The Crackin' Backs Podcast

Exercise Effects on Cancer? Shocking Revelations! Dr. Riggs Klika

• Dr. Terry Weyman and Dr. Spencer Baron

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Welcome to the latest episode of the Cracking Backs podcast, where we're peeling back the layers of science and diving deep into the world of exercise physiology!  Join us as we sit down with the globally celebrated exercise physiologist, Dr. Riggs Klika.
 
Ever imagined the thrilling world of motorcycle racing having anything to do with cancer rehabilitation? Prepare to have your mind expanded! In this riveting session, Dr. Klika enlightens us on how athletic performance could potentially revolutionize the road to recovery for cancer survivors. Drawing from his extensive background in oncology and exercise physiology, which spans from the romantic landscapes of Italy to the prominent institutions in the US, we delve into the groundbreaking potential of HIIT in cancer rehabilitation and the astonishing overlap between the vigor of athletes and the resilience of cancer survivors.


But that's not all.


 From insights into his 2021 publication in ACSM’s Health and Fitness Journal, to an in-depth discussion on his association with the awe-inspiring Bridging Bionics Foundation, and the future of personalized exercise regimes in cancer treatments—this episode is a treasure trove of knowledge and inspiration.


Plus, we touch upon a hot topic: the motivation of NCAA Division I student-athletes amidst the global pandemic. Whether you're a fitness enthusiast, a medical professional, or simply someone passionate about the power of science to transform lives—this episode is a MUST-LISTEN. 


Settle in, press play, and let's unravel the marvels of the human body with Dr. Riggs Klika.


We are two sports chiropractors, seeking knowledge from some of the best resources in the world of health. From our perspective, health is more than just “Crackin Backs” but a deep dive into physical, mental, and nutritional well-being philosophies.

Join us as we talk to some of the greatest minds and discover some of the most incredible gems you can use to maintain a higher level of health. Crackin Backs Podcast

Dr. Spencer Baron:

Hey crackenback listeners ever wonder if the secret to fighting cancer lies in our workouts? Today we've got world renowned exercise physiologist, Dr. Riggs Kilka. In the studio, this genius bridge building high intensity interval training with wait for it. Cancer Rehabilitation. We have a great discussion when we explore the shocking parallels between the elite athletic performance and Cancer Survivorship. From Italy to the US, Dr. kilka has experiences are reshaping our understanding of exercise oncology, plus, a sneak peek into the groundbreaking future of personalized exercise regimes in cancer treatments. This episode, it's a game changer. If you've ever been touched by cancer, or know someone who has been or just love a mind blowing medical revelation. You can't miss this. Share, Subscribe, and get ready for a knowledge explosion. Let's crack it.

Dr. Terry Weyman:

All right. Hey, Doc is great to see you. And it's been way too long since we've been hanging out in a surfboard in the Pacific, North Pacific, Pacific Northwest, but this Pacific Ocean and so honored to have you I know you're traveling around the world. You just got back from a river trip to Amsterdam. And now you're living back in Aspen, Colorado. So welcome to our show. I appreciate you, man.

Dr. Riggs Klika:

Pleasure to be here. Thanks. Good to see you, Terry. All right,

Dr. Terry Weyman:

with your rich career involving various positions in academia at both the Olympic level and the professional level. You were the team physiologist for the US Ski Team. Among other things, you have a lot of experiences and current positions that lead you to the research in the field of athletic performance and Cancer Survivorship. How did all that? Let's give a little background how this all transpired?

Dr. Riggs Klika:

It's a good question because people asked me quite a bit. It's like, Do you have family members that were affected by cancer and that's the reason you got into this. And I do I lost my father to metastatic colon cancer, my sister do have metastatic breast cancer. But um, you know, and those are horrific. I think everybody gets touched by cancer at some level, whether you have it or you have a relative or friend or something that has it. But that really wasn't how I got into cancer survivorship. I had come off the US Ski Team and moved back to Colorado. And I had done a quite a bit of personal training and I had a young athlete, I was coaching and his mother had breast cancer. And she had called me up and said, hey, they told me I shouldn't be doing anything after my breast cancer, basically treatment plan. They said I shouldn't even lift up anything over three pounds. And I said, Well, Mary, that's not really going to work. I mean, you got to carry your skis. Now we're up in Aspen, Colorado, you get to carry your boots and all that stuff. That's pretty heavy. And I said, it just didn't make a lot of sense. And I thought, you know, let me use a little bit of my brainpower to figure out what are the recommendations being made right now for cancer patients. This is about 2004. And so I started doing my homework on that. And I looked at the rehabilitation standards that were out there, basically, to follow and it was basically coming from a nursing background. Love nurses love what they do bright ladies, but that the recommendations following cancer treatment really didn't have any evidence based medicine behind it at all. It was just suggestions and anecdotal evidence. So I kind of took it upon myself to sort of look at how we treated a Olympic athletes at the time. And can I just apply that but at a different level take you in considerations that I should take into consideration. I mean, the medications that they're on the adjunct therapies that were in monitor this person, so I spent a year doing that. And then all of a sudden, that sort of snowballed. And then I got more and more clients. And they were like, well, what are you doing for Mary? Why is she you know, looking so good, and so fit and so how happy and we just sort of went from there, and it snowballed into starting to work with cancer patients. So that's the long story of how I got into it.

Dr. Spencer Baron:

It's great, you know, I think it's a fascinating combination of things because I've never, I've never heard about having such a making exercise such an integral part of, you know, oncology, you know, rehab after chemo and things like that, because otherwise you don't hear anything about it. You don't know what the parameters are. So how do you see that integration coming? Coming along now is you know, clinical exercise physiology and enhancing the quality of life for cancer survivors.

