Exercise Guidelines and Certifications: What s new? Anna L. Schwartz, PhD, FNP-BC, FAAN

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2 Exercise Guidelines and Certifications: What s new? Anna L. Schwartz, PhD, FNP-BC, FAAN

3 Overview Review of Research Evidence ACSM Cancer Survivor Exercise Guidelines ACSM/ACS Certification

4 Collaborators

5 Current State Over 1.5 million new cases cancer in 2009 Over 12 million survivors alive in U.S. Burden of cancer Morbidity, mortality, Economic cost Lost work days, Reduced quality of life, Family burden Need for cancer rehabilitation Need for exercise guidelines

6 ACSM Roundtable Round table and Consensus meeting June 2009 Siteman Cancer Center, Washington University, St. Louis, MO Oncology Nursing Foundation International multidisciplinary team Nursing Medicine Epidemiology Exercise physiology Representation from National Cancer Institute (divisions Survivorship & Epidemiology) Lance Armstrong Foundation YMCA American Cancer Society

7 Review of Evidence National Health, Lung, & Blood Institute (1998) Category A: Overwhelming RCT data Category B: Few RCTs, small in size and results inconsistent Category C: Uncontrolled/nonRCTs and/or observational studies Category D: Panel experts opinion when evidence is insufficient Category

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9 Consensus Recommendations the same as for age appropriate guidelines from the US DHHS Physical Activity Guidelines for Americans 150 minutes/week moderate-intense aerobic exercise or 75 minutes/week of vigorous exercise Strength training 2-3 time/week, 8-10 exercises of repetitions/set, with at least one set per session Avoid Inactivity!!! Return to normal daily activities as quickly as possible Continue normal daily activities and exercise as much as possible during and after non-surgical treatments

10 What to do?

11 Avoid Inactivity!!!

12 Goals of Exercise Prescription Regain and improve physical function, aerobic capacity, strength and flexibility Improve quality of life Improve body composition and body image Improve cardiorespiratory, endocrine, neurological, muscular, cognitive and psychological outcomes Potentially reduce or delay recurrence or secondary primary cancer Reduce, attenuate and prevent long term and late effects of cancer treatment.

13 General Contraindications Extreme anemia or ataxia Follow ACSM Guidelines for exercise prescription regarding cardiovascular and pulmonary contraindications to exercise Potential for adverse cardiopulmonary event may be higher in cancer survivors than age matched comparisons given toxicity of treatments and long term/late effects of cancer.

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15 General Injury Risks Osteoporosis from bone metastasis and bone-wasting drugs Peripheral neuropathy Immune function

16 Weighty issues

17 Special Considerations Breast Cancer Lymphedema Fracture risk Prostate Cancer Fracture risk Pelvic floor exercises Colorectal Cancer Physician recommendation after ostomy if contact sports Stoma herniation risk Avoid excess intra-abdominal pressure Adult Hematologic Cancers Osteoporosis risk (especially with multiple myeloma)

18 Special Considerations Gynecologic Cancers Morbid obesity Lower limb lymphedema After Bone Marrow Transplant Daily exercise as tolerated Immune status Resistance training may be most important immediately following transplant Childhood Hematologic Cancers Physician permission Immune function

19 What do we need to do???

20 How to Apply to Practice Provide clear instructions to exercise and avoid inactivity Reassure patient that exercise is safe Instruct patient to exercise: At least every other day Build up to 30 minutes Start slowly and Progress slowly Moderate intensity Choose an activity they enjoy Aerobic and resistance exercises

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22 ACSM/ACS Certified Cancer Exercise Trainer

23 ACSM/ACS Certification: Cancer Exercise Trainer Train cancer survivors Provides fitness assessment Makes exercise recommendations Has understanding of cancer: Diagnosis Surgeries Treatments Symptoms Side effects

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25 Recommended Competencies Knowledge and ability to: Discuss cancer diagnosis, treatment and side effects Discuss effects of exercise Discuss cancer specific benefits and risks of exercise Select appropriate exercise program Understand impact of cancer treatments, risks of injury, complications such as lymphedema Evaluate adverse responses to exercise training and how to modify exercise program, Seek clinical consultation for client during or following treatment.

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27 Resources for CET ACSM Certification department acsm.org/cet Training information Knowledge Skills & Abilities (KSA s) Live Webinar August 12-September 23 $240 registration 6 90-minute sessions

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29 CET Exam Online Cost: $150 ACSM Certified Professions

30 Summary Points Aerobic exercise 150 minutes/wk moderate intensity 75 minutes vigorous exercise/week Resistance Exercise 2-3 days/week Avoid Inactivity ACSM/ACS Cancer Exercise Trainer Acsm.org/CET Study resources and information

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