Moving Through Cancer
Dr. Kathryn Schmitz • Episode #101
Today’s new podcast episode with Dr. Kathryn Schmitz is full of game-changing research on cancer. Kathryn’s empowering message will not only resonate with anyone who has been diagnosed with cancer but with their family and loved ones as well.
After twenty-six years of researching the benefits of exercise for cancer patients, Kathryn and her wife, Sara, experienced firsthand the restorative power of exercise as a part of cancer treatment. In 2016, Sara was diagnosed with stage 3 squamous cell carcinoma. She is currently NED, which means no evidence of disease, and is cancer free. Moving Through Cancer is inspired by Kathryn’s professional and personal experience with cancer.
Kathryn’s must-read book, _Moving Through Cancer _presents the science of using exercise as a tool to help reduce the risk of developing some of the most common cancers. In this groundbreaking book, she says…
“We looked at all of the major published research on the subject—and the findings were conclusive. The publications from Holmes and Meyerhardt were the first, but dozens of observational epidemiologic studies now support a strong role for exercise in preventing cancer-specific and overall mortality, particularly in breast, colorectal, and prostate cancer survivors. And exercise is especially effective in reducing the risk of developing some of the most common cancers, including colon, breast, endometrial, kidney, bladder, esophageal, and stomach cancers. But very importantly, the benefits don’t end there….
One benefit of the explosion in research on exercise and cancer is that we can look at more and more specific questions in our studies, such as what ‘dose’ of exercise should be recommended for a specific problem or to try and achieve a specific outcome. This is the other major step forward that we have only just recently been able to take: *We can now ‘dose’ exercise for specific cancer-related problems in exactly the same way that your oncologist might prescribe a drug or chemotherapy regimen.”
You don’t want to miss this episode.
FOLLOW ALONG WITH THE TRANSCRIPT
Kathy Smith: I’m so excited! When I heard about your research from Dr. Bob Sallis and heard what you were doing, I just dove into it because, again, we all… If we haven’t experienced cancer personally, then we know people. We have family members, we have friends. It’s just remarkable the impact of exercise, and I don’t think most people know about it. When I started talking to other friends, they’re sort of looking at me kind of quizzically.
So, before we jump in, though, what prompted you to get involved with this research 26 years ago?
[13:03] Dr. Kathryn: Okay. So, I was a post-doc at the University of Minnesota, and thought I was going to have a career looking at exercise and obesity prevention, diabetes, heart disease. I was a little concerned with the fact that it really felt to me like I was going to be doing incremental science. You know? Just sort of one step, and then the next step. All of the big leaps forward in the field of exercise and cardiovascular disease had already been made. We already knew that exercise was good for heart attacks. Right?
So, I had a conversation with a faculty mentor who asked me if I had ever considered working in the area of exercise and cancer. I said, “I can spell cancer.” So, I spent about three weeks focusing on exercise and cancer, and there wasn’t a whole lot to read. The field was really nascent at that point.
There was one paper in particular by Anne [inaudible 14:03]. This paper was a call to action, and it was a call to action for people just like me, with just my kind of training. It basically said, “If you are trained/work in exercise and cardiovascular disease and diabetes and metabolic disease, we need you over here in cancer. Please think of switching tracks and focusing on cancer.”
I emailed her, and she emailed back, and we met at a scientific conference, and she became a close mentor for the earlier part of my career and remains a mentor today.
I started working in cancer. I wrote my first grant to the Susan Cohen Foundation, and I got the grant, and I never looked back.
Kathy Smith: Well, it’s interesting because you hear… When you get a cancer diagnosis, most of the time you’re told the best remedy is rest, rest, rest, and more rest. You’re kind of trying to change that culture – or you are. You are changing that to let’s move, move, move! It seems counterintuitive to most people, as we were talking about, but you really believe, and the science is showing it. Not that you just believe, but the science is showing that once diagnosed, that exercising actually changes the trajectory of your cancer.
So, I want to just, for all of the Doubting Thomas out there – for all the people going, “No!” – can you just start where you want to dive in, just talking about what you’ve learned through your research?
[15:35] Dr. Kathryn: Sure. So, I think that there’s actually a little bit of an analogy that I’d like to draw first in order for people to understand the kinds of changes that can happen over time because of science.