Dr. Riggs Klika:

I think we've made tremendous strides in 20 years, like I said, I'm talking about about 2004, if you will, with no standards, to where we actually have now a new branch called Exercise oncology. We what can we use is exercise. Lee Jones out of Memorial Sloan Kettering is looking at can we even use exercise as a therapeutic to increase metabolism and clearance rates of all the drugs. And so we're actually researching that, then Katherine Smith out of Penn, Penn State, you know, publishing in JAMA about 10 years ago about the the effects of exercise in reducing lymphedema for breast cancer patients, that got a lot of traction, because it obviously hit the Journal of American Medical Association. So now we've got this small fraternity sorority of cancer researchers, if you will, that are working in exercise. It's pretty small pocket, but really bright people doing really good work. We started at the basic levels of what can we do, what can't we do? What should we do? And now we're advancing that. Should we be what you know, now we've incorporated our plans into rehabilitation. But what about during treatment? And that's, that's a hot topic. I know. Terry, you were interested in sort of hot topics today? And is there something we could be doing during treatment with exercise that might help in the outcome measures that we're looking for survival and decrease in side effects and whatnot. So it's, it's, it's come a long way. And especially let me give you sort of an one more little story on that, you know, I live up in Aspen. And you know, we get a lot of people coming up here and I see a lot of sort of movers and shakers in the world. And I was I was actually writing a ski lift with the director of one of the directors at MD Anderson, in Houston. A lot of the Houston group comes up here. And I just, you know, by the by was just saying, hey, yeah, this is what I do when he goes, Oh, I'd love to see what you do. And he came over, he goes, Yeah, I'm gonna just come over for 20 minutes, he spent about two hours with me. And at the end of the phone call, he called up their Office of Cancer Survivorship and said, Why are we doing a program like this? Wow, this is 20 years ago, right? And even MD Anderson with 1000 oncologist didn't have a cancer survivorship plan. Now they do. Wow. So it was really fun to be on that forefront of writing programming. And my expertise is programming, not necessarily an ecology, per se, or treatment, per se. Yeah. So I've been involved in that level. And like I said, the people that are doing this work are really, really bright people doing good work.

Dr. Spencer Baron:

You published an article in 2021, the American College of Sports Medicine on health and fitness in their journal, on high intensity exercise in cancer. Yeah. God, you gotta elaborate, because like, you would never put the two things together. Right. So,

Dr. Riggs Klika:

you know, let's talk about cancer for survival rates are going up, we're starting to look at it almost as as chronic disease, right? So a lot of our chronic diseases, we're training people, right, we want them to exercise, certainly, we want them to get better weight control, better metabolic control, just the wellbeing you get from exercise, but so we're looking at cancer as a chronic disease now, especially with with the survival rates going up so high. Well, we know the barriers also to exercise, don't have enough time, don't have a facility, I don't I can't drive over there, whatever it is, there's a myriad of variables that go into why we can't exercise. So in that article, the whole journal for that particular volume was devoted to high intensity exercise from number of chronic diseases. So I was tasked to do the, the cancer component of it. And we just wanted to make sure that the efficacy doesn't work first off, and it wasn't safe. And in certain populations, as long as now there, you know, cancer is very complex. And the different levels, the stages, the treatments, the side effects, the type of cancer. But if you're relatively healthy, and that's a really broad stroke there. Can you do high intensity interval training to increase your cardio respiratory fitness, you bet it can it be done? Well, yeah. So what what constitutes high intensity? That was the other thing that we tried to define carefully about how high is high enough to stimulate but not so high that we cause a problem. That's research that we're still trying to figure out. By the way,

Dr. Spencer Baron:

I was actually gonna ask you about how energy demands for someone who is exhausted and depleted and rundown and, you know, I understand that there's research regarding professional motorcycle racing. And if, if you can touch off on, I know, that's like Terry's favorite subject matter right there. But the parallels between the athletic performance in the field and rehab with cancer survivors,

Dr. Riggs Klika:

I took a Spencer, it's kind of come a long way around to answer that just to let me be long winded on that. So I had, one of the things I looked at was cancer related fatigue, when I was actually tearing down at Pepperdine, I was doing a nice project down there on cancer related fatigue and looking at exercise, and whether exercise decreases cancer related fatigue, that sounds like it might not work. But it did. But what we first did and I did it with a graduate student, is we did a very simple leap, our research lit on all the effects of what cancer related fatigue actually is. And then I lined up overtraining of world class athletes, and I put them side by side on a chart, and they were all the same. So you're talking about energy demands. So you're talking, okay, here's a cancer patient under this enormous load of a tumor burden and treatment. What ends up happening to someone like that, okay. We understand they're trying to treat it, it there is really depleting their energy reserves. It's having an incredibly maybe long term effect on their cardio, respiratory fitness and muscle metabolism and bone, mineral density, all those things. That's exactly what happens to an overtrained athlete. And I sort of did an aha moment. And I understand that etiologies are completely different. But I said, You know what, we can manage athletes, I know how to manage athletes. I know what to measure for I know how to put a load on them. I know how to get them out of being stale or overtrained. I know how to work on their nutrition, their mental well being. And I said, Could I apply that to my cancer patients? And that's what we did. Does that. Does that make sense? Yeah. So looking at energy demands are really, really is important. And then okay. What should we do? That always gets down to the questions like, What should I do with the group? And then I didn't have any direction? None. So I thought, okay, let's be careful. Let's do it, right. But let's start working with this group, and monitor them closely. And that's how I actually ended up starting and then, you know, what happened is we started a document very carefully, all the loads that I put on my cancer patients, their blood works, the follow up with the physicians everything very, very closely. And guess what, we weren't hurting anybody. And they were getting fit, not just healthy, but fit. And fair enough. I had a fairly healthy group of cancer patients, if that makes any sense. Yeah. I worked him I pushed him. Yeah. And we weren't hurting him. And that was the AHA, it's like, Okay, let's get this stuff published. And that's how I started down that road. Does that make sense? Yeah.

Dr. Spencer Baron:

To put it in, like, simple terms for some of the audience isn't medically or healthcare oriented, but are highly interested in the perspective of training, you know, what are some of the consequences? Like, you know, we could easily overtrain an athlete that's been trained, you know, overt or that's been training consistently. How do you know if you're overtraining a cancer patient?

