new program brings science-backed results of exercise to cancer treatment
13 minute read
alethea greyeyes (centre race director) lives with breast cancer. she's determined to improve lives for those with cancer and others with exercise, launching orange shirt day runs in saskatoon and edmonton for the national day for truth and reconciliation.
supplied
stay up to date on this topic
this article was produced by the healthing editorial team with the support of a grant from the canadian society for exercise physiology (csep). while the csep made the production of this article possible, they did not have any editorial influence or control over the content, including review prior to publication.
alethea greyeyes is all set to compete with her teammates at the raven 50 mile ultramarathon in july in whitehorse, yukon, through the rugged wilderness of the north. the 44-year-old saskatoon athlete and coach has come full circle after completing a race in the phoenix desert after she first felt a lump in her breast in october 2024.
she was diagnosed with estrogen and progesterone receptor positive, her2-negative breast cancer in january 2025. this means her cancer cells rely on these hormones, estrogen and progesterone, to grow. around 70 per cent of breast cancers are hormone-receptor positive, which also means they can be targeted with hormone therapy to slow or prevent growth.
“there were no symptoms,” greyeyes says of what that lump could mean. she didn’t stop training for the phoenix ultramarathon and finished with one of her best times, helping her two nephews, one just 15-years-old, to finish as well.
“now that i recall, there was a little bit of like nerve zapping. but nothing. to be quite honest, i thought it was my period. now, i’m glad that i didn’t go to have it checked until after i came home. so i was fine and it was a lot of fun, a lot of dust and lots of holes all around, which i later found out are not only snake holes, but tarantula holes.” she didn’t see any aliens though, despite all the arizona signage for sightings, she laughs.
bringing the power of exercise to communities
greyeyes is an adventurer, charismatic and soulful about her passion for wellness through self-reflection and fitness—and bringing opportunity for running to her home cree communities and other indigenous communities throughout saskatchewan. as a professional shoe fitter at a running store called brainsport in saskatoon, she recently launched an indigenous outreach program to visit communities and fit people with running shoes, introducing them to the “self-efficacy of running and having a pair of shoes that is just really well built.”
advertisement
known as a “powerhouse badass indigenous runner,” she also cofounded the indigenous runners alliance and hosts races in edmonton and saskatoon for “runconciliaction” on orange shirt day, september 30, to commemorate the national day for truth and reconciliation.
why is all this important to mention?
exercise isn’t an option for emotional and physical resilience and wellness, it’s essential. “running for me is therapy,” she says, which is even truer for her now after going through the extreme challenges of cancer treatment.
cancer isn’t new to her family, with several women experiencing breast cancer and losing her brother to pediatric cancer when he was a young teen just a few years older than she was, which struck her when she started treatment.
“i knew that i would be faced with a new set of people, hospitals, doctors, oncologists. and the only thing that to me was very heartbreaking is that i was experiencing the same things my brother did. that broke my heart, because i thought he must have been so scared and in so much pain, and he was 13, and i’m a woman, i have kids, i’ve had experiences, i’ve lived.”
she had a double mastectomy soon after her diagnosis, immunotherapy, 15 rounds of chemotherapy over seven months and then 15 rounds of radiation.
movement before and after breast cancer surgery
with a mastectomy, lymphedema (swelling of tissues) can occur, or cording because of lymph node removal where a cord-like structure forms under the armpit skin that can restrict movement and cause pain. “so, if you don’t move, if you don’t start doing stuff quite quickly, you can become frozen,” greyeyes notes. “it’s imperative that you move just like in hip surgery; movement is imperative.” this wasn’t about running trails right away, but about range-of-motion stretching and breathing.
sponsored by:
canadian society for exercise physiology
advertisement
twenty years ago, the attitudes around cancer and exercise were different, prescribing to take it easy and bed rest to get through cancer treatment and recovery. since then, a growing body of research has shown that exercise is tremendously beneficial for most people with cancer both during and after treatment, improving their ability to manage treatment side effects, recover strength and stamina and reduce risk of cancer recurrence.
dr. kristin campbell is a leading researcher on this front. she’s a physiotherapist, a professor in the department of physical therapy at the university of british columbia in vancouver and the co-lead of the exercise guidelines for cancer survivors, which are followed around the globe by the american college of sports medicine. her work focuses on exercise in cancer prevention, rehabilitation and survivorship.
