Exercise and epidemiology: Bench to bench


Weight lifting and heavy resistance exercise  are good for are good for your general health and muscle function. But what effect do they have on life after cancer?  And how does it do anything at all?


Dr Jessica Gorzelitz leads a team at the University of Iowa that aims to uncover muscle strengthening epidemiology, and what can be done to improve cancer patients strength throughout the balance of their life.


Read the original article: https://doi.org/10.1093/jncimonographs/lgad002


Image Source: Adobe stock / Magdal3na






The following transcript is automatically generated.


00:00:05 Will Mountford 

Hello I’m will welcome to research pod. 

00:00:08 Will Mountford 

Exercise and activity are good for your health. Hardly a controversial statement, but one whose applicability may be further reaching than you suspect. For example, weight lifting and heavy resistance exercise. Sure, it’ll help with muscle tone and function. How about life after cancer? 

00:00:27 Will Mountford 

What does a bicep curl do for cancer, survivorship and prognosis, and how does it do anything at all? 

00:00:34 Will Mountford 

Doctor Jessica Gorzelitz leads a aeam at the University of Iowa that aims to uncover muscle strengthening epidemiology and what can be done to improve cancer patients strength throughout the balance of their life. 

00:00:49 Will Mountford 

Doctor Gorezelitz. Hello. 

00:00:51 Dr Jess Gorzelitz 

Hi, how’s it going today? 

00:00:52 Will Mountford 

I’m very well. Thanks for your time. Could you tell us a bit about your research, your work, what’s led you to the position that you hold now? 

00:00:58 Dr Jess Gorzelitz 

Yeah, I’m currently an assistant professor of health promotion at the University of Iowa, and my research is focused on physical activity and cancer survivorship truly helping individuals after a cancer diagnosis to improve both the quantity and quality of their lives. 

00:01:14 Dr Jess Gorzelitz 

I come from a background, frankly, as a chubby kid who was not very athletic but wanted to be. And when I was. 

00:01:24 Dr Jess Gorzelitz 

Studying in college, I didn’t know what I wanted to study. 

00:01:27 Dr Jess Gorzelitz 

I just know that you. 

00:01:28 Dr Jess Gorzelitz 

You go to college and I hung out a lot in the weight room and I found out that exercise science was a major, which I promptly switched to and really loved. It really made a lot of sense to me, especially in the practical applications of teaching, you know, muscle attachments and how muscles work. 

00:01:43 Dr Jess Gorzelitz 

But I didn’t know what I wanted to do after college, so I worked as a personal trainer, which was really rewarding. But the behavior change on an end of 1 is is challenging. So I thought, hey, maybe I’ll go back to grad school. I’ll get a degree in population health, figure out how to scale this. 

00:01:59 Dr Jess Gorzelitz 

After my Masters degree, I was kind of hooked and I loved science and then stayed on for a PhD and allowed me to specialize in where my heart is is really in cancer and and exercise. And then after my PhD I went and trained at the NCI, which is the National Cancer Institute, got some very specialized training there. 

00:02:19 Dr Jess Gorzelitz 

Which just kind of led me there. So it’s a long circuitous route. A lot of themes of of exercise, physical activity and cancer. 

00:02:27 Dr Jess Gorzelitz 

In terms of my career, I’m launching at a new institution, so building that momentum is really critical for me right now. And I think this work is more important than ever. I think I have lived experience as a woman, which is really important in science. 

00:02:45 Dr Jess Gorzelitz 

Especially when you look at those people. 

00:02:46 Dr Jess Gorzelitz 

Who are studying weightlifting scientifically? It’s predominantly XY people. 

00:02:51 Dr Jess Gorzelitz 

So in terms of equity, it’s really important that I’m one of the voices here contributing equally to those individuals and then politically in the United States currently, like I feel like there are more and more attacks on women ideologically. And what we represent, I will not go quietly. So there is a theme of strength, not just physically, but then. 

00:03:11 Dr Jess Gorzelitz 

Ideologically, that we are not just women and and sort of talking about how you can regain and reclaim that strength. Again, not equating any political strife to a cancer diagnosis, but the themes still persist. 

00:03:24 Dr Jess Gorzelitz 

So I am the director of the physical Activity and cancer survivorship. Yes, yes, we call it PAX lab and that is my research group at the University of Iowa. She’s brand new only about a year old. But the purpose of her lab is twofold. What our lab group does is we contribute primary literature to the field. 

00:03:44 Dr Jess Gorzelitz 

By better understanding the relationship of exercise and cancer survivors with a unique focus on gynecologic, gynecologic populations, and then additionally, we help to implement that evidence by working with patients with cancer and and delivering those exercise interventions. So our mission is indeed both scientific and and. 

00:04:03 Dr Jess Gorzelitz 

As it stands currently, I have two graduate students and I think we have 6 undergraduates, which is a promising start. We are looking for more graduate trainees, postdocs and I’m trying to hire some professional lab managers and study coordinators. What’s unique about where we are in Iowa is. 

00:04:23 Dr Jess Gorzelitz 

So where I live in in Iowa City, we have the only Cancer Center in. 

00:04:26 Dr Jess Gorzelitz 

The state and Cancer Center serves something called the catchment area. It’s basically where patients come from, which means that if we’re the only Cancer Center, our catchment area is huge. And this one institution, this one agency, is meant to serve a lot of patients. 

00:04:41 Dr Jess Gorzelitz 

Indeed, Iowa is very unique in that we are one of the rare states that cancer incidents or new cases is actually going up, I think we’re only second. 

00:04:49 Dr Jess Gorzelitz 

To Kentucky, which is is not what you would expect with all of. 

00:04:52 Dr Jess Gorzelitz 

Our efforts and prevention and detection and screening. 

00:04:56 Dr Jess Gorzelitz 

So Iowa has a huge public health challenge, so we really want to contribute to that mission not only of university, but then further more of the Cancer Center to help improve population level health, which is it’s a big lift, but we’re starting strong with our team to contribute to those missions. Furthermore, of all the NCI designated cancer centers, we’re actually one of the smallest. 

00:05:17 Dr Jess Gorzelitz 

So when I was leaving my postdoc I had a couple. 

00:05:20 Dr Jess Gorzelitz 

Of options of places I could go. 

00:05:22 Dr Jess Gorzelitz 

And I liked Iowa for the people here are fantastic. But then. 

00:05:25 Dr Jess Gorzelitz 

Also, there are a. 

00:05:26 Dr Jess Gorzelitz 

Lot of challenges here that are potentially addressable, but it’s it’s big thinking with good people and it is amazing. You know, you have people who are wealthy and they live near the Cancer Center and they can have all the resources to them. But we’re also working with people who don’t have Internet like 3 hours. 

00:05:42 Dr Jess Gorzelitz 

Away and those two people should have access to the same care, but it is. 

00:05:47 Dr Jess Gorzelitz 

Not that simple. 

00:05:53 Will Mountford 

Activity as disease prevention fairly well discussed when it comes to what that means for after disease onset. Can you give us some of the kind of the headline facts and figures what you see from all of your experience and kind of maybe any National Cancer database tracking there is about what mortality and comorbidity there is associated with? 

00:06:13 Will Mountford 

Inactivity, quality of life and. 

00:06:15 Will Mountford 

Everything that goes with that. 

00:06:17 Dr Jess Gorzelitz 

Yes, this is one of my favorite topics Harry has. I could go off so you know. 