Dr. Riggs Klika:

That was a good question to what metric should I be using to say they're overtrained? Because if I just give you chemotherapy and radiation, you're going to be tired one way or the other? There's just no question about it. Yeah. Okay, but we know that exercise will improve the immune system function will metabolize all the drugs a little bit faster. Okay. So what should we be looking at? And that was a good question. Because chemotherapy is always associated with taking blood work, I looked at complete blood counts. So I looked at their blood work. And I watch for their white blood cell and red blood cell counts. And if I saw them tailing in any direction, downward based on basically bloodwork, I know that the load that I was putting them under was too much at that point, and we would back out from the exercise component of it doesn't mean we stop exercise, we would just back off on it. Well, it's kind of what you do with a world class athlete too. Have you monitor their red blood cells? Are they in Mnemic? Are their white blood cells plummeting? Or are they elevated? Because they're sick? So what do we do with a world class athlete? Well, we don't stop him from training, but we certainly pull off the load, and we did the exact same things. So I use bloodwork basically as a monitoring on the metric to see whether I should continue or not continue.

Dr. Spencer Baron:

Super, super cool. So to put it in to, you know, basic training terms, like what do you actually what are you actually doing? What are you actually giving these cancer patients? And is it contingent on what cancer they may have long? You know, kidney, prostate, colon, throat? Is there is your regimen very, does it vary depending on their the foci of the cancer and their, you know, how far they end with treatment or how far they end with what stage they're in?

Dr. Riggs Klika:

Let's let me address the first part. Okay, Spencer, because that's a great question. When I first started in the research started coming out, we were looking at us the good workflow side of the cancer where it's a tumor burden, is it breast cancer? Is it pancreatic cancer, it's a brain tumor? And should we treat those differently? Obviously, each one has a different effect on the body. I took a slightly different approach not to discount the the importance of where the tumor was, but I was looking at the treatment of it. Did they have chemotherapy, radiation, some type of immunotherapy, targeted therapy, adjuvant therapy, because I was interested in the effects on the body of that treatment. Does that make sense? Oh, yeah. And so a simple surgical procedure may be to remove a tumor might be, no matter where it is, might be treated, or we might do rehab differently. But those that had all the therapies in that were stacked on top of each other, I had to put that all together all the variables to basically do the exercise program for him. And here's how I looked at the exercise program. I mean, in its most simplistic form, I thought aerobic base training was the most important part to start with, because I needed cardiovascular and cardio respiratory health. I don't want to discount the other parts there, you got to be strong, you got to have good bones. But that was going to be secondary. So first, let's make sure you can breathe and circulate oxygenated blood, why? That out your stamina, and help you recover and to help clear out the metabolites from the liver, and actually process them out through the system. So we based our training programs that way. But then gay as we got more complex, you're right. See, the women who undergo breast cancer treatment, basically advanced their aging process by 10 years. So they're now if they were pre menopausal, now they're menopausal. So they're going to drop their, obviously other hormones, they're going to drop their bone mineral density, they're going to increase the risk for cardiovascular disease. So we thought, okay, again, that's working on the heart, and lungs, but better, we started lifting some weights to in there somewhere, to try to increase our bone mineral density. So then we had to work or get into that. And so that became interesting in and of itself. You know, you can tell people to exercise but the standard was, don't lift a weight, because you're going to exacerbate the lymphedema in your left arm. Oh, yeah,

Dr. Spencer Baron:

yeah,

Dr. Riggs Klika:

we were like, guess what, we started doing that. And I went, that doesn't make any sense to me. And I don't, I'm not trying to again, pretend like I knew the answers. I was just asking questions. And I said, you know, what, if an athlete came to me, and they had a demon and swelling, I would do us an act of muscle pump and try to push it out of the system, you know, or manual or massage or some other things like that. And so, the lymphedema became a way of saying, Well, why don't we just do some act of muscle pumping and just do some exercise and see if we can reduce the lymphedema? And lo and behold, can you shoot it's published that paper and it was really fun to see because I was doing some work on that, but she published papers she was doing on the East Coast and it was just, it was really fun to see that come out. And that really, really, really helped us so again, look into the athlete look into the cancer patient, but how does exercise help? You know, it's funny, man, I'm sure you guys you guys are in this sort of the you know, the rehabilitation side of it. As, let's just say you see a breast cancer patient with a unilateral unilateral mastectomy. They're imbalanced. There, maybe even he's of capsulitis or something along there like a frozen shoulder or something along those lines. And they're protecting and they have horrible posture. I work with a good aging population. So certainly out here in Aspen, quite a bit of my my clientele is older. And posture is one of our key go to sort of common threads that I've been working on with everybody stand up taller, have better posture, work on your alignment, that was right in your wheelhouse guys, so. So I'm taking breast cancer patients and going, here's what I do for Healthy People, here's what they do for breast cancer patients and see if we can get this all mesh together, while I'm taking care of all the internals if you will, the complete blood counts and white blood cell counts for the cancer patient.

Dr. Spencer Baron:

So I've always heard about them not exercise like like, you know, bilateral unilateral mastectomy, they have to remove all the lymph nodes, the arms are swollen and everything's like that. And and they've been afraid to exercise, which didn't quite make sense, but I knew nothing about it. Are you saying that, that some sort of exercise and you know, maybe some compression where things like that would be helpful?

Dr. Riggs Klika:

Absolutely. Okay. Without without question. Oh, I think we I mean, I'm not even I'm not. Now there are some people with severe lymphedema that is uncontrolled lymphedema. Yeah, that's a different group. Yeah. If you're talking about somebody who's gotten axillary node removal or a certain amount, and they're having some problems of lymphedema, yeah. You guys are both well trained. I mean, you'd want to get that fluid out. The last thing I would want to do is not move the affected arm. Beautiful. Yeah, leaving the lymph down in the peripheral tissues, right. So that that wouldn't be the right thing to do. I just had a move them, but it wasn't hard exercise. And it's just rhythmic.