“the role of exercise for cancer is being more and more understood as an important part of care, says dr. campbell. “so we were a bit behind some of the other specialties like cardiac rehab and pulmonary rehab. they’ve been well established for many years. but for cancer, it has been a bit of a slower appreciation, mostly because for a long time, the cancer treatments were addressing the cancer type, but not the impact on people’s lives afterward and some of the long-term side effects of those treatments.”
as treatments have improved, people have been living longer, bringing more questions about mitigating the side effects of the treatments so that people can improve their quality of life. for example, one of the most common side effects of chemotherapy is fatigue, dr. campbell notes, where physical activity is the most effective intervention for addressing cancer-related fatigue.
exercise guidelines for cancer help guide patients and professionals
advertisement
but how much activity can people living with cancer actually handle? how can they get started?
the exercise guidelines outline a fitness prescription of how much activity people should be doing to start to see those benefits that also include better sleep and reduced anxiety and depression that often come with cancer.
so, aerobic activity on its own, like walking, dancing, or cycling, three times per week for about 30 minutes per session, should start to show benefits for cancer-related fatigue. that’s a little bit less than the general physical activity guidelines of 150 minutes per week, she explains. or you can do resistance training two days a week for about 20 minutes for the same benefit. if you can do both, even better, but the aim is to give patients and exercise professionals more guidance on what’s needed and how it can fit into your life with or without equipment at home.
“the oncologists want to get the most drug they can with the minimum amount of side effects because that’s linked to higher survival. so when the exercise world and the physiotherapy and rehab world are talking about exercise in the oncology space, it’s nice, but it seemed like it wasn’t essential to treatment. and so there was a lot of thought about what would really show that exercise is like a need to have as part of care, not just a nice to have.”
dr. campbell talks about the game-changing challenge clinical trial spearheaded in canada for people living with stage 3 or high-risk stage 2 colon cancer, the type where chemotherapy is part of the treatment. it was designed like a drug trial, but the intervention was behaviour change with survival as the endpoint. the intervention was a three-year behaviour change programme after surgery and chemotherapy, providing people with the tools and skills to add activity to their lives and sustain it.
advertisement
the trial results confirmed that integrating structured exercise programs into cancer care has benefits associated with survival and prevention. the participants had a 28 per cent lower risk of recurrence and developing a second cancer, and a 37 per cent lower risk of death than people who did not participate.
“the big thing that it showed is that exercise really did change these outcomes that we look for in oncology trials,” she says, also adding that trial participants were doing exercise that they could easily incorporate into their lives. one long-haul truck driver would run laps around his truck when he parked for a break from the road.
incorporating exercise improves adherence to treatment and outcomes if you do it.
as most of us know, exercise for anyone, including people living with cancer, needs to be doable and enjoyable or it’s not sustainable. what has been missing in cancer care is the infrastructure to make exercise a key part of care, dr. campbell notes, with oversight from health-care and exercise professionals who are trained through programs at the american college or sports medicine and canada’s thrive health services, for example, to develop safe and effective individualized exercise programs for those living with or beyond a cancer diagnosis.
also in canada, the canadian society for exercise physiology (csep) was one of the partner organizations to review the scientific evidence and offer recommendations on the exercise guidelines for cancer survivors and what both patients and health-care and fitness professionals should know.
prehabrx offers free professional exercise support
not everyone, of course, is like greyeyes who wanted to get back to running as soon as she could. her cancer clinic in saskatoon gave her a booklet that outlined safe exercises to follow over time, which was helpful, but she was also pointed to prehabrx, a new virtual program free of charge for prehabilitation and rehabilitation services primarily for those with cancer with guidance from qualified professionals.
advertisement
“prehabrx was like this glimmer of hope, and it just made me feel like, okay, there’s something designated specifically for me because cancer isolates you,” greyeyes says. “you’re so scared when amputation happens; oh, it’s wild.” in the program, people do a quick assessment and are matched with a kinesiologist or exercise physiologist as a coach to develop a program and meet regularly to offer support and monitor progress.
“i felt so confident, and i felt happy, and i was like, there’s somebody who’s going to look after me who i don’t have to over-explain myself.” she calls her coach a lifesaver, bringing guidance based on how greyeyes was feeling, her energy levels and her goals. about 10 weeks after her mastectomy, she was able to do some running along the riverside trail by her home. she even took time away from the treatment regimen to run the first 14 km (to the first aid station) of the raven 50 mile last year in july 2025.
“even strong people need somebody,” she says. she almost died twice during treatment, one because of an allergic reaction to a drug, and then when she was feeling so sick because the toxicity of treatment was so effective, it put her body into complete shutdown. “i was that person that the chemotherapy just did its job and like wiped everything out,” she says.
