso about movement, mindset, and
the body's ability to heal itself.
At the University of MarylandSchool of Nursing, his team is
helping survivors rediscoverstrength, confidence, and control.
By asking the question, can you rewirethe brain to provide some physical relief?
Dana Rampolla (23:57):
Our thanks to Dr.
Kleckner for sharing his insightand to you for joining us for
this episode of the UMB Pulse.
If you enjoyed today's conversation,tap that like button, subscribe to our
channel, and follow the pulse wherever youlisten to podcasts so you can never miss
a story about discovery and innovationat the University of Maryland, Baltimore.
(24:17):
And we'll see you next month on the Pulse.
Jena (24:25):
The UMB Pulse with Charles Schelle and Dana Rampolla is a UMB
Office of Communications and PublicAffairs production edited by Charles
Schelle marketing by Dana Rampolla
You are listening to the heartbeat of the University of
Maryland, Baltimore, the UMB Pulse.
Dana Rampolla (00:17):
Cancer treatment saves lives, but it can also leave
lasting reminders, tingling, numbness,even pain in the hands and feet.
For some survivors, just walkingacross the room or buttoning a
shirt can be a daily challenge.
It is called chemotherapy inducedperipheral neuropathy, nerve damage
caused by certain cancer drugs.
(00:39):
It affects nearly two thirdsof patients who receive those
treatments, and for many the symptomscan last months or even years.
Charles Schel (00:48):
At the University of Maryland School of Nursing, Dr.
Ian Kleckner exploring a new ideathat exercise, simple movement
might help the brain and bodyrelearn how to work together again.
His research asks a powerfulquestion, can movement itself
be medicine for cancer patients?
Dana Rampoll (01:09):
On this edition of the UMB Pulse, I sat down with Dr.
Ian Lerner to learn how his teamis using exercise to help cancer
survivors move and feel better again.
If you enjoy stories like this one, besure to like, follow and subscribe to
the UMB Pulse so you will never miss anepisode about discovery and innovation
(01:29):
at the University of Maryland Baltimore.
Now here's my conversationwith Dr. Kleckner.
Ian, thank you so muchfor joining us today.
I have a lot of questions for you.
Ian Kleckner (01:43):
Yeah, thank you for having me.
I'm really excited to be here.
Dana Rampo (01:46):
And tell me a little about your, your, hypothesis that
exercise can be used as medicine?
Ian Kleckner (01:53):
Yeah.
So, one of the, I think, cool ideas, anew idea and exercise oncology is this
idea that, exercise can help people.
Get comfortable being uncomfortable.
We know that patients with cancer duringtheir treatment have symptoms like
fatigue, distress, pain, and so forth.
And exercise can reduce the intensityof those symptoms for many patients,
(02:18):
but sometimes it will not reducethe intensity of those symptoms.
But even still, it canhelp people feel better.
And so, as an example, we have data froma couple of our studies showing that.
Patients with pain or fatigue whenthey exercise, the intensity of
those symptoms might not go down,but they interfere less with what
(02:42):
the patient wants to do on that day.
And so those people who are exercisingare able to do the things they want to do.
Those symptoms don't interfereas much, even if those symptoms
are at that same level.
So for example.
If you had a patient in a clinic whocame in with seven outta 10 distress,
which is really severe, very highlevel of distress, if that patient were
(03:06):
randomized to the exercise group andregularly exercising, that distress
would interfere only a four out of 10.
But if the patient was not exercising,that distress would be a six outta 10.
So they're still experiencing someinterference where the distress
is getting in the way of whatthey want to do, but if they're
exercising, it gets in the way less.
(03:28):
And so that leads to the idea thatexercise helps people feel comfortable
being uncomfortable, and that exercisecan help people live the lives they wanna
live, even with the symptoms they have.
Because the unfortunatetruth is, although.
we would love to prevent cancer.
People still get cancer and although wewould love to perfectly prevent all of
(03:50):
their symptoms, people still get symptoms.
So what we can do is just try to helppeople live their best lives with
the situation they're currently in.
And new evidence suggestsexercise can do that.
The other cool thing is thatwe were not trying to do that
with our exercise intervention.
It just happened to be that way.
