Changing the National Standard of Care with Karen Wonders

Foreign. What is up? What is up? Look, one of my favorite topics in the world is how do we get better outcomes for patients that are struggling with cancer? And how do we reduce the. The incidences of cancer? You know, for those of you that have been following me for a long time, you know that for the last two White Houses, I've been a special advisor to the White House, Chairman of the President's Cancer Panel, something I'm incredibly honored to be able to have participated in the cancer moonshot project. And I'm the only marketer in that group loaded with rockstar doctors and specialists that are all in the fight against cancer. And my wife's a survivor. And my wife just celebrated last month her 10th anniversary, and we're incredibly grateful for that. And my stepmom is on her 13th year of breast cancer survivorship, and my dad just went through lung cancer. And this is a topic that I know hits far too many of us, and I'm intrigued by something we witnessed with my wife. You know, my wife is a. A fitness professional, has been her whole life. And whenever we went and met with doctors and they were looking at her, her diagnosis, they all would look at her and say, you're going to go through this really quickly because of your level of fitness. And we didn't give that too much thought. Right. But before you knew it, her breast cancer situation was behind us and we went back to living and. But along the way, we've noticed that there's something about fitness in cancer. And I want to make sure that in this episode of the Todcast, you get the opportunity to really unpack this and understand where fitness not only plays in your life, but how it plays in for you and survivorship if, well, God forbid, you're ever diagnosed with cancer. And all of that is coming up after these words. This podcast is brought to you by the Wire Buzz team. Now, if that name sounds familiar, it's because I've spent the past decade growing Wirebuzz into a digital marketing powerhouse designed to maximize clarity in complex sales processes so we can help accelerate revenue. And we do this in three phases. Phase one, we transform your website to function so like your best salesperson and then also incorporate persuasive on demand sales videos. Now, your entire team is aligned on messaging, and they're injecting massive clarity into your prospect's head. So your site looks great, but it also has engaging content that helps your team sell on demand 24. 7. The next phase. Phase two, we train your sales and marketing teams to sell remotely or in person to expand the impact of your sales team. And the third phase is we develop and run targeted ads to your prospects. Scale those ads to help you achieve more business results. Sign up for the Wirebuzz Company newsletter to learn more about effective and simple ways to improve your company messaging, attract more digital attention, and ultimately make more sales. All right, so one of the cool things I get to do is I'm kind of on the medical conference tour, and I go to all of medical conferences all over the US and even outside of the US and it's a real honor to get to meet people that are doing things that are groundbreaking, that are going to impact people's lives that they'll never get to meet. And one of the people that I'm incredibly grateful to have befriended over the years is today's guest, Karen Wonders. She is the founder and CEO of Mapletree alliance and a professor of exercise physiology at Wright State University. And her passion is to advocate for exercise to become part of a national standard of care for cancer. And Karen and I've got a ton of friends that are like the top cancer experts in the world that somehow, Karen Wonders, has gotten them to all be on her team so she could spread the word about exercise and how it helps in the role of cancer. And that's why I'm super excited to say, Karen, thanks for joining me on the Todcast.

Well, thanks for having me. I'm excited to be here.

You know, Karen, it's. It is.

It.

It is amazing to me when I've talked to you about how a patient's outcome is changed if they're. If they are using exercise. And I'm intrigued by the whole topic of even prescription exercise as a prescription. And I want to get into all of that good stuff. But let's start at the very beginning. How did you first get started in exercise oncology?

That's a great question. I always say that I didn't choose cancer. Cancer chose me. And that's really how it happened. I had a degree in exercise science. I didn't really know what I wanted to do with that job, so my philosophy was, I'm just going to stay in school until I figure it out. And got a master's degree and went on to get a doctorate. And while I was interviewing for my PhD program, I went to the University of Northern Colorado, and they were the first people in the world that studied exercise oncology.

Wow.

So this is 2003. I'm 23 years old. I'm interviewing for a doctoral program where they Only accept two students a year. And I really wanted to get in because I wanted to move to Colorado. I thought it'd be cool to live in Colorado. And so in my interview, my soon to be professor said, well, you can come to school here, but you're going to have to do research in cancer and exercise. And that was my introduction to the world of cancer and exercise. And at that point in my life, I never knew anyone personally who had cancer. And so I had all these visions in my mind of someone who's too sick or too tired. How in the world are they going to be able to exercise while they're going through treatment? So I was scared to definitely to get started. But it wasn't long before I saw firsthand that the benefits that exercise had. And now I feel that this is the reason that God has put me on this earth, is to do this work. That's how sold and bought into it I am.

