Exercise For The Cancer Survivor

ELISABETH TOMERE, PT, DPT, CLT

SCCA PHYSICAL THERAPY

Presentation Topics

• Benefits of Exercise

• Guidelines and Recommendations for Exercise

• Strategies for Exercise Participation

• Community Resources

• Closing Comments and Questions

“Lack of activity destroys the good condition of

every human being, while movement and methodical

physical exercise save it and preserve it.”

--Plato (427-347 BC)

The Relevance Of The Holidays

• Expectations

• Time Constraints

• Environmental Barriers

• New Beginnings

• Life Long Commitment

Deep Breathing Exercise

Exercise?

What Are The Benefits?

• Prevention of cancer and recurrence

• Improved aerobic fitness and muscular strength

• Normal body weight/insulin regulation

• Increased BMD and decreased injuries

• Improved energy, reduced fatigue, better sleep

• Cognitive gains and elevated mood

• Improved balance and agility

ACSM Cancer Exercise Guidelines (2009)

1) Exercise training is safe during and after cancer treatments.

2) Improvements in physical functioning, quality of life, and cancer-related fatigue in several CA groups (breast, prostate, colon, blood, stem cell transplant, and gynecologic).

3) Survivors should follow the 2008 Physical Activity Guidelines for Americans and ACSM recommendations with specific individualized exercise prescription based on their disease and treatment related side effects.

Courtesy of Lexi Harlow, PT, DPT, CLT

How Much And What Kind Of

Exercise Do I Need?

US Dept Of Health And Human Services: 2008 Physical Activity Guidelines For Americans

Adults:

-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

Courtesy of Lexi Harlow, PT, DPT, CLT

ACSM Guidelines

Cardiorespiratory Exercise

• Adults should get at least >/=150 minutes of moderate-

intensity exercise per week.

• Exercise recommendations can be met through 30-60

minutes of moderate-intensity exercise (five days per week)

or 20-60 minutes of vigorous-intensity exercise (three days

per week).

• One continuous session and multiple shorter sessions (of at

least 10 minutes) are both to accumulate desired amount of

daily exercise.

Higher all cause mortality rates for sitters

Distinct health risk

Physical activity outside of sedentary time was not protective

ACSM Guidelines

Resistance Exercise

• Adults should train each major muscle group two or three days

each week using a variety of exercises and equipment.

• Two to four sets of each exercise will help adults improve strength

and power.

• For each exercise, 8-12 repetitions improve strength and power, 10-

15 repetitions improve strength in middle-age and older persons

starting exercise, and 15-20 repetitions improve muscular

endurance.

Other Considerations For Exercise

Cardiovascular

• Warm-up/Cool-down

• Target HR Zone

• RPE (Rating of Perceived Exertion)

Strength training

• 2-3x/week

• For arms, abdominals, and legs

• Slow, steady progression

• 10 repetition maximum

Balance

• ACSM recommends 2-3 days per week

• Important to train with age

• Fall prevention

Stretching

• 2-3x/week

• Avoiding injury

• Importance of technique

• Yoga

Triangle Stretch

Safety Guidelines

• Gradual increase in exercise intensity, volume

• Heed warning signs of injury

• Proper attire, equipment in good working order

• Tape, braces, compression garments

• Protect against the elements, especially heat—

HYDRATE!

Precautions

• Physician Clearance

• Lymphedema

•Neuropathies

• Severe fatigue

•Heart conditions

•Metastases

What Else Can I Do To Improve My

Fitness?

DON’T SIT!!!

• Cardiovascular disease

•Depression

•High blood pressure

•Worsening metabolic biomarkers

MINI SQUAT

Challenges Along the Way

Immediate and Late Effects of:

• Chemotherapy

• Radiation

• Surgery

• Hormonal Changes

• Disease specific barriers

• Lack of time, enjoyment and social

support

• Filling multiple roles; caretaking

• Medical appointments

• Change in physical appearance

• Concerns about safety

Solutions!

