Lecture 3 - Cancer & Exercise Flashcards
Exercise as medicine for Advanced Cancer:
Define Advanced Cancer:
AC is a primary cancer that is unlikely to be cured
AC is a secondary metastatic Cancer that’s unlikely to be cured
Why could exercise be important in advanced cancer?
Those with best cardiorespiratory fitness have longer survival
Those that are more physically active have better QOL, anxiety, and depression.
What are the goals of Exercise for Advanced Cancer:
Improve or maintain QOL, well-being
Maintain/improve functional independence
Maintain/improve cardiorespiratory fitness and muscular strength
Manage symptoms such as fatigue and cachexia
Exercise & Advanced Cancer: Evidence in advanced lung cancer
Evidence suggests:
It’s safe and feasible with acceptable completion rates
Results in improvements in: functional capacity & strength
Results for QOL are mixed
Advanced Cancers: Stage IV
Exercise prescription is tricky [Tumour burden, side effects of treatments and tumor]
Beware: Bone Mets Pain SOBOE Cognitive changes [Brain mets] Changes in organ function as a result of tumor [SVCO] Medication to treat side effects Depression/anxiety Deconditioning
Depends on extent of disease spread
Cancer can progress or change quickly
Advanced cancer - Bone Mets
Bone disease:
- use extreme caution, need to work with clinicians
- avoid contact sports or activities
- activities with high risk of falls/injury
- avoid high impact activities, heavy lifting, twisting & turning
Exercise in water:
- aqua size
- strengthening exercises
- swimming
Stationary bike/recumbent bike
-low resistance
Proceed with caution
Advanced Cancer: Goals & Guidelines
Goals:
- needs to have a focus on QOL
- maintaining function
- spending time with family
- home-based
- avoiding activity
No Guidelines
Little research
Proceed with caution and multidisciplinary team
- need to communicate with care providers
- physical therapy, OT, dietician, physician, nurses
Exercise:Children & young adult survivors of cancer
Limited research
Exercise resulted in positive intervention effects for:
- body comp
- flexibility
- cardiorespiratory fitness
- muscle strength
- health related QOL
Cancer Specific Side Effects Fatigue:
Rest doesn’t relieve CRF
Deconditioning makes fatigue worse
-decreases in cardiorespiratory fitness can precipitate and exacerbate CRF
Exercise needs to be appropriately prescribed
- can prevent, alleviate, and manage CRF
- aerobic exercise had moderate effect for those completed treatment
- exercise had effect during treatment
- multimodal exercise also effective [aerobic + resistance + stretching]
Role for education
Exercise Prescription based on fatigue severity: Mild Fatigue [<3/10]
Start with appropriate ACSM recommendations coupled with a RT program in line with standard guidelines
Exercise Prescription based on fatigue severity: Moderate Fatigue [4-6/10]
Start with repeated short bouts of aerobic activity [5-10min as tolerated], progressing to 60-80% of HRmax
Progression should increase freq and duration prior to intensity
RT should include the major muscle groups, but could need to be prescribed to a low intensity [e.g. 30-50% of 1RM], with high reps [e.g. 10-15], for 1 to 2 sets. Progression to a standard prescription should occur over time.
Exercise Prescription based on fatigue severity: Severe Fatigue [7+/10]
Prescription could begin with low intensity bouts of aerobic activity [e.g. 5-10 min] spaced throughout the day
Duration should be progressed gradually as tolerated
Referral to a Physio for active ROM, gravity only resistance, or light weight if tolerated.
Tips for Avoiding Fatigue:
Program considerations:
-RT = increases recovery between sets [2-3min between sets, decreasing recovery time can be used as a variable for progression]
=use lighter loads and higher reps
=decrease intensity if fatigue gets worse
=progress slowly
=break training up into smaller bouts
RET alone might be necessary for the first 6-12 weeks in very fatigued survivors.
Describe Lymphoedema:
Caused by abnormality of lymphatic system
- secondary to surgery radiation
- melanoma or breast
- head and neck, prostate
Upper or lower extremity
Leads to build up of protein rich fluid and cell debris
Causes swelling
Left untreated can cause :
- chronic inflammation
- infection
- hardening of skin
- could cause further lymph vessel damage
Can develop immediately - or weeks, months, years later.
Risk of lymphoedema increase with obesity
Early detection and treatment important
Who’s at risk of developing lymphoedema?