So, back in the 1950s, Dwight Eisenhauer was sitting president, and he had a heart attack. His cardiologist was sharply criticized for getting him out of bed so quickly (three weeks after his heart attack). Today, we laugh at that idea because we know that we get people who’ve had a heart attack out of bed. Within 24 hours, we know that we get them exercising.
If you ask the average person with an eighth-grade education in this country, “Should you exercise after a heart attack?” they’ll say yes. There has been an enormous paradigm shift since the 1950s because of the science but also because of the advocacy on the part of organizations like the American College of Sports Medicine, American College of Cardiology, the American Heart Association. We now understand – and we connect exercise with heart disease. We know that exercise… The average person knows that exercise is good for somebody who has had a heart attack and has heart disease.
Well, we need a similar paradigm shift. We have the evidence base. This is not something that I cooked up in my garage this weekend. We have 15,000 peer-reviewed scientific articles in the peer reviewed literature that tell us that exercise is helpful for people living with and beyond cancer.
So, we need a paradigm shift, and we know that exercise is not only good for all of the symptoms that people have as they’re going through their cancer. We also know that exercise is preventive from the development of cancer in the first place, and we know that for three very common cancers (colon, breast, and prostate cancer) that exercise is powerful medicine for preventing the recurrence and death for people who have had a diagnosis of those cancers.
So, there is as preponderance of evidence that tells us that people living with and beyond cancer should be physically active, and yet we have a culture that tells them to rest, take it easy, don’t push yourself. So, it’s time for a paradigm shift; that’s why I wrote the book.
[17:47] Kathy Smith: Well, I want to go a couple of different directions. But before I do, completely relate to the cardiovascular side of this. I ran my first marathon in ’75, but the way that I got into that was Dr. Ken Cooper and all of his research on aerobic exercise and heart disease. I have heart disease in my family. But most importantly, there happened to be – when I was at the University of Hawaii – there happened to be a doctor, Dr. Scaff [sic], who was taking like 26 heart patients (people that have had episodes or whatever), and then training them to run a marathon. Now, you can imagine, even in the early ‘70s, this was like, “If you’d had a heart attack, you do not walk up a flight of stairs, you don’t have sex, you don’t look at a good-looking man or woman. You just keep everything very calm.”
So, this was really one of these real game-changers. I would go on the weekends and run with these guys, and eventually ran a marathon in ’75.
So, kind of just supporting what a difference to where the science is today. But getting back to prevention. I want to get into prevention. Not only exercise, but also a little diet. Before we jump into that, though, you had all of this research going on. Then, you had this personal situation with your wife Sarah. Do you mind jumping in and telling us about what happened, and how that changed your perspective not only from the professional, but now coming from the personal?
[19:26] Dr. Kathryn: Yeah. I don’t mind talking about that at all.
So, Sarah was diagnosed with a stage 3 squamous cell carcinoma in a very rare location: inside her nostril. We still don’t know what caused it, but it was stage three, so it was fairly far advanced. So, she had to have her entire nose removed – a complete rhinectomy was the name of that surgery. She also underwent combined chemo and radiation, which is the toughest version of cancer treatment you can ask for.
It was in the process of her going through that that I learned some powerful lessons about how to apply the results of the research that I had been doing at that point for well over a decade. Before that, I think that I had this kind of sense of, “Well, people should do this. They should just do it. Just exercise. Just go do it.” You know? It’s important, I know what the benefits are, you should just go do it. Then, the lived experience of working with Sarah really had me sort of rocked back on my heels of the reality of just how difficult what she went through was. That I came up with the concept of just “bad days.” You know, you have bad days as you’re going through treatment. If you have a bad day, then you do what you can, and you just keep moving. More movement is better.
So, the way that I approach cancer patients and survivors now is more human, more humane, I think. There is certainly an evidence base behind what I am recommending, but I think that there’s a recognition – or a need for a recognition – of the person that’s sitting in front of you, and what they’re actually experiencing. We can’t push somebody past what is humanly possible as they’re going through their treatments.
So, I’m glad to tell you that there has been some really lovely research out of Canada that has talked about the importance of exercising during treatment, and a recognition of a sawtooth approach of the symptoms get worse, and then they abate, and they get better, but they never quite come back to baseline. Then, they get worse a little more. Exercise can kind of shift that whole equation so that somebody can recover more quickly after they’re done with their treatment if they’re physically active as they’re going through treatment.