(04:11):
And so the next big idea is about canwe make an exercise intervention that
does that on purpose, that helps peoplefeel like they can live the lives they
wanna live alongside their symptoms.
I think in the far future, I hopeto dissolve the false distinction
(04:31):
between physical exerciseand psychological exercise.
if we can dissolve that boundarythe patients are gonna benefit.
Dana Rampo (04:40):
Well, before we jump into what your actual research is,
I unfortunately, my dad passed awaya few years ago from lung cancer,
and part of what he was experiencingwas something called neuropathy as
he was reaching the end of his life.
And I think that when we think aboutcancer, you know, we're all familiar
with side effects like nausea, losingour hair, those sorts of things.
(05:03):
But what exactly is neuropathy?
Ian Kleckner (05:06):
Yeah, that's a great question.
And um, yeah, I'm sorry about your dad.
It's, you're in good company 'causea lot of people have, you know, seen
their loved ones lost to cancer and,seen their loved ones experience the
side effects of cancer treatment.
So what is neuropathy?
Neuropathy means nerve damage.
And so when those nerves get damaged,you can imagine like if it were an
(05:29):
electrical circuit, now it's notconducting the signals that it was used
to conducting through your whole life.
So you might have a loss of sensation.
You might touch something and youdon't feel anything at all, or you
might have unusual sensations likepins and needles, even if you're
not touching anything at all.
Or you might have sharp shooting orhot burning pain, for no particular
(05:53):
reason that you can be aware of.
Dan (05:56):
And do you usually see that throughout your chemotherapy treatments
or more so at the end or afterwards?
Ian Kleckner (06:03):
It can depend upon what type of chemotherapy is used.
So sometimes the chemotherapycan cause neuropathy right away.
So a patient will sit down fortheir chemotherapy infusion
and have sensitivity to coldimmediately for the next few hours.
And you might have other peoplegetting neuropathy that builds
(06:25):
over the weeks of chemotherapy.
So if a person, a woman with breastcancer gets chemotherapy for three
months with a taxane based drug likePaclitaxel, that neuropathy could build
over the course of those 12 weeks and getworse and worse and worse and worse and
worse, um, in a dose dependent manner.
(06:45):
Sometimes there's thisthing called coasting.
And coasting is when a person'sneuropathy symptoms get worse after
they've finished their chemotherapy.
Dana Rampolla (06:56):
And so it really can just be different.
Based on all kinds of factors.
Maybe the type of medication, maybe the,just how your body itself reacts to it.
Ian Kleckner (07:05):
Yeah, I think mostly it's different based on
the type of medication., Okay.
And um, also, I don't think that peoplehave good explanations for how that is
happening, so that's a bit of a mystery.
How is it that some of them have a fastonset or a slow onset or a delayed onset?
Dana Rampolla (07:28):
Interesting.
So tell us a little bit then about whatit is that you are researching and how
it might help something like neuropathy.
Ian Kleckner (07:37):
Yeah.
So, I'm the director of mylab, which is called the Cancer
Control Mind and Body Lab.
And the mission of our lab is tounderstand how the body and brain
produce subjective feelings like symptomsand try to use that knowledge to help
patients with cancer feel better.
We have two main goals.
One is to test the effects ofexercise on symptoms that patients
(08:00):
with cancer have with a specialfocus on chemo induced peripheral
neuropathy and fatigue and distress.
And then the second thing wedo is to look at how the brain
is involved in those processes.
How does the brain processthat information from the body?
How does the brain make the symptomsthat we have as perceptions and how
(08:21):
does exercise affect the brain and howcan we use that to help us feel better?
So, in a nutshell, we wanna know howis it that you feel, what you feel, and
then how can we help you feel better?
So, the types of things that we'redoing are all about helping patients
with cancer and their symptoms.
The number one symptom wefocus on is chemo induced
(08:41):
neuropathy, or CIPN chemotherapyinduced peripheral neuropathy.
Dana Rampolla (08:46):
Interesting.
And Ian, what made you startwondering if movement itself
could help people feel better?
Ian Kleck (08:52):
We know that exercise is generally healthy and that
it helps people feel better, andpersonally, I've been exercising.
Vigorously for, you know, almost 30 years.