I love it. You know, I, I get to spend time with Karen, you guys, when we're at these medical conferences. What I've really discovered is exercise is kind of late to the cancer topic. And we've studied everything but the obvious. And it feels like there are very few people in this world that are trailblazing in what should be an obvious space how cancer is impacted by exercise for, you know, people that, that are trying to decrease their chances of developing cancer, for those that are trying to increase their longevity. And you know, Karen, it's just so interesting to me, like, wow, first what are we seeing in the data and then we're going to talk about, you know, how people are using it and how exercise science specialists are starting to provide this and where your organization comes in. But let's start at the very beginning. Like, Karen, how does exercise impact cancer? Like, what is the connection here?

So you're right in that there's not many people in the world that are doing exercise oncology research. But I will say there is a plethora of published data out there that shows the benefits of exercise during cancer treatment. In fact, we always say that if this were a drug or a technique, it would have been approved by insurance a long, long time ago. To date, there's more than 20,000 published peer reviewed articles that can validate the efficacy of exercise during cancer recovery. And so I think that the question really is, what does it not impact? Because it impacts everything it does. It has been shown to be preventative in certain types of cancers. That's a slippery slope to, you know, it's kind of A dangerous thing to say, because there still are people who exercise and who are diagnosed with cancer. So it's not across the board. And a lot of times people who exercised and then were diagnosed with cancer feel like their bodies let them down or why did I even bother? But I always say that you just never know. Maybe you prevented it for years before your diagnosis. Now you're strong enough to handle the treatments and to handle what's coming. So you just. It's always going to be beneficial. Now, most of the time, 90% of the time, patients have never exercised before their cancer diagnosis. And then with them, we're kind of starting from ground zero. And a little bit is still going to be better than nothing. And that's where the exercise prescription comes in. So if we can measure what are your strengths, what are your weaknesses, and then tailor the exercise program to target those, you're going to see such functional improvements in those patients. They're going to be able to handle their treatments better. They're going to have fewer dose delays, fewer dose reductions, fewer trips to the ER. I know for me, every time I go to the ER, it's a $300 copay. So that's more money in your pocket. I mean, it helps every single aspect of your life.

Okay, so let me see if I got this straight. You're saying that there's a ton of data that indicates that patients are benefited in their fight against cancer if they exercised before they were ever diagnosed, after they were diagnosed, and then. And even during their. Their fight against cancer, like in all of the stages before, during, and after a patient who exercises is going to have benefits?

Absolutely. Yes. Yes, absolutely. There is a recent study that was just published earlier this year that showed that patients who exercise during remission. So once active treatment has been completed, those patients have five times higher survival rates than patients who don't exercise during remission.

Wow.

Which is mind blowing.

Okay, so I. It brings up the question then, if it's that big of an impact. And by the way, I've seen it, because you and I have a mutual friend, Dr. Jay Harness, who's a past president the American Society of Breast Surgeons, that works closely with you. And when my dad was diagnosed with lung cancer, my dad's really not been an exerciser at all. When my dad was diagnosed with lung cancer, Dr. Harness and my dad have become friendly over the years. And Dr. Harness was my dad's personal cancer coach. And his first advice to my dad was, Howard, you got to get out and start exercising now. I think what Happens. And by the way, my dad did brilliantly through lung cancer this last year. But what I think is happening is the body has greater circulation, the muscles are growing and cells are like fighting for nutrients. And that makes your, your, like your whole system work better in its, in a more optimal way. So the immune response can also play a role. I mean, is it with my layman's mind, is that part of what's going on? Karen?

Yes, absolutely. So whenever you look at the effect of exercise on immune function, it's actually kind of tricky because if you don't exercise at all, you have a negative impact to your immune function. But on the other side, if you exercise too much, it actually can negatively impact your immune function. And this is seen whenever someone runs a marathon, they often get a cold, cold the next day, right when it's, I know you live in Arizona, but here in the Midwest we have snowstorms in the wintertime. And when the elderly who've been cooped up all winter go outside to shovel their driveway, they sometimes will have a heart attack because it's this very strenuous exercise that their body isn't accustomed to. There's a free radical buildup. It can be, it can be dangerous. But if you keep them in that moderate intensity exercise where you can still talk, maybe not the way we're talking now, but you can talk, you are not gasping for air, you're not feeling like you have chest pain when you exercise at moderate intensity, that's when people see optimal immune function. And so what we try to do at my center is exercise them in that moderate intensity level. It's low to a moderate intensity level, especially while they're going through chemotherapy, because we've been able to show and have published data that shows that the patients who exercise during chemotherapy have an improved immune function and as a result see fewer dose delays and fewer dose reductions while they're receiving their chemotherapy, which makes them better able to handle the medicine that's coming their way. And so everyone wins. When, when that's the case.

