When Jeff Berman was diagnosed in 1990 with a chronic form of leukemia, many doctors told him there was nothing he could do to change the course of his disease. They told him to rest, they didn't want him to tax his energies.

FOCUS ON CANCER

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But Berman, now 45, kept moving. He was training for a triathlon at the time and went on to compete anyway. After the cancer spread to his lymph nodes three years later, he ran the first of 10 marathons. He figured that the same activity that science had shown could keep his immune system strong would only help him to fight harder against the disease.

That was 13 years ago, and since then a growing body of research has shown he was on the right track.

The latest came last week in a study announced at the American Association for Cancer Research conference in Orlando, Fla., that showed modest amounts of exercise -- even a half hour walk a day -- can substantially improve women's chances of surviving breast cancer.

The findings were based on the Nurses Health Study, which has followed the health of almost 122,000 female nurses since 1976. Of the 2,167 women diagnosed with breast cancer during the study, those who got lots of exercise were most likely to survive their disease. In fact, exercise reduced their chance of dying by 25 percent to 50 percent, depending on how active they were.

While that study didn't begin tracking activity in these participants until two years after their diagnosis, Berman, in a special program he has developed, encourages exercise right through chemotherapy.

Good idea, good evidence

It's an idea that is gaining momentum across the country.

"The evidence is pretty clear that exercise, particularly moderately intense exercise, helps alleviate fatigue," said Frank Perna of Boston University Medical Center, who is directing a nationally funded study on breast cancer patients that looks at the safety and efficacy of exercise during treatment and beyond.

"It also significantly reduces nausea. It improves mood and psychological outlook and particularly some perceptions of control over being able to cope and deal with this treatment."

Perna aims to recruit 135 sedentary breast cancer patients to see if they can be encouraged to start and stick with regular exercise. "Part of our thinking is it's a good time to make changes in their life. They're quite motivated to do what they do."

The study promotes walking and light resistance training. Preliminary results show that those in a structured exercise group have heightened mood, psychological outlook and oxygen consumption compared with those in a control group.

Connie Bayles of West Mifflin, the program director for the Center for Healthy Aging at the University of Pittsburgh Graduate School of Public Health, knows first-hand how exercise can aid cancer treatment and wished more people embraced the concept.

"I really feel that saved my life," said Bayles, 52, who was diagnosed with breast cancer more than five years ago. Doctors removed a lump in her left breast, and then 17 lymph nodes. She underwent radiation and chemotherapy. She reached her five-year survival mark in February.

The treatments made her feel like she had the flu. But as a former marathon runner and competitive tennis player, she was accustomed to exercising. On treatment days, she would walk on the treadmill for five or 10 minutes. A few days later, she'd be out in the neighborhood, walking two miles at a time. She also did some light weight training.

"Chemo is nasty," she says. "Exercise does help you refocus your energy. It elevates your mood. It helped me sleep better, maintained my cardiovascular system. It enhanced my flexibility."

Bayles recently returned to the tennis court. "To play tennis, you need to have a lot of stamina. The exercise these past five years has left me able to get back to what I loved."

In other advantages, a 2001 study by Duke University researchers showed that patients who are active during chemotherapy can prevent weight gain. Women typically gain five to 15 pounds of fat, not muscle, during treatment, which can put them at higher risk for recurrence. Those in the study who exercised, however, lost on average five pounds, those who didn't, gained five.

"Even with concerns about immune system suppression, it's important that patients not cloister themselves throughout their treatment," the researchers concluded. "This research should be a motivator for women getting chemotherapy for breast cancer to stay as active as they can."

Some doctors don't push it

Most oncologists agree that patients should try to keep as a normal routine as possible after cancer diagnosis to keep stress levels down. But few actively push exercise or encourage patients to start a program, especially during treatment.

"I'm personally hesitant to recommend exercise for people who have not been exercising," said Dr. Charles Geyer, director of Breast Medical Oncology at Allegheny General Hospital. "Trying to get people to change their behavior can make their life more stressful.

"The problem is when you're told you have cancer, you lose control of your life; you frequently look for something you can do to be a part of this. If people want to exercise, I think it's great. I encourage that. But we don't say that you'll tolerate [treatment] better if you start an exercise program."

At the same time, Geyer said the results of last's week study might prompt him to be more aggressive in pushing exercise after treatment.

"I think this is an exciting study because if it is true, any intervention that would reduce risk of death from breast cancer by 25 to 50 percent is huge. This is clearly something a woman can do for herself."

Dr. Francene Mason, a medical oncologist in Colorado who collaborated on a book with Jeff Berman, isn't surprised that more doctors aren't beating the drums over exercise.

"It's absolutely not something that is part of the plan. Oncologists may be the last people on the block to really appreciate what people can do with exercise."

The motivation, in fact, has been coming more from exercise specialists and therapists, not the medical establishment. It's only been within the last year that important studies outlining the benefits have started to emerge.

"We're really in a position where cardiac rehab patients were 20-25 years ago when they were 'cardiac cripples', they were told to rest, not exercise," she says. "We treat cancer patients with the same kid gloves. What we need to be doing is say, 'This is your wake-up call. Use your cancer diagnosis as a pivitol point in your life to make changes.' "

Mason, who got her medical training at University of Pittsburgh Medical School, has been writing "prescriptions for exercise" for her cancer patients for years. She has exercise physiologists and physical therapists in her office who guide patients through the process.

Locally, organized exercise programs for cancer patients are few and far between, despite the fact they're encouraged by the American Cancer Society and National Cancer Institute.

The Burger King Cancer Caring Center, based in Bloomfield, has sponsored an ongoing gentle movement program for the past two years, although the handful of participants generally come after treatment, said Bonnie Shields, director of support services. For the first time, the center plans a workshop on May 17 to demonstrate low-impact exercises for cancer patients.

Hospitals and YMCAs in the area from time to time have held exercise classes, usually for recovering breast cancer patients. The American Cancer Society Web site notes a few exercise programs designed specifically for cancer patients being held across the country.

One of these is The Force Program, (Focus on Rehabilitation and Cancer Education) developed by Berman, a former New York media sales businessman.

After his initial cancer treatments, Berman joined Fred Lebow, the late chairman of the New York Road Runners Club, to form a cancer support group for fellow runners. For Berman, that work evolved into his nonprofit Cancer Support Services, which in 1998 launched the exercise, nutrition and motivational program. He follows his own advice through continued rounds of chemotherapy.

Until recently, he says, the mainstream medical community has ignored both the anecdotal and growing scientific evidence that suggests physically fit patients can fight cancer better and live longer.

"We try to break down the myths, the misconceptions about what you can and cannot do," he says about the program, which is funded in part by the Susan G. Komen Breast Cancer Foundation's New York City affiliate.

Citing an extreme example, Berman says no one epitomizes the power of exercise better than cyclist Lance Armstrong, who went from the brink of death from cancer to win five straight Tour de France titles.

"He was a phenomenal cyclist before this happened," he said. Cancer "helped bring him to the next level."