Movement (Exercise)

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Movement (“Exercise”)

Rocks are composed of a dense, physical body but do not have a metabolism requiring nutrients or gasses, e.g., oxygen or carbon dioxide. Plants are distinguished from stones by the fact that they not only have a dense body but are capable of growing and propagating (breeding), requiring a metabolism to convert raw materials into energy and structure for growing. Finally, animals are endowed with both a dense body and the capability of growing and propagating, but further, they are endowed with the additional ability of locomotion. They are animated. This word is derived from the Latin loco “from a place” + motionem “motion, a moving”. This word entered the English language in 1640, to indicate the “action or power of motion,”, i.e., movement from place to place. This ability increased the functionality of the creatures and required a new type of organ system, muscles. Almost all multicellular (many cells) use muscles to move, which requires some form of contracting fibers in which filaments of the proteins “actin” and “myosin” pull past one another to generate force.

In ancient China, the idea of mind and body exercises developed into specific disciplines, for example, Tai Chi, Qigong, Baduanjin, or Yijinjing more than 4000 years ago. The concept that health required physical movement was reinforced by Confucius around 2500 years ago who taught it was necessary to engage in physical activity to avoid blockages and prevent organ dysfunction. In India, yoga is thought to have had its beginnings at least 5000 years ago. And, the Egyptians, as far back as 2575 BCE independently furthered sports and physical activity for health, and entertainment as well as to prepare young men for the military. Although the ancient Chinese and Egyptians were the first known to engage in sports, e.g., wrestling, long jump, swimming, rowing, fishing as well as athletics, in Greece it was the duty of citizens to perfect their minds and bodies, together. However, in the modern world, the concept of engaging in physical activity for no other reason than fitness or health is thought to have begun in the 19th century in Germany. Father Jahn developed the first modern gymnasium to help his fellow Germans resolve their humiliation and regain their spirits hence he is credited with opening the first Turnplatz, (open-air gymnasium) in 1811, in Berlin. This increased in popularity and spread throughout Germany.

Physical Movement and CFCs

Physical movement is imperative for human health. Humans have been physically highly active throughout their existence and so have all the body systems evolved in that context and therefore are dependent on exercise for optimal functioning. Along with modern lifestyle physical movement has dramatically decreased and the time spent sedentary has started to dominate our lives such that. In addition to numerous other health effects, lack of exercise is considered one of the biggest lifestyle factors that contribute to the development of cancer, or as we call it, chronically fermenting cells (CFCs), because that is what they are. They are not a crustacean or a zodiac sign.

On the other hand, studies show that regular physical activity prevents the formation of CFCs, and in people with active CFCs it enhances the effectiveness of conventional treatments such as chemotherapy and radiation therapy, improves survival, and can bring relief to practically any symptom caused by CFCs or treatments. It improves heart and lung function, and treats pain, lymphedema, anxiety, depression, sleep disturbance, and a sense of fatigue. Recent studies have revealed that many effects of exercise can be used also to directly treat CFCs. Some of the most important aspects regarding CFCs that exercise improves are:

  • Improves body composition with increased muscle mass and strength
  • Lower insulin and blood glucose levels
  • Relieves stress
  • Alters the tumor microenvironment
  • Enhances immune system
  • Reduces oxidative stress and supports detoxification

Improving Body Composition

Exercise helps to increase muscle mass and decrease body fat. This is essential since both fat cells and muscle cells have an impact on CFCs but in opposite ways. While some people with CFCs, especially in advanced state suffer from muscle wasting and weight loss others may experience significant weight gain due to treatments. Both conditions are harmful and put the person at risk of accelerated progression of CFCs and poor survival. Weight loss from muscles (cachexia) and other vital tissues is caused by insulin resistance, high metabolic demand of CFCs, mitochondrial dysfunction, and inflammation. As a result, the energy storages are consumed by CFCs while healthy tissues including muscle struggle to get energy and nutrients due to insulin resistance. Exercise has been found to be the only effective approach to reversing this process because it greatly improves insulin sensitivity, uptake of glucose and amino acids into muscle cells, muscle protein synthesis, mitochondrial function, and inflammation. Also, the fatigue that people with CFCs experience seems to be caused by high levels of inflammatory cytokines and damage to mitochondria. Since mitochondria are responsible for generating energy, their dysfunction limits the energy production in cells and exhausts the whole body. Exercise has so far been found to be the only way to counter fatigue related to CFCs by enhancing the function and number of mitochondria in cells.

