Lecture 2 - Cancer And Exercise Flashcards
Side effects/Adverse events of Cancer and it’s Treatment.
Increased:
-fatigue, depression, anxiety, weight gain, risk of other cancers, CVD, diabetes and osteoporosis risk, functional decline
Decreased:
-physical activity, QOL.
Benefits of increasing PA:
Decreases side effects/adverse events of diagnosis, surgery and treatment:
- Decreased fatigue, depression and anxiety, CVD , diabetes, and osteoporosis risk, risk of recurrence, risk of new cancers, all cause mortality risk.
- Increased: QOL, weight loss and weight maintenance, overall survival, cancer specific survival.
Why recommend exercise to cancer patients and survivors?
Many cancer patients and survivors have lifestyles that could contribute to a recurrence an/or poor QOL
Exercise and prostate cancer survival: Statistics
Men with > 3 hrs per week of vigorous activity had a 49% lower risk of all-cause mortality.
61% lower risk of PCa death.
Benefits for symptoms and toxicities:
Aerobic exercise= reduced nausea & body fat.
Decreased = fatigue,
Increased = muscle function, physical performance, aerobic exercise, QOL, body comp.
General increases=
- muscle and bone tissue mass
- cardiorespiratory fitness
- max walk distance
- immune system capacity
- physical functional ability
- flexibility
- muscle strength
- QOL
- haemoglobin
General Decreases=
- Nausea
- body fat
- fatigue
- symptom experience
- duration of hospitalisation
- anaerobic energy reliance
- heart rate
- resting systolic BP
- insulin and IGF1
- Estrogen in women
- psychological and emotional stress
- depression and anxiety
Benefits of exercise before cancer treatment:
Exercise intervention pre-treatment:
- high completion rates and adherence
- improves muscle strength, cardiorespiratory fitness, motivation.
Benefits of Exercise During cancer treatment:
Reduced :
- incidence and severity of fatigue
- incidence and severity of depression
- incidence of lymphoedema
- incidence and severity of anxiety
- incidence and severity of sleep disorders
Improved positive mood
Increases physical reserve capacity
Benefits of Exercise Following cancer treatment:
Improved functional capacity
Reduced incidence & severity of comorbid conditions
Improved overall QOL
Improved survival
Generic exercise prescription:
Mode- Aerobic= 150min p/w moderate intensity [RPE 5-6 out of 10]
120 min p/w vigorous intensity [RPE 7-8 out of 10]
- Resistance = 6-10 exercises, 6-12RM, 2-3x p/w, 3-4 sets per exercise.
ACSM Roundtable on Exercise guidelines for Cancer Survivors:
Exercise is safe during and after cancer treatments
Results in improvements in physical functioning, QOL, and cancer-related fatigue in several cancer survivor groups
Cancer survivors to follow PA Guidelines, with specific exercise programming adaptations based on disease and treatment-related adverse effects
Advice to “avoid inactivity” even during difficult treatments
Overall objectives of exercise prescription:
- regain and improve functioning, aerobic capacity, strength, flexibility
- improve body image and QOL
- improve body composition
- potentially reduce or delay reoccurrence
- reduce and prevent long-term and late side effects of treatment
- improve capacity to withstand future treatments
Principles of Exercise Testing and Prescription:
Each parameter measured must be relevant to the improvement of cancer survivor’s outcomes
All procedures valid and reliable
Protocols consistent and rigidly controlled
Patient’s rights protected
Testing repeated at regular intervals
All results reviewed and discussed with patient
Report provided to referring doctor
Tests inform the exercise prescription
When do you need a Medical clearance:
If patient is over 35yrs of age
Has any primary risk factors for cardiovascular diseases such as: family history of heart attack or stroke, high BP, high cholesterol, existing cardiovascular disease
Overweight
-need to consult doctor before starting an exercise program
History of cancer Diagnosis and Treatment:
- Diagnosis
- types of treatment
- first cancer, other cancers?
- treatment ongoing, finished, more to come?
- if complete, when was it finished
- for each treatment, consider possible side effects
Consider functional changes of surgery, radiation, chemotherapy, hormone therapy:
Changes in function, ROM, Strentgh declines, endurance declines, other side effects.
Surgery- what surgery was performed
Radiation- what was the site?
Chemotherapy - what drugs?
Hormone therapy - ongoing ? Type of treatment? Other treatments to offset side effects
What are Cancer Specific contraindications to exercise testing:
- Relative and absolute contraindications to exercise testing - follow ACSM Guidelines
- ACSM recommendations in cancer
- Monitor HR, BP, breathing frequency
- RPE [should not exceed 11-13 for submax tests]
- compromised skeletal integrity could make some tests inappropriate
- time of day could impact fatigue and other symptoms
Name 6 Precautions:
Severe anemia = delay exercise until improved
Compromised immune function = avoid public guys and other public places until WBC counts return to safe levels
Severe fatigue = encourage low vol and intensity training
Radiotherapy = avoid chloride exposure to irradiated skin
Indwelling catheters= avoid water [risk of infection], resistance training of muscles in the area of the catheters
Peripheral neuropathic or ataxia= reduced ability to use affect limbs
What test to perform?