[22:19] Kathy Smith: Yeah, which as I was reading about that, it’s quite miraculous. Yet, we know that whether you have cancer or no cancer, if you’re feeling fatigued – and we all have that experience of feeling fatigued, where it’s, “Ugh, I can’t do my workout today, or I can’t get to the gym, or I just don’t have the energy.” Now, you add onto that cancer treatments, and how you hear that that is one of the common symptoms. You just get so, so fatigued. So, it almost seems… Well, let me put it another way. How do you blend compassion with what you know has to be done? How do you do it in a way that you don’t look like an asshole? There’s no other way to say it, but just like, “Get out of bed and exercise now!”
Dr. Kathryn: Yeah. So, the recommendation that I have heard from so many exercise oncology professionals is that it’s counterintuitive when you feel that fatigued, but we know from the evidence base that exercise is the number one treatment for cancer-related fatigue. It is better than any pharmacologic agent on the market for cancer-related fatigue.
So, the recommendation is if you don’t feel like it, get up anyway and do 10 minutes. If you don’t feel worse after 10 minutes, then you keep going. If after 10 minutes you’re like, “No, this is not happening today,” then you’ve done 10 minutes – and that’s great. If you get up and you can only do 5 minutes and that’s all that you can handle today, you’ve done five minutes. So, that’s the recommendation: you try. Even if you don’t feel like it, you try. If you feel worse by virtue of trying, then you know that’s a bad day, and you don’t do any more.
The other thing that I think ends up happening – and I think that this is crucial for your listeners to hear – is that there is the tendency during the period of treatment to just have kind of a get-out-of-jail-free card for any kind of movement and any kind of exercise. The problem with that is that we know that people who do nothing during their treatment come out of treatment in much worse shape than people who continue to exercise during their treatment.
So, what do you do with that? How do you balance that? The way that you put that together is you recognize that you will have bad days.
So, let me give you an example. Let’s say that you have chemotherapy every two weeks. So, day one is the day that you have your chemo. It’s very common for people to feel pretty pukey, pretty not-so-great for day two, day three. But, by day four, they’re probably feeling better. Well, you’ve got day four to day 14 to exercise when you’re feeling much better. Then, maybe you don’t exercise for a few days again once you get your chemo again, and the next cycle.
So, the way that it works is you start to recognize the pattern as you go through your treatment as to either what days work for you for exercise in the cycles of chemotherapy, or what time of day. It could be that exercise works best in the morning. It could be that it works best before two o’clock in the afternoon. Most people find that their energy wanes by the evening if they’re currently going through treatment. So, usually, it’ll be earlier in the day when it will work.
[25:59] Kathy Smith: Makes sense. Well, that leads us into, then, dosage. How much are the recommendations? I know in the book you lay out a course, which I appreciate, with strength-training and cardiovascular training. But why don’t we talk about both approaches to movement? I know some of the approaches help with, perhaps, the anxiety, or the fatigue, or mental depression, and maintaining muscle mass, obviously. Then, others are more long…
Do I have this right, that one of the things about cardiovascular exercise is that it helps get the medicine spread throughout your body a little better, or am I making that up?
Dr. Kathryn: Yup. So, one of the hypotheses that comes out of the animal research that we have in exercise oncology is that by doing cardiovascular exercise, we increase sheer stress on vessels – blood vessels – in the body. There is some animal research to show that the sheer stress affects the vessels around tumors, and that has importance because usually tumors are very poorly vascularized. There’s very poor blood vessel structure around tumors. So, if you improve that blood vessel structure/architecture around a tumor, then the chemotherapy can be better delivered to the tumor, and the tumors shrink more quickly. So, absolutely brilliant work on that topic coming out of [inaudible 0:27:41] Anderson.
So, yes. We believe that cardiovascular exercise actually may potentiate the ability of the body to receive and use chemotherapy. So, that’s really important.
You’ve asked another crucial question, and that is: what’s your why? I think that’s really important for patients to ask themselves. If your why is, “I don’t to feel so fatigued,” then the type of exercise that you’re going to focus on could be aerobic or resistance exercise. If your why is anxiety and depression, then it’s aerobic exercise. That’s really, really the focus. If your why is function – physical function, and you’re really interested in maintaining your muscle mass – then the type of exercise you’d want to focus on is resistance exercise.
So, what is it that you really care about? What is it that you’re really looking to get out of the exercising during and after your treatment? That guides you. Within the book, we outline which types of exercise are more important for which types of outcomes.