And I've experienced its benefits,As a scientist, I got into science because
I was curious about how the body worked.
(09:13):
And then I was curioushow the mind worked.
And so for me, it was very naturalto try to study whether exercise
was helpful for a clinical problem.
And cancer is one of the biggestclinical problems that we're
facing in the world right now.
Dana Rampolla (09:28):
So you noticed that research focused on damaged
nerves, not so much on the brain.
Talk a little bit about howthe brain fits into the story.
Ian Kleckne (09:38):
When we think about how do people have symptoms and how
do they have the symptoms they have?
For me, it is natural to ask, well, whatis the brain's role in that process too?
So when I got into cancer research overa decade ago, I came from psychology and
neuroscience where I thought a lot about.
(09:59):
What the brain was doing tohelp us feel what we feel.
And when I got into cancerresearch, I knew I wanted to
look at chemotherapy inducedneuropathy because I was so curious.
What does the brain do when the peripheralknowledge, when the information from the
body is altered, what does the brain do?
(10:22):
And of course people in cancer researchknow that the brain is important, but
it is more often associated with chemobrain, meaning cognitive impairment.
I can't remember where I put my keys.
I can't concentrate, and things like that.
And we all know that chemo brain,you know that common phrase, um, but.
(10:44):
People usually say it refers tocognitive function and not necessarily
emotional function or pain ordistress or other things that the
brain also it plays a key role in.
So that's kind of where I got startedand what I was really excited about
Dana (11:03):
When you say exercise can retrain the brain, what's really happening
inside the body when someone moves?
Ian Kle (11:11):
What exercise has a lot of effects upon the body, and it is
called a pleiotropic intervention,meaning it has multiple effects.
And so I'm gonna tell you aboutthree things that I think are
important, that what exercisedoes to the body and to the mind.
Number one is anti-inflammation.
(11:31):
We know that exercise has a reallystrong anti-inflammatory effect, and
inflammation is the body's molecularlevel process for healing injuries.
So it's an important part of thebody, but when inflammation is too
much and too long, that is not good.
It can make you feel tired.
It can make you feel achy,like when you have the flu.
(11:54):
And, exercise can reduce inflammation.
So it can reduce inflammation inthe periphery, in the muscles, in
the nerves, in, in your brain too.
And so the first way that exercise canhelp is through reducing inflammation.
The second way that exercisecould help is by allowing you to
(12:15):
train how to move your own body.
People with chemo inducedneuropathy can have nerve damage
to their feet that prevents themfrom maintaining their balance.
Exercise and walking regularly and doingbalance exercises will help the brain
use the information it does have accessto in order to maintain your balance.
(12:37):
The third part I would say ispsychological level stuff like improving
your feeling that you can help yourself.
when someone starts exercising, theyprove to themselves, I can do this.
I can have some control over my health,my life and get some independence back.
(12:59):
And so the knowledge that theyare helping themselves can feel
better and their worry can go away.
, Their pain can go away.
And we have data showing thatpeople who worry less about
their pain will exercise more.
Dana Ramp (13:14):
So when you work with your patients, uh, you're working in
the lab with them and you're giving themdifferent things to test and try, and
then you see what their reaction is orhow do, how do, how does your research
actually work on a day-to-day basis?
Ian Kleckne (13:28):
So for our clinical trials where we are looking
at the effects of exercise,we have a really great team,
including, uh, Mr. Javier Rosales,who is our lead coordinator.
He's been with me for, um,over two years and he has a
background in exercise science.
He screens and recruits people, from the oncologist's clinic.
(13:50):
And so they say yes, then they join ourstudy and they will be randomly assigned
to either get an exercise interventionor a non-exercise intervention.
And so the exercise interventionwas developed by my mentor, Dr.
Karen Musin at University of RochesterMedical Center, who I mentioned before.
So the exercise interventionis daily walking.
(14:13):
And daily resistanceexercise with stretchy bands.
So Javier will teach thepeople how to do the exercises.
There are 16 upper and lower bodyexercises done with resistance bands.
Javier will meet with them for likean hour in the beginning of the
study and show them how to do allthe exercises, Correct form, how to
choose the right resistance level,how many sets and repetitions to do.
(14:36):
And then he'll also talk about theirdaily steps and a walking goal for them.
