wellspring cancer exercise lay presdsantamina

Preparedby:DanielSantaMina,PhD(Cand);CEP/CES

ExerciseforCancerPatients: EvidenceandBenefits

Whendothebenefitsstart?

Now!

Extensiveresearchhasshownthatexerciseatany

pointduringthecancerjourneyisbeneficial

Prevention/

PreD

iagnosis

DuringTreatment

PreTreatment

PostTreatment

ResearchatAllLevelsofLife

QOL

Physical

Emotional

Cellular

CancerandAssociatedTreatments CanCause:

Weightgain

Fatigue

Boneloss

MuscleLoss

AppetiteLoss

Depression

Anxiety

Poorsleep

Pain

Stiffness

Confusion

ReducedQualityofLife

ExerciseCanHelp!

ExerciseforPrevention/PreDiagnosis

Prevention/

PreD

iagnosis

PhysicalActivityCanHelpPreventSome Cancers

ColonCancer

(2025%riskreduction)

BreastCancer

(25%riskreduction)

EndometrialCancer (2030%riskreduction)

ProstateCancer

(1020%riskreduction)

LungCancer

(2040%riskreduction)

OvarianCancer

(20%riskreduction)

((FriedenreichFriedenreich, 2010; 2002), 2010; 2002)

Howexercisecanprotectusfrom cancer

Exercisecanimprove:

Immunesystemfunction

Bodyfat%

Hormoneregulations(e.g.insulin,testosterone,

estrogen)

Overallhealthierlifestyle(quitsmoking,betterdiet,

cancerscreening)

ExerciseBeforeCancerTreatment

Prevention/

PreD

iagnosis

PreTreatment

PreparingforTreatment

Exercisecanhelpyouprepareforyourtreatment byimprovingyourfitnesslevels,soyoucan:

Tolerateyourtreatmentbetter

Proceedwithdifficulttreatments

Reducetreatmentcomplications

Reducehospitalizationduration

Maintainminimumlevelsofstrength,evenafter

longperiodsofbedrest

Keepyoucalm

Recovermorequickly

ExerciseDuringTreatment

Prevention/

PreD

iagnosis

DuringTreatment

PreTreatment

ExerciseDuringTreatmentIS possible!

Exercisecanbesafelydoneduring:

Radiation

Chemotherapy

Hormonetherapy

Beforesurgery(andafterrecovery)

Bonemarrow/Stemcelltransplant

Immunotherapy

ForstageIIVcancers

(Young-McCaughan & Arzola, 2007)

WhatExerciseDoesNOTDo

ExerciseDoesNOT:

Worsentreatmentordiseaserelatedsymptoms

Compromisetreatmenteffectiveness

ExerciseDuringTreatment: TheBenefits

Improvesfatigue

Improvesphysical

function

Decreasesweightand

bodyfat

Improvesimmune

systemfunction

Improvescardio

pulmonaryfunction

Improvesupper

extremitylymphedema

Improvesqualityoflife

Reducesdepression&

anxiety

Regulatesbowelmovements

Improvesappetite

Improvessleep

Preservesbonehealth

Reduceshospitalization

duration

(Systematic Reviews: Galvao & Newton, 2005; Schmitz et al, 2005; Knols et al, 2008)

Fatigue

Fatigueisthemostcommonsideeffectofcancerandits treatment,affecting70100%ofpatients

Fatigueisthemost

distressingtreatmentrelated symptom

94%ofoncologiststreatpain;only5%treatfatigue

Maycausepatientstodiscontinue/reducetreatment

(Mock et al, 2001, Cancer Practice)

(National Cancer Institute, 2007)

CancerRelatedFatigue(CRF):

Decreased

Functional &

Fitness

Anxiety/

Depression

Other

illnesses

Sleep

Disturbance

Treatment

Tumour

CRF

Sedentary

Behaviour

Physical

Deconditioning

FatigueCycle

ExerciseFatigue

Better Sleep

& Functional Capacity

RECONDITIONING

Reduced functional capacity/

Increased work for routine tasks

Manyresearchstudieshaveshownthatexerciseimproves cancerrelatedfatigue

FatandCancer

Maybelifestyleortreatmentinduced

Obesityincreasesriskforseveralcancers:

Colon,breast(postmenopausal),

endometrial,kidney,esophageal

Obesitynegativelyaffects:

Cancerprogression(byhormonechanges)

Otherillnesses(cardiovasculardisease,diabetes,etc.)

Jointpain/dysfunction

Treatments(e.g.surgicalrisk)

Mortality

CancerRelatedOsteopenia

&Osteoporosis

Bonelossduringcancerandtreatmentcanbedueto:

Thetumour

itself(osteosarcoma,metastatic

lesions)

Chemotherapy

Radiation

Steroids

Surgery

Hormonetherapy

ReducedcalciumandVitaminDabsorbance

Resultantsedentarylifestylefromfatigue&malaise

ExerciseandBoneDensityinCancer

Onlyafew(8)studieshaveassessedtheeffectof exerciseonbonehealthforcancerpatients

Researchshowsthatexercisecanhelpmaintainbone health

Exercisemayaddtothebenefitsofbonemaintaining medications(bisphosphonates)

Resistancetrainingandpossiblyhighimpactexercise maybebestforstimulatingbonedevelopment

Waltman , 2010

Newton et al , 2010, ACPCRA Conference

Lymphedema

Lymphedemaisanaccumulationoflymphatic fluid,oftenintheextremities.

