Lexi Harlow, DPT, CLTPhysical Therapy DepartmentSeattle Cancer Care Alliance
June 26th, 2010
Presentation Topics1) What are the benefits of exercise?2) How can exercise help cancer survivors?3) What does research on survivors tell us about the
importance of exercise?4) How much and what should I do for exercise?5) How can physical therapy help me?6) What exercise programs are available for cancer
survivors?
General Benefits of Exercise
Cardiovascular fitness Building muscle strength
Cancer and chronic disease prevention
Weight loss Improve balance Osteoporosis prevention
Decrease depression Energy boost Improve sleep quality
PHYSICAL EMOTIONAL
lifestyleguide.us
How Can Exercise Help Cancer Survivors?
The benefits of exercise and physical activity can help survivors to address some of the side effects of surgery, chemotherapy, and radiation.
Possible Side Effects of Surgery Scar tissue restrictions Limited range of motion or flexibility
Possible Side Effects of Chemotherapy
Change of body image‐Hair loss‐Weight gain or loss
Diarrhea or malnutrition Peripheral edema
Fever, risk of infection Orthostatic hypotension Peripheral neuropathy Balance loss
Possible Side Effects of Radiation
Fatigue Osteopenia Neutropenia Radiation induced fibrosis contracture
Fragile skin or tissue
What Do Survivors Notice? “I can’t get my shoes on anymore.”
(Edema or swelling in feet) “I can’t lift what I used to be able to.”
(Decreased strength or muscle mass) “I catch myself stumbling or reaching for the wall.”(Decreased balance and safety)
“I need someone to help me do chores around the house.”(Decreased independence)
“I have to rest when going upstairs or on inclines.”(Decreased endurance)
Do Survivors Need Exercise?
Research: Survivors and Exercise
“Survivors tend to decrease their physical activity levels after their diagnosis of cancer, and most continue lower levels of activity through treatment and beyond, rarely returning to their pre‐diagnosis levels of activity.”
Irwin, Crumley, McTiernan, et al. 2003; Courneya & Friedenreich 1997
www.examiner.com
Summary of Exercise ResearchWhat types of cancer have been studied?
ProstateBreast Lung ColorectalGynecologicHead/NeckLymphomaLeukemia
What has exercise improved in cancer survivors?
Aerobic fitnessMuscle strengthBody compositionPainDepressionFatigueQuality of LifeChance of RecurrenceMortality
New Cancer Exercise Guidelines New recommendations made after expert panel reviewed and evaluated literature on the safety and outcomes of exercise training during and after cancer therapy.
Cancer patients and survivors should get the same 150 minutes per week of moderate‐intensity aerobic exercise that is recommended for the general public.
Health care providers should tailor exercise recommendations to individual patients based on fitness level and side effects from treatment.
University of Pennsylvania School of Medicine (2010, June 1). New cancer guidelines: Exercise during and after treatment is now encouraged. Science Daily.
World Cancer Research Fund: Physical Activity Recommendations for Survivors
Be physically active as part of everyday life Be moderately physically active, equivalent to brisk walking, for at least 30 minutes every day
As fitness improves, aim for 60 minutes or more of moderate, or for 30 minutes or more of vigorous, physical activity every day
Limit sedentary habits such as watching television
General Exercise Recommendations
US Dept of Health and Human Services:
2008 Physical Activity Guidelines for Adult Americans
2.5 hours/week of moderate intensity or 1.25 hours/week of vigorous intensity
Should increase to 5 hours/week of moderate intensity or 2.5 hours/week of vigorous intensity
2x/week of strengthening of major muscle groups
General Exercise Recommendations
Cardiovascular Daily if possible, minimum of 30 minutes
Warm‐up/Cool‐down Target HR Zone
General Exercise RecommendationsStrength training 2‐3x/week For arms, abdominals, and legs
Slow, steady progression
General Exercise Recommendations
Stretching 2‐3x/week Avoiding injury Importance of technique Yoga
www.emzr.com
Exercise Precautions Always consult with your MD or other practitioner to clear you for exercise
Seek advice from a trained professional (PT) Blood lab values (platelets, Hct, Hgb)MetastasesHeart conditions Lymphedema Chronic orthopedic injuries
Other Considerations
Gradually increase time and intensity Proper hydration and rest Cross training Use of appropriate equipment Dressing properly
HELP! Join a team (accountability)
Get your spouse, best friend, children, or animals to join in
Exercise journal or log Local classes or support groups
Join a gymwww.foreverfitwomen.com
PHYSICAL THERAPY! Survivors should get consultation as soon as possible after diagnosis
Focus on education, especially exercise precautions and safety
Manual therapy (stretching, scar tissue mobility, etc.)
PHYSICAL THERAPY! Exercise prescription and consultation for managing fatigue and improving endurance
Comprehensive individually tailored exercise program prescription which includes cardiovascular conditioning, strength training, and flexibility exercises
Seattle Area Exercise Programs Cancer Lifeline
(www.cancerlifeline.org)‐Stretch and Strengthen, Yoga, Lebed
Team Survivor Northwest(www.teamsurvivornw.org)‐Women only; yoga, fitness training, swimming, hiking, dragon boating and canoeing, biking
Gilda’s Club(www.gildasclubseattle.org)‐Yoga, Pilates, Tai Chi
YMCA Exercise and Thrive(www.seattleymca.org)‐10 week fitness program; need medical clearance
12‐week, 2x/week, 90 min. strength and fitness program for survivors
Training provided by Y and the SCCA / Hutchinson Center
Content foci: resistance exercisedidactic/support
13 locations, 26 sessions to date
www.fhcrc.org/exerciseandthrive
Exercise and Thrive Program
EXERCISE!
Exercise is something you have control over before, during, and after treatment…this doesn’t change.
You may not have control over many factors during treatment…but you do have a say in helping yourself recover faster, making yourself feel better, and ensuring a great quality of life as a cancer survivor!
Acknowledgements and References
“Clinical Implications for Therapists Working with Oncology Patients”, 11/06, Andrea Leiserowitz, MPT
Rachel Douglas, MPT American Cancer Society Nutrition and Physical Activity During and After Cancer
Treatment: An American Cancer Society Guide for Informed Choices; Doyle et. al; CA Cancer J Clin 2006;56;323‐353.
World Cancer Research Fund/American Institute for Cancer Research. Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective. Washington, DC: AICR, 2007.
US Department of Health and Human Services: 2008 Physical Activity Guidelines for Americans
ANY QUESTIONS?