00:06:22 Dr Jess Gorzelitz 

The physical activity. 

00:06:23 Dr Jess Gorzelitz 

Epidemiology has been around for decades. The first time we found out that or some of the first evidence we had, that physical activity was associated with improved health outcomes was the conductor study. The one in bus studies, where they were able to look at rates of heart disease. 

00:06:38 Dr Jess Gorzelitz 

And the conductors versus the drivers to see the the the individuals. 

00:06:43 Dr Jess Gorzelitz 

Who are up walking around taking the tickets versus the people who are sitting all day and the findings were the conductors, the ones who are up and walking around had lower. 

00:06:51 Dr Jess Gorzelitz 

Rates of heart disease. 

00:06:52 Dr Jess Gorzelitz 

And that is a very simple example of how we started, and indeed our interest and obsession in cardiovascular disease in physical activity epidemiology. We know that aerobic exercise. 


Is associated with. 

00:07:05 Dr Jess Gorzelitz 

A ton of health outcomes. 

00:07:07 Dr Jess Gorzelitz 

Lower risk of death, lower risk, heart disease, lower risk cancer, diabetes. You know aerobic exercise is really important for disease prevention. 

00:07:14 Dr Jess Gorzelitz 

The evidence base is not nearly as robust for muscle strengthening exercise, and I call up the designation here because it’s really important to consider that both are different types of exercise. But a lot of us, when you say exercise, you imagine running or rowing or biking. But if we’re going to exercise is meant to improve the Physiology. 

00:07:32 Dr Jess Gorzelitz 

Of the body. 

00:07:33 Dr Jess Gorzelitz 

Muscles and bones are a huge component to that. 

00:07:36 Dr Jess Gorzelitz 

Furthermore, if you want your muscles to move, you need to get your heart and lungs to pump oxygen to them, so bring up the chubby kid thing because I was, I couldn’t run is. 

00:07:46 Dr Jess Gorzelitz 

I can’t, but I was always really strong and I loved weightlifting. My dad got me in the gym and I felt like that was my place and it was sort of body habitus agnostic. It didn’t really matter how you looked, it’s what you could perform. So when I started studying physical activity epidemiology, there’s quite a bit on aerobic exercise, but in our surveys. 

00:08:06 Dr Jess Gorzelitz 

And in our instruments that measure population level health, there’s not actually good or frequent measures of muscle strengthening activity. And I should say that this is in the public health guidelines from the World Health Organization. For us Americans, it’s in the physical activity guidelines for Americans. 

00:08:22 Dr Jess Gorzelitz 

And we still have. 

00:08:24 Dr Jess Gorzelitz 

Evidence to show that it has health benefits, but the scope, like the scale of evidence, is is five to one for every five pieces of aerobic exercise we might have one study, and yet, weightlifting persists. Muscle strengthening activity. Is that beneficial for us? So I couched, I I set that up before we start talking about health outcomes to remember that. 

00:08:43 Dr Jess Gorzelitz 

Muscle strengthening activity, those that strengthen the muscles are often overlooked, and there is a disproportionate representation of the evidence. 

00:08:51 Dr Jess Gorzelitz 

Yet what we have also shows that in my study that we’ll talk about later is one of the contributions to that. But we do know that muscle strengthening activity is also independently associated with lower risk of death, typically lower risk of cardiovascular disease and in some studies, muscle strength and activity is associated with lower risk of. 

00:09:11 Dr Jess Gorzelitz 

So population level health. It’s really easy to, I should say, easy. It’s one of the hallmarks of physical activity, epidemiology, to look at the big outcomes, you know, death and disease onset. 

00:09:22 Dr Jess Gorzelitz 

Because typically those things happen once and they’re very clean. Individuals don’t have multiple death records, so analytically it’s very simple for us to look at. Did this person say they were exercising here and then was there a death later? Similarly, we can do. 

00:09:37 Dr Jess Gorzelitz 

That for. 

00:09:37 Dr Jess Gorzelitz 

Disease diseases like did. 

00:09:39 Dr Jess Gorzelitz 

This person have diabetes now. 

00:09:41 Dr Jess Gorzelitz 

Did they get it later? 

00:09:43 Dr Jess Gorzelitz 

Some of these quality of life outcomes, morbidity function, some of the things I’m more interested in are far more complicated because they change often over time. Some quality of life is time, age, location dependent and we can do tighter, different types of studies to examine the relationship. 

00:10:03 Dr Jess Gorzelitz 

Of exercise on some of the. 

00:10:04 Dr Jess Gorzelitz 

These outcomes, but we typically can’t do them at the scale that we can for. 

00:10:08 Dr Jess Gorzelitz 

These large physical. 

00:10:09 Dr Jess Gorzelitz 

Activity Epidemiology investigations of hundreds of thousands, if not millions, of individuals. 

00:10:15 Dr Jess Gorzelitz 

So some of. 

00:10:16 Dr Jess Gorzelitz 

The work that we have in exercise on college, we can do experimental studies of individuals coming off treatment or in the treatment period or when they’re off treatment. 

00:10:24 Dr Jess Gorzelitz 

For a few years and sort of experimentally manipulate what they’re doing for exercise and then look at how some of these functions change and by functions I mean quality of lives, functionality, just activities of daily living performance force. 

00:10:39 Dr Jess Gorzelitz 

But the types of evidence. 

00:10:40 Dr Jess Gorzelitz 

Is different and for many reasons. 

00:10:43 Will Mountford 

Well, to think about the other people involved in this coming out from a patient perspective. 

00:10:48 Will Mountford 

How much energy? Time? Motivation. Just like the share ability to get out of bed sometimes. How much of that does a patient have coming out of treatment and then like being given the idea of, OK, now we get you fit now we get. 

00:11:03 Will Mountford 

You. Well, there’s a. 

00:11:04 Will Mountford 

Quote you put in. I think if there’s an e-mail of sure you had cancer, but how do you live? 

00:11:08 Will Mountford 

Your best life post diagnosis. 

00:11:11 Dr Jess Gorzelitz 

Yeah, the answer is it depends because things like cardiovascular disease and diabetes, they’re very like similar. This is discounting the individual level variation, but like diabetes is dysregulated blood sugar, heart disease is, you know, it depends if it’s aflor sclerosis or hypertension, but we know the etiology, they’re pretty well. 

00:11:32 Dr Jess Gorzelitz 

Cancer is, by definition, unregulated cell growth, and where the person was diagnosed, what treatments they received and what is their prognosis varies intensely. Just to compare, for example, pancreatic cancer and breast cancer, those individuals have very different outcomes on life and prognosis as how much time they. 

00:11:50 Dr Jess Gorzelitz 

Could have left what? 

00:11:51 Dr Jess Gorzelitz 

What happened was. 

00:11:52 Dr Jess Gorzelitz 

Associated with their diagnosis, their treatment, so a lot of us think of like cancer, like picture your average cancer patient. 

00:12:01 Dr Jess Gorzelitz 

And it’s just so varied due to this factor. So it is challenging to sort of categorize that. I’ll tell you that I do a lot of work with endometrial cancer, which is the inner lining of the uterus that typically gets shut. 

00:12:14 Dr Jess Gorzelitz 

Every month, but that is. 

00:12:16 Dr Jess Gorzelitz 

A tissue that can become malignant, and it’s typically treated with hysterectomy. 

00:12:21 Dr Jess Gorzelitz 

And sometimes additional chemotherapy and and in. 