Dr. Spencer Baron:

And makes sense. It makes sense. And I think in the degree of like, when you said, when there's a chronic lymphedema, like with cellulitis and things like that, maybe not to Okay. All right, good. That's a little

Dr. Riggs Klika:

different. And yeah, lymphedema specialists are excellent at working with that particular population. But I think it's certainly a risk. But again, I don't know that we had enough data to say that exercise was contraindicated. Right, right. Does that make sense? Yeah. That's one of the ones we're working on right now. So good. I mean, we're 20 years into this, I think you're seeing a bulk of the information come in the last 20 years. So we're, we're kind of a new science, if you will,

Dr. Spencer Baron:

I love that. There's also a It was fascinating about maybe six, seven years, eight years ago, my neighbor had bilateral mastectomy, and you know, with, obviously, you know, lymphadenopathy and I don't know why I said something about using what you know, of his kinesiology tape or kinesio. Dara KT tape, you know, the elastic. And I don't recall, I had some I used on one of her kids or something like that. And she goes, I wonder if that would work on me. And I go, Listen, I mean, I know nothing about this, your skin looks, you know, healthy enough. We tried it. And then she found out that they're using it, they were using it in one of the, you know, PT clinics or rehab clinics. And they would tape the, they would do the same type of kinesio taping on the arm to get lymph drainage going. But what was of course, what was fascinating about that is that they would charge like four times as much red tape job on a cancer patient, then you know, that I would on an athlete and here you go. So I just gave her a roll of tape.

Dr. Riggs Klika:

I think oppression has its, its, its use in that. I think, but what are the here's another one of those good ones, like, again, where I just jumped out and went, Oh, okay, they have a compression sleeve. Well, if you put a compression sleeve on your arm and it's graded and it works, obviously from the wrist up to the basically armpit, okay, they actually you know, it's, you know what, it's gotta, it's gotta cover it there. I know and I went well, and I did the same thing for lower for lower extremity lymphedema as well. So we just wear a surgical, you know, stocking if you will. Yeah. I said, we got to, we got to change that. And all the compression garments that are using the athletic industry right now are outstanding, and they go over the arm and over the shoulder elite with the compression in the arm. So I started, I went I still do, I still recommend that use a compression garment that goes up and over the entire body for breast cancer patient and up and over the waist. So that they live that, you know, the lymphatic drainage for those that don't know, I mean, it's obviously in the near the armpit in near the window folds, you know, basically down for them rock region. And so why occlude that? See some of those were just sort of, yeah, basic questions. I guess I'm not the brightest guy, but I was using some of that physiology behind me. And I was like, Okay, let's see what we can do. I think that's a better strategy. That's just an opinion. I don't want to go to war with lymphedema specialist or anything.

Dr. Spencer Baron:

Oh, why not?

Dr. Riggs Klika:

And they do a good job. Because lymphatic drainage is a really important component of it, like you said, for cellulitis. And it's got to be done if we have severe cases, for sure.

Dr. Spencer Baron:

Do this, I'm sorry. Do you hold on? Do physical therapists are they? Do they do lymphadenopathy? Is it the physical therapist role in doing the similar type of stuff? Or to understand what you do? Or is it something that is exclusive to a different entity?

Dr. Riggs Klika:

Well, there are lifted down left the demons, specialists, and trained usually coming from a nursing background. But the PTS have been thrown into it heavily. We're doing such a good job, their colleges are doing such a good job of getting people past treatment and keeping them alive. And we have all the side effects. So you're following up from a surgical procedure, you're going to PT, well, the PTS when I first started, and a lot of them didn't have a lot of background and Cancer Survivorship. But I think that's changed. I see that in the curriculums. Now, as a former professor, I, I saw that moving that way, which is great. I actually did lectures for PTS at the University of Indianapolis when I was there. That's good. So they're addressing it first. But as you both know, PT is limited to a certain amount of visits, boom, they're done. I was the guy kind of right after that surgical intervention and 12 sessions of PT, now what? Right, okay, let's put you back together for the next two years, so to speak. And then hopefully, the goal was get them healthy enough and back into their normality, if you will, within a year to two years to see what you get them. You know, cancer is tough. I was thinking when you asked me to come on this thing, and I recall them a lecture here, or Harold Varmus, the former director for the National Cancer Institute, and he said something when I was young, and I'm not just paraphrasing, but I remember him saying, Well, you know, once you get cancer, you typically die of cancer. You know, even if you you know, I know, that's a horrible statement to say. But it comes back in and my thought was, wow, you know, that's the head of National Cancer Institute. This is one of the brightest man, brightest researchers. And that's a scary thought My job was then okay, boy, I hope I can make this person live as long as possible that as healthy as possible. And if it does come back, maybe they have a better reserve capacity to handle the second time around, you know, that's kinda, again, sort of how a lot of that started. Sorry, that was I got one up. No, that's

Unknown:

good. No, no,

Dr. Terry Weyman:

it's great. You know, one of the questions I have is, you have a vast experience traveling, I mean, you've you've worked academia and the United States and in Europe, how these diverse environments and cultures and thought processes kind of influenced your work, and what do they do better than we do? And what do we do better than they do?

