Strength after Cancer: How to safely progress with an exercise program from treatment to survivorship. Julie Everett DPT, CLT Laurie Fitz PT, CLT

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1 Strength after Cancer: How to safely progress with an exercise program from treatment to survivorship Julie Everett DPT, CLT Laurie Fitz PT, CLT 1

2 Objectives Provide an overview of common physical side effects experienced by cancer survivors Define lymphedema and appropriate exercise guidelines Discuss cancer related fatigue and management Educate on general exercise guidelines 2

3 Cancer Survivor Any person who has been diagnosed with cancer, from the time of diagnosis through the balance of life 14.5 million ACS Facts and Figures

4 As Physical Therapists Our goal is to improve quality of life of cancer survivors by managing/reducing physical side effects of treatment 4

5 Side Effects of Treatment Pain Fatigue Weakness Stiffness Balance Decreased endurance Lymphedema 5

6 Good News: Positive health outcomes of an exercise program Endurance Cardio respiratory fitness Insulin level Body composition and weight Bone mass Muscle strength Balance Reduced Fatigue Reduced Nausea Sleep Social well being Decreased risk of reoccurrence 6

7 Lymphedema Disruption to system Arteries Lymph vessels Capillaries Veins 7

8 Causes Surgery Node removal from axilla, groin, neck Radiation Scar tissue _0623_LymphaticSystem_Female.png 8

9 Lymphedema Need to Know Symptoms Visible swelling Feeling of fullness/firmness/heaviness Feeling of tightness from clothes or jewelry Reducing Your Risk Avoid: Blood Pressure Needle Sticks Tight/restrictive clothing DO: Take care of your skin Exercise 9

10 If you develop lymphedema: Notify your doctor Evaluation by a Certified Lymphedema Therapist (CLT) Treatment is called Complete Decongestive Therapy (CDT) Massage, skin care, compression, education, exercise** 10

11 Exercise and Lymphedema Scientific literature demonstrates safety Should be done in a systematic manner May have a protective benefit 11

12 Exercise Key Points: Lymphedema must be stable Initial exercise should be supervised Start with lowest possible weight Monitor for symptoms Increase weight slowly after 2-4 sessions of no negative changes Wear compression garment 12

13 Compression Garments Should be worn with exercise if diagnosed with lymphedema Enhances lymphatic return Evidence less clear for women at risk for lymphedema 13

14 Discussion for Cancer Related Fatigue Cancer pain- what is it? Cancer related fatigue- how is this different? Exercise- how can it help? Moving forward- what can I do?

15 Cancer Related Pain An unpleasant sensory and emotional experience associated with actual or potential tissue damage Survivors can have pain from surgery, chemotherapy, or radiation 33% of people with cancer will continue to have pain after curative care (National Cancer Institute) Medication, therapy, exercise and relaxation techniques are useful treatment options

16 Pain Healthy Movement Injury Pain Healing Through Movement Using safe and appropriate exercises to help increase the healthy movement Move the sensation of pain further away from painful activities

17 Cancer Related Fatigue Most common side-effect complaint Physical, emotional, or cognitive tiredness or exhaustion that is not proportional to recent activities and interferes with functioning. This fatigue does not get better with rest % of people during treatment and 19-82% of people after treatment (National Cancer Institute)

18 Cancer Related Fatigue Other reasons for fatigue Anemia Medications Poor nutrition Emotions 18

19 Treatments for Fatigue and Pain #1 Treatment?

20 EXERCISE!

21 Fatigue and Exercise I m way too tired to workout today. I m scared I m going to hurt myself. I need to save what little energy I have to go home and take care of my family. I ll start an exercise program tomorrow. Everything hurts and you want me to do WHAT?!?

22 Treatments Exercise! Improved energy level Appetite stimulation Increased blood flow to tissues Decreased pain Improved quality of life Increased strength and flexibility Mood stimulation Improved outlook on cancer challenges 2007 Study: Moderate physical activity after treatment (not household activities) had decreased fatigue and pain

23 Exercise Principles Speak to your health care provider before starting an exercise program! Become knowledgeable about the resources out there: Physical Therapists Occupational Therapists Personal Trainers Start LOW and go SLOW

24 Exercise Principles Heart rate targets Stay between 50-80% of maximal heart rate Maximal Heart rate: 220 minus age (ex: = 188) 188 X.5 = x.8= 154 Breathing You should be able to have a conversation while working out. You can start exercising during treatment! Know your exercise level BEFORE diagnosis/treatment

25 Fatigue and Exercise Beginners Sedentary lifestyle and/or low level of exercise Able to complete household chores and family obligations Intermediates 2-4 x a week to the gym Exercises classes and/or weekend warrior Experts 4-5 x week at the gym Competitive athlete and/or active lifestyle

26 Exercise for Beginners Start with 3-4 days a week building up Start with smaller bouts (10 minutes) and building up the time (45 minutes) Choose an activity that interests you: Walking, swimming, biking, hiking Have buddy that will encourage you Balanced program: cardio, stretching, and weight training

27 6 Exercises Daily 1. Shoulder and Pec Stretch Lie on your back Hold a broom or umbrella in both hands Reach overhead until you feel the stretch Hold for 15 seconds

28 6 Exercises Daily 2. External Rotation Standing with arms bent and at side Rotate arms outward with elbows still at side Slowly return to standing position

29 6 Exercises Daily 3. Shoulder Flexion Start with arms at your side Keep elbows straight and raise arms to shoulder height Can do with palm down (as shown) or thumbs up Slowly lower arms to starting position

30 6 Exercises Daily 4. Abdominals Lay on your back with knees bent Slight press your low back into the floor Keeping back flat, slowly raise one knee to chest Maintaining control in the back, slowly return

31 6 Exercises Daily 5. Bridging Lay on your back with knees bent Squeeze buttock Lift buttock off the floor Slowly return back to floor

32 6 Exercises Daily 6. Clamshells Lay on side with knees bent, keeping feet together Lift top knee up, not allowing body to roll backwards Slowly lower to starting position Repeat on other side

33 Intermediates and Experts Don t be concerned if you need to scale back your previous activities during treatment- YOU WILL GET BACK! Consider joining group fitness challenges to stay motivated Certified Personal Trainers to help you reach your goals Cancer Exercise Specialist

34 Additional Exercise Tips: Aerobic exercise Walking Stationary bike Circuit Training Work large muscle groups Flexibility Stretching 34

35 Exercise Alternatives Yoga Tai Chi Qigong

36 References: er/centers/cancer_rehab ehabilitation/index.html National Cancer Institute ( AlfanoCm, Smith AW, Irwin ML, et al. Physical activity, long-term symptoms, and physical health related quality of life among breast 36 cancer survivors: a prospective analysis. J Cancer Surviv 1 (2):116-28,

37 References National Cancer Institute ( Alfano CM, Smith AW, Irwin ML, et al. Physical activity, long-term symptoms, and physical health related quality of life among breast cancer survivors: a prospective analysis. J Cancer Surviv 1 (2):116-28, 2007 Garcia, DO, Thomson, CA. Physical Activity and Cancer Survivorship. Nutrition in Clin Practice 29 (6): ,

38 Thank you! To learn more about our program, visit our websitehttp://bit.ly/jhbreastcasurvivorship To view this webinar and previous webinars, check out our media libraryhttp://bit.ly/jhbreastcasurvivorshipwebinars Questions or concerns, please contact Elissa 38

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