Built environments have vast effects on the ways we move throughout our day. Jeff Sledge, a research scientist in the Department of Planning and Landscape Architecture, is interested in how they can help us heal.
Collaborating with researchers at UW-Madison and Indiana University’s Melvin and Bren Simon Cancer Center, Sledge developed tools that assess breast cancer patients’ energy capabilities during and after treatment and created individualized interventions based on their physical locations and movement patterns to lead them on paths to better health.
Regaining strength after chemotherapy or hormone therapy is difficult yet crucial. Many doctors prescribe exercise, but every woman is different, says Sledge.
“What physicians were missing were the tools and algorithms to deliver the specific metrics that informed them about where women are in their energetic capacity as they progress through disease treatment and beyond,” he says.
The tool Sledge and his team developed, the Power Protocol™ Test, provides those metrics. And it prompted them to use technology to help patients regain strength lost while battling cancer.
Why is energy important in patients battling breast cancer?
Patients going through primary therapy — such as chemotherapy and hormone therapy — often experience extreme fatigue that leads to diminished mobility, lack of ability to accomplish daily tasks and a loss of quality of life. It has long been assumed that these “symptoms” abate over time.
In our first clinical study in an oncologic setting, we were trying to find out how much motive capacity a woman has near the time of diagnosis and then how various types of therapies affect her ability to generate power and her body composition. We ran assessments at baseline and after six months and twelve months.
What we found was that patients’ energetic capacity worsened as they went through chemo and hormonal therapies — many lost more than 20 percent of their motive capacity post-therapy. At the 12-month mark there was little to no spontaneous rebound in their abilities.
Scans also revealed an often-alarming drop in lean mass and an increase in fat mass post-therapy. A growing body of evidence directly links physical activity and physical function to both the odds of developing breast cancer and the ability to survive the disease and minimize the risk of recurrence.
This trial provided us with new and deeply challenging information on how chemo and hormonal therapies were affecting an individual’s ability to move not only during treatment but potentially for the balance of her life.
How did you use these discoveries?
My prior research revealed that most people are deeply habituated to the energy demands of their local environments. How we design the places where we live and work can directly impact how well and how long we live. From a disease intervention perspective, if we don’t meet people where they are — quite literally on the street where they live — we will miss the mark in changing the arc of their long-term health.
In the system we developed for breast cancer patients, a woman wears a GPS-enabled biometric monitoring device that relays near-real-time information about her patterns of movement and condition to our system. Our analytics give the physician and patient guidance that is designed to meet specific clinical outcomes by making daily incremental changes in the patient’s movement patterns using her own environment — right down to the block she lives on or what she does on her lunch break. Instructions come via texts, e-mail and push notifications to the wrist-worn bio-monitor and change based on the information coming into the system.
The result of that work is called iMETx™Therapy. iMETx entered clinical trials in 2017 and our final research patient started therapy in mid-September. The results have been very encouraging. Patients are complying with movement recommendations, we are seeing above-predicted transformations in their body composition and physical capability and in some cases, patients are being taken off of drugs as their condition improves.
Both Power Protocol and iMETx are headed to a life of their own outside of the university.
From a disease intervention perspective, if we don’t meet people where they are — quite literally on the street where they live — we will miss the mark in changing the arc of their long-term health.
As you look back on this work, what has it meant for you?
I take seriously the challenge of working to create novel solutions to complex health problems and to improve quality of life.
But it is the patients — the women in the studies — who give the work its full meaning. Over the years we have asked our clinical trials patients to undergo difficult tasks on some of the worst days of their lives so that we can extract small parcels of data that build to provide new insight and new knowledge. It is an enormous request and these women come forward without complaint and without expectation. They have always been my real heroes.
How does your work with breast cancer patients relate to other work going on in your department?
It always raises a few eyebrows when people learn that my academic home is within Planning and Landscape Architecture. But for both historic and contemporary reasons, it makes sense: 150 years ago, the disciplines of urban planning, design and public health were actually one and the same. Urban spaces were deeply linked to a broad sweep of health harms, from communicable diseases or toxic industrial contaminates near or in buildings where people lived, to poor respiratory health from unregulated burning. It was the nascent profession of urban planning that was at the forefront of change, creating enlightened policy from research and driving civic infrastructure investment to improve health. Over time the disciplines diverged, but the underlying goals of health, safety and welfare never left the lexicon of planning or public health.
Today’s urban planning and design are at the nexus of health and built environment issues. My colleagues in DPLA study and are engaged with communities on a broad range of questions including site design, transportation, recreation, finance, law, urban food system, disparities in housing and health equity. My work on movement and metabolic health dovetails into all of these areas.