I think that it’s important to say that because I think that exercise is medicine. So, if exercise is medicine, then we need to dose it like a medicine. We don’t just say, “Go get some chemotherapy.” We don’t say that. We say, “I’m going to give you Adriamycin, I’m going to dose it according to this milligrams per kilogram of your bodyweight. We’re going to give it to you in this specific timing.” So, what they’re doing is they’re looking at frequency, intensity, the time that they’re giving you the chemotherapy, as well as the type of chemotherapy. We can do the same thing using the FITT principle with exercise – Frequency, Intensity, Time, Type – in order to address specific outcomes for cancer patients and survivors.
[29:48] Kathy Smith: Well, going back to the question before about if you’re feeling fatigued, there’s a bit of this periodization that could also happen. Just meaning that you can also pick and choose throughout the course between your chemo treatments certain days. Perhaps, right after, a walk, or just getting outdoors. By the third day, it might be a little bit more training – a little bit of a faster walk. Maybe you can add some strength training in. But I would imagine that you can start to see the course of the two weeks and your pattern, and maybe create a little workout schedule.
You mentioned about journaling that you think logging is really important. Can you explain a little bit why?
Dr. Kathryn: Yeah. So, I actually think that the logging is the secret sauce of the book. The reason for that is, you know, I think that the exercise combined with the logging helps patients to understand what’s happening with their bodies in ways that are not available to them if they’re not moving on a regular basis.
So, if we use the analogy of somebody who is an elite athlete, that person goes out for a run, and they know how their body is on that day. Right? But if somebody goes out for a run, and they haven’t been out for a run for 12 years, it’s all unfamiliar.
Another analogy is: how often do you drive your car? You drive your car every day. If there’s a new squeak or a new rattle, you know it. Right? Then, you know. You can go the mechanic and say, “There’s a new squeak or rattle. It’s not normal.” So, the analogy is somebody who is exercising on a regular basis knows how they feel, and they know how their body feels. If they are logging and they’re saying, “This was hard at a level of four out of 10 today, four out of 10 the next day, and then the next day it’s an eight out of 10,” and you’re wondering, “What in the world is going on? Why is this so hard today?” Then, things just start just being really hard for reasons you don’t understand, you can go back to your doctor and say, “Something’s going on. Something different is happening to my body.” This is a new squeak or rattle, if you will – a new symptom. Physicians trust me.
I’ll give you a great analogy. Keegan Randle is a US Olympian, gold medalist, cross-country skier. She had stage three breast cancer. You’ve got to know that she was training while she was going through breast cancer. If she had a symptom, and it was like a weird symptom and something was different, her doctors were listening to her because she knew her body, and she knew what was happening with her body. So, what I’m suggesting is that the average person, if they start exercising as they’re going through their cancer treatment, and if they have a chance in what they feel is going on with their body while they’re doing their exercise, that can then be reported back to the physicians. That can help the physicians know how to help the patient.
[33:11] Kathy Smith: Yeah. Armed with that extra information, you can just have a better dialogue. As opposed to there’s this joke about Dr. Google I’m sure you’ve heard, but so many people just like… You know, their doctor sometimes, “Let’s Google this.” Which is good sometimes, I guess. There’s a lot of good information…
Dr. Kathryn: Also, you know, if you have a new squeak and rattle, and you’re not exercising on a regular basis, and there’s some new symptom, you might panic and think, “What does this mean? What does this mean?” You know?
If you’re exercising on a regular basis, you come to know your body. You come to understand what various aches and pains are. Then, if something’s new, then you really can trust that you’ve got some helpful information for you physician.
Kathy Smith: So, you think that exercise is so powerful, as you’ve mentioned in your book, and you’ve talked about today. You’re wanting to make it the fourth pillar – I think that’s how you stated it – of treatment. So, combining that with chemo, radiation, surgery, and then exercise. You’re hoping that this becomes just part of every cancer patient’s treatment at one point. Where is it now, and where do you see it going? How can we support that effort?
[34:03] Dr. Kathryn: Right. So, where it is now is that just recently the American Society of Clinical Oncology released a new clinical guideline stating that oncologists should be referring their patients to exercise during treatment for all of the symptom outcomes that we already had recommended were helpful from the American College of Sports Medicine guidelines. So, basically, we have guideline upon guideline upon guideline.
In addition to that, I’m happy to say that I have worked for the past two years with the National Accreditation Program for breast centers on their standards. The new standards that will be coming out as of 2023, 2024, require that breast centers refer their patients to exercise during chemotherapy and in survivorship phase.