“but i’m stubborn, and i like living too much. i love people. i love people, and i love happiness way too much. and i’m like, nah, i’m going to be here for a long time.”
in february 2026, she also underwent hysterectomy and oophorectomy, removal of her uterus, cervix and ovaries, to protect against cancer recurrence or other cancers. as research published in the lancet journal confirms, people who’ve had breast cancer are more likely to develop a second cancer like ovarian cancer or uterine cancer.
she’s now on a daily pill for the next five years. nothing is for certain because her cancer could recur.
advertisement
what she’s learned through prehabrx is that if you overdo it with exercise that is too much, too soon, it’s like cashing a cheque with no funds in your bank account. you will pay for it dearly, trying to recover from it financially. her coach patty would give her “little gems” of support and direction.
the program offers six months of intensive care, and then six months of a self-management phase where participants can take the tools and continue themselves, reaching out for check-ins when they need.
“patty is the only woman that i could talk to about my breasts. she’s the only health-care provider i felt comfortable like crying in front of,” adds greyeyes. “i had my last checkup with her a couple months ago, and i cried pretty hard the next day and my husband asked if i was okay and i said ‘i’m happy that i’m on the way to recovery, but i’m sad that she’s gone.’”
building access and capacity for exercise in cancer care
prehabrx founder dr. daniel santa mina is a csep member, professor at the university of toronto and clinician investigator at the university health network in toronto where he’s also the director of the surgical prehab program. he says greyeyes is a remarkable person and advocate for the program. “as someone who loves exercise and was a high performing athlete, even they need support trying to figure out what is right, what they can do. they need support. they need motivation. you know, the people you think are least likely to need it, they need it too.”
he established the program to build access and capacity for individualized exercise programs for people living with cancer to experience the benefits. and it really all started when he focused his career on exercise and oncology with the death of a close high school friend who was diagnosed with cancer in his early 20s and passed away shortly after.
advertisement
“although i was highly interested in sports and high-performance training, when this happened to my friend, i could just see that his deconditioning and his loss of function was just a huge part of who he was. i didn’t think that it was absolutely necessary for him to be stuck in bed, isolated in the way that he was. and over the last 20 years, we now recognize that that really isn’t healthy for the patient.”
he talks about how exercise facilitates a lot of positive changes in the body that help people manage the tumor itself, as well as the treatment that they’re going to receive or have received. “we would never say to someone who is decommissioned to just wait it out until they felt better. there’s an active role that we have to play in trying to recover. and that doesn’t necessarily just come with the passing of time, there is a role that we have to play in getting our bodies fit again.”
just as athletes would never go into a world cup match unprepared, there’s a need to be prepared mentally, nutritionally and physically. and after a match, teammates wouldn’t necessarily just lay on the couch, but go through a recovery process that requires a little bit of movement and some stretching.
“the challenge and the stress of treatment is somewhat analogous to the challenge and stress of other athletic activities that just need preparation and maintenance to sustain wealth.”
as well, our body’s immune system is stronger when we are fit and are exercising. we handle inflammation better. we activate anti-tumor metabolic and biochemical pathways. and all of these have contributed to literature that has shown an improvement in cancer survival, he continues. “the evidence at the molecular level and at the functional and survival level is really so strong that every major oncology and exercise agency recommends exercise for your cancer care.”
advertisement
back in 2012, dr. santa mina launched a program at toronto’s princess margaret cancer centre that is now one of the largest clinically integrated exercise and rehab programs for people with cancer in the world. then he moved to toronto general hospital to research and establish prehabilitation practices to make people fitter for surgery so that their treatment outcomes are better, so cancer patients, along with people with heart disease and other injuries or conditions that require surgery in their journey.
he explains that prehabrx was an opportunity to create impact at the national level, if not the international level. one member of the team is american and treating u.s. participants. “i love research and i love patient care. those are great. but how do we take what we’ve done in the lab and in one hospital and make it accessible and available to everyone? because to me, that would be impact. that would be taking the research and putting it into the world for some good.”
so the momentum has just begun with more than 350 canadians enrolled in the program since opening in january 2025, pharmaceutical companies joining on as sponsors and a drive to reach as many people living with cancer as possible.
exercise a win-win investment for pharma and health care
he’d like to see provincial authorities treat exercise like a health intervention that they would otherwise fund in pharma or radiation or surgery.
“if the system is willing to fund these drugs that have a comparable advantage that cost hundreds of thousands of dollars, why is it not willing to cover the costs of another intervention that has similar at a fraction of the cost? one-10th to one-100th of the cost.”
bottom line, in five or 10 years, exercise should be on the prescription for cancer treatment. “when someone is diagnosed, they get a prescription for their chemotherapy, radiation, or whatever it is, but also an exercise prescription. that’s where we want to be.”
advertisement
greyeyes wants to champion the cause as well. at the tail end of her last surgery, she began a certification program to become an accredited cancer health and wellness coach.
“i want to be an indigenous community initiatives lead so that i can take this wonderful oncology health and wellness to communities across canada, and then go into the states and then go worldwide,” she says, embracing the good and what’s possible.
“everything is intersecting in a good way, and cancer gave me a lot of things.”
share story