Are you seeing a day where there's a prescription for exercise that's provided when a patient is diagnosed?

I do. I do. We have seen such great momentum and such great strides in the field of exercise oncology, especially in the last couple of years. And breast cancer, the accrediting body for breast cancer, just recently published standards that say that patients who are being treated for breast cancer should be assessed for exercise, should be referred to an exercise program. Those are huge steps. We're also working with the Commission on cancer to do the same thing for all cancers. And so I do believe, just as you see with a heart attack, if someone has a heart attack, if someone has bypass surgery, it's always now you need to go to cardiac rehab. And I really do believe that the day is coming very, very soon that when you're diagnosed with cancer, it's going to be expected that you enter an exercise oncology program to help you, I mean, it's to help, we want to help you manage your symptoms, we want to help you stay functional, we want to help you stay independent, all of those things. And exercise will help with all of that.

Hey, Karen, I, I, I'm curious what percentage of hospitals have exercise as something that they could actually prescribe to a patient? It just doesn't like, I'm a little worried here because, you know, most of my medical provider friends and my wife says I have too many medical provider friends and I need to broaden my friend scope a little bit. And, but none of them have a concept really on or few of them have for a few of them, very few of them even exercise, but almost none of them are involved in nutrition and, you know, the healthy components that happen between nutrition and exercise. But are we like, what percentage of cancer hospitals are even at that point now where exercise is part of their, their protocol?

Well, I think if you look Nationally, nationally, about 5% of cancer patients are referred to an exercise program. So if you're thinking 2 million diagnoses every year, about 5% of those patients will be referred to an exercise program. I don't know how many cancer centers actually have an exercise program. I know sometimes people will try to say, oh well, let's do a yoga program, let's do, you know, a walking group, which are all great. And they're, I think, a good start to an exercise program. But I think where they're going to really see the biggest impact is having an evidence based exercise program where it's supervised and individualized for that person. And right now our biggest roadblock is the fact that it's not covered by insurance. I have an organization, Mapletree Cancer alliance, and we are the biggest provider of clinical exercise oncology in the world. To give you an indication of how many centers we work with, We've got about 50 clinical locations across the country. So it's great. You know, we're the biggest in the world, which is awesome. But at the same time, there's fifth, there's 1500 accredited cancer programs in the US and we're in 50 of them. So we still have a ways to go, but I believe we're going to get there. I believe we're working really hard at a national level to get this paid for, to get this into standard of care. And I think you will. Will see tremendous growth over the next couple of years.

You know, for people like my wife and I, you're a hero. Like, we see what you're doing, and we see the vision that you have and the impact that it's going to have on patients. And, you know, we too, find it to be incredibly frustrating how far behind the medical community is in something that has such a big impact on patient outcomes. And, you know, it just, It's. It can be frustrating, but on the other side of that, you're a visionary and you're bringing something that'll help us. And what kind of cancers are impacted by exercise?

Every type of cancer. I mean, I think there's more than 200 types of cancer. So the data is largely focused on the big fat four, which is breast, lung, prostate, colon cancer. But I believe, honestly, I believe our bodies were created to exercise. And whether you have cancer, whether it's diabetes, whether it's Parkinson's, whether you're perfectly healthy, exercise helps every single thing your body does. And what's even crazy, and I get geeked out about this because I'm a physiologist, there are things in your body that happen to accommodate exercise. So, for example, your blood pressure naturally increases during exercise, which normally would sound the alarms, and your body would try to bring it, you know, calm you down, like that fight or flight system. Well, during exercise, your body senses that it's exercising, and it allows for that natural increase in blood pressure so that you can continue exercising. And there's examples like that all over the place. It's the coolest thing. I just think this is how we were created to be. We weren't created to sit on the couch all day. We were created to move.

I don't know. I mean, sometimes I feel like that's my calling, is to sit on the couch right when passion kicks in. You know, our first act of the day is to exercise. It's the, you know, caring of ourself. And I know that every time we. We contract a muscle, it releases hope molecules into our body. And who needs more hope than somebody that's going through a fight against cancer? And it's okay. So paint this picture for me. Like, if I ran for president, I. This would be one of the issues that I would be fighting for. But don't hold your breath on that because there's no decision. I'm not announcing it right here now. But like, what is the trend of how do you see this becoming the standard of care and adopted across hospitals and cancer facilities around the country? What's that kind of trajectory like from where we are now to all 1500 centers?