So, we have some clinical guidelines that are out there, but there are also some standards that are requirements of accredited centers, and they send their patients to some kind of programming.
There’s also the Moving Through Cancer Taskforce from the American College of Sports Medicine, which lives under the auspices of the Exercise as Medicine program from ACSM. We have a website that includes an exercise directory, that includes 1,800 different programs from around the world. So, people can go to that website and find an exercise oncology professional and program near them, and there are a lot of online programs for people who don’t find something near them.
So, there is sort of a burgeoning list of programs that are out there. But, when it comes to the average person at the average cancer center across the United States, only about 15-20% of patients are reporting that their oncologist is actually talking to them about physical activity during and after their cancer treatment.
So, we have to do better with educating oncologists so that we make it easier for them to be able to talk to their patients about physical activity. We need to train way more fitness professionals to work with this population. Right now, there is actually a small number of fitness professionals who are specifically trained to work with oncology patients. So, that’s a major initiative of the American College of Sports Medicine at this point: to increase that by partnering with an organization from the UK called Can Rehab to train more exercise professionals to work with this population.
Also, the Moving Through Cancer Taskforce has written a booklet that is intended to be an educational booklet for patients, caregivers, and clinicians. I’m happy to say that AbbVie – the pharmaceutical company – has funded us to try to disseminate that booklet across the United States. So, we’ll be trying to get that word out.
But, for the average patient, for the average cancer center, there is a patchwork of likelihood that somebody is going to be connected to high-quality exercise oncology programming. We have to keep the drumbeat up. We have to increase the number of exercise professionals available, train the oncologists, and increase the amount of programming that’s out there. So, it’s a big lift right now. There’s a lot to do. I’m busy!
[38:22] Kathy Smith: Well, anything I can do – and we can talk afterwards – to support your efforts. Because I did. I mean, I went to the website looked at all of the resources, but as we know, it’s one of these things that it can start… There’s got to be ground swells that start in different areas, including the consumer, the friend, the customer, the person out here who has a friend who has just been diagnosed, or maybe they’ve gotten a diagnosis. Now, they go in armed with a little bit more of information, so maybe they can ask some questions. Maybe the questioning then prompts the healthcare provider to get more involved.
But I do see that… I remember back when Exercise as Medicine came on the spotlight – it started to be spotlighted – at the conventions. The idea of convention, at these different conventions. Even that took a while to catch on to what does that mean? How potent is this dose of exercise? When I would give my speeches, I would get the little, “If a doctor told you…” We’ve all heard this before, but I would have a little, like, prescription bottle. “If a doctor told you there’s a pill in here that can reduce anxiety,” blah, blah, blah. The list of 25 things. You’d jump on that pill right away! Okay, I got the pill. Let’s start exercising.
We’ve been giving that message, as you said, for so long for cardiovascular disease, for even diabetes, but we haven’t heard that message that much for cancer. I’m sure it’s out there, but even myself – who, here, is checking in and reading all the time. It’s not what you hear cancer patients talking about that much.
[40:11] Dr. Kathryn: I have this dream of something that could happen. I think it has to do with [inaudible 40:21], the cultural paradigm shift. If you think about it, think about the last time you saw someone with cancer in a TV show or in a movie. Think about what they looked like, and how they were portrayed. They were portrayed likely with a scarf on or bald, very waxy, IV in the arm, sitting with a blanket over their legs. They were pictured near death, and that is not what cancer looks like. Go look in cancer centers; go walk around cancer centers. That is not what cancer looks like. It’s a small proportion of cancer – a very small proportion of cancer – but a lot of people are living with and beyond cancer now.
So, I have this dream of connecting with… There’s an organization at the University of Southern California that is about accuracy in media. They’ve done remarkable work with television shows doing a better job of depicting the truth of what happens with CPR – because CPR was depicted in TV shows and movies as always working. The truth is it doesn’t always work. Right? So, they’ve worked with television writers to get them to depict it accurately.
Well, what if we worked with some television writers that had a storyline that included cancer, and go them to depict a cancer patient walking, exercising, moving?
Kathy Smith: Brilliant. Now, I got chills when you were talking about that because you’re absolutely right. You never see that kind of image on television. It would be so powerful to see somebody in the throws and diagnosis.
