Lexi Harlow, DPT, CLT Physical Therapy Department Seattle Cancer Care Alliance June 26 th, 2010

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1 Lexi Harlow, DPT, CLT Physical Therapy Department Seattle Cancer Care Alliance June 26 th, 2010

2 Presentation Topics 1) 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?

3) What does research on survivors tell us about the importance of exercise?

3 General Benefits of Exercise PHYSICAL Cardiovascular fitness Building muscle strength Cancer and chronic disease prevention Weight loss Improve balance Osteoporosis prevention EMOTIONAL Decrease depression Energy boost Improve sleep quality lifestyleguide.us

Weight loss Improve balance Osteoporosis prevention EMOTIONAL

4 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.

5 Possible Side Effects of Surgery Scar tissue restrictions Limited range of motion or flexibility

6 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

malnutrition Peripheral edema Fever, risk of

7 Possible Side Effects of Radiation Fatigue Osteopenia Neutropenia Radiation induced fibrosis contracture Fragile skin or tissue

8 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)

(Decreased strength or muscle mass) I catch myself stumbling or reaching for the wall.

9 Do Survivors Need Exercise?

10 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

through treatment and beyond, rarely returning to their pre diagnosis levels of

11 Summary of Exercise Research What types of cancer have been studied? Prostate Breast Lung Colorectal Gynecologic Head/Neck Lymphoma Leukemia What has exercise improved in cancer survivors? Aerobic fitness Muscle strength Body composition Pain Depression Fatigue Quality of Life Chance of Recurrence Mortality

has exercise improved in cancer survivors?

12 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.

Cancer patients and survivors should get the same 150 minutes per week of moderate intensity aerobic exercise that is recommended for the general public.

14 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

least 30 minutes every day As fitness improves, aim for 60 minutes or more of moderate, or for 30

15 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

25 hours/week of vigorous intensity Should increase to 5 hours/week of moderate

16 General Exercise Recommendations Cardiovascular Daily if possible, minimum of 30 minutes Warm up/cool down Target HR Zone

17 General Exercise Recommendations Strength training 2 3x/week For arms, abdominals, and legs Slow, steady progression

18 General Exercise Recommendations Stretching 2 3x/week Avoiding injury Importance of technique Yoga

19 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) Metastases Heart conditions Lymphedema Chronic orthopedic injuries

trained professional (PT) Blood lab values (platelets, Hct,

20 Other Considerations Gradually increase time and intensity Proper hydration and rest Cross training Use of appropriate equipment Dressing properly

21 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 gym

22 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.)

23 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

24 Seattle Area Exercise Programs Cancer Lifeline ( Stretch and Strengthen, Yoga, Lebed Team Survivor Northwest ( Women only; yoga, fitness training, swimming, hiking, dragon boating and canoeing, biking Gilda s Club ( Yoga, Pilates, Tai Chi YMCA Exercise and Thrive ( 10 week fitness program; need medical clearance

25 Exercise and Thrive Program 12 week, 2x/week, 90 min. strength and fitness program for survivors Training provided by Y and the SCCA / Hutchinson Center Content foci: resistance exercise didactic/support 13 locations, 26 sessions to date

26 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!

28 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; World Cancer Research Fund/American Institute for Cancer Research. Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective. Washington, DC: AICR, US Department of Health and Human Services: 2008 Physical Activity Guidelines for Americans

29 ANY QUESTIONS?

Physical Activity and the Cancer Patient

Physical Activity and the Cancer Patient In the past, people being treated for a chronic illness (an illness a person may live with for a long time, like cancer or diabetes) were often told by their doctor