00:12:24 Dr Jess Gorzelitz 

Severe cases radiotherapy. 

00:12:27 Dr Jess Gorzelitz 

And I’ve done some. 

00:12:27 Dr Jess Gorzelitz 

Focus group work some qualitative interviews. 

00:12:29 Dr Jess Gorzelitz 

With these patients. 

00:12:31 Dr Jess Gorzelitz 

And we recently completed a study where we spoke to some women who are currently on treatment, whether that’s either right or on that surgery period. They’re in the chemo suite or they’re scheduling their radiotherapy appointments. 

00:12:44 Dr Jess Gorzelitz 

And in these themes, so with qualitative interviews, we’re speaking with them. We’re using their words as the unit of analysis. And in every patient we talked to, there was some degree of expressing like I know my body has changed or I know I have lost strength. I just don’t know how. 

00:12:58 Dr Jess Gorzelitz 

To get it back. 

00:12:59 Dr Jess Gorzelitz 

Or it’s not a priority for me right now or it’s. 

00:13:03 Dr Jess Gorzelitz 

Frustrations by the complication of aging, plus their treatment. 

00:13:08 Dr Jess Gorzelitz 

So I think it really depends. I like working with. 

00:13:10 Dr Jess Gorzelitz 

This patient population. 

00:13:11 Dr Jess Gorzelitz 

Because they’re they’re motivated and they’re engaged and and some. 

00:13:14 Dr Jess Gorzelitz 

People will be. 

00:13:15 Dr Jess Gorzelitz 

But it’s it’s really hard to categorize a group and say Yep, they’re ready for training versus now. Leave them alone. So that’s part of the difficulty with applying these, these interventions and implementing it because everybody is different. 

00:13:30 Will Mountford 

Have to look forward to that when it comes out. If we could look at some of your past publications, then the lifespan paper looking at well span of life and quality to go over some of the scope and methodology and the findings from that paper. 

00:13:45 Dr Jess Gorzelitz 

Yeah. So I did my PhD doctoral work at the University of Wisconsin, Madison. My accents in there, the the good old Wisconsin accent. And when I started my training there, I was really interested in. 

00:14:00 Dr Jess Gorzelitz 

Overlooked cancers so endometrial cancer is actually the second most prevalent disease in women. Breast cancer is number one. We have pink ribbons everywhere. We have marches we have. 

00:14:11 Dr Jess Gorzelitz 

Susan G Komen, but then endometrial cancer is, you know, the overlooked second place person. So when I started learning about it in Graduate School, I was fasting. 

00:14:20 Dr Jess Gorzelitz 

And and to complete. 

00:14:21 Dr Jess Gorzelitz 

Your PhD you have. 

00:14:22 Dr Jess Gorzelitz 

To do a dissertation, I followed the three paper model, so we had to do 3 separate analysis, three separate manuscripts, to basically prove competency. 

00:14:30 Dr Jess Gorzelitz 

And two of my papers were focused on a behavioral intervention that. 

00:14:33 Dr Jess Gorzelitz 

We’ll talk about. 

00:14:34 Dr Jess Gorzelitz 

About basically strengthening survivors in an experimental context, but this paper was an epidemiologic investigation. 

00:14:42 Dr Jess Gorzelitz 

And we were able to use previously collected data of 745 women from the cancer registry. 

00:14:50 Dr Jess Gorzelitz 

So in the United States, typically every state has a mandate where cancer cases are enrolled in something called the registry. Now this keeps track of Histology, number of cases. 

00:15:02 Dr Jess Gorzelitz 

It registers how many people there are, which is a great infrastructure for monitoring public health, but then furthermore, it was really helpful for this analysis. 

00:15:11 Dr Jess Gorzelitz 

So we had 745 women who were diagnosed from the registry, so we indeed know their outcome. And then in this analysis, what the original investigators had done, they asked these women to self report their activity levels from age 12. I think it’s age 20. 

00:15:32 Dr Jess Gorzelitz 

And then five years before their diagnosis. 

00:15:35 Dr Jess Gorzelitz 

And this is something as simple as. 

00:15:37 Dr Jess Gorzelitz 

We’ll think back to when you were 12. 

00:15:39 Dr Jess Gorzelitz 

Years old, if you had. 

00:15:40 Dr Jess Gorzelitz 

To guess, or if you had to estimate how many hours per week were you spending in moderate intensity aerobic activity? 

00:15:47 Will Mountford 

Ohh I don’t want to. 

00:15:48 Will Mountford 

Answer that. 

00:15:48 Dr Jess Gorzelitz 

Question. I mean, and you regardless of what the answer is, you won’t be precise because memory is. 

00:15:55 Dr Jess Gorzelitz 

An imperfect tool. 

00:15:57 Dr Jess Gorzelitz 

They had them repeat that procedure for age 20 and then five years prior to their diagnosis. So for some people they were aged 60, some people they were age 40. It depends on when they were diagnosed. 

00:16:08 Dr Jess Gorzelitz 

And then analytically, we were able to look. 

00:16:09 Dr Jess Gorzelitz 

At those associations, OK, so. 

00:16:11 Dr Jess Gorzelitz 

It’s based on the amount. 

00:16:12 Dr Jess Gorzelitz 

Of activity, they said at age 12 versus this. 

00:16:15 Dr Jess Gorzelitz 

Age and and and those outcomes there. So it’s not surprising to know that those were null null findings in that paper and it’s mostly attributable to I’m attributed to measurement error. 

00:16:27 Dr Jess Gorzelitz 

Because first of all, we don’t have good device based measurements like this is 5 decades of data that would be so inefficient in such a waste of resources. But it was one of the first. 

00:16:37 Dr Jess Gorzelitz 

Papers for me. 

00:16:38 Dr Jess Gorzelitz 

To sort of like light, my investigation to see like what’s going on in this population is there potentially a signal. 

00:16:45 Dr Jess Gorzelitz 

And keep in mind this is all aerobic intensity physical activity, so they’re potentially. 

00:16:52 Dr Jess Gorzelitz 

Pre diagnosis activity is maybe not as important, but also most people don’t recall what happened at age 12 without any good reliability. 

00:17:02 Will Mountford 

A more recent investigation looking at telehealth, which I mentioned has gained tremendous popularity in the last, let’s say, 3 calendar years or so. Could you go over some of the scope and assessments from that publication? I think there were 7 assessments, 7 measures. 

00:17:19 Dr Jess Gorzelitz 

Yeah, this makes me feel like a hipster when I talk about it, because this was back in 2018, we were doing telehealth before. It was cool, like pre pandemic before it was required, but this was worked on at at Wisconsin that. 

00:17:32 Dr Jess Gorzelitz 

I talked about. 

00:17:32 Dr Jess Gorzelitz 

University of Wisconsin with my mentor, Doctor Lisa Kevin Bertram, who was incredibly helpful and supportive in this endeavor. 

00:17:40 Dr Jess Gorzelitz 

And she was an expert in behavior change and had done a lot of work in breast cancer and other cancer survivorship populations. 

00:17:49 Dr Jess Gorzelitz 

She didn’t have any strength interventions in her portfolio and was willing to take a chance on a on a blonde graduate student who was like. 

00:17:58 Dr Jess Gorzelitz 

Really, when I do drink training with them, I’m really proud of this investigation. That was a team. 

00:18:04 Dr Jess Gorzelitz 

So Wisconsin has has similar to Iowa, the state of Wisconsin only has one Cancer Center, 1 comprehensive one in Madison to serve. 