• Increase your knowledge

• Join a team or group

• Get your spouse, best friend, children, or animals to join in

• Exercise journal or log

• Local classes or support groups

• Do something that you enjoy

• Set realistic goals

Modifications to slide courtesy of Lexi Harlow, PT, DPT, CLT

EXERCISE AND THRIVE™ PROGRAM

• YMCA, LIVESTRONG and Hutchinson Center

collaboration

• 12-week, 2x/week, 90 min. strength

and fitness program for survivors

• Training provided by Y, FHCRC and SCCA

• Assessment Pre and Post class

• Content foci: resistance exercise

aerobic exercise

support, nutrition

Rajotte et al. J Cancer Survivorship, 2012

Seattle Area Exercise Programs

Cancer Lifeline www.cancerlifeline.org Team Survivor Northwest www.teamsurvivornw.org Gilda’s Club www.gildasclubseattle.org YMCA Exercise and Thrive www.seattleymca.org

Holiday Exercise Strategies

• Walk as much as possible

• Do extra laps at the mall

• Take stairs

• Park further away from doors

• Involve family, loved ones, and friends in fitness activity

• Suggest a walk or other physical activity after eating a

meal

• Play with kids or grandkids

• While watching football games, get on floor and do some

exercise or think of exercises to do while seated on the

couch

Courtesy of Lexi Harlow, PT, DPT, CLT

What’s New For Cancer Survivors

• Low intensity exercise regimens may not be effective

• 150 minutes per week of walking—is it enough?

• Not all exercise is equal

• New studies on brief, high intensity exercise

The Scientific 7-minute Work-out

High-intensity circuit training (HICT) using body

weight as resistance.

Combines aerobic and resistance training into a

single exercise bout lasting approximately 7

minutes.

Participants can repeat the 7-minute bout 2 to 3

times, depending on the amount of time they

have. As body weight provides the only form of

resistance, the program can be done anywhere.”

The 7-minute Work-out

1. Jumping jacks

2. Wall sit

3. Push-up

4. Abdominal crunch

5. Step-up onto chair

6. Squat

7. Triceps dip on chair

8. Plank

9. High knees

10. Lunge

11. Push-up and rotation

12. Side plank

EXERCISE!

• “By exercising regularly, you are helping yourself to heal, potentially preventing new cancers from developing and preventing previous cancers from recurring, and at the same time lowering your risk of developing the most common life threatening medical condition – heart disease. The benefits of exercise are enormous.”

-Dr. Julie K. Silver

Courtesy of Lexi Harlow, PT, DPT, CLT

Knowledge IS Power!

Best wishes for an amazing holiday

season. Be well!

REFERENCES

1. Lamanne, D. Cassileth, B, Gubili, I. The Role of Physical Activity in Cancer Prevention,

Treatment Recovery and Survivorship. CancerNetwork.

http://www.cancernetwork.com/survivorship/role-physical-activity-cancer-prevention-

treatment-recovery-and-survivorship. Published July 18, 2013. Accessed October 10, 2013

2. Schmitz, KH, Courneya, KS, Matthews, C. American College of Sports Medicine

Roundtable on Exercise Guidelines for Cancer Survivors. Medicine & Science in Sports &

Exercise. 2010; 1409-1428. doi: 10.1249/MSS. 0b013e3181e0c112

4. US Department of Health and Human Services. 2008 Physical Activity Guidelines for Americans. www.hhs.gov. http://www.health.gov/paguidelines/guidelines/default.aspx. Published October 2008. Accessed November 10, 2013. 5. Garber, CE, Blissmer, B, Deschutes MR, et al. Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory, Musculoskeletal, and Neuromotor Fitness in Apparently Healthy Adults: Guidelines for Prescribing Exercise. Medicine & Science in Sports & Exercise. 2011; 43: 1334-1359. doi:10:1249/MSS.0b013e318213fefb

REFERENCES CONT’D

6. Mustian, K., Sprod, L, Janelsins, M, et al. Multicenter, Randomized Controlled Trial of Yoga for Sleep Quality Among Cancer Survivors. J of Clinc Oncol. 2012; 31: 3233-3243 7. Owen, N, Healy GN, Howard, B, Dunstan, DW. Too Much Sitting: Health Risks of Sedentary Behavior and Opportunities for Change. President’s Council on Fitness, Sports & Nutrition. 2012; 13:1-11

.8. Pekmezi, D. Martin, M, Kvale, E, Meneses, K, Demark-Wahnefreid, W. Enhancing Exercise Adherence for the Breast Cancer Survivor. ACSMs Health Fitness Journal. 2013: 16; 8-13 9. Klika, B, Jordan, L. High Intensity Circuit Training Using Body Weight: Maximum Results With Minimum Investment. ACSMs Health & Fitness Journal. 2013; 8-13. doi: 10:1249/FIT.0b013e31828cble8 10. Silver, JK. After Cancer Treatment: Heal faster, Better, Stronger,. MD. Baltimore: John Hopkins University Press; 2006.

SUGGESTED RESOURCES

• American College of Sports Medicine. ACSM.org

• Dept of Health and Human Services. hhs.org

• CancerNetwork. cancernetwork.org

• President’s Council on Fitness, Sports & Nutrition. fitness.gov