Lecture 2 - Cancer And Exercise

Question 1

Side effects/Adverse events of Cancer and it’s Treatment.

Answer 1

Increased:
-fatigue, depression, anxiety, weight gain, risk of other cancers, CVD, diabetes and osteoporosis risk, functional decline

Decreased:
-physical activity, QOL.

Question 2

Benefits of increasing PA:

Answer 2

Decreases side effects/adverse events of diagnosis, surgery and treatment:

• Decreased fatigue, depression and anxiety, CVD , diabetes, and osteoporosis risk, risk of recurrence, risk of new cancers, all cause mortality risk.
• Increased: QOL, weight loss and weight maintenance, overall survival, cancer specific survival.

Question 3

Why recommend exercise to cancer patients and survivors?

Answer 3

Many cancer patients and survivors have lifestyles that could contribute to a recurrence an/or poor QOL

Question 4

Exercise and prostate cancer survival: Statistics

Answer 4

Men with > 3 hrs per week of vigorous activity had a 49% lower risk of all-cause mortality.

61% lower risk of PCa death.

Question 5

Benefits for symptoms and toxicities:

Aerobic exercise= reduced nausea & body fat.

Answer 5

Decreased = fatigue,

Increased = muscle function, physical performance, aerobic exercise, QOL, body comp.

Question 6

General increases=

Answer 6

• muscle and bone tissue mass
• cardiorespiratory fitness
• max walk distance
• immune system capacity
• physical functional ability
• flexibility
• muscle strength
• QOL
• haemoglobin

Question 7

General Decreases=

Answer 7

• Nausea
• body fat
• fatigue
• symptom experience
• duration of hospitalisation
• anaerobic energy reliance
• heart rate
• resting systolic BP
• insulin and IGF1
• Estrogen in women
• psychological and emotional stress
• depression and anxiety

Question 8

Benefits of exercise before cancer treatment:

Answer 8

Exercise intervention pre-treatment:

• high completion rates and adherence
• improves muscle strength, cardiorespiratory fitness, motivation.

Question 9

Benefits of Exercise During cancer treatment:

Answer 9

Reduced :

• incidence and severity of fatigue
• incidence and severity of depression
• incidence of lymphoedema
• incidence and severity of anxiety
• incidence and severity of sleep disorders

Improved positive mood
Increases physical reserve capacity

Question 10

Benefits of Exercise Following cancer treatment:

Answer 10

Improved functional capacity
Reduced incidence & severity of comorbid conditions
Improved overall QOL
Improved survival

Question 11

Generic exercise prescription:

Answer 11

Mode- Aerobic= 150min p/w moderate intensity [RPE 5-6 out of 10]
120 min p/w vigorous intensity [RPE 7-8 out of 10]

       - Resistance = 6-10 exercises, 6-12RM, 2-3x p/w, 3-4 sets per exercise.

Question 12

ACSM Roundtable on Exercise guidelines for Cancer Survivors:

Answer 12

Exercise is safe during and after cancer treatments
Results in improvements in physical functioning, QOL, and cancer-related fatigue in several cancer survivor groups
Cancer survivors to follow PA Guidelines, with specific exercise programming adaptations based on disease and treatment-related adverse effects
Advice to “avoid inactivity” even during difficult treatments

Question 13

Overall objectives of exercise prescription:

Answer 13

• regain and improve functioning, aerobic capacity, strength, flexibility
• improve body image and QOL
• improve body composition
• potentially reduce or delay reoccurrence
• reduce and prevent long-term and late side effects of treatment
• improve capacity to withstand future treatments

Question 14

Principles of Exercise Testing and Prescription:

Answer 14

Each parameter measured must be relevant to the improvement of cancer survivor’s outcomes
All procedures valid and reliable
Protocols consistent and rigidly controlled
Patient’s rights protected
Testing repeated at regular intervals
All results reviewed and discussed with patient
Report provided to referring doctor
Tests inform the exercise prescription

Question 15

When do you need a Medical clearance:

Answer 15

If patient is over 35yrs of age
Has any primary risk factors for cardiovascular diseases such as: family history of heart attack or stroke, high BP, high cholesterol, existing cardiovascular disease
Overweight

-need to consult doctor before starting an exercise program

Question 16

History of cancer Diagnosis and Treatment:

Answer 16

• Diagnosis
• types of treatment
• first cancer, other cancers?
• treatment ongoing, finished, more to come?
• if complete, when was it finished
• for each treatment, consider possible side effects

Question 17

Consider functional changes of surgery, radiation, chemotherapy, hormone therapy:

Answer 17

Changes in function, ROM, Strentgh declines, endurance declines, other side effects.

Surgery- what surgery was performed
Radiation- what was the site?
Chemotherapy - what drugs?
Hormone therapy - ongoing ? Type of treatment? Other treatments to offset side effects

Question 18

What are Cancer Specific contraindications to exercise testing:

Answer 18

• Relative and absolute contraindications to exercise testing - follow ACSM Guidelines
• ACSM recommendations in cancer
• Monitor HR, BP, breathing frequency
• RPE [should not exceed 11-13 for submax tests]
• compromised skeletal integrity could make some tests inappropriate
• time of day could impact fatigue and other symptoms

Question 19

Name 6 Precautions:

Answer 19

Severe anemia = delay exercise until improved
Compromised immune function = avoid public guys and other public places until WBC counts return to safe levels
Severe fatigue = encourage low vol and intensity training
Radiotherapy = avoid chloride exposure to irradiated skin
Indwelling catheters= avoid water [risk of infection], resistance training of muscles in the area of the catheters
Peripheral neuropathic or ataxia= reduced ability to use affect limbs

Question 20

What test to perform?