Excess body fat promotes CFC development and progression, and obesity is noted to be one of the most prevalent risk factors for developing CFCs and weakening survival. The reason obesity is so harmful is that in addition to serving as an energy storage, fat tissue secretes signaling molecules including hormones and cytokines that interact with all the other tissues and promote inflammation in the body. The main molecules fat cells release are:

Insulin-like growth factors (IGFs): Excess body fat increases IGF levels in blood. IGFs promote cell growth, and growth of new blood vessels and prevent cell death. Physical activity has been shown to lower IGF levels in people, slow the growth of CFCs and improve survival. In fact, CFCs have many more IGF-1 receptors, just as they have many more insulin receptors and insulin can activate an IGF-1 receptor and IGF-1 can activate an insulin receptor. IGF-1 is the acronym for “insulin-like growth factor-1” Receptors for IGF being increased greatly in CFCs are associated with more rapid progression of CFCs.

Furthermore, CFCs can produce their own insulin and IGF-1 when they need more. This is called autocrine when a cell produces a chemical it needs, paracrine when a cell produces chemicals that its neighboring cells need, and endocrine (hormone) when a chemical is released into the blood, where it will have an effect on distant cells. Clearly, both insulin and IGF-1 are critical to CFC survival hence all steps must be taken to prevent either substance from increasing.

Female sex hormones: Fat tissue contains aromatase enzymes which convert hormone precursors into female sex hormones estrogens. Excess body fat is responsible for higher levels of estrogen hormones which is associated with a higher risk of breast CFCs in postmenopausal women. For this reason, it has been found that women have higher estrogen levels in their breasts than in their blood.

Leptin: Leptin is secreted increasingly as the fat mass expands. The main function of leptin is in the nervous system where it suppresses appetite. However, continuously elevated leptin levels may lead to leptin resistance in obese individuals, which weakens the perception of satiety. Additionally, leptin has been shown to stimulate the growth of CFCs in several ways. It increases the production of proinflammatory cytokines including IL-1, IL-6, IL-12, and TNF-α, and activates certain signaling pathways in CFCs which stimulate cell growth and angiogenesis (blood vessel growth) and prevent apoptosis (cell death).

Adiponectin: Adiponectin enhances the uptake and use of glucose for energy in the liver and muscles. It also lowers inflammation, and in experimental and human studies it has been found to resist tumor growth. Many of these effects are brought up through the AMPK (AMP-activated protein kinase) signaling pathway which adiponectin activates. AMPK is a cellular fuel-sensing enzyme, and it gets activated when the energy of a cell is low. However, obesity decreases the production of adiponectin while weight loss increases it. The cause for this is unclear.

In multiple studies, regular exercise has been found to relieve the proinflammatory condition in obesity by decreasing leptin and increasing adiponectin levels. The main reason for this is most likely due to a reduction in body fat, and even a small amount of weight loss will significantly lower leptin levels. Physical activity also has an impact unrelated to weight loss by resulting in the reduction of the proinflammatory cytokine “IL-6,” which is known to increase leptin while decreasing adiponectin levels.

In addition to countering harmful signals of fat cells, contracting muscle cells produce their own signaling molecules called myokines. One of the myokines is called oncostatin M (OSM) which has been proven in animal and human studies to resist growth and to induce cell death of CFCs.

Another myokine is interleukin -6 (IL-6) released from working muscles. Although IL-6 is released from fat cells, the short-term release of IL-6 from muscle cells seems to have opposing effects, as it promotes glucose uptake in muscles and enhances the immune system to attack tumors.

Lowering Insulin and Blood Glucose Levels

Since CFCs need 19 times more glucose than normal cells, they have many more insulin receptors than a normal cell and these insulin receptors have a 70% higher affinity for insulin, meaning that insulin molecules are 70% more like to stick to a CFC insulin receptor than a normal insulin receptor.  So obviously, elevated insulin and blood glucose levels are especially harmful in people with CFCs. The cause is a condition called insulin resistance, where the cells’ ability to take glucose from blood as a response to insulin is weakened because there are many fewer insulin receptors than a cell that is not insulin resistant. High blood glucose levels provide more fuel for CFCs to grow. To correct the elevated glucose levels, the pancreas needs to secrete more insulin than before. High levels of insulin also promote the growth of CFCs. One of the reasons is that CFCs have 6 to 17 times more insulin receptors than normal cells. This is because they need 19 times more “fuel” (glucose) to maintain their energy requirements now that they have shifted their metabolism from the mitochondria (oxidative phosphorylation) to the cytoplasm (the main body of a cell) where they produce energy by way of fermentation (glycolysis). One of the deleterious results of high blood glucose is that it stimulates the pancreas to produce or release increased insulin. Moreover, insulin can bind to an IGF-1 receptor, which in turn causes the cell to start dividing, hence progressing.

In addition to these metabolic concerns, insulin resistance accelerates muscle wasting since insulin is needed for amino acid uptake and muscle protein production (synthesis). Since muscle cells use great amounts of blood glucose, loss of muscle further disturbs glucose and insulin regulation, and insulin resistance is aggravated.