Dr. Riggs Klika:

That's a great question, Carrie, because I think also preparing for today. I think you'd asked me what, what it was some cutting edge things and I want to do I do want to share one thing that I think it's different in I spent a year working at the University of Florence in Florence, Italy, in the sports medicine department, how sports medicine departments in Italy, are staffed by cardiologist, not orthopods. Who Interesting, interesting, right? Yeah. So I have a dear friend, Laura, Stephanie, who was there, one of the directors at the university. And one of my goals was to go learn, basically a European model. And the really cool thing about being in Italy is I could travel to Heidelberg, up at the National Tumor Center and with my colleagues there, and look at best practices, so I was able to do that. But here's here's one of the differences. Terry, we will send you to go to MD Anderson, and you will get three outstanding physicians. All right, we'll come and see you. Hopefully, they come up with the same diagnosis. Most likely, all three of them are a couple with slightly different treatment plan. Okay, that's great. And they're good. They're really good. You know, amen for that particular group. And then they treat you and MD Anderson says, Okay, go home. So now you fly back to Kansas, and you've been treated, and you're kind of you're cancer free that, you know, so to speak at that point. But again, the follow up at that point. Well, in Italy, it was really interesting, all chronic disease patients go through, it's a basically socialized medicine platform. And so if you had cancer, or diabetes, or chronic kidney disease, you go to see your specialist, they do their work, and hopefully get the same response and get you cured. If you will have the disease. Your next appointment is to go to sports medicine. All of them. So all the chronic disease patients come into our clinic, seven cardiologists in this particular clinic and we have a full exercise, EKG echo stress testing unit to test everybody. Now, let's go with that one a little bit. If you do cancer treatment, many times what we we call it subclinical cardiomyopathy, meaning we probably damaged your heart. Our cancer treatments don't ever test you, they don't do an EKG and you they don't even look at that. They said we cured your cancer. Again, guys, I'm talking about a little bit gross, General, General generalities here, that's not true for everybody. But that particular group in Italy has to come through and so we checked on their hearts. And we were seeing a lot of subclinical cardiomyopathy, I mean, it's not going so okay, we want you to get healthy, obviously socialized medicine, they don't want you to come back, they're gonna live forever, it's Italy. So they want, they want you to go back out and be productive out there. And so we would do an a complete test, just like I would do, Terry, you and I have done some work before. Like, we're trying to set up a performance testing lab and whatnot, you know, do the EKG stress test, do a vo two Max, do a bone mineral density scan, do sit and reach do some power exercises, that we have that and then that group would tell them that that particular patient what to do as part of their rehab. So we don't do that. And it's not incorporated. And I always thought that that was such a great addition to the health care system. And could it potentially help us with the treatments knowing that somebody's got a slightly damaged heart? Or how hard should we be pushing them, I would have loved to have known that. When I started my particular group of cancer patients, I had all the equipment, but I'm not a cardiologist. But I was still running EKG stress test to look for some type of pathologies, because I had people that wanted exercise, and I wanted we then I had a physician, consult with me to make sure that they were cleared to go out and do the exercise. But that's part of the that that group, so much, much different than ours.

Dr. Spencer Baron:

You know, early on in your answer, you pose questions, you know, that are that are very, I want to highlight them, because we strongly urge our patients to question authority or questions, you know, you mentioned you, you could, you could send a patient to three different, you know, oncologists or three, three different doctors in the same field, and they'll give you a slightly different approach, or I call it a recipe of treatment, that, you know, there's no, there's no standard. And so now you're embarking on creating a new standard of, of oncology or cancer care, want to call it, and I find that fascinating, because it's really embarking on, you know, questioning the way things have been done. And now moving into a new, a new level of care. I love that.

Dr. Riggs Klika:

I think they're really ahead of us on that particular component right there. I mean, I love the medical field in America, I mean, go to an ER, room and America, you're gonna get Outstanding, outstanding care. But then like, here's a perfect example of boy, we could adopt a sort of more European model. I think we might, I think, for the health of the nation, if you will, in our healthcare system, but man that is so far beyond my wheelhouse guys like not to change that, that I can just tell you that I think that that was a great strategy to helping individuals. So yeah, there's there Some opinion statement right there.

Dr. Spencer Baron:

Could you I can't wait to hear about this research found or this foundation that you work with bridging bionics. Could you share a little bit more about the, you know, background in exercise science and human development? Foundation? Yeah,

Dr. Riggs Klika:

that's a great, great group of people. So I moved back to Colorado. I, as I mentioned, or didn't mention, I retired as a professor, if you will, but I need to be academic as well. So I still see cancer patients here. I have a small health facility, gym facility, but I jumped on to help a dear friend of mine, Amanda Boxtel, who was I don't want to say like a poster child, if you will. But she was an advocate of using the Esko, bionic skeletons, the external skeletons to help her walk. She's a paraplegic, she had a ski injury here. And so I don't know if you know what I'm talking about. But the robotics, if you will, yeah, the external robotics. And so she became the spokesperson for this particular group, she started a foundation up here, where we're looking at trying to integrate, its cutting edge technologies we possibly can, with basically spinal cord injuries, stroke patients, the patient list is a myriad is it's a large list up here. But I was always, always always fascinated with the interaction between prosthetics if you will, and the human body. I think that's and the DOD and the Department of Defense is really interested in that because of our soldiers and those that are injured, and combat. So how can we put those people back together, and you've seen, you know, that hits the headlines, because that kind of stuff is really, really spectacular when you can integrate, maybe somebody that's lost their arm and make a prosthetic arm that actually responds to commands from the brain, I think that's, it's really hitting some really neat areas in neuro muscular function that are just really cool. And I think there still are a particular group is just trying to help people increase their mobility. So they can be independent. But we're trying to use whatever is available to us. And we do some slight, we do some smaller research projects, because we don't have a large population. But we do research and to say whether these projects are actually working, we just finished a study on virtual reality. So everybody has to come in, it's got maybe a spinal cord injury, and you know, they've got some mobility issues, and they can't move maybe, or maybe they have CP and some spasticity with virtual reality, like the goggles, and you guys have seen it, you can almost, you know, do some of the games and play with them. Would that potentially help with neural networking, if you will? So I would love to give you the answer to that question today. But I didn't literally we had the meeting last night, and they asked me, Do you have the results? I said, Nope. I just have the data. So we just finished the study. So I don't have an answer for that. Or we know that the patients themselves enjoyed it and sort of helps with compliance to the rehabilitation. I think our group is a little bit small, I'm not 100% sure whether you know, the control group versus the VR group actually get incredible changes in function. But, you know, we're pushing those levels to so that's a whole new area for me to be involved with.

