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Exercicio e cancer

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  • 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