Transcript Exercise Management

Exercise Management
Cancer
Exercise Management
Pathophysiology
Cancer is not a single disease; it is a
collection of hundreds of diseases that share
the common feature of excessive, uncontrolled
cellular proliferation and the potential for these
cells to spread to distant anatomical sites (e.g.,
metastasis).
Treatment of cancer can include surgery,
radiation, chemotherapy, and immunotherapy,
either singly or in combination, and can be
designed to attempt a cure or remission, or for
control of disease and relief of symptoms.
Exercise Management
Pathophysiology
Cancer
is cured when a remission is thought
to be permanent, but many cancers are
considered cured if the client does not have a
recurrence within five years after treatment.
Recurrence
of cancer occurs when a few
cancer cells escape being eradicated and
subsequently grow back over time.
Exercise Management
Effects of the Exercise Response
The specific effects of cancer on the exercise
response are determined by the tissues
affected and by the extent of involvement. The
result is often exercise intolerance, but the
limiting factors can be varied.
The
side effects of anticancer therapy also
affect the exercise response. These can be
acute onset with treatment, but are often
delayed onset and permanent (see Table 27.1, next
slide)
Exercise Management
Exercise Management
Effects of Exercise Training
For patients undergoing therapy for
cancer, exercise training should have the
objectives of maintaining strength,
endurance, and level of function.
For cancer survivors who have completed
treatment, exercise training should have
the objective of returning patients to their
former level of physical and psychological
function.
Exercise Management
Effects of Exercise Training
Regular, moderate-intensity aerobic
exercise during cancer therapy results in
reduced levels of fatigue, improves aerobic
capacity, mood, and promotes a higher
quality of life.
Exercise Management
Effects of Exercise Training
Results of exercise studies during and following cancer
treatment have shown improvements in:
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Shoulder range of motion
Flexibility
Muscle strength
Balance
Treatment-related side effects
Aerobic capacity
Weight control
Body image
Sense of control
Depression and mood, and
Quality of life
Exercise Management
Recommendations for Exercise
Testing
Exercise testing is appropriate for persons
actively receiving therapy and persons
whose cancer is in remission.
Formal exercise testing should be
individualized to the client with attention to
the disease, type of treatment, and
physical limitations (see Management and Medications
section, text).
Exercise Management
Effects of Exercise Training
A concern with adult cancer survivors is
that they are more likely to have co-morbid
conditions such as coronary artery disease,
high blood pressure, diabetes, or high
blood lipids.
These conditions may actually influence
exercise management more than the
history of cancer does.
Exercise Management
Recommendations for Exercise
Testing (see Table 27.2, follows)
Depending on the functional ability of a
client, exercise testing can usually be
performed using standard protocols.
Submaximal and subjective symptomlimited treadmill tests are well tolerated,
even by debilitated clients, and provide
information on aerobic capacity.
Exercise Management
Special Considerations for Exercise Testing Among
Cancer Patients:
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Obtain basic history of diagnosis and treatment protocols
Assess for adverse acute, chronic, and late effects of cancer
treatment
Evaluate other comorbidities that may influence ability and safety
to exercise
Consider how cancer and its treatments may effect balance,
agility, speed, flexibility, endurance, and strength and select,
modify, and interpret fitness tests accordingly.
Determine if medical clearance is required prior to exercise
testing.
Consider relative and absolute contraindications to exercise
testing.
Exercise Management
Exercise Management
Recommendations for Exercise
Programming
Recommendations
for exercise
programming are dependent on whether
the person is actively receiving cancer
treatment, is a survivor cured or in
remission, or is being treated for recurrent
or metastatic disease
Exercise Management
Recommendations for Exercise Programming
For
cancer patients receiving treatment or with
recurrent, localized disease, the goal is to
preserve and possibly even improve function.
For survivors, the goal is to return to a healthy,
active lifestyle and make exercise an integral part
of everyday life.
For patients with recurrent or metastatic
disease, the goals need to be tailored to the
patients current level of function.
Exercise Management
Recommendations for Exercise
Programming
The
optimal frequency, duration, and time
course of adaptation are not known. There
appears to be a dose response relationship
of exercise to fatigue, with less fatigue
being experienced in persons who exercise
for a duration of more than 10 min, and for
clients who exercise at least every other
day.
Exercise Management
Recommendations for Exercise
Programming (see Table 27.3, follows)
Exercise
prescriptions should consider
where a patient is in treatment and
accommodate for periods of increased
fatigue, and for cycles of treatment.
Because most patients are treated with
combinations of surgery, radiation,
chemotherapy, and immunotherapy, a
combination of treatment-related problems
are likely.
Exercise Management
Recommendations for Exercise
Programming
Virtually all anticancer drugs cause fatigue
and declines in blood cell counts. Thus,
exercise therapy must take into account
where a patient is in the treatment cycle
and adjust the exercise prescription
accordingly
Those
patients with thrombocytopenia (platelet count
, 50,000/mm3) are at a greater risk of bleeding. One
should seek to prevent falls and limit exercise to
low intensity.
Exercise Management
Recommendations for Exercise
Programming
The following are special considerations for exercise
programming among cancer patients:
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Assess client’s current medical condition, functional ability, and
general health before each exercise session.
Consider relative and absolute contraindications to exercise
Develop and exercise program to accommodate to changes from
cancer and its treatment that may alter balance, agility, speed,
flexibility, endurance, and strength.
Know where a patient is in the treatment schedule and adapt the
exercise program to the patient’s ability
Recognize when to refer the patient back to their physician for
evaluation of new or worsening symptoms.
Know cancer specific emergencies and plan for handling an
emergency situation. (continued on next slide)…
Exercise Management
Recommendations for Exercise
Programming
The following are special considerations for exercise
programming among cancer patients:
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Assess risks for adverse late effects of treatment that could increase
risks associated with exercise
Adjust program for the presence of a central line (catheter, or port)
Modify exercise program based on current medical condition if the
patient is actively receiving treatment or has complicated treatment.
Exercise Management
End of Presentation