Physical movement acutely raises blood glucose levels when the liver releases its glucose storage as a response to hormones. However, insulin levels are suppressed which reduces glucose uptake of most cells in the body. This does not deprive muscles of glucose since muscle contraction stimulates muscle cells to bring insulin-dependent glucose transporters (GLUT4) onto the cell surface. This way, blood glucose is directed to muscles. Fortunately, just like CFCs have more insulin receptors that allow them to “eat” before the other cells, regular physical movement increases the number of insulin receptors on the muscle cells so that they can extract more insulin and glucose from the blood, leaving less for the CFCs. This markedly improves blood sugar regulation in only a few days after beginning to exercise.

Movement, therefore, lowers blood glucose levels despite insulin resistance. Exercise improves insulin sensitivity; that is it increases the cells’ ability to bind insulin. Thereby less insulin is needed. Regular exercise leads to longer-lasting insulin sensitivity but even one session can improve glucose uptake by cells, which can last up to two days. Trained muscle cells go through several adaptations that lead to these effects. These include enhanced glucose and fat handling capacity, increased mitochondrial mass and function, as well as increased density of blood vessels in muscles. In other words, these changes result in the muscles being able to utilize any excess fuel sources, hence precluding them from being utilized by CFCs or being stored as fat.

Relieving Stress

Learning to manage the psychological stress that comes along with ill health is required to not only restore the quality of life but also to alleviate the physical consequences of distress, which slow down healing and promote CFC progression.

Psychological stress, regardless of the cause, triggers a set of neuronal and hormonal responses to prepare the body for a physical act against an acute threat. The same symptoms, raised heart rate, blood flow to skeletal muscles, and elevated blood glucose occur even with prolonged situations or thoughts that are not resolved by physical activity. Prolonged stress leads to several disturbances in the body. In other words, if one is faced with a real physical threat, such as being confronted by someone with a gun, they will use the increased glucose and blood flow to their muscles to either fight or flee. However, if there is no physical threat and one is experiencing psychological stress, the excess glucose and shunting of the blood away from the internal organs to the muscles prevents healing and causes all of the complications that come from high blood sugar to occur.

Stress hormones such as cortisol, adrenocorticotropic hormone (ACTH), and noradrenaline enhance the production of proinflammatory cytokines such as IL-1 β, TNF-α, IL-6, and COX-2. These cytokines activate transcription factors NF-KB and STAT-3 which in turn activate genes involved in CFC progression, such as inflammation, cell growth, angiogenesis (growth of new blood vessels), prevention of cell death, invasion, and metastasis.

The beneficial effects of physical movement on stress and mental well-being have been suggested to result from increased release of neurotransmitters (signaling molecules of the nervous system) dopamine and beta-endorphins as well as lowered levels of inflammation. In addition to creating sensations of well-being, relaxation, and euphoria, beta-endorphins and dopamine have been found to affect several tissues of the body including tumors.

In addition to the nervous system, receptors for beta-endorphins are found in immune cells including macrophages, natural killer (NK) cells, monocytes, and T and B lymphocytes. Beta-endorphins have been found to enhance the response of immune cells against tumors, reduce proinflammatory cytokines such as TNF-α, IL-1, IL-6, and IL-8, and inhibit a transcription factor NF-κB, which controls key processes of CFCs progression and metastasis. Beta-endorphins also inhibit the release of substance P, a neurotransmitter involved in pain and inflammation.

Beta-endorphins increase the expression of E-cadherin which is a protein responsible for attaching cells and maintaining normal tissue structure. Loss of E-cadherin function is essential in CFC progression as it allows the cells to detach and migrate from their original site. Another protein needed for migration and metastasis by CFCs is a group of proteolytic enzymes called matrix-metalloproteases (MMPs), which are involved in the degradation of structures between cells. Beta-endorphins also reduce the release of MMPs.

Another neurotransmitter dopamine has been suggested to prevent CFCs from metastasizing and forming stem cells. Studies on mice identified raised dopamine levels during exercise to be responsible for preventing epithelial-mesenchymal transition (EMT) in a tumor, a process where CFCs turn into multipotent stem cells capable of becoming mature CFCs, essential since they are responsible for forming metastasis and developing resistance to treatments. Dopamine prevented this process by suppressing a cytokine called transforming growth factor-beta (TGF-β1) that CFCs require for EMT.