00:18:13 Dr Jess Gorzelitz 

The whole state. 

00:18:15 Dr Jess Gorzelitz 

Now, Wisconsin is bigger than Iowa geographically, but. 

00:18:18 Dr Jess Gorzelitz 

The same type of. 

00:18:20 Dr Jess Gorzelitz 

Heterogeneity exists in terms of urban rural dispersal, some. 

00:18:24 Dr Jess Gorzelitz 

You could drive for six hours and you’re still not out of Wisconsin. If you’re driving from Madison, so it is a big state. So when we were designing or thinking about a design. 

00:18:35 Dr Jess Gorzelitz 

It was really. 

00:18:35 Dr Jess Gorzelitz 

Focused on the reach, how can we get more patients into our trials that they don’t have to drive back, patients will drive or the hypothesis is that patients will drive for chemo or radiation. 

00:18:46 Dr Jess Gorzelitz 

Which you could argue is life saving treatment. Exercise is good for you, but it’s not chemotherapy. It’s not radiotherapy. We classify it as supportive care. We know it’s important, but prices of gas is real. Childcare is real. 

00:19:00 Dr Jess Gorzelitz 

So we thought a home based approach. 

00:19:01 Dr Jess Gorzelitz 

Would help with. 

00:19:02 Dr Jess Gorzelitz 

That reach so that these individuals could exercise in the comfort and safety. 

00:19:05 Dr Jess Gorzelitz 

Of their own home. 

00:19:07 Dr Jess Gorzelitz 

Without having to come back to us. 

00:19:09 Dr Jess Gorzelitz 

Furthermore, when thinking about endometrial cancer. 

00:19:12 Dr Jess Gorzelitz 

That disease is associated. 

00:19:14 Dr Jess Gorzelitz 

With obesity, excess adiposity, and physical inactivity, the typical person with endometrial cancer has a pretty high BMI, and they’re carrying. 

00:19:23 Dr Jess Gorzelitz 

Excess body fat. 

00:19:25 Dr Jess Gorzelitz 

That body living in that experience is not the same. The sort of weight stigma that these people experience. The shaming the idea of going into the gym may not be the same as it is for you or me. So it is really important to consider the context we thought, and that’s a true barrier. If a person doesn’t feel comfortable in the space and they think they’re going to. 

00:19:45 Dr Jess Gorzelitz 

Be judged. They’re not going to do the behavior. 

00:19:46 Dr Jess Gorzelitz 

Like it’s pretty obvious. 

00:19:49 Dr Jess Gorzelitz 

But the behavior is extremely important. 

00:19:51 Dr Jess Gorzelitz 

So we thought, well, let’s set up. 

00:19:53 Dr Jess Gorzelitz 

  1. A paradigm where individuals can do it in their pajamas regardless of judgment, you know, hang out with their dog.

00:20:00 Dr Jess Gorzelitz 

So we devised a home based strength training program. 

00:20:04 Dr Jess Gorzelitz 

And this was a 10 week long training program. We chose 10 weeks because it’s the midpoint of 8 to 12 weeks, which exercise Physiology will show you. That’s how long it takes to improve strength. It was a randomized design, so individuals either got the exercise right away or they got the exercise later. We call that a. 

00:20:22 Dr Jess Gorzelitz 

Wait list control. 

00:20:23 Dr Jess Gorzelitz 

Because we want to see like a comparison group and it’s, I would argue. 

00:20:26 Dr Jess Gorzelitz 

Unethical to withhold? 

00:20:27 Dr Jess Gorzelitz 

Exercise from patients. So instead of getting it immediately, we just give it to them later. 

00:20:33 Dr Jess Gorzelitz 

And again, we designed this program for strength now. 

00:20:37 Dr Jess Gorzelitz 

We adopted a. 

00:20:38 Dr Jess Gorzelitz 

Full body strength training program to be consistent with guidelines and we had them importantly training our strength hypertrophic range. So it’s two to three sets of eight to. 

00:20:47 Dr Jess Gorzelitz 

12 repetitions. 

00:20:49 Dr Jess Gorzelitz 

Now, a lot of these patients or these individuals had very limited experience. 

00:20:53 Dr Jess Gorzelitz 

With muscle strength activity, some of them didn’t have it in gym class. They didn’t play sports. They’ve heard about strength and toning, and at the time I had a lot of patients endorsing Michelle Obama arms as a motivator to, like, get their arms lean and tone. 

00:21:08 Dr Jess Gorzelitz 

And which is interesting because past experiences are a huge predictor of self efficacy and self efficacy moderates the relationship based on the social cognitive theory for an. 

00:21:18 Dr Jess Gorzelitz 

Individual to do. 

00:21:19 Dr Jess Gorzelitz 

This behavior so we know these individuals don’t have past experience. Hopefully teaching them this behavior in a context, in an environment that. 

00:21:26 Dr Jess Gorzelitz 

Works well for them. 

00:21:27 Dr Jess Gorzelitz 

Will lead to higher fidelity overtime. 

00:21:30 Dr Jess Gorzelitz 

So again, we designed this ten week long program twice a week, strength training, we had really good adherence. I think overall people adhere to 75% on average, but we had women in the trial who were above and beyond. They loved it. They were lifting every other day a week and we did an assessment battery, it’s called the functional. 

00:21:51 Dr Jess Gorzelitz 

Fitness test by Jones and Rickley. You know, if you’re trained for strength, a lot of people and as a powerlifter people will think. Let’s test their one Rep Max with their what is the maximum amount of weight that they can lift in one Rep. 

00:22:04 Dr Jess Gorzelitz 

That is wildly inappropriate for this sample of people who are completely naive to the lifting lack the neuromuscular coordination, and you’re not going to get a reliable. 

00:22:13 Dr Jess Gorzelitz 

Estimate. So we use a. 

00:22:15 Dr Jess Gorzelitz 

Battery that is geared towards older. 

00:22:18 Dr Jess Gorzelitz 

Adults who are inactive. 

00:22:20 Dr Jess Gorzelitz 

So we tested upper and lower body strength, upper and lower body. 

00:22:24 Dr Jess Gorzelitz 

Flexibility. We did an assessment of agility and aerobic fitness. 

00:22:29 Dr Jess Gorzelitz 

And of those seven and well, there’s a hand grip strength. I guess that’s your additional upper body strength. But interestingly, you trained for strength. We saw improvements in strength, which is very consistent in kinesiology. That’s the specificity paradigm. You train for what you train for. 

00:22:49 Dr Jess Gorzelitz 

But interestingly, so in addition to seeing improvements in upper and lower body strength. 

00:22:54 Dr Jess Gorzelitz 

We also saw. 

00:22:54 Dr Jess Gorzelitz 

Changes in that time 8 foot up and go. 

00:22:58 Dr Jess Gorzelitz 

Which is a yield measure of agility. An individual starts in a seated position, stands up, walks around a barrier 8 foot in front of them as quickly as they can, and returns to a seated position. 

00:23:10 Dr Jess Gorzelitz 

So we saw clinically meaningful improvements in that agility measure. 

00:23:14 Dr Jess Gorzelitz 

Which is surprising. Good, surprising, and it’s not easily explained for sure. But I do think there is something to be said about the neuromuscular coordination that when learning a new movement pattern, it’s not just your muscles that are doing this. Your brain has to. 

00:23:29 Dr Jess Gorzelitz 

Tell you what to do. 