That's a great question. I think to answer that, I think it's first important to see where we began. Because the reason I started my organization was after I had my doctorate and I'd done all that research in cancer and exercise. My grandfather was diagnosed with colon cancer. So this was in 2007 and he was active before his cancer diagnosis, but had a very aggressive tumor. And so I told him, I said, patient, there's no way you're going to be able to continue doing the level of activity that you've been able to do. He lived four hours away from me, so I was kind of limited in how I could help. So I said just. And I was naive at the time. I thought exercise and cancer were just like cardiac rehab. So I said, go ask your doctor, find the nearest cancer and exercise program and see how you can get started. Well, his doctor said, oh no, you need to rest during exercise. During cancer, exercise is not safe. You can't do that. That's why I started my organization. Now here we are in 2023, we've already been able to get breast cancer to say, yes, this should be a part of the standard of care. We're working with the commission on cancer. My organization is a member organization of the commission on Cancer. We're working with them to write standards that include exercise. Then from there we go to the government and we go to CMS and we go to Congress and we say in order to get something paid for, and you probably already know this, but to get it paid for by insurance, you need to show medical necessity and you need to show evidence. Well, as I said, we have the evidence. There's no denying that once it's standard of care, then we do have medical necessity. And so I believe the path is very clear. I believe we're going to get there. I've predicted as early as 2026 that might be a little bit overzealous, but I'm one to just dream big. And I believe with all of my heart that once that is paid for, that will take away the biggest roadblock we face. Then it's, then it's easy, then it's a no brainer for the hospitals. It's a Win for them, It's a win for their patients. Why wouldn't they do this?

Well, I'm going to be at that party when it happens and I hope it happens sooner because I know there's so many people in need. But I remember when Wendy was going through breast cancer. It's not something that I can easily forget. And Wendy's a, you know, a lifelong fitness person. And I remember thinking, and I'm sure a lot of patients and their loved ones have this thought about exercise, that it's actually by exercising you're moving the cancer around in the body. Is that a myth?

That is a myth, yes. But I've heard it before. That's something I've heard before, but no, that, that's definitely a myth.

Interesting. So it's so ironic to me that you go to Northern Colorado and you go to the one place where they're studying this and the next thing it becomes your career and your life purpose and where does somebody go if they like, if they is there. Does Mapletree Cancer alliance provide resources for an individual or just to facilities?

That's a great question. So yes. So let me back up a little bit. We do provide, you know, we partner with cancer centers and we raise the money with them so that we can provide our services free of charge for patients. So in doing so we're able, you know, that takes away a huge barrier for patients and not having to pay for it. Now if someone wanted to use our services but they were not affiliated with a program where we already had a partnership, then we do have self pay options and we have different tiers where, you know, this one's very hands on all the way to we give you a program and you kind of do it unsupervised and then you check in with us on an as needed basis. So we have different tiers of that. But you know, my dream is that every cancer center would have an exercise program. And that doesn't have to be necessarily a maple tree as much as I want it to be a maple tree. But in reality, when you look at the workforce and I don't know if this was the direction you were going with it, but if you look at the need for a workforce, we're going to need about 20,000 trained and certified personnel professionals in exercise oncology. And Mapletree is working towards trying to achieve that goal. We have a certification program that we use and then me and my other life as a professor, we're also working to create an exercise oncology major where people can come all over the country, it'll be virtual and become trained and certified as well.

You know, there's a movie, it feels like I'm going to see a movie about this. It reminds me of Annie Parker, if anybody hasn't seen the movie about my dear friend Annie Parker, who was the patient advocate that discovered hereditary connection to breast cancer long before the. The geneticist discovered it. But you're. You're doing really incredible work. And I know along the way with it feeling like it's moving slow, that it can get frustrating, but I also know that it requires a visionary that is given the backbone and perseverance to be able to make something like this a reality. And that's why you inspire me so much, is that you're willing to do this for all of us in the process. And you're trailblazing the way. And so many gifted oncology experts, like world class experts, have seen what you're doing and they're jumping in to support you. And that's super cool. You know, my wife Wendy, when she was going through cancer at her hospital, they had a. They had yoga at night, and they had like a therapy, individual therapy sessions for patients that have PTSD and are struggling to get returned to their life. I know that my wife would go regularly to both the therapy and to the yoga and the drumming circles and the cooking classes. And these are things that are transformational for a patient to go through. And that facility shut down all of its exercise and life adjustments when Covid happened and never brought it back. And it feels like another missed opportunity where we could put patients in the right path. Did you see Covid, where some of these organizations that were starting to lean into the exercise for oncology path dropped it and never returned back to it.