Altering The Tumor Microenvironment (TME)

Physical movement increases blood flow throughout the body, including tumors. This can assist therapeutic agents in reaching the tumors, which may be one reason why movement, has been found to make chemotherapy treatments more effective. What is more, is that increased blood flow also helps to reverse the acidic and hypoxic (low oxygen) tumor microenvironment that CFCs create with their metabolism. Due to the high levels of aerobic glycolysis (Warburg Effect), CFCs produce excessive amounts of lactate in their surroundings which inhibits immune cells from functioning and acting against the tumors. During physical movement, there is an increased blood flow into tumors, which washes away accumulated lactic acid, allowing the immune cells in the TME that have been altered (“switched sides”) are then able to go back to using their abilities to eliminate CFCs, instead of protecting and helping the tumors to grow. Furthermore, low oxygen levels (hypoxia) in the TME trigger the expression of several genes that are essential for the cell to adapt to the low oxygen conditions as well as for CFC growth, metastasis, generation of stem cells, and resistance to chemo and radiotherapies. Together these alterations from increased blood flow into the tumors can easily be understood to help reverse the progression of CFCs.

It is hypoxia (low oxygen) levels and acidic (low pH) levels in the TME that are responsible for causing immune cells to stop killing the CFCs and begin helping the tumor grow.

Enhancing The Immune System

Perhaps the main mechanism of exercise to resist tumor growth is its ability to enhance immune function. During exercise, several signaling molecules (such as hormones epinephrine and norepinephrine and myokines) are released which have been shown to direct immune cells towards the tumor and activate them to identify and destroy CFCs. Of all the immune cell types, natural killer (NK) cells are the most responsive to exercise. The activity of NK cells is essential for protection against CFCs since they are responsible for immune surveillance and can efficiently recognize and destroy CFCs without having to rely on other cells to communicate the need. In contrast, other immune cells, such as T lymphocytes require specific molecular elements (antigens) to recognize CFCs, hence they rely on antigen-presenting cells like macrophages and dendritic cells (DC) to inform them of the threat. Most CFCs remove these antigens called major histocompatibility complex 1 (MHC-I) from their cell surface and therefore can disable the immune cells to recognize them. Epinephrine together with myokines released from the working muscles have been shown to cause NK cells to migrate into tumor tissue and resist its growth. NK cells are therefore essential in anti-tumor immunity and low levels of NK cells in people are linked to increased tumor growth and poor survival.

The most beneficial type of physical activity for the immune system seems to be moderate intensity to vigorous intensity of brief duration. Longer lasting exercise (over 1 hour) starts to increase cortisol levels in the blood which lowers the number and activity of NK cells, T, and B cells. Very intensive exercise is followed by a temporal immune suppression which is due to reactive oxygen species and inflammation that occurs in muscles. However regular exercise can increase antioxidant defenses in the body which may counter the temporary immune suppression.

Reducing Oxidative Stress and Supporting Detoxification

Regular physical movement protects the body from oxidative stress and toxic substances by triggering the cells to produce antioxidant and detoxification enzymes, which eliminate cellular waste, speeding up blood and lymph flow and increasing sweating.

Studies suggest that by producing moderate amounts of reactive oxygen species (ROS), also called free radicals, exercise activates a protein called transcription factor Nrf2 (nuclear factor erythroid 2-related factor 2) which causes the cell to produce antioxidant enzymes and phase 2 detoxifying enzymes in the liver. Antioxidant enzymes neutralize free radicals and phase 2 detoxifying enzymes are specialized for eliminating potential carcinogens from the body. Experimental studies on mice have demonstrated the necessity of these enzymes in preventing the formation of CFCs since mice lacking Nfr2 activity are unable to produce these enzymes in response to carcinogens and consequently develop CFCs significantly more often. Similar to exercise, some external sources such as phytochemicals from plants (such as curcumin, quercetin, sulforaphane, etc.) can activate Nrf2.

Physical movement can also support the cells to maintain proper function by balancing the production and recycling of intracellular structures. The switch between building new and degrading old structures in a cell is regulated by the target of rapamycin complex 1 (TORC1). When energy and nutrients are sufficient TORC1 is activated and promotes protein synthesis other cellular structures and cellular growth. This is balanced by a process called autophagy which is responsible for degrading and recycling old proteins and cell organs. Autophagic activity declines during aging. This leads to the accumulation of dysfunctional and damaged cells which results in the degeneration of the whole body. In CFCs, TORC1 is abnormally activated and it signals cells to grow and metastasize. Exercise has been shown to inhibit the activity of TORC1 in healthy cells and CFCs.

Physical activity that is intense enough to raise body temperature and cause sweating helps the body to eliminate toxic compounds. Increased temperature and blood flow to the skin also enhance the antioxidant and detoxifying enzymes of the skin. This promotes the elimination of substances such as metals, drugs, cytokines, and steroids. Many compounds, some of which are toxic, are preferentially excreted in sweat instead of urine.

Although any kind of physical activity is beneficial, some aspects mentioned above are improved more by certain types of exercise. For example, resistance or strength training is most effective in increasing muscle mass and strength, and lower insulin levels. Strength training does not require lifting heavy weights, since most evidence comes from studies that often involve bodyweight training or yoga. On the other hand, moderate-intensity aerobic exercise, such as brisk walking can have impressive effects on immune function and mood.

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