00:23:30 Dr Jess Gorzelitz 

So I think that there is a signal for future investigations that we’re building on because improvements in agility and coordination like that have huge implications for fall risk for aging in place. 

00:23:42 Dr Jess Gorzelitz 

You name it. 

00:23:43 Will Mountford 

If we were to try and put a money value to that in terms of savings in healthcare, you mentioned the reduced fall risk, the less severe injuries, that lack of frailty associated with sedentary. 

00:23:55 Will Mountford 

If the overall cost burden that’s reduced, do you see? 

00:23:58 Will Mountford 

This being a. 

00:23:59 Will Mountford 

Worthwhile intervention not just for health reasons, but also for healthcare budget balancing. 

00:24:05 Dr Jess Gorzelitz 

I mean, I think so. Unfortunately, I’m not a health economist to quantify that. But I will tell you with every oncologist I’ve ever worked with, they know that their patients need this. They see the degradations and strength. 

00:24:19 Dr Jess Gorzelitz 

But just in the same way that you don’t want me giving a chemo regimen, those individuals aren’t suited for. They’re not reimbursed for. They don’t really have the. 

00:24:27 Dr Jess Gorzelitz 

Time to give this type. 

00:24:29 Dr Jess Gorzelitz 

Of supportive care. And yet they know their patients need it. 

00:24:32 Dr Jess Gorzelitz 

Whether it’s in a clinicians care about their patients living their best life or healthcare organizations could be saving a ton of moolah if you connected patients with the correct resources that. 

00:24:43 Dr Jess Gorzelitz 

We need. 

00:24:44 Will Mountford 

We are leading directly now to the strength specific study connecting muscle and mortality in a much more kind of 1 to one fashion than the past papers we’ve discussed so far. And there was a figure that had picked out from this as reading through that the value of improvement on mortality rates were some in the region of up to 22%. 

00:25:03 Will Mountford 

Could you tell me? 

00:25:04 Will Mountford 

How that it’s hugely significant number comes to be. 

00:25:09 Dr Jess Gorzelitz 

So we kind of talked about the highlights of Wisconsin before. 

00:25:12 Dr Jess Gorzelitz 

You know this? 

00:25:12 Dr Jess Gorzelitz 

Was the highlight of my post doctoral training period at the NCI. Again, I keep banging my drum of like I want to study what I want to study and we need to focus on. 

00:25:20 Dr Jess Gorzelitz 

This you know before I talked. 

00:25:22 Dr Jess Gorzelitz 

About these big epidemiologic data sets, one type is called a cohort or prospective cohort. 

00:25:29 Dr Jess Gorzelitz 

You take X number of patients enrolled in a baseline and follow them up over time. And that’s great because you have temporality. What did you do today? 

00:25:38 Dr Jess Gorzelitz 

In 10 years, do you get heart disease? So these studies are really great. 

00:25:43 Dr Jess Gorzelitz 

This investigation that we have actually started out as a randomized control trial that got converted. 

00:25:50 Dr Jess Gorzelitz 

Into a prospective cohort. 

00:25:52 Dr Jess Gorzelitz 

So investigators at the National Cancer Institute wanted to examine different cancer screening strategies for four major cancer types. They were looking at prostate screening. 

00:26:02 Dr Jess Gorzelitz 

Which I believe was the prostate. 

00:26:03 Dr Jess Gorzelitz 

Specific antigen tests at the time they were looking at lung cancer screening in the form of CT spiral thoracic image. 

00:26:10 Dr Jess Gorzelitz 

They were looking at colorectal cancer screening. I think in the terms of colonoscopy and then ovarian cancer screening with the CA-124 biomarker C one 25125 for ovarian cancer. So I just listed off prostate, lung, colorectal, ovarian, they called it the plco cohort. 

00:26:28 Dr Jess Gorzelitz 

Which is just those are the. 

00:26:30 Dr Jess Gorzelitz 

Letters of the first organ sites. So again they were doing randomized controlled trial to look at cancer screening practices, but the investigators had the foresight to be like let’s continue to follow these people up for, for decades and that sort of cohort data from that original trial is what informed my investigation. 

00:26:49 Dr Jess Gorzelitz 

It’s important to bring this up because we probably have healthier, more liberal, more educated individuals in our study than the average population. That’s typically what you get when you do research. You get people who trust the system generally better well off, generally better, well educated, which is a limitation, and it’s a call for more equitable and diverse. 

00:27:11 Dr Jess Gorzelitz 

Studies, but nevertheless we use that data to look at an individual’s self reportable weight lifting and then we followed them up over time to look at death death rates. So it was great. We were using national data sets from like the national death. 

00:27:27 Dr Jess Gorzelitz 

Index and social. 

00:27:28 Dr Jess Gorzelitz 

Security index we know pretty reliably who’s dead and who’s not. 

00:27:31 Dr Jess Gorzelitz 

Which is our outcome. We’re able to look at death from any cause, death attributable to cardiovascular disease or deaths attributable to cancer. So death for many reason is called all cause mortality. 

00:27:43 Dr Jess Gorzelitz 

And these individuals, they self reported their health behaviors in this study and they were asked. 

00:27:52 Dr Jess Gorzelitz 

Do you weight? 

00:27:52 Dr Jess Gorzelitz 

Lift and it would be yes now and. 

00:27:54 Dr Jess Gorzelitz 

Then if yes, you would. 

00:27:56 Dr Jess Gorzelitz 

Report the frequency. So do you weight lift? 

00:28:00 Dr Jess Gorzelitz 

Once a month, 3 * a month, once a week, once to twice a week, three to six times. 

00:28:06 Dr Jess Gorzelitz 

A week or 6 plus. 

00:28:09 Dr Jess Gorzelitz 

Which and then that’s the end of the story. Period. OK, analyze it. So that was the measure of weight lifting, which is truly a very crude assessment, you know, for someone like me, I will. I’m going to. 

00:28:22 Dr Jess Gorzelitz 

Flag the power lifter card again, but sets routes relative intensity, percent effort. What is your rest ratio? How long have you been training like strength performance measures? There’s so many things that you would want to know to parameterize the strength training components. However, going back to my very first comment. 

00:28:42 Dr Jess Gorzelitz 

That this is a very rare exposure. Most studies don’t actually ask about lots. 

00:28:47 Dr Jess Gorzelitz 

Of strengthening activity. 

00:28:48 Dr Jess Gorzelitz 

And at minimum here we have frequency per week that we could aggregate out. 


So that is. 

00:28:53 Dr Jess Gorzelitz 

What we investigated. 

00:28:55 Dr Jess Gorzelitz 

In our analysis, we wanted to look at what is the effect of weightlifting alone. 

00:28:59 Dr Jess Gorzelitz 

Which is we call that independent, so regardless. 

00:29:02 Dr Jess Gorzelitz 

Of how much cardio you do. 

00:29:03 Dr Jess Gorzelitz 

Or aerobic activity, what is the? 

00:29:05 Dr Jess Gorzelitz 

Influence of weight lifting and then analytically, we also wanted to look well, what’s the marginal benefit for you aerobic people plus the weight. 

00:29:12 Dr Jess Gorzelitz 

Lifting so the. 

00:29:13 Dr Jess Gorzelitz 

Largest point estimates in that study were actually for the people who did both who were meeting the aerobic activity. 

00:29:20 Dr Jess Gorzelitz 

Guidelines and who are strength training at least? 

