Transcript Chapter 15 - Delmar Cengage Learning

Chapter 15
Resistance-Training Strategies for
Individuals with Cancer
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Cancer
• Disease family marked by unregulated cell
growth and proliferation
• Can affect virtually any bodily organ or
system
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Cancer
• New treatments and rehabilitation making
some cancers less likely to be fatal
• Rehabilitation involves adverse effects of
disease, plus effects of radiation/
chemotherapy and/or surgery side effects
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Prevalence of Cancer
• Second leading cause of death in US
• Lifetime risk:
– Males = 50 percent
– Females = 33 percent
• Overall death rate has declined
• Risks of developing increase with age
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Prevalence of Cancer
• Most common cancers per 100,000 people:
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Prostate = 72
Breast = 68.5
Lung = 63.9
Colorectal = 50.6
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Economic Impact
• Growing steadily
• In 1996, total direct cost = $42.39 billion
– In 1963, $1.28 billion
• Accounts for approximately 5 percent of
total health expenditures over time
• Includes loss of person-years of life and
corresponding income potential
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Etiology of Cancer
• More than 100 forms identified
• Genesis multi-step process resulting in
aggregate proliferation of abnormal cells
• Triggered by exposure to intrinsic or
environmental carcinogens
• Carcinogens damage deoxyribonucleic acid
(DNA) and invade tissue anywhere in body
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Etiology of Cancer
• Process under genetic control
• Dysregulated growth site-specific or
systemic
• Treatment specific to site and cancer type
• Metastasis may cause cancer to spread to
other sites
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Cancer Staging
• Assesses range and severity of progression
• TNM staging system one of most widely
used
– Evaluates tumor (T), lymph node (N), and metastasis
(M)
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Benefits of Resistance Training
• Physical activity:
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Aids recovery process
Is key to prevention
Maintains strength
Slows rate of age-related decline
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Research Supports Resistance
Training
• May help alleviate physical and
psychological symptoms of cancer
• Helps manage depression
• Improves physical status and quality of life
• May be used alone or in conjunction with
aerobic exercise
• Refer to Table 15.1
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Individualization Key to Program
Design
• Stage of illness
– Pre-, during, or post-treatment
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Prior exercise experience
Age and general physical status
Physical conditioning level
Goals, aspirations, and motivation
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Consider Side Effects of
Treatment
• Treatment may include surgery, radiation,
bone marrow transplantation, and systemic
interventions
– May include chemo-, hormone, and immunotherapy
• Web sites have updated information on
treatment agents and side effects
– E.g., www.cancer.org, www.cancer.gov
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Possible Concerns of Cancer
Patients
• Exercise may:
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Promote/Hasten spread of cancer
Further weaken already compromised immune system
Increase fatigue
Make physical impairments related to disease worse
Cause additional impairment or injury
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Response of Exercise Professional
• Address all concerns as part of training
design and implementation
• Encourage individual’s active participation
in program design
• Be aware of psychological issues related to
having life-threatening condition
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Training During Treatment
• Treatment may place limitations on
individual’s ability, ROM, or energy levels
• Identify individualized goals
• Steady, regular progress may be unrealistic
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Training During Treatment
• Multiple assessments useful for measuring
performance improvement/decrements
• Consider individual’s cancer staging
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Exercise Testing Considerations
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Health and medical history evaluation
Physical fitness assessment
Lifestyle/Activity evaluation
Due to disease and treatment limitations on
individual’s performance, 1 RM may be
inadvisable
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Exercise Testing Considerations
• RPE ratings based on Borg scale may be
more useful
• Assess ROM
– Refer to Table 15.2
• ACSM guidelines advocate 1 RM to 3 RM
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Comorbidities of Older Adults
with Cancer
• May include:
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Sarcopenia
Decreased metabolic rate
Reduced bone density
Reduced insulin sensitivity
Decreased aerobic capacity
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Comorbidities of Older Adults
with Cancer
• May include:
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Obesity
Diabetes
High cholesterol
Hypertension
Heart disease
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Side Effects of Cancer Treatments
• Toxic impact of chemotherapy or radiation
on body
• Pain
• Fatigue
• Sleep problems
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Side Effects of Cancer Treatments
• Lymphedema
• Psychological issues
– E.g., depression
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Involve Individual in Goal Planning
• Progress may be variable based on
treatment and progress of disease
• Provide individual with structure and level
of control
• Show positive benefits of being physically
active
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Involve Individual in Goal Planning
• Develop short-term, manageable goals
– Instead of long-term goals
• Consider using “intention” instead of “goal”
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Program Components
• Emphasize improvements in functional
capabilities
• Highlight trunk and extremity strength
• Initially, prescribe 50 percent of 1 RM
– Two to three times per week
• 2 to 3 sets of repetitions
– Ranging from 3 to 12
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Program Components
• Use Borg RPE scale
• Refer to Table 15.3 for recommended
guidelines
• Refer to Table 15.4 for muscle group
exercises
• Review sample 24-Week Program
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ACSM Recommendations
• Keep intensity levels low
• Perform repetitions slowly through full
ROM
• Sustain ECC phase longer than CON phase
• Adapt training protocols to novice,
intermediate, and advanced levels
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ACSM Recommendations
• Teach correct form and breathing with
minimal resistance
• Control ECC and CON contractions to
avoid bouncing and promote smooth,
deliberate movements
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ACSM Recommendations
• Perform all movements in pain-free manner,
making adjustments as needed
• Begin with minimal resistance to allow for
adaptation and ROM assessment
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Modify Guidelines as Needed
• Use “beginner” to “advanced” approach
– Refer to Table 15.5
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