So I personally have not experienced that. In fact, we more than doubled our volume during COVID which kind of flies in the face of a lot of people's experiences. But what we were able to do, and really this was me in panic mode because I got a call on a Friday afternoon that said, hey, we got to close you down for a couple weeks, just till this Covid thing passes. And I thought, you close us down, you'll never let us back on site. And then where are the patients? I mean, who's going to be caring for them? They're going to be stuck in their homes, and most of them live alone. They have no contact with anybody. How are they going to continue to feel supported and cared for? And so in desperation, I said, will you allow us to do virtual exercise training. And I honestly didn't think they would go for it, but they said, well, if you can make it work, it's worth a shot. And luckily, my chief science officer, who just so happens to be one of the leading researchers in the world in Exercise Oncology, Dr. Catherine Schmitz, she had the wherewithal to say, now we need to collect data on this because we have to show the safety, the feasibility and the efficacy of such a program. And I remember the next day I went on Facebook Live and I did a tutorial on how to do a zoom call and how to do FaceTime and all of these things because I really wanted our patients to adopt it. We were able to get 84% of our patients transitioned by Monday into a virtual exercise setting. And since then, it's just taken off. We still do our in person settings for a lot of our partners, but we always have virtual as an option. And in some programs where the cancer center is rural or the cancer centers in an urban area like New York City, we do entirely virtual because that's easier for the patient to do. And then it's also less expensive for the hospitals because I can staff it in Dayton, Ohio, which is cost of living is a lot less than New York City.

But this is a great indicator for your persevering spirit. And I've heard a lot of people rave about Dr. Schmidt and had never met her before. But when you and I were recently in Boston at the American Society of Breast Surgeons, when I last saw you in person, I was sitting down at a table and our dear friend Dr. Harness came by with Dr. Schmidt and they sat down and talked with me for maybe 45 minutes. And it was so great to hear from her what she's seeing on the horizon for patients all over the country and how we're going to use exercise to impact them. Now, I know Your website's mapletree alliance.org I know that you are incredibly passionate about this. If somebody is in the audience and they want to help a loved one, they can go to mapletreecanceralliance.org and get information, correct?

Absolutely. Yes. Yes. And we have an email place where they can send in an email as well. And I get those.

Perfect. And then if somebody in the audience happens to be a leader in the fight against cancer, and I know that I've got them there because what else are they going to listen to besides my podcast? And I'm, you know, I know that they listen because they tell me you can also get information @mapletree cancer alliance.org about how you can bring Exercise Oncology and Mapletree into other facilities. That's accurate too, right?

Yes. In fact, I talk to new facilities almost daily. I talk to one today.

That's great. Well, I'm. I'm so incredibly grateful for what you're doing. And we're at 50 locations now, and the goal is to get to 1500. And for people that are listening, please help spread the word about Exercise Oncology, spread the word about what Karen Wonders is doing. And I think what we're all going to discover is someday soon, it's going to be Mapletree. And Mapletree's impact is going to be all over this country helping patients. And, Karen, your persevering spirit is really inspiring, and thank you so much for what you're doing.

Well, thank you for having me.

Yeah, it's super cool. All right, guys, if anybody wants more information, go tomapletree cancer alliance.org and Karen, thanks for joining me on the Todcast.

Thank you. Bye.

Yeah, yo, that was a powerful episode. And from what we just learned, it should be obvious how you can now implement these lessons in your life to get to the next level. Now, before you bounce, I just have three quick thoughts. First, thank you for taking me on your incredible life journey. Second, if you receive some value from me and you want to pay it forward, it would mean the world to me. If you left an honest rating and review at Apple, Podcasts, Spotify, or wherever you listen, I'd be incredibly grateful. And lastly, if you share this episode, whether it be a screenshot or a photo from where you're listening, anything via Instagram stories or LinkedIn, Facebook, or any of the social media sites, just tag me and the guest. I'll repost your content and I'll reply back in the comments because I love mixing it up. In fact, I'd love to share your shoutouts in my feed, too. Not only are these shout outs really good for you and for me, but they also help us book more amazing guests because they'll be able to see the reach that you're helping to cultivate. This is a way for you to help contribute to the show. So thank you again for listening, and I look forward to earning a regular spot inside that ear of yours. Let's grow. Rock.