Itcancause:

Swelling

Pain

LossofFunction

IncreasedRiskofInfection

Hardening/Thickeningoftheskin

Ulcers

ExerciseandLymphedema

Researchshowsthatexercisedoesnotworsenupper extremitylymphedema;butmayactuallyhelpit

Personswithlymphedemashouldexercisewith caution(consultwithyourdoctor,aphysiotherapist,

ortrainedWellspringCancerExerciseleader)

Therelationshipbetweenlowerlimblymphedema andexerciseisnotwellunderstood

(Schmitz, 2010, NEJM, Harris, 2000, J Surg Onc; McKenzie & Kalda, 2003, JCO, Ahmed et al, 2006, JCO; Lacomba, 2010, BMJ; Katz, 2010)

ExerciseCanImproveEmotionaland CognitiveWellbeing

Inmanycancers,exercisehasshowntoimprove:

QualityofLife

Confusion/MentalFunction

Mooddisturbance

Anger/Hostility

BodyImage

WeightConcerns

SexualAttractiveness

SelfEsteem

ExercisePostTreatment

PostTreatment

Prevention/

PreD

iagnosis

PreTreatment

DuringTreatment

PhysicalActivityPostTreatment... ContinuedBenefits

Fromsystematicreviews

Cardiovascular& musculoskeletalfitness

Vigor

MentalClarity

Lymphedema

Physicalfunctioning

Fatigue

Bonemineraldensity

Bodycomposition

Jointmobility

Immunefactors

QualityofLife

ReducedRiskofcomorbidities

Reducedchronictreatment

relatedsideeffects

Improvedbodyimageand

selfesteem

Survival

(Schmitz et al, 2005, Ca Epi, Bio, Prev; Galvao et al, 2006, JCO)

ExerciseandPostTreatmentPain

Concernthatexercisewillcausepain

Highlysensitivetochangesinpain

Exercisehasbeenassociatedwithreducedpain incancerpatients

(Alfano et al, 2007; J of Cancer Survivorship; McNeely, 2004, Head & Neck)

ExerciseandSurvivalAfterCancer

Newresearchisdemonstratingthatsurvivalcanbe improvedwithexercisefor

BreastCancer

ColorectalCancer

ProstateCancer

Benefitsincludecancerandnoncancersurvival improvement

Holmes, 2005, JAMA; Meyerhardt, 2006, JCO; Kenfield, 2011, JCO)

PhysicalActivityPostTreatment/Palliation

Inlatestagecancer,Exerciseisassociatedwith:

Improvedtoleranceofsymptoms

Improvedmobility

Improvedcoping

Maintenanceofphysicalfunction

Maintenanceofqualityoflife

andisgenerallywelltolerated

(Courneya & Friedenreich, 2007, Seminars in Nursing Oncology;

Oldervoll et al, 2004/2005)

AgainWhendothebenefitsstart?

Now!Exerciseisbeneficialduringeveryphaseofcancer:

Prevention/

PreD

iagnosis

DuringTreatment

PreTreatment

PostTreatment

Exercise Guidelines

GoalsofExerciseProgramsforCancer Survivors1.

Regainandimprovephysicalfunction

2.

Improvebodyimageandqualityoflife3.

Improvebodycomposition

4.

Improvecardiorespiratory,hormone,neurological, muscular,cognitiveandpsychosocialoutcomes

5.

Reduceordelayrecurrenceorsecondprimarycancer6.

Improvecopingwithrecurrence/asecondprimary

7.

Reduce/preventlongterm&lateeffectsoftreatment8.

Improvetolerancetocurrent&futuretreatments

(Schmitz et al, 2010 MSSE, ACSM Roundtable)

CarefulConsiderationBeforeStartingAn ExerciseProgram

Consultwithyourfamilydoctororoncologistortrained WellspringCancerExerciseleaderbeforestartinganexercise

program.

Becautiouswhenexercisingifyouhave:

Recentlycompletedsurgery(upto8weeksaftersurgery)

Extremefatigueoranemia

Lowbloodcountsofimmunecellsorplatelets

Anylocalrestrictions(e.g.lymphedema,scarring,skin

sensitivity)

Drains(e.g.JPdrains,ostomy,catheters)

Highfracturerisk

(Schmitz et al, 2010 MSSE, ACSM Roundtable)

ExerciseGuidelinesforCancer SurvivorsGeneralStatement:

Avoidinactivity

Returntodailyactivitiesasquicklyaspossibleafter

surgery

Continuenormaldailyactivitiesasmuchaspossible

duringandafternonsurgicaltreatments

Individualswithcardiacconditionsmayrequire

modifications&greatersupervision

3060mins

ofmoderatetovigorousPA, >5d/wk

(Schmitz et al, 2010 MSSE, ACSM Roundtable)

CancerandExerciseGuidelines: FITTPrinciple

Frequency

Thenumbe