As of 2017, there are 200 dragon boat teams in 26 different countries dedicated to breast cancer survivors. Twenty-two years ago, there were none. Many rehab experts believed that regular strenuous exercise was too risky. In particular, they expressed concerns about possible lymphedema, swelling of the lymph nodes in the upper arm area. Had it not been for Dr. Donald McKenzie of the University of British Columbia (UBC), this might have stayed the prevailing wisdom. McKenzie recruited and trained a team of breast cancer survivors who competed in the first dragon boat festival in North America in Vancouver, Canada in 1996; they showed that strenuous upper-body exercise could not only be safe but actually therapeutic. We’re thrilled that Dr. McKenzie was willing to answer some of our questions.
MF: I understand that in addition to your academic background, you’ve been a paddler yourself for much of your life.
DM: I was a competitive flatwater (sprint) paddler for many years. I also competed in outrigger, downriver and dragon boat. I still am involved in dragon boat, longer distance kayaking and surfski (a form of kayaking devoted to speed in open water).
MF: What’s been your own experience paddling a dragon boat? What was your first time like?
DM: The first dragon boat arrived in Vancouver in 1986 for the World’s Fair (EXPO 86’). They were delivered to False Creek Racing Canoe Club where I was a member. We paddled them in EXPO and later the Vancouver Dragon boat Festival started. Compared to flatwater kayaking they are stable and slow but the teamwork aspect is fun.
MF: How did the Abreast in a Boat team come about?
DM: The issue was lymphedema (swelling of the lymph nodes). I had a patient who refused to do some exercises for her shoulder problem because she was worried about developing lymphedema. I started Abreast in a Boat to challenge that myth. Dr. Susan Harris, also of the University of British Columbia and the lead author of the paper “We’re All in the Same Boat” that documented the benefits of dragon boat racing for survivors was one of the original paddlers for the team.
MF: What’s been your involvement with the sport since 1998, both as a promoter and participant?
DM: I have coached, acted as medical director and continue to give talks and do outreach projects (help new teams get started). I am the Chair of the International Canoe Federation Medical Committee, so am heavily involved in competitive canoe racing .
MF: You had the great honor of being awarded the Meritorious Service Medal in 2001 for your contributions to changing views about the benefits strenuous exercise for breast cancer survivors. Where do you keep the medal?
DM: It is in a drawer in my home.
MF: I’m a little compulsive, so I have a couple science questions. I noticed that the early studies on the benefits of paddling for breast cancer survivors –including your own– were relatively cautious: they mostly claimed that regular strenuous exercise didn’t make lymphedema (swelling of the lymph nodes) any worse. Dr. Harris’s “We’re All in the Same Boat” is similarly cautious as late as 2012. Laura Stefani in 2015 and Kathryn Schmitz in the New England Journal of Medicine 2009 both appear to claim that paddling or weight lifting actually have a positive impact on reducing or limiting lymphedema.
DM: There is ample evidence to show that strenuous exercise, if preceded by some training, does not cause lymphedema. With some patients with lymphedema, we have seen some remarkable improvements.
MF: Dr. Harris cited Ibrahim and Al Ahmadi’s research that indicated that survivors engaging in strenuous physical exercise tended to live longer. They also indicated that estrogen-receptor negative cancers do not seem to show the same positive effects from regular strenuous exercise. Is it still beneficial for women with estrogen-receptor negative cancer (20-25% of breast cancers) to engage in dragon boating?
DM: Yes, there are many reasons to exercise. It improves the quality of life and has measurable benefits in physical and mental health.
MF: The early literature refers to dragon boating as a “complementary therapy” for breast cancer survivors. Is dragon boating just a complementary therapy or can we now say that it has more direct benefits?
DM: It has direct benefits.
MF: Are you still doing research of your own on the impact of paddling on breast cancer survivors?
DM: Yes, more on exercise per se rather than just dragon boat paddling
MF: What topics are you currently researching?
DM: Genomics, proteomics and metabolomics. The molecule to the organ; breast cancer interaction with exercise.
MF: If you don’t mind, I have some less wonky questions. There now appear to be 200 Cancer Survivor Dragon Boat teams in 26 countries. How many have you heard from?
DM: Lots, we get together every 3-4 years at participatory regattas. Next one is in Florence in 2018.
MF: Because it’s primarily upper body, I’ve wondered if dragon boat paddling has gotten traction with paralympic athletes. Are you aware of rehab or survivor teams beyond breast cancer survivor teams? (many breast cancer survivor teams include survivors of all forms of cancer and some include men)
DM: There are lots of teams that use dragon boat paddling in rehabilitation. In Vancouver we have teams that have chronic kidney disease, multiple sclerosis, solid organ transplants, kids recovering from central nervous system cancers and a team that is visually impaired. I was involved with the ParaCanoe athletes who were in the Games in Rio last year. The kayaks are modified for stability and the Canoes are essentially a single outrigger. Many of these athletes also compete in DB.
MF: What are the prospects for dragon boat racing to gain Olympic status?
DM: Zero. There is an athlete quota for canoeing at the Games; it’s about 360 athletes total, for slalom and sprint. There are 170 countries that have competitive athletes in canoe sports and if all the quota went to DB there would only be ~18 entries. It’s not going to happen.
MF: You’re the father of a movement which by its nature mostly involves women. You’re on the advisory board for IBCPC and a male researcher who’s been an advocate for a major women’s health care issue. In the current U.S. Health Care debate, there’s been serious concern about men dictating health care policy for women at the political level. Do you feel there are cultural differences between Canadian and American attitudes about gender specific health care issues?
DM: There are definitely differences between Canada and America when it comes to health care and I am sure that we are not dictating policy for women. Our Federal Health Minister is a woman. As far as the dragon boat paddling goes, it is driven completely by women with the disease.
MF: For the paddlers out there who can’t get on the water year round, I’ve noticed that most gyms have rowing machines, but I’ve never seen indoor exercise equipment dedicated to paddling. Are there any?
DM: There are some reasonable paddling ergometers but this aspect of the sport has never had the profile of the rowing erg with International competitions, ranking, Master’s events, etc. Just never had the consistency in the ergometer numbers. We do use them for testing the elite athletes.
MF: Dr. McKenzie, thanks for taking time from your very busy schedule.
DM: You’re welcome. Best of luck with your dragon boat festival on September 23!