Dr. Spencer Baron:

It is unbelievable. So, okay, now, you are masterful at combining things that something, a subject from here and a subject from here, putting it together, like cancer, an exercise about cancer exercise, and now, you know, paraplegics, quadriplegics and putting them in Bionic I mean, do you see patients that are disabled like that, that ended up with cancers as well?

Dr. Riggs Klika:

That's another great question. Because one of the side effects we see quite often in our cancer patients is peripheral neuropathy is, right. Yeah. So I've got a lot of peripheral neuropathy is, from my understanding the treatments of peripheral neuropathy are relatively poor. I mean, there's a lot out there but they don't seem to work. All that well. exercises, we use it to the best of our abilities. I do a lot of power plate movements with some of my cancer patients, just to see if we can stimulate blood flow and the peripheries. But here's that would be a nice combination of something I could learn from this side over here and bridging bionics. Could it be helpful for cancer patients with purple? I haven't. It's good question. You're like setting me up for the next project, right.

Dr. Terry Weyman:

You're welcome.

Dr. Spencer Baron:

So So wait, you I have I'm sorry, I have to ask you because, but you mentioned you put up Would you use a power plate? Which is a high intensity vibration? For who? The cancer patient? Or the of course, okay, okay, that's what I thought you were gonna say. So let me let me ask you. So I, this is old school thinking, too much circulation on a cancer patient will you know spread the disease? I know that's ancient. Well, I'm ancient but old thinking, but you're using a power plate? And what are you looking to stimulate for those listeners out there and viewers

Dr. Riggs Klika:

well, okay the peripheral neuropathy for those that don't have the medical background, basically just a destruction of the small nerves in the periphery. And then ultimately, they get side effects of basically pain or numbing or that old feeling of pins and needles in the feet, that's a good way to put that. And the treatments for that are poor, there's some drugs that are used, but it doesn't work very well. So we just said, Hey, this power plates kind of interesting, we know it stimulates a lot of the peripheral muscles a small ones, well, that augments blood flow, would that help in the regeneration of peripheral nerves which do regenerate? The animal model is clear. It works. If you exercise a rat with a basically some type of peripheral neuropathy in it, exercise will actually help with the repair and growth of that peripheral nerve. It takes a while, but it works. Well, you know, human beings are a little different. We're not quite so uniform, we're all have different reasons at different stages cancer, and, you know, health, if you will, and age. It's promising. How's that? Hello. So I use it, it's not hurting anybody. And so the answer your question, does that increase blood flow? Is that causing a problem? No. That's not going to be our issue.

Dr. Spencer Baron:

I like it. Okay, now, switch gears just a little bit. Let's hear your postdoctoral training at the National Institute of Aging. You know, especially at this age, I want to hear everything you got on anti aging. Okay, you can say because, you know, I'm sure we don't have 10 hours today here. But the I'll come back and the next Yeah. So, so but, you know, if there's one single subject that has the most convincing research, and that is exercise and anti aging or you know, longevity? How do you intertwine that with, you know, cancer survivorship, you know, how have you installed that in, you know, for America, to completely understand that

Dr. Riggs Klika:

you have to understand the cancer is a is a disease of the aging population. If you look at the prevalence rates coming up to about 50, they're relatively at a certain level, I'm not going to get into the stats, I actually, I have those or you can look them up. But once you hit 50, you look at the prevalence rates of cancer in the United States that go through the roof. So, you know, once you get to 50, because you've got these cancers growing in you, we all have them, whether they get expressed or grow bigger, that's dependent on you and some genetics and some variability. But yeah, once you're up into that age 65, those death rates start to go pretty high. So it's a disease of the aging population. Right. So what do we need to do? We need to prevent this first and foremost, just like we talked for the aging population, what are we trying to do? Well, we're trying to get them as healthy as possible. So when they get old, they can still continue to do things. When you're in cancer treatment, though, you age prematurely by about 10 years. Now, wouldn't it be cool this is supposed to wear I really think that there's some information to it's like, what's another good reason that you might want to exercise obviously, so you can go out and play with your grandkids and be healthy and do the things you want to so I go out with Terry and do some stand up, you know, out there, point Doom and this guy's gonna hammer me out there and, and serve. Okay, that's all great, but I mean, you certainly want to be functional. And now you've sort of gone through this premature aging. What if you were healthier? What if you had a certain level of fitness here, and you did get a chronic disease, and you're out of commission for a while? That's horrible, but you come down to here. What but the problem is, Americans are starting here. They're not healthy, they're overweight. We're not exercising, we're not doing good things. I mean, you know, talking to you maybe your listeners here will kind of the people that do enjoy exercise, but not that's not everybody. So they're starting here and then the cancer takes them down here. We got a problem. So my my thought is working We do, obviously to increase your reserve, if you will, from chronic disease, and then you might be able to respond better, we certainly are thinking at this point that the healthier individual cancer, and I don't want to say this about everything, because we do, Terry and I have a very good friend that's struggling, who's healthiest can be, and it hurts, you know, to watch those things. But for the general, you know, to be honest, he's around also, because he's so strong, he has a ton of reserve capacity, and he can handle the treatments better. Yeah. So, you know, the exercise, you know, and, and prevention and pre cancers really important, what we're doing during treatment as becoming important. And certainly afterwards, I want to try to get people as healthy as possible in case it comes back the reoccurrence rates, or they pick up a secondary cancer, or, you know, here's the reality in America, they may not die their cancer, but they're gonna die of cardiovascular disease or some type of metabolic disease. So, you know, we're just trying to do the best we can with our little corner of exercise over here, as a medicine is if you will prescribe it, do it correctly, figure out the dosage and see what the side effects are right now, the side effects are pretty good, we don't have a lot of adverse side effects.