00:29:22 Dr Jess Gorzelitz 

Twice a week I should back up this. 

00:29:25 Dr Jess Gorzelitz 

Was explicitly weightlifting, so I should be very careful with my language. It’s not even strength. 

00:29:29 Dr Jess Gorzelitz 

Training it was specifically weightlifting. 

00:29:32 Dr Jess Gorzelitz 

So again, individuals who are meeting the physical activity guidelines plus weight lifting one to two times a week had the lowest mortality risk. I think it was up to 49. 

00:29:41 Dr Jess Gorzelitz 

Percent, which is huge. 

00:29:43 Dr Jess Gorzelitz 

Lower your risk of death and keep in mind on average individuals are 71 years old in this study. 

00:29:48 Dr Jess Gorzelitz 

So we’re talking about older. 

00:29:49 Dr Jess Gorzelitz 

Adults who you could argue, have the highest risk of death. 

00:29:53 Dr Jess Gorzelitz 

But the independent point estimates are weightlifting. We’re indeed 22% alone. So regardless of how much you’re. 

00:30:00 Dr Jess Gorzelitz 

Doing for aerobic activity. 

00:30:01 Dr Jess Gorzelitz 

There is a signal for weightlifting. Now. Again, this type of study needs to be replicated and then followed up. But I’m very proud of this investigation, especially being one of the unique. 

00:30:13 Dr Jess Gorzelitz 

Female first led author publications in this space. I look forward to continuing this line of work. 

00:30:23 Will Mountford 

We don’t have a for sure answer here, but if you were to be pressed on any candidate reasons for what is the mechanistic cause here? If you to spitball some ideas, is there any reason why? Any rationale, any thing that you could put together to suggest how this functions on the kind of? 

00:30:41 Will Mountford 

Either the cellular. 

00:30:42 Will Mountford 

Or tissue lead level. 

00:30:44 Dr Jess Gorzelitz 

Yeah. So we have, there’s a couple of hypotheses and like we can speculate on, this obviously can’t be tested, the first of which is improved Physiology because again. 

00:30:54 Dr Jess Gorzelitz 

The weightlifting taxing behavior that requires both cardiovascular and lung benefit, so again, the indication of weight lifting here could be of an indicator that this person is aerobically fit. This person is exercise, you know it’s it’s kind of like we call it. 

00:31:12 Dr Jess Gorzelitz 

The healthy adherer effect. 

00:31:13 Dr Jess Gorzelitz 

So weightlifting could be. 

00:31:15 Dr Jess Gorzelitz 

Standing in for a myriad of other. 

00:31:18 Dr Jess Gorzelitz 

Behaviors that are linked to improve Physiology and then lower your risk of plenty of disease, the second of which is the strength. You know, weight lifting typically yields improvements in strength and that is associated with body composition differences and lean tissue specifically. So there has been evidence of the role of lean tissue, so muscles. 

00:31:38 Dr Jess Gorzelitz 

In the body. 

00:31:39 Dr Jess Gorzelitz 

Also being associated with lower mortality risk, so the more muscle that a person has. 

00:31:45 Dr Jess Gorzelitz 

Lower the risk of. 

00:31:45 Dr Jess Gorzelitz 

Death. And this isn’t like bodybuilder muscle. This is like lean tissue. In the absence of. 

00:31:51 Dr Jess Gorzelitz 

Yeah. So it could be that weight lifting is an indicator for strength that the person has and lean tissue. And the third of which, which I think is really interesting to consider is the sort of mechanism by which this could be acting and weight lifting could be an indicator for social support and social networks. So I have a lifting crew. 

00:32:11 Dr Jess Gorzelitz 

People that I like to hang out with. 

00:32:12 Dr Jess Gorzelitz 

At the gym. 

00:32:13 Dr Jess Gorzelitz 

It’s germs, you know, I’m building my. 

00:32:15 Dr Jess Gorzelitz 

Immunity. But I have this social. 

00:32:17 Dr Jess Gorzelitz 

Contract with these individuals. I could see them people care about me. They wanna see if I’m coming to the. 

00:32:22 Dr Jess Gorzelitz 

Gym and I care. 

00:32:23 Dr Jess Gorzelitz 

About them. So for these older adults, this could be, if they’re weightlifting, they’re. 

00:32:28 Dr Jess Gorzelitz 

They’re not alone. They’re not isolated. They have a community in the form of weight lifting, assuming that they’re not weight lifting alone, which is an assumption that we have to have. But given that the fact that most adults don’t have. 

00:32:41 Dr Jess Gorzelitz 

Elaborate home gyms. I think that’s a fair assumption. 

00:32:44 Will Mountford 

Do you see this being indicative of weightlifting for umbrella health? 

00:32:49 Dr Jess Gorzelitz 

Yeah, so it’s interesting. 

00:32:51 Dr Jess Gorzelitz 

Because this was so, this pleco data set. Again, they’re probably healthier, patient or healthier individuals than you’re average American, but these were just regular older adults. You know, they didn’t have to have any formal diagnosis. 

00:33:04 Dr Jess Gorzelitz 

So I think it speaks to the applicability of. 

00:33:08 Dr Jess Gorzelitz 

Getting older adults to do this or consider like adding it into their routine, and it’s a consideration, right? This isn’t a demand. 

00:33:15 Dr Jess Gorzelitz 

But it is important to consider because the dose or the frequency of activity that individuals were doing in this study was no more than what’s in the physical activity guidelines or in The Who guidelines. This isn’t some super herculean. 

00:33:30 Dr Jess Gorzelitz 

Effort it’s twice a week. 

00:33:31 Dr Jess Gorzelitz 

Just training those muscles, making sure you don’t lose it. 

00:33:35 Dr Jess Gorzelitz 

So we have to. 

00:33:36 Dr Jess Gorzelitz 

Use it. I will say that I in future directions maybe I’m getting ahead of myself, but we’re replicating this methodology, this and analytic process to look at cancer survivors. So in these cohorts we can identify individuals who have had an incident cancer crop up while they were being followed and then compared their rates. 

00:33:56 Dr Jess Gorzelitz 

Of post diagnosis, weightlifting on mortality risk so that analysis is currently underway, but to my knowledge that will be the first post diagnosis, weight lifting, epidemiologic investigation, and cancer survivors. 

00:34:10 Will Mountford 

Do you find that there might be and this could be something mediated through the telehealth investigation, the value of having a guided physical intervention rather than someone who might go off the deep end and end up, I don’t know, trapping their foot under a Bowflex bar that falls out of things and having some negative health effects associated with doing either too much or the wrong thing. 

00:34:31 Will Mountford 

Or not quite in the right form? Are there any tempering of expectations we should have against possibly too much exercise or the wrong exercise for the wrong people? 

00:34:39 Dr Jess Gorzelitz 

Yeah, it’s a good question. Important to consider that exercise is inherently dangerous. All the adaptations that we get from exercise are from. 

00:34:48 Dr Jess Gorzelitz 

For us, so the easiest thing to do is sit on your couch and do nothing. That is your zero risk situation. 

00:34:56 Dr Jess Gorzelitz 

The difficulty is that exercise has to be applied very specifically and safely to benefit from these adaptations and for cardiovascular exercises like aerobic activity. It may it’s intuitive for people they walk as quickly as they want to. They run as long as they you know as they can or or whatever their metric is. Muscle strength and activities like weightlifting are so much more. 

00:35:17 Dr Jess Gorzelitz 

Challenging because if an individual is inexperienced. 