So we give everyone, an activity trackerand it tracks their daily steps and
we build their exercise prescriptionon how many steps they tended to be
walking in the beginning of the study.
that number will increase overthe 12 weeks of the intervention.
(14:58):
So by the end, they're doing not 5,000,but maybe 8,000 or 9,000 steps per day.
And by the end, they're notdoing their lower intensity
exercises with a resistanceband, but they're doing a higher.
Resistance level, they're doing morerepetitions, We check in with people
every week or two on the phone andjust give them the rah rah, you
(15:19):
know, coaching and you can do it.
And how's your stuff going?
What barriers are you facing Andhelping them solve their own barriers.
Dana Rampoll (15:28):
That sounds great.
I mean, just intuitively you wouldthink if you're doing stuff, you're
getting up, you're moving, you'regoing to feel better, you're going to
have a better mindset, which hopefullywould help you get through all of it.
What about the person who's, who maynot been, may not have been very active
before, or the person who says, I'mafraid, like my feet don't feel right,
I'm, it's not connecting with my brain.
(15:50):
I'm afraid I'm gonna fall.
Maybe they're elderly and then theycould have other complications.
How do you kind of work with those people?
Ian Kleckne (15:58):
Yeah, so all of the people on our exercise studies
are currently not exercising.
Dana Rampolla (16:04):
Okay.
Ian Kleckne (16:05):
A lot of them might have been former exercisers, but
after their diagnosis and treatment,they stop, and the exercise study is
a great way to start that up again.
Or they might not have been active at all.
And, and the cancer diagnosisis a teachable moment.
American College of Sports Medicinehas created guidelines for how
(16:26):
much a patient should exerciseafter they got a cancer diagnosis.
And the rule is start low and build slow.
Most people are walking every day,even a little bit, and we just
say, try to add a little bit more.
And if they're not familiar withhow to exercise, we show them.
those are basically the things thatwe do with people who are not um,
(16:49):
regular exercisers, I should say.
Yeah.
Dana Rampolla (16:52):
Okay.
And then does that daily walking kind ofhelp rebuild that brain and body sink?
Ian Kle (17:00):
so I mean, I'm assuming that that's part of the mechanism.
I think that the resistance exerciseis playing a really big role because
although everyone on our studies, hasalready been walking, you walk to the
bathroom, you walk to the kitchen,you've walked to your bed, whatever.
(17:21):
Most people are not doing resistancetraining, and so the addition of
resistance training is probablymore different than the increase
in walking, if that makes sense.
And so if I were to guess, I would thinkthat the resistance exercise is playing an
important role, but any exercise is good.
(17:44):
So I, I don't want people to thinkthat they need to do this perfect
type of exercise to get a benefit.
Any exercise is good.
Dana Rampolla (17:51):
Yeah.
And that was going to be my next question.
What, what one should I start withor a person start with if they're
going through treatment or recovery?
any data on how if people have been activebefore chemotherapy, that maybe they
have had fewer side effects later, andif so, why do you think that would be?
Ian Klec (18:11):
So there are many more studies suggesting that people who are
more active, before or during their cancertreatment have less severe symptoms.
people who are more active beforetheir treatment starts, those people
have less severe symptoms during thetreatment, which suggests that the
moving of the body actually helped them.
(18:33):
And I would come back to those same threethings I mentioned in the beginning.
exercise can reduce inflammation.
Exercise can help the brainmake use of the information
it does have from the body.
And exercise can help improve people'sself-efficacy and the belief that they can
help themselves and it helps them worryless about the symptoms that they do have.
Dana Rampo (18:57):
Can you picture that at some point, movement might be
prescribed like a medicine for treatment?
Yes.
Or is essentially what you feellike you're doing now, I guess.
Right.
Ian Kleckner (19:08):
Yeah, definitely.
in exercise science, we do callit an exercise prescription.
Dana Rampolla (19:13):
Okay.
Ian Kle (19:14):
And the largest body, a governing body for exercise science.
The American College ofSports Medicine has a movement
called Exercise is Medicine.
And so we do talk about that inthe field of exercise science,
using exercise as a prescription.