Answer 20

1. Is the parameter required for /Imortnat to the patients goals, or the intended training program?
2. Does the client report issues/problems with that parameter?
3. is the information required for exercise prescription?

These could guide wether a test of the parameter is required
The assessment need to fit the activity - tests need to fit the program and amity of the client

Question 21

Name 8 Assessments that could be used:

Answer 21

Healthy history questionnaire [General Health Questionnaire - medical history, family history, current meds, lifestyle].
Height, weight, waist girth
Resting heart rate
Resting blood pressure
Resting pulse oximetry
Pulmonary function
Blood profile
DEXA for body comp and bone density

Question 22

Aerobic capacity tests:

Answer 22

400m corridor walk - easy and no equipment
Step test
Cycle test
Metabolic measurement

Question 23

Strength Tests:

Answer 23

1RM testing
Multiple repetition testing
Isometric testing
Isokinetic testing

Question 24

Flexibility testing:

Answer 24

Sit and reach

Goniometry

Question 25

Physical function tests:

Answer 25

6 metre walk = normal, fast, tandem, backward tandem. Balance - SOT Sit to stand Stair climb

Question 26

Quality of Life

Answer 26

SF 36 | Cancer specific questionnaires: QLQ-C30, Prostate Specific

Question 27

Depression and Anxiety Assessment

Answer 27

DASS | BSI-18

Question 28

Selecting an Exercise Program:

Answer 28

``` Has to work for the patient and fit with: Time available Geographic location Disabilities Economic circumstances Family and friends Personal preferences ```

Question 29

Warm-up

Answer 29

May reduce the susceptibility to musculoskeletal injury by improving joint ROM and reduce risk of adverse cardiovascular events.

Question 30

Exercise Order

Answer 30

Generally, anabolic before aerobic Anabolic exercises should generally follow these rules in terms of ordering: -large muscle groups first [e.g. legs] -multi-joint exercises [e.g. bench press] before single joint [e.g. elbow extension] -abdominal and lower back exercises after whole body ground based exercises such as squat, deadlift, bench press, etc. -this is to avoid pre-fatiguing the muscle groups which stabilise and support the trunk -also important NOT to program abdominal and lower back exercises last sa the person may often be getting tired and drop them from the program These exercises are very important for posture and protecting the lower back and must be completed during each session.

Question 31

Exercise Programming 1

Answer 31

1. Objectives: increase = physical/physiological/psychological Decrease = risk treatment induced-comorbidities Aerobic 30min, ACSM= 5x p/w moderate int. [5-6/10], Prostate studies= 15-45min 3-5x p/w 20min, ACSM= 3x p/w vigorous int. [7-8/10], Prostate studies= 60-70% HRmax or 50-75% VO2max 2. Resistance, ACSM= 8-10 exercises, 10-15RM, 2-3x p/w at least 1 set; Prostate studies= 8-12 rep, 60-70% 1RM, 3x week [2 sets] 6-12RM, 2x week 6-12RM or 50-80% 1RM, 1-3x week [ 1-4 sets] Flexibility, ACSM= 10-30s static stretch [3-4 sets] same day of aerobic/resistance. Prostate Studies= 10-30s 2-3x week [2-4sets] per muscle group. 3. Contraindications - ACSM/AHA guidelines unstable disease. Reasons to stop - same as exercise testing, acute postoperative phase Risk of injury - bone metastases risk of fractures, single report of non fatal MI Considerations - No data

Question 32

Why Cool Down is important:

Answer 32

Gradual recovery from the specific activity performed and includes exercises using lower intensities. Allows appropriate circulatory adjustment of HR, BP to near resting values, facilitates dissipation of heat, reduces potential exercise hypotension and promotes removal of lactic acid.

Question 33

Describe over exercising:

Answer 33

Volume and intensity beyond which body cant adapt- over training. Very unlikely in non-athletes ``` Signs: Increased incidence of injury Very low body fat or sudden weight loss Increased incidence of upper respiratory infections Anaemia Sleep problems Increased resting HR Persistent muscle soreness Depression Irritability Decreased appetite. ```

Question 34

How to prevent Over-Exercising:

Answer 34

1 day each week should be exercise free or very light recovery Avoid repeating the same type of exercise on consecutive days Allow at least 48hours between RT on the same muscle group Measure resting HR each morning on waking to detect increases Keep exercise sessions to less than 60 min

Question 35

Why use a 12 week plan?

Answer 35

It’s a workable strategy because its long enough to allow variation in volume, intensity, and activity type while also being sufficient to produce significant and observable improvements in health and fitness. This plan can then be repeated or modified according to the season’s, exercise opportunities, and increasing fitness. Graduation

Question 36

Transitioning to Graduation

Answer 36

Can’t stay with clinic forever From day 1 we prepare patients for graduation Manage expectations Education on home exercise Experience in fitness centre - incursions Transitioning - increasing external sessions

Question 37

Barriers to Exercise

Answer 37

``` Not easy Cancer patients face enormous hurdles not the least fatigue Doctor is usually greatest motivator Education as to importance Doesn’t have to be expensive Any is better than none Religious and cultural issues ```

Question 38

Sample prescriptions: Home based anabolic [gymstick, there and, and dumbbell]

Answer 38

``` Warm up Squat Upright row/ bent over row Lunge Kneeling press Sit-ups/crunches Shoulder press Cool down ```

Question 39

Conclusion

Answer 39

``` Cancer patients can tolerate and enjoy a structured exercise program Meaningful improvements: Strength Endurance Functional capacity Body comp QOL and symptom experience Social functioning Fatigue ```