00:35:20 Dr Jess Gorzelitz 

With this it. 

00:35:20 Dr Jess Gorzelitz 

Takes so much more support in the beginning period. 

00:35:25 Dr Jess Gorzelitz 

Now our lab tries we always say like we’re teaching people to fish because we don’t think that people need trainers forever. There are certainly going to be people who need personal. 

00:35:34 Dr Jess Gorzelitz 

Trainers, but there are also people who you give them ten weeks of training and they’re ready to to join their local gym. There are some people that they start this program and they love working out at home. 

00:35:45 Dr Jess Gorzelitz 

They love being with their dog or what have. 

00:35:48 Dr Jess Gorzelitz 

You there are people who? 

00:35:49 Dr Jess Gorzelitz 

Spend 10 weeks in the training program and identify that they want to support. 

00:35:54 Dr Jess Gorzelitz 

Buddy or peers? 


So it’s really. 

00:35:56 Dr Jess Gorzelitz 

Important about this initiation of the behavior and then the handoff. Our paradigm is that if we sort of heavily support this beginning period teaching about the bio mechanics, where are the muscles working? How do you breathe? What is the progression schema? Once you get stronger that an individual build that mastery? 

00:36:15 Dr Jess Gorzelitz 

And that self efficacy, so that they’re ready to go. And when I say go, that’s different for every person. So then going back to my former comment about connecting. 

00:36:23 Dr Jess Gorzelitz 

Patients to resource. 

00:36:25 Dr Jess Gorzelitz 

There are community based programs. There are individual gyms. You could hire a personal trainer or you’re perfectly fine to stay at home. It’s really important that the behavior continues, but there’s not one answer. It’s sort of like figuring out what works best for that person, and I will say just getting back to your former. 

00:36:42 Dr Jess Gorzelitz 

Comment that is probably. 

00:36:43 Dr Jess Gorzelitz 

The most when we were talking about like older adults, these are. 

00:36:46 Dr Jess Gorzelitz 

You know, women endometrial cancer survivors who are getting strong. 

00:36:50 Dr Jess Gorzelitz 

It speaks like this sort of research paradigm speaks larger to the role of in a way, women in society. You know, these women are post menopausal. Typically they’re older, they’re not really as valuable to society as they once were. Especially nowadays when when women are valued for their youth and for their beauty. 

00:37:09 Dr Jess Gorzelitz 

And they may or may not have grown up in an area where they were encouraged to do sports or exercise. And yet this population has an interest and they want to learn, and they want to grow. 

00:37:20 Dr Jess Gorzelitz 

And it is so empowering to see these people reclaim their health and reclaim their bodies. Cancer can be such a terrifying experience. Your outcomes are in the fate of your team. You know you’re trusting your oncologist. You’re hoping that the surgery goes well. You do whatever Kevo they tell you to you. 

00:37:39 Dr Jess Gorzelitz 

Trust these people and. 

00:37:40 Dr Jess Gorzelitz 

The oncologists and the clinicians, they know what they’re doing, but there is an enormous loss of control when a person goes through that in their life. 

00:37:48 Dr Jess Gorzelitz 

And I can’t guarantee that it’ll never happen again, but I can help these patients reconnect with their body and their strength and reclaim it. Previous investigations and endometrial cancer have focused on weight loss because we do know that adiposity probably is carcinogenic, but there is sort of something very demoralizing about constantly making yourself smaller. 

00:38:08 Dr Jess Gorzelitz 

And lesser and. 

00:38:09 Dr Jess Gorzelitz 

Using and, it’s flipping that and being like. Well, you got these cards that you were adults, but can we empower? Can we strengthen? Can we build? And so far that’s been really successful and I think that that’s something that our lab really wants to focus on. 

00:38:23 Will Mountford 

Any plans for that? Not just weight lifting analysis, but also the well-being analysis of activity of quality of life of. 

00:38:32 Will Mountford 

Occupying space and being back in your body after being kind of medically forced out of it in order to get a. 

00:38:39 Will Mountford 

Cancer out. Yeah, we have a project. 

00:38:41 Dr Jess Gorzelitz 

That we’re working on right now. 

00:38:43 Dr Jess Gorzelitz 

That’s a great question. The great thing about where I am geographically is I have. 

00:38:49 Dr Jess Gorzelitz 

The connections with the gynecologic oncologists at Iowa, they trained at Wisconsin. So I have my colleagues there and then I have some phenomenal team members at the Mayo Clinic. Then we’re working on a large application to sort of pull all this together because there’s all this like patient reported symptom and patient reported symptoms are one and quality of life. 

00:39:08 Dr Jess Gorzelitz 

As a component of that, but then also the sort of psychological well-being and the psychological reclamation that this, that these activities can have, the work that I’ve all done thus far, admittedly is quite small. You know, pilots of like 10/20/40 women. 

00:39:24 Dr Jess Gorzelitz 

So in order to get a large sample size to do these types of investigations, we have to collaborate. And luckily these oncologists are some of the best people you’ll meet and they’re very eager to collaborate. But we need a lot of individuals to be able to glean this level of inference. So to answer your question, yes it is a work in progress and. 

00:39:39 Dr Jess Gorzelitz 

It’s something that I. 

00:39:40 Dr Jess Gorzelitz 

Think is truly unique and I think needs to be talked to it more. 

00:39:44 Will Mountford 

This is a good opportunity to mention some of the other ongoing studies that you’ve got going and upcoming publications. Could you give us a whistle stop tour of some of the? 

00:39:53 Dr Jess Gorzelitz 

Yes. So currently I have a pilot grant from the American Cancer Society and that’s also an endometrial cancer. We have two aims associated with that grant. I kind of talked about the first one, it’s our qualitative interview study and that publication is currently underway. It’s just amazing to look at the themes there of these women who are on treatment. 

00:40:15 Dr Jess Gorzelitz 

And in different stages of their life, but having very similar attitudes and different preferences. And there is a theme of body shaming and body habitus fear and, like, overwhelm, so that is underway. 

00:40:29 Dr Jess Gorzelitz 

We also are currently replicating our Wisconsin trial of that home based exercise program. We’re doing it here in Iowa. So we have recruited 10 patients with endometrial cancer and they’re doing a combined now strength and aerobic program. We’ve given all of our participants Fitbits that we monitor remotely and I have a trainee. 

00:40:49 Dr Jess Gorzelitz 

Fantastic trainee who is monitoring and serving as a study coordinator. 

00:40:54 Dr Jess Gorzelitz 

For that study. 

00:40:55 Dr Jess Gorzelitz 

So we’re using that as a proof of concept sort of clinical indication study to see. 

00:40:59 Dr Jess Gorzelitz 

Combining strength with aerobic in that order purposefully to see if the magnitude of effect is the same for this population. 

00:41:08 Dr Jess Gorzelitz 

Because it could be. 

00:41:08 Dr Jess Gorzelitz 

That when you start to dilute and add multiple behaviors that it could decrease the strength effects. So we’re currently recruiting for that. We have our patients on trial. So stay tuned on that. 

00:41:20 Dr Jess Gorzelitz 

We also have. 

00:41:22 Dr Jess Gorzelitz 

A more epidemiologic investigation going on, which is the Instrument development project, as I’ve kind of alluded to throughout this interview, the way that we our assessment tools are limited in terms of physical activity, epidemiology, and a lot of the surveillance tools that we have or the ways that we monitor behaviors. 