Even in your book where you say, “When you get the diagnosis, even if your chemotherapy is going to start – or whatever-therapy – in a month, that golden 30 days (or whatever) to start to build and strengthen and build up your strength so that you can take the hit of a lot of what chemo and radiation does.” I mean, it’s very powerful. To see somebody get that diagnosis, and then go out for their run and say, “Okay, we got this. We’re going to tackle this. We’re going to bring in all of the forces – everything I can do.”
We’ll have to have another conversation. I don’t know… We can’t get into it in this show because we’re winding down now, but I’m sure there’s a whole nutritional element here.
[42:53] Dr. Kathryn: Oh, absolutely. Absolutely. However, I do want you to note that the ASCO guideline that came out – the American Society of Clinical Oncology guideline came out – just in May about exercise and nutrition during cancer treatment. It concluded that there was no evidence that any particular way of eating during chemotherapy made any difference. So, you do need to know that. That doesn’t mean that it doesn’t. It means that the research is not clear. So, we do have really clear evidence that exercising is helpful. We do not have evidence that eating in a particular way is helpful to treatment.
Kathy Smith: Okay. Good to know and thank you for clarifying that.
Well, I have to say it’s a lot to take in. I’m sure that through the years… I’m so proud of you because through the years, I bet there have been a lot of nay-sayers, perhaps, through the times of this research. Have you been welcomed with open arms or through the years have people said, “No, that can’t be accurate,” and you just have to keep piling on the research?
[44:06] Dr. Kathryn: So, the funniest conversations I’ve had were right at the beginning when I was first doing this work and first talking about this work. I was at the University of Minnesota, and I went to Doug Yee, who is now head of that cancer center, and said, “I’d like to do this work in breast cancer.”
He said, “Great! Let’s write a grant.” We wrote it to the Susan Cohen Foundation; we got the grant.
Well, I saw right away that there were opportunities in colon cancer, so I went to the colon cancer group at the University of Minnesota, and I said, “I’d like to do this with your patients.”
They looked at me like I had lobsters crawling out of my ears. So, you know, they were like, “No, we’re not going to let you do that with our patients.”
So, it’s been interesting to watch how this happens. I think that there are different cultures that are more interested in this kind of innovation than others.
One of the stories I love to talk about that is my visit to Israel, and how they had a national program that is an exercise oncology program, that is better than anything I’ve seen in any other country. They did it very early on; they adopted it very early on. They’re actually doing exercise sessions with chemotherapy patients just before they get hooked up to their chemotherapy.
So, I mean, how innovative! There are pockets. There are places where amazing things are happening in exercise oncology. We just need to make it so that…
One of my frustrations, based on what I just said to you a moment ago, is that nearly every cancer center has a nutritionist; they don’t have an exercise trainer. Yet, we know that exercise is useful during cancer treatment. So, let’s fix that.
[45:55] Kathy Smith: Let’s fix that. Okay! I’m on board, and we’ll talk more. As I said, I’ll reach out to you because anything I can do. I’m passionate about this, so anything I can do to help spread the word.
On that note, I’m going to say goodbye. I’ll do my wrap-up, but I’ll mention all of the websites, the book, where you can get it all. We’re going to have it all in the close and in the liner notes so that people can find you. Not necessarily call you – we’re not giving the phone number. But, you know, find you, find your book, find everything that you’re doing, and become an advocate, and/or just learn more about the process – especially people who are going through or have had a diagnosis recently.
So, I thank you. I thank you for all of your work. Can you sign off by just…? You don’t have to do the longer version, but for the audience out there listening and watching, when Kathryn came on, she said before being a doctor she was a dancer and was into fitness in the ‘80s. Guess whose videos she kind of looked at a little bit?
[47:05] Dr. Kathryn: Yes! So, I’m on my third career. My first career was a professional classical dancer. I was a Graham dancer in my youth in New York City. I was tired of being poor, so I got into fitness training back in the late 1980s. As I was learning how to be a fitness trainer, I was really interested in as much excellence as I could find, and what was the highest bar that I could reach for. The highest bar I could reach for was Kathy Smith. I watched your videos endlessly! I listened to how you queued. I paid attention to your warmth in those videos, and how human you were with everyone. I felt like I was in the room with you, and I wanted people to have that experience with me when I was a fitness trainer. I modeled my work after you, and I just…
Kathy Smith: You are such a doll. That is such a great story. Okay. Well, we’ll end on that. My heart is filled for many different reasons. But thank you for being on this show. Look forward to continuing dialogue and helping get the message out.