- Is the parameter required for /Imortnat to the patients goals, or the intended training program?
- Does the client report issues/problems with that parameter?
- is the information required for exercise prescription?
These could guide wether a test of the parameter is required
The assessment need to fit the activity - tests need to fit the program and amity of the client
Name 8 Assessments that could be used:
Healthy history questionnaire [General Health Questionnaire - medical history, family history, current meds, lifestyle]. Height, weight, waist girth Resting heart rate Resting blood pressure Resting pulse oximetry Pulmonary function Blood profile DEXA for body comp and bone density
Aerobic capacity tests:
400m corridor walk - easy and no equipment
Step test
Cycle test
Metabolic measurement
Strength Tests:
1RM testing
Multiple repetition testing
Isometric testing
Isokinetic testing
Flexibility testing:
Sit and reach
Goniometry
Physical function tests:
6 metre walk = normal, fast, tandem, backward tandem.
Balance - SOT
Sit to stand
Stair climb
Quality of Life
SF 36
Cancer specific questionnaires: QLQ-C30, Prostate Specific
Depression and Anxiety Assessment
DASS
BSI-18
Selecting an Exercise Program:
Has to work for the patient and fit with: Time available Geographic location Disabilities Economic circumstances Family and friends Personal preferences
Warm-up
May reduce the susceptibility to musculoskeletal injury by improving joint ROM and reduce risk of adverse cardiovascular events.
Exercise Order
Generally, anabolic before aerobic
Anabolic exercises should generally follow these rules in terms of ordering:
-large muscle groups first [e.g. legs]
-multi-joint exercises [e.g. bench press] before single joint [e.g. elbow extension]
-abdominal and lower back exercises after whole body ground based exercises such as squat, deadlift, bench press, etc.
-this is to avoid pre-fatiguing the muscle groups which stabilise and support the trunk
-also important NOT to program abdominal and lower back exercises last sa the person may often be getting tired and drop them from the program
These exercises are very important for posture and protecting the lower back and must be completed during each session.
Exercise Programming 1
1.
Objectives: increase = physical/physiological/psychological
Decrease = risk treatment induced-comorbidities
Aerobic
30min, ACSM= 5x p/w moderate int. [5-6/10], Prostate studies= 15-45min 3-5x p/w
20min, ACSM= 3x p/w vigorous int. [7-8/10], Prostate studies= 60-70% HRmax or 50-75% VO2max
2.
Resistance, ACSM= 8-10 exercises, 10-15RM, 2-3x p/w at least 1 set;
Prostate studies= 8-12 rep, 60-70% 1RM, 3x week [2 sets]
6-12RM, 2x week
6-12RM or 50-80% 1RM, 1-3x week [ 1-4 sets]
Flexibility, ACSM= 10-30s static stretch [3-4 sets] same day of aerobic/resistance.
Prostate Studies= 10-30s 2-3x week [2-4sets] per muscle group.
- Contraindications - ACSM/AHA guidelines unstable disease.
Reasons to stop - same as exercise testing, acute postoperative phase
Risk of injury - bone metastases risk of fractures, single report of non fatal MI
Considerations - No data
Why Cool Down is important:
Gradual recovery from the specific activity performed and includes exercises using lower intensities.
Allows appropriate circulatory adjustment of HR, BP to near resting values, facilitates dissipation of heat, reduces potential exercise hypotension and promotes removal of lactic acid.
Describe over exercising:
Volume and intensity beyond which body cant adapt- over training.
Very unlikely in non-athletes
Signs: Increased incidence of injury Very low body fat or sudden weight loss Increased incidence of upper respiratory infections Anaemia Sleep problems Increased resting HR Persistent muscle soreness Depression Irritability Decreased appetite.
How to prevent Over-Exercising:
1 day each week should be exercise free or very light recovery
Avoid repeating the same type of exercise on consecutive days
Allow at least 48hours between RT on the same muscle group
Measure resting HR each morning on waking to detect increases
Keep exercise sessions to less than 60 min
Why use a 12 week plan?
It’s a workable strategy because its long enough to allow variation in volume, intensity, and activity type while also being sufficient to produce significant and observable improvements in health and fitness.
This plan can then be repeated or modified according to the season’s, exercise opportunities, and increasing fitness.
Graduation
Transitioning to Graduation
Can’t stay with clinic forever
From day 1 we prepare patients for graduation
Manage expectations
Education on home exercise
Experience in fitness centre - incursions
Transitioning - increasing external sessions
Barriers to Exercise
Not easy Cancer patients face enormous hurdles not the least fatigue Doctor is usually greatest motivator Education as to importance Doesn’t have to be expensive Any is better than none Religious and cultural issues
Sample prescriptions: Home based anabolic [gymstick, there and, and dumbbell]
Warm up Squat Upright row/ bent over row Lunge Kneeling press Sit-ups/crunches Shoulder press Cool down
Conclusion
Cancer patients can tolerate and enjoy a structured exercise program Meaningful improvements: Strength Endurance Functional capacity Body comp QOL and symptom experience Social functioning Fatigue