Those with:
- sustained damage to lymphatic system due to surgery or radiation therapy
- surgical incision in vicinity of lymph transport vessel
These risks could change over time depending on factors such as:
- weight gain
- age
- changes in delicacy conditions
Symptoms of lymphoedema:
Feeling of heaviness or tightness
Notice swelling or puffiness in affected area
Arm/chest becomes hot or red
Full sensation
Tightness of skin
Decreased flexibility in hand and wrist
Difficulty fitting into clothing in one specific area
How to avoid exacerbating lymphoedema:
Incorrect or unsafe exercise may increase risk of lymphoedema
Beware cuts, bruises, as risk of infection high
Skin care very important
Avoid trauma - avoid falls, and injuries
Follow advice of treating physician or physio - compression, or other treatments
Avoid taking BP on affected or at risk arm - if necessary use tactics to reduce high pressure of measurements
Be cautious with use of hot/cold therapies
Exercise Prescription
Recommended for those at risk for and with a diagnosis of lymphoedema
Program should start low and progress slow
- 40% of 1RM to start, no weight, or very low weight
- very gradual progression [smallest increments possible after 2 sessions of reaching the desired repetition range]
Exercise should be:
- started gradually
- increased cautiously
- stopped for pain, increased swelling or discomfort
Beware of participants with breaks in training
-reduce intensity and gradually increase
Monitor for symptoms
Avoid high stress or inappropriate tests
-push up test
Use caution with 1RM testing
- e.g. bench press
- complete a warm up of 5-10 min of low intensity aerobic exercise
- warm up with 5 lbs of weight on chest press
- resistance is added until can no longer perform the complete movement without change in biomechanics, or failure.
NLN position stand: Recommendations
Participants should be cleared by physician before beginning a program
Should perform aerobic and resistance exercise in ‘safe manner
Allow adequate rest between sets
Avoid weights that wrap tightly around extremity or clothiers that cause constriction
Wearing a compression garment when recommended
Maintaining hydration
Avoid extreme heat or overheating
Incorporate variety
Form is very important
Avoid repetitive use
Sudden increases in usual exercise duration or intensity could trigger or worsen lymphoedema
Slowly progressive exercise could decrease risk of overuse.
Cancer-specific Side effects: Other
Effect of exercise on cancer related cognitive impairment - insufficient evidence
Peripheral neuropathy
Limited evidence in cancer
- balance training appears to be the most effective
- strength, or a combination of endurance and strength, appear to have a lower impact.
Immunology
Neutropenia or low white blood cell count due to the effect of treatment can result in a increase risk of infection
Sign and symptoms- fever, sore throat, SOB
Exercise recommendation during time of infection include: avoid high intensity exercise, exercise to ability to tolerate activity, avoid public places with increase risk of infection.
Neurological:
Neurological issues such as:
- impaired sensation [numbness, tingling] in the extremities
- brain foggiest, chemo brain
- seizures
- impaired balance and coordination
Exercise recommendations with these conditions:
-wear good shoes
-avoid exercise that requires high levels of coordination
-walk on even surfaces
=increased risk of thermal and ischemic injury of the extremities if your ability to feel hot or cold temp is impaired
-use caution with balance exercises
-use caution with activities such as treadmills, free-weights
Peripheral Neuropahty
Impaired sensation in the extremities as a result of cancer treatments may pose specific risks when exercising
Wear good shoes
Walk on even surfaces- increased risk of falls and injury if you cant sense change in terrain while walking
Protect extremities of hot and cold when exercising
Use caution with balance exercises
Use caution with activities such as treadmills
Blood pressure alterations
Haematological
Anaemia or low RBC count can be cause by cancer treatment
Sign and symptoms:
- SOB
- dizziness, chest pains extreme fatigue
- cold hands and feet
- irregular HR
Exercise recommendations for these patients include:
- avoid high intensity exercise
- reduce volume till condition is resolved
- delay exercise if severe anaemia
Catheter or an ostomy:
Certain treatment commonly used catheters for treatment purposes and usually are inserted just under the skin in the forearm, upper arm, or chest.
These sites are susceptible to bleeding or infection and there is a possibility it may move position or pull during exercise movement
Consideration for exercise include:
- measure BP with other arm
- avoid vigorous exercise
- avoid repetitive upper limb exercises
- avoid swimming
Some cancer survivors have a stoma and wear an ostomy bag for waste removal
Consideration for exercise include:
- avoid vigorous abdominal exercises - low level is suitable
- care need to be taken as this new stoma is a route for infection
Shortness of breath
Common and distressing symptom
Research indicates that 85% of patients report suffering from intermittent SOB that largely tends to be brought on by exertion
Deconditioning, muscle weakness, and loss of cardiovascular fitness can make sob worse
Being inactive can lead to a downward spiral of sob
Seek medical advice Encourage to remain physical active Take frequent breaks Use interval training if appropriate Start slowly and build up slowly Take breaks when required Avoid supine exercises Try relaxation techniques to manage anxiety Use RT, induces less SOBOE Being active can help with ‘sensitisation’ to sob