Dr. Spencer Baron:

Yeah, it's tough. It's just gonna say it's a tough pill to swallow. But actually, you know, it's, you know, that's the problem with a very, they're, they're swallowing too many pills, because that's so easy to do versus going out and exercises or, or, you know, understanding that food is medicine, or it could also kill you, you know, so

Dr. Riggs Klika:

an exercise to answer your question about, like, sort of the National Institutes of Aging, you know, they're interested in all these things, they want to look at your bones, your heart, your metabolic, your, your mental well being. Yeah, you know, are we want, you know, when I went there, that was a long time ago, 97. And I was the outcast, I was the one clinical exercise physiologist, everybody else was coming at it from a different perspective, let's put it that way. And it was fun to actually sit around and around tables with very incredibly bright people. But they're asking me about exercise, which I really enjoyed. You know, like I said, we're not the end all be all, I don't think, you know, exercise is not going to cure cancer. It's just going to help us the best we can. But it's an important component of lifestyle management, it has to be part of it. And you know, I think, you know, for the aging move, the worst thing you can do, stop moving. If you want a sure way to die, sit on the couch, are you good? Oh, I'm afraid to go out and do something well, sit on the couch, you're gonna die faster that way, I promise you. And you know, do you remember the all those statistics back in the years where, you know, gosh, if you go out and do some exercise, you increase the risk of actually having some type of cardiovascular event? Well, none of that really made sense to me either. And when I started to do my homework on that it's not really as big as we think the risk benefit ratio is way is way in our favor, if you will, yes, there are a few people that go out and exercise and die, there's a few, most likely it's the guy that gets off the couch who goes shoveling snow in Ohio. Sorry, I'm from Ohio, I can do that one hiking. So my point being here is that we got to move and we got into cancer patients, it really became apparent to me it's like, you know what, they have cancer, and they're getting training adaptations. That's really important. I mean, I really think that that's a piece of of, you know, Terry, you're asking for really cool stuff. Billy Jones did a study on stage four lung cancer patients, these people are going to die. And he trained him. And I was new into this area. And he got changes in via to max with this group. And, and then I said, Okay, somebody goes, well, what's the functional outcome of that? He goes, Well, the trained group lived about a month longer than the non tree group. And I remember there's stage four cancer patients, they're all going to die. There's really we don't have a treatment for them that much we can do. But they all got fit. Yeah. And they're dying of cancer, meaning I can push you pretty hard. And then somebody said, Well, one month isn't very much, I'd say, Well, I don't know if you're struggling with that I you know, and a life is really difficult stuff to talk about. But you know, when you're trying to get things together, and you want to spend a little bit more time with your loved ones, or even one month is important. But I remember asking me I said, Well, why would you train stage for cancer patients? A little naive on this one. And I think he's a brilliant physiologist. And he said, If I can get adaptations in this group, I can get adaptations in any group. Yeah, and that was really important. To me, and then I just started going, I'm going to push them. I'm going to watch them, I'm going to take care of them, I'm not going to do anything. Crazy here. This is a far left set of ideas. It's training individuals watching them and monitoring and close. And, you know, that's how it sort of launched my career in this and started writing programming for this particular group.

Dr. Spencer Baron:

Thanks now we're gonna switch gears and we're going into our one of our favorite sections of our podcast called rapid fire questions.

Dr. Riggs Klika:

Elaborate I just have to do yes no or something.

Dr. Spencer Baron:

No, no, you well, we we always say try to give like a one you know, answer one sentence answer, but Terry always makes it longer.

Dr. Riggs Klika:

I'm an old professor, I talk forever I lecture.

Dr. Spencer Baron:

Well, we're gonna throw them at you pretty fast and furious. So here if you're ready, if you're already rich, we got you ready. Okay. All right. Here we go. Question number one. You live to spend a lot of time in Aspen, obviously Aspen, Colorado, and as a ski instructor yet, what is your one? What is one of your fondest memories?

Dr. Riggs Klika:

fondest memories I have a lot. But you know what Jimmy Buffett just Jimmy Buffett just died. And I got to ski with Jimmy a couple times, long time ago. And back then he was cool. He was a cool guy. He had a house up here. Here's some really good stories. He entered COVID. He actually filmed from Florida down in Key West. For the graduating class of aspen High School. He's filmed a song and he sent it to him online. And so you know, you get to meet some pretty cool people up here. That's just one. So there's a lot of those.

Dr. Spencer Baron:

That was good. That was good. All right. So far, so good. here's question number two. You've obviously met some amazing people, gifted athletes and people what is your one person that stands out and why?

Dr. Riggs Klika:

This might I've never met this one, but Alex Honnold. And we're actually watching solo at least four or five times the climber who soloed El Capitan. On unaided, right. I have always been enamored with world class athletes, and I know a lot of them. I've never seen somebody so mentally strong in my entire life to do an event like that. I think it took them under four hours to climb on anything without rope 3000 Straight up, I'd bend El Cap. And I put my hand on the wall. I didn't even know how you actually step onto the wall. So like, but I think the mental fortitude to some of the athletes is fascinating to me, and how you can control your emotions in your fears, to be able to do an athletic event. That strenuous is really cool. I agree.

Dr. Spencer Baron:

I was out there. I was out there not to climb but like from several miles away. And the tour guy was telling us how 20 people die a year. And that's why would they have a helicopter, right? Oh my god. So to hear that. That's pretty fascinating. Question number three. What is your go to activity to open up your brain when you are trying to figure something out.

