exercise based rehabilitation

Mike GrisenthwaiteDirector and Founder

Diagnosed 2000 – Lymphatic Cancer NHL

Ironman Triathlon 2001Numerous other endurance eventsRelapse 2005 Donor stem cell transplant or BMT.2007 Tour de France 2200 miles in

19 daysPersonal Trainer and Certified

Cancer Exercise Specialist – Northern Colorado University

About me…..

Overall Cancer Risk Involvement in occupational or leisure-time activity or being physically fit is associated with a reduced risk of cancer

Typical risk reduction of 20-30% Independent of other lifestyle factors Risk reduction is dose-related

Physical Activity and Cancer Prevention:Possible Mechanisms

Sex steroid hormones: oestrogen, testosterone Energy balance & fat distribution Growth factors: Insulin/ IGF-1/IGF-BP3 Anti-inflammatory system – C reactive Protein, interleukinsImmune defence system: NK cellsAntioxidant defence system/DNA damage/ apoptosis

Cancer SurvivorshipCancer Statistics - 2002

Cancer incidence:One in three people in UK will develop some form of cancer in

their lifetime.

Cancer survival rates have increased: 43% of men and 54% of women survived to five years after

diagnosis (prostate has improved to 60% and breast to 77%)

Number of survivors:2% of men and 2.7% of women in Scotland are living with

cancer (1.2% of women in Scotland are living with breast cancer).

The few childhood studies are far more neutral.

Restricted by numbers of participants

Access to facilitiesMeasurement comparisons -

ageActivity motivation

Exercise and Activity for Children and TYA’s - Evidence

Research evidenceBeneficial effects of exercise interventions

Exercise during treatment

Exercise after treatment

Functional capacity

Body weight & composition

Fatigue

Nausea

Flexibility

Physical well-being

Satisfaction with life

Quality of life

Exercise capacity

Natural killer (NK) cell activity

Mood

Self-esteem

Lean body mass & body fat %

Decreased levels of depression & anxiety

Quality of life

No adverse effect on Lymphoedema

Exercise After Diagnosis & Association with Recurrence & Mortality Data from Cohort of 2987 Breast Cancer Survivors in Nurse’s Health Study

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1

<3 3-8.9 9-14.9 15-23.9 24+

recurrence

breast cancer mortality

all cause mortality

Level of Exercise (MET hrs/week)

Holmes et al. JCO 20:2479-86, 2005

Re

lativ

e R

isk

The Rehabilitation Exercise for Health After Breast Cancer (REHAB) Trial

RCT comparing aerobic

exercise to control in 53

postmenopausal BC

survivors post therapy.

Primary endpoints were

QOL, fitness, biomarkers.

Peak Oxygen Consumption(ml/kg/min)

17

18

19

20

21

22

Baseline Posttest

Pea

k O

xyge

n C

onsu

mp

tion

ExerciseControl

Baseline (p=.807)Change (p<.001)3.3 (18%)

(Courneya et al. JCO 2003;21:1660-8)

Overall Quality of Life(FACT-B: 0-140)

108

110

112

114

116

118

120

122

Baseline Posttest

Ove

rall

Qua

lity

of

Lif

e

ExerciseControl

Baseline (p=.286)Change (p=.001)8.8 (3.6 to 14.0)

(Courneya et al. JCO 2003;21:1660-8)

IGF-1/IGFBP-3 Molar Ratio

0.024

0.026

0.028

0.03

0.032

0.034

0.036

0.038

0.04

Baseline Posttest

IGF

-1/I

GF

BP

-3 M

olar

Rat

io

ExerciseControl

Baseline (p=.518)Change (p=.017)-0.006 (-0.01 to -0.001)

(Fairey et al. CEBP 2003;12:721-7)

Natural Killer Cell Cytotoxic Activity (E:T = 3:1)

3

4

5

6

7

8

9

10

11

12

13

14

15

Baseline Posttest

% S

pec

ific

Lys

is

ExerciseControl

Baseline (p=.307)Change (p<.001)6.0 (2.8 to 9.1)

(Fairey et al., submitted)

30 minutes5 days a weekTo a moderate intensity i.e.60 – 70% of Maximum HeartCan be accumulative.This applies to everyone here!VERY IMPORTANT – Practical noteCarers need to buy in to this

Activity Levels for Patients and Survivors What is recommended?

Nacer – Wish listTo get exercise based rehabilitation results into practice via;

Integrating physical activity with other supportive care

interventions:

Physiotherapy.

Psychosocial interventions.

Complementary Therapies etc.Training of primary, secondary and tertiary health

professionals and community based exercise instructors.Provision of information through various existing media

channels

Future Projects - NacerParticipation in TYA Cancer Survivorship programme at the

Christie Hospital.More user friendly Website Focused on Patients and

Support NetworksSupplying information on local initiativesCancer Exercise SpecialistsOne to one consultationLatest proven research, downloads etc.

in 2CFC award new bikes, tandems and specially adapted trikes to children and young people who have been affected by cancer throughout the UK and Northern Ireland.

We encourage cycling as the best form of exercise based rehabilitation for those children undergoing and recovering from cancer treatments.

To encourage them further CFC also give bikes to their siblings and in many cases their parents in order that they can take part in an activity as a family once again after what can be years of hospitalisation and disruption.

Awarded over 300 bikes so far.

Cyclists Fighting Cancer

Referrals via Clic Sargent and other social workers, Physios, Consultants, Support groups etc.

0-18 yearsSiblings IncludedCan include parentsNo Cost whatsoeverUK and Northern Ireland

Bike Awards

Moment of delightAssists mobilityGives back choice Family ActivityReintegration/normalityReconditioning of MusclesHelp with side affects of

treatment

The Benefits

Pilot Scheme at the John Radcliffe Hospital Oxford.

CFC has provided 2 static exercise bikes in junior and Adult size. 5’ 2” upwards

Currently undergoing evaluation by physio’s on site.

We hope to identify 2 further hospitals in 2009.

Future Projects - CFC

Contact detailsemail: mike@cyclistsfc.org.ukWeb:www.cyclistsfc.org.ukwww.nacer.org.uk

Thank you.

Get Set, Ready, Go!