00:41:41 Dr Jess Gorzelitz 

Are crude and they’re crude intentionally because we want the most efficient way to measure behaviors. However, when we’re thinking about access to physical activity and planning future interventions, we’re missing a whole lot by just asking. Well, are you active? Yes or no. So we’re currently working on developing. 

00:41:58 Dr Jess Gorzelitz 

A tool that is specific. 

00:42:00 Dr Jess Gorzelitz 

To cancer survivors in Iowa. 

00:42:02 Dr Jess Gorzelitz 

Which is going to include a heavy rural component, but looking at different factors that influence behavior. So not only asking about behavior. 

00:42:10 Dr Jess Gorzelitz 

Interpersonal relationships. What would you want from your provider? What about reimbursement preferences for community versus partner and to create a brand new instrument is a lot of work. We have to do the appropriate testing. All the psychometrics of the instrument to make sure this test or this assessment is actually. 

00:42:30 Dr Jess Gorzelitz 

Testing what we think it’s testing our participants interpreting the questions, the way in which we intend and is this instrument not only sensitive to change, but then also is it reliable and valid. So it’s very like research method, it’s like F101. 

00:42:46 Dr Jess Gorzelitz 

Type of project. 

00:42:47 Dr Jess Gorzelitz 

But it’s very important for sort of understanding the context of what’s going on in Iowa, because we often make a lot of assumptions and so far, culturally, Wisconsin and Iowa seem very similar, but this investigation is revealing a lot of contextual factors that are indeed quite different. 

00:43:06 Will Mountford 

Well, we are almost leading into the conclusion questions now, but are there any other papers or objects that you want to? 

00:43:12 Will Mountford 

To give a special shout out to you mentioned there was the one that was coming up in publication. Anything else that’s in the works that readers might be heading to soon? 

00:43:22 Dr Jess Gorzelitz 

So there’s two. I just wanna briefly highlight. I’ve already talked about one the sort of weightlifting, the epidemiologic of the epidemiologic investigation of post diagnosis, weight lifting and cancer survivors based on our analytic data thus far we should be able to look beyond just breast and prostate, which unfortunately is a lot where the evidence is an exercise oncology and it doesn’t capture the whole landscape. 

00:43:45 Dr Jess Gorzelitz 

Of cancer survivors. So that is several months out, but that will be coming. 

00:43:51 Dr Jess Gorzelitz 

And then one of my colleagues from my postdoc, Dr. Courtney and Williams and I are Co leading an investigation using SEER Medicare data, which is a linkage of cancer registry data and health insurance claims based data. And we’re looking at cancer rehabilitation patterns in breast cancer. Again, breast Cancer Research is very represented. 

00:44:11 Dr Jess Gorzelitz 

It’s typically because we have. 

00:44:13 Dr Jess Gorzelitz 

Large sample sizes with which to draw. 

00:44:16 Dr Jess Gorzelitz 

But we are looking at patterns and demographic factors associated with cancer rehab. One of the reasons why rehabilitation services are really important is because physical activity and exercise exist on a continuum. If you have a bad back, for example, or if you have a frozen shoulder or post diagnosis, that is going to impact your ability to do recreational and leisure time. 

00:44:36 Dr Jess Gorzelitz 

Activity because you have this concern or this functional limitation. So we’re currently finalizing that data. It’s brilliant because it is a national data set and it allows us to draw inferences broadly. 

00:44:47 Dr Jess Gorzelitz 

We have about. 

00:44:47 Dr Jess Gorzelitz 

60,000 breast cancer survivors in that analysis. 

00:44:56 Dr Jess Gorzelitz 

You know, following my line of research and physical activity and cancer survivorship, we have evidence that muscle strengthening activity in the form of strength training program is really beneficial for endometrial cancer survivors. The question remains there as to how to scale this so that more patients have access to this type of strength, strength exercise given that the guidelines. 

00:45:16 Dr Jess Gorzelitz 

So that all cancer survivors do this type of exercise twice a week. 

00:45:20 Dr Jess Gorzelitz 

But then you’re on a population level. We were able to lead an investigation of weightlifting in older adults, which revealed that weight lifting was independently and in conjunction with aerobic. 

00:45:31 Dr Jess Gorzelitz 

Activity. It was both associated with lower. 

00:45:34 Dr Jess Gorzelitz 

Risks of mortality. 

00:45:35 Dr Jess Gorzelitz 

So some evidence that older adults too, should be doing weight lifting exercise. 

00:45:40 Dr Jess Gorzelitz 

But again, these doses aren’t enormous. It’s more important to consider that these are consistent with the physical activity guidelines and that when an individual is thinking about these behaviors and why people don’t do it, it’s quite complicated and the context truly matters. And there are a lot of factors that impact both participation and access. 

00:46:00 Will Mountford 

And if there are any doctors healthcare providers out there listening to this who want to frame to their patient that this is going to be a worthwhile intervention despite the weakness that they might be feeling, how would you encourage them and encourage other patients to take up the weights and start lifting? 

00:46:19 Dr Jess Gorzelitz 

It’s finding the correct support resources that an individual needs. It’s considering that individual context. I will say that everything we recommend is evidence based. It’s not just the results of. 

00:46:29 Dr Jess Gorzelitz 

My few studies this is based on. 

00:46:31 Dr Jess Gorzelitz 

International expert consensus roundtables. You know, the evidence is supporting the frequency of this behavior, but the amount of support and ability of every person will vary. So I know some really good physical therapists who specialize in cancer who help individuals begin activity to begin to address some of those. 

00:46:51 Dr Jess Gorzelitz 

Symptoms and impacts. 

00:46:53 Dr Jess Gorzelitz 

There’s a lot. 

00:46:54 Dr Jess Gorzelitz 

Of community based programming across the United States. It’s not as common as. 

00:46:58 Dr Jess Gorzelitz 

You would think. 

00:46:59 Dr Jess Gorzelitz 

But to find the types of resources that you need, I think the home based approach can be really advantageous for many. 

00:47:06 Dr Jess Gorzelitz 

But there are support groups and community gyms and other things like that. I think it’s important to consider that not one person can be all things to all people and it’s connecting with the support and resources that the person needs because it will vary. 

00:47:19 Will Mountford 

And if anyone listens, this wants to hear more from you specifically or from anyone else at the PAX lab, and your upcoming publications. Where can they go to find? 

00:47:28 Dr Jess Gorzelitz 

I have a lab website. You can Google my last name. It’s Jeff scores. Let’s you, Iowa, and it’ll pull up my faculty profile where my lab website is located. I’m also always open to e-mail questions. It’s my first dash, last name at uiowa.edu. I’ve heard a lot from people when my last publication came out. It was very divisive. 

00:47:49 Dr Jess Gorzelitz 

And I’m always happy to engage on this topic. 

00:47:52 Dr Jess Gorzelitz 

I am currently recruiting for graduate students and postdocs. You know if this type of messaging and this type of work resonates with you, I’m always happy to talk about degree options. Our programs offer funding for two years from master students typically, and then PHD’s are guaranteed for five years. I’m looking to build my lab and and train trainees who are committed to the mission and who are. 

00:48:12 Dr Jess Gorzelitz 

Interested in this type of work? 

00:48:14 Dr Jess Gorzelitz 

So if I can use that as a plug for people to contact me for education and employment opportunities, this is my life mission is to help individuals with cancer to improve their quality and quantity of life. So I’m always happy to engage with whomever. 

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