Dr. Riggs Klika:

I'm an old swimmer. I still love to swim. Pretty good. But I remember after I finished my college career, I was like, I want to go see something also. So I ride my bike quite a bit so I can get out. You know, we live in the mountains. And so yes, I love to road ride and do all the things I was living in Southern California do a lot of road riding. But, man, you can also just just disappear up into the mountains and a mountain bike. And yeah, if if you had a little stressor during the morning, that might take care of it a little bit for the afternoon. Oh, he's made? Oh, it makes me a little bit happier in the afternoon. So maybe tired. But that's that's

Dr. Spencer Baron:

great. All right. Now this is I love this. This one. You're the biggest public myth. When it comes to cancer prevention

Dr. Riggs Klika:

myth, prevention,

Dr. Spencer Baron:

myth or misconception, something that that people think is I mean, we've actually touched off on

Dr. Riggs Klika:

that it's all genetics. I'm just gonna get it. There's nothing I can do to control that. But we look at the genetic environmental interaction, meaning, okay, maybe, you know, suppose we're maybe you're at high risk for developing lung cancer, but you don't smoke. So you're not going to get right. You're not most likely not going to get lung cancer. So what you do has a tremendous effect on the amount of cancer that we're seeing, right. And so that environmental pollutants exposures, UV radiation, whatever it might be. Those have a tremendous effect on the expression of that cancer, prolong trician has an expression, right? So it isn't, these are just my cards, and I'm gonna get it. Yeah, I can do a lot to prevent it.

Dr. Spencer Baron:

I'm so glad you said that. Because some people feel like it's their death sentence when they find out, you know, they get the genetic testing or, you know, any kind of, you know, are there

Dr. Riggs Klika:

closure to that, right? Yeah, yeah. Oh, fantastic. And I think Spencer, you know, you guys could go down this and probably have I haven't seen all the podcasts. I've seen a few of them. But you know, like, what we put into our mouths have got to be some of the biggest problems. And I'd say it's not just the amount, but also the quality of it. So, you know, are those causing insults that are causing the mutations that are causing the cancers? Yeah. My thought Yeah, probably.

Dr. Spencer Baron:

Fantastic. Thanks. Good answer. Last and final question, what is your favorite place to go to for an adventure? Oh, gosh,

Dr. Riggs Klika:

I've traveled all over the world. I don't know that's a my next time my trip list is Majorca, Spain, I want to go ride around in those mountains, I can tell you that that's high, high on my list. I've been to Everest base camp, I don't climb. I'm not a climber. But I've been to Everest base camp, I'd like to take my son back there that's on my list of thinking of things to do. It ventures, Oh, gosh. But that's the coolest thing. Man. I used to him as a professor, you get to stand up occasionally the SATs until it gets as a good travel and go see that world out there and go to all those places. Because it's so cool. You have such a great appreciation. So where am I going next for an adventure? I don't know. But I always have an idea about somewhere where I want to go see. So that's my best answer. That's great.

Dr. Spencer Baron:

It's great.

Dr. Terry Weyman:

So we'll have to we'll have to talk off air of where we can go ski together in here. We'll pick a place that we haven't gone before. Will I go have some fun? All right. So you did a recent publication in 2023, exploring the motivational sources in the NCAA Division Two student athletes during the COVID pandemic? Can you discuss the implications of this study? And how am I shape feature? understands that the psychological effects and athletic performance?

Dr. Riggs Klika:

That's a good question, we were trying to see what's going on, you know, we obviously have a student, everybody went through it, right. So all student athletes had to go in quarantine as well. And they were trying to do independent work at home are training. And we were interested in like, what was that going to be on the psyche of that particular group, compared to the general population of the school at that point? You know, I was at a school moderate size, but 5500 students, so we could kind of get a large group to answer those questions. And it was, you know, we had two ideas, are the athletes more resilient and can handle it better, or than the general population or not? That was one or were they just going to fall apart. And I think, unfortunately, what we found out of there is sort of a mixed bag, if you will, Terry. Like, they, they're motivated, but it was so difficult to transition to like, let's say you're on a soccer team, for instance. American traditional football club, you don't have a team to work out with, that really sends that particular group into depression, anxiety, you know, this is my one shot to perform at the highest level that I'm ever going to make it in life. And so they lost those opportunities. So that that research was a little bit sort of mixed. We saw some resiliency, but we also saw the loss of specially team sports with regards to you know, they wanted their camaraderie they wanted the team they wanted to have that experience. You know, some individual sports may be a little bit different. If you're on the cross country team. Yeah, you have a team, but you're it's an individual sport, if that makes any sense. So that was the big difference that we just saw in that particular group.

Dr. Spencer Baron:

Reach we're gonna wrap it up, but I got one, one more thoughtful question for you about what do you see? What do you see your future with exercise and cancer treatments and how do you how do you feel other healthcare professionals should prepare for this shift in consciousness?

Dr. Riggs Klika:

That's that is really you know that to forecast is going to be difficult I think Spencer where I'm at, I can only see a certain amount of time right now. But I see that could exercise be very beneficial during the treatment phase, and I'm talking about a cancer patient has to sit in a chair for six hours to go through chemotherapy. That's a lot of time to sit. So. And there's some complications during during chemo and infusion therapy. Would it be beneficial for them to actually be moving while it's happening? That's just thought, you know, and so our good friend, virus, Terry's and I, we had him doing some light exercise during infusion therapy. Now, I'm sure there's a few nurses in that room that weren't happy about that. But if you think about, you want a drug to come and do its job in your body, but then you want it to get out of your body? Well, sitting isn't going to help that. And, you know, blood flow is going to help that. So would that be something that we should be doing regularly? I don't think we know the answer to that. So I'm going to keep that really narrow, like in the future, like, that's something that we're experimenting with right now. And there's some really crispy Campbell up in Canada's doing some work on that, and some really good people doing that, too. I think I would just help, you know, they're going to try to be a little open to some of our modalities here. That's all you know, there's always that group that just, it's new, it's novel. We're not doing it, but there's this right. And so I think that goes across the medical profession, and we just want to do it safely, too, as well. So that's what I

Dr. Spencer Baron:

love it. Great stuff.

Dr. Terry Weyman:

Perfect. Thanks, doc. We really appreciate your time, man. And it's always good to see you. Always good to see you. Thank

Dr. Riggs Klika:

you. Yeah, I love talking about this stuff. I obviously can talk about it forever. So it's all fun to see you and very good opportunity.

Dr. Spencer Baron:

Great to meet you. Thank you for listening to today's episode of The cracking backs podcast. We hope you enjoyed it. Make sure you follow us on Instagram at cracking backs podcast. catch new episodes every Monday. See you next time.