However, you don't see doctorsnecessarily write a prescription for
(19:36):
exercise, although some of them do,and they write it on their prescription
pads, and it's been shown to helpimprove adherence to exercise and help
people exercise more when a doctorwrites it down on a piece of paper.
Um,
Dana Ramp (19:49):
it's official, right?
You have to do it.
Ian Kleckner (19:51):
Yeah.
Doctor's orders.
Yeah.
I think that exercise, I think that using.
If any means we can to help peopleexercise more, will be helpful.
And if that means writingit down and calling it a
prescription, that sounds great.
And, if it means, you know, sendingthem an app that helps track
(20:12):
their exercise, that sounds great.
If it means meeting weekly ortwice a week with a physical
therapist, that sounds great.
you know, people knowthat exercise is helpful.
And I think part of the problem isthat they maybe have a hard time doing
it or prioritizing it in any way.
(20:32):
We can do that.
That that sounds great.
Dana Rampolla (20:35):
Right.
I know just on a healthy dayit's hard to prioritize it, you
know, when you're balancing workand kids and family and whatnot.
So even more so whenyou're, when you're ill.
one last takeaway, Ian, what if you couldtell every survivor one thing about hope,
healing, or movement, what would that be?
Ian Kleckner (20:56):
I would say probably keep moving.
just keep it simple.
Keep moving.
You know, everyone, you know, I, I'malso a Buddhist and so I do really
like those principles from Buddhism.
I think they're very useful.
Um, there are phrases , that come aboutacross multiple, cultures and things.
(21:18):
Marines say pain isweakness, leaving the body.
Bodybuilders say, no pain, no gain.
And Buddhists say, no mud, no lotus,because the lotus, the beautiful
lotus flower grows out of the mud.
And there is a lot to be said aboutkeeping moving and to understand
(21:39):
that everyone will experience pain.
Everyone will experience somesuffering and, we might not want that,
but can we keep moving and tryingto live the life we want to live?
And how do we make meaning outof what we have, regardless of
what cards we've been dealt.
Dana Rampolla (22:01):
Right, right.
Well, I think you've inspiredme to, to get off of here and go
get a little exercise in today.
would, would your, is your feelingalso, and I think I know the
answer to this, but that exercisethroughout your life really does, I
mean, certainly anything can happen.
We're exposed to a lot of differentenvironmental and, and biological
(22:22):
influences, but generally speaking,it sounds like your prescription
is to exercise no matter what.
Right.
Ian Kleck (22:29):
Yeah, I think there's always something that we can do and
definitely there are people who arebedbound or in other situations, they
might not be able to do the exercise thatthey see on TV or the types of exercise
that I've even mentioned here, but.
I would say work with an expert, workwith a physical therapist or somebody
(22:50):
who can help you figure out whatcan you do that gives you meaning,
that helps move your body, and, thattries to leverage those three things
we talked about, anti-inflammation,helping the brain make use of the
information it does have and helping yourealize that you're helping yourself.
Dana Rampolla (23:10):
Well, I love the example you gave about yoga not being
created for that purpose, but yet thatis what it's, it's doing for many.
So thank you for, for sharing with usand for all that you are doing, and we
will definitely try to stay connectedto hear what's ahead in the future.
Ian Kl (23:26):
Yeah, thank you so much.
It's great to talk with you.
Charles Schelle (23:31):
Dr. Kleckner's work reminds us that recovery
isn't only about medicine, it'salso about movement, mindset, and
the body's ability to heal itself.
At the University of MarylandSchool of Nursing, his team is
helping survivors rediscoverstrength, confidence, and control.
By asking the question, can you rewirethe brain to provide some physical relief?
Dana Rampolla (23:57):
Our thanks to Dr.
Kleckner for sharing his insightand to you for joining us for
this episode of the UMB Pulse.
If you enjoyed today's conversation,tap that like button, subscribe to our
channel, and follow the pulse wherever youlisten to podcasts so you can never miss
a story about discovery and innovationat the University of Maryland, Baltimore.
(24:17):
And we'll see you next month on the Pulse.
Jena (24:25):
The UMB Pulse with Charles Schelle and Dana Rampolla is a UMB
Office of Communications and PublicAffairs production edited by Charles
Schelle marketing by Dana Rampolla
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