When most people think of aging, they envision graying hair and lines on the face. But for many cancer survivors, aging can take on a different form: one that begins at the level of the heart, muscles, and even the regulation of genes. In the years after cancer treatment ends, many survivors face the invisible challenge of biological aging at the cellular level — caused by the cancer treatments that saved their lives.
“Therapies such as chemotherapy and radiation are designed to target rapidly dividing cancer cells,” noted Dr. Savannah Rauschendorfer, director of the Clinical Exercise Oncology Laboratory at Baylor, “but they can also affect healthy tissues throughout the body.”
These “off-target” effects, she said, can be long-lasting and, in young adults, may not become fully apparent until years after treatment has ended.
It’s becoming increasingly understood that cancer-free survivors face elevated risks of cardiovascular disease, she said, or other chronic conditions typically associated with aging.
“After cancer care is finished,” she said, “individuals then enter into cancer survivorship where they have a higher risk of comorbidities like reduced cardiovascular function, loss of muscle mass, and metabolic dysfunction.”
What helps reverse this epigenetic aging? More and more research in the field known as exercise oncology points to moving the body. (A quick Google search reveals more than a thousand randomized controlled trials that confirm the benefits of exercise for mitigating non-targeted cancer treatment side effects have been conducted since 2019.)
At Baylor, Rauschendorfer is studying what kinds of structured exercise interventions can preserve or restore healthy biological function by either slowing treatment-related aging or by reducing the risk of chronic conditions in cancer survivors to begin with.
“Many people understand the detrimental impact of radiation and chemotherapy during treatment,” she noted, “but what is less known outside of the medical community is the way cancer therapies can accelerate biological aging by disrupting epigenetic regulation, leaving long-term molecular damage. In other words, cancer patients are known to experience accelerated epigenetic aging, and are actually biologically older after treatment, shown by their accelerated DNA methylation.”
Specifically, Rauschendorfer’s lab is looking at how exercise may modify molecular markings of aging and “shift the body to a younger biological state,” she said. “My research looks at how to slow down or prevent the higher risks of other issues in cancer survivorship.”
In addition to studying exercise during survivorship, she is interested in “prehabilitation,” or interventions that take place before or during treatment to improve baseline health and potentially reduce the severity of treatment-related side effects.
It is already known, she said, that traditional endurance and resistance exercise has an impact on epigenetic aging, but precisely what combination of exercise works for different age groups with different morbidities and different levels of overall health or fraility?
“Not all patients experience treatment-related aging in the same way, and responses to exercise interventions can vary,” she explained.
Part of her work, for example, is to identify an intervention that could potentially reverse this aging with an exercise regimen that is not too intense for patients to do in a weakened or frail state.
“We’re looking to tailor an exercise prescription that matches the physical capacity of an individual,” she said. “We also look at individual patients to see which types of exercise they can and are willing to maintain.”
For inspiration, she said, her lab keeps an eye on innovative, and novel models coming out of sports science that combine approaches for physical therapy and sports performance.
Rauschendorfer also noted that almost 20 years ago, Dr. Robert Sallis proclaimed, “Exercise is medicine,” while serving as president of the American College of Sports Medicine.
“It’s just something we learn over and over again,” she said. “Exercise has all the benefits that we could potentially imagine, but with none of the negative side effects that pharmaceutical drugs have. It’s so much more than just exercise, it’s medicine for our health and well-being.”
Rauschendorfer, who came to Baylor in 2024, has always made exercise part of her life, she said, but it wasn’t until she was in graduate school that it changed her life. Born in Indianapolis, she is the first person from both sides of her family to graduate from college. She received her MS in clinical exercise physiology from the University of Miami, and her Ph.D. in exercise physiology from the University of Texas at Austin. She went on to complete her postdoctoral fellowship in Houston at MD Anderson Cancer Center in the Department of Pediatric Research.
“While completing my dissertation work in a population of GI cancer patients, I implemented an exercise program for patients before their abdominal cancer surgery,” she said.
The goal was to see whether improving patients’ physical condition before surgery could affect their recovery afterward. The data showed that it did: Patients who participated in the program improved their physiological reserve. Their bodies were better equipped to withstand the stress of surgery and recover more effectively. But what struck her just as much, if not more, was that patients experienced a noticeable shift in how they saw themselves.
Many entered the process feeling overwhelmed, passive, or defined by their diagnosis, she noted. Through the program, they began to feel a sense of agency again — like they could actively participate in their own care.
“I got to see for the first time how all-encompassing exercise could be,” she said. “There was an almost tangible confidence that these individuals gained from exercise, going from feeling hopeless, or out of control, or victimized, to feeling in control over their health and grateful for their bodies.”
The genuine gratitude they expressed after their surgeries moved her deeply.
“Seeing their incredible transformation is what made me want to go into this field for the rest of my life,” she noted.
It’s not just about extending life, she said, but to improve its quality and durability.
“I hope that’s what we can offer the Waco community and this central Texas area,” she added. “We’d like to be a resource to offer the right kind of exercise intervention to help cancer survivors.”
