canadian blood and marrow transplant group patient and ... · s. nicole culos -reed, phd . june 10,...

S. Nicole Culos-Reed, PhD June 10, 2017

Physical Activity in Cancer Survivorship Canadian Blood and Marrow Transplant Group Patient and Caregiver Symposium

www.thriveforcancersurvivors.com 403-210-8482

The Health & Wellness Lab is committed to building a clinic-to-community model grounded in evidence-based research to demonstrate the benefits of physical activity for cancer patients and survivors. Research shows that regular exercise can significantly reduce the impact and intensity of the multiple diseases linked to many primary cancer treatments, while simultaneously improving the physical functioning and emotional wellbeing for cancer survivors, during treatment and rehabilitation, and into long-term survivorship.

What are we talking about??

• Exercise • Physical Activity • Movement

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MOVE MORE!!!

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CANCER & EXERCISE

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Exercise is both safe and beneficial at any stage of the cancer experience

PRE-TREATMENT

Including surgery, chemotherapy, radiation therapy, and palliative care as needed

Rehabilitation and/ or maintenance therapy as needed

TREATMENT POST-TREATMENT

CANCER CONTINUUM

SURVIVORSHIP

PALLIATIVE CARE

BENEFICIAL TO EXERCISE

Tug of War CANCER NEGATIVELY AFFECTS: • Body Composition • Weight management • Fatigue management • Sleep management • Cardiovascular fitness • Bone Strength • Muscle Loss • Loss of Appetite • Depression • Anxiety • Pain • Hormone-regulation (i.e. insulin

sensitivity) • Quality of Life • Physical functioning and mobility • Survival

PA POSITIVELY AFFECTS: • Body Composition • Weight management • Fatigue management • Sleep management • Cardiovascular fitness • Bone Strength • Muscle Loss • Loss of Appetite • Depression • Anxiety • Pain • Hormone-regulation (i.e. insulin

sensitivity) • Quality of Life • Physical functioning and mobility • Survival

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Research Summary: Benefits of Exercise for Stem Cell Transplant Patients

• Improved fitness parameters – Increased aerobic capacity

– Increased strength

• Improved physical functioning – Activities of daily living

• Decreased fatigue – Faster recovery with exercise vs wtihout

• Improved quality of life – Stress, Anxiety, Depression, Quality of Life


Survival Benefits • Latest survival research…breast, prostate, colorectal, ovarian:

• Significantly reduced risk of cancer recurrence

• Significantly reduced risk of cancer-mortality

• Significantly reduced risk of all-cause mortality

• Modest amount of moderate to vigorous activity (90 minutes – 3+ hours per week)

Meyerhardt; Kenfield et al., 2011

Exercise and Cancer Research

Health and Wellness Lab


Adding in Physical Activity

•ALL movement is beneficial

•SOCIAL SUPPORT: active lifestyles are easier to maintain with outside support

•Ask family/friends to get active with you •Ask family/friends to be an accountability partner •Adopt a 4-legged friend for motivation •Join a group activity program or class

•Consider potential BARRIERS

•What do you enjoy?

•What’s accessible?

•What’s sustainable?


Additional Considerations

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• Start with less than your mind thinks you can do and gradually build up

• Set SMART(T) goals

• SPECIFIC

• 10 min of walking, 3 x/wk

• MEASURABLE

• Track your behaviour

• ATTAINABLE – match your fitness level

• RELEVANT – to your lifestyle

• TIMELY…AND TOGETHER

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•Smaller bouts of exercise throughout the day may be more realistic (10 min bouts)

• Mild to moderate activity most days of the week during treatment, depending on fatigue levels

• Listen to your body


Types of Physical Activity

• Find ways to incorporate key types of exercise into a weekly program

1. Aerobic

2. Resistance/Strength Training

3. Flexibility

Image Sources: SXC


1. Aerobic Exercise

• Activities that use large muscle groups

• Can be maintained continuously

• Rhythmic in nature

• Works the heart and lungs due to higher oxygen intake

Image Sources: SXC


2. Resistance Training

• Muscles work against weights or other resistance (i.e., tubing, gravity, body weight)

• Designed to build lean muscle

• Increases strength in muscle groups and increases maximum muscle force

• Can easily integrate functional movements and balance exercises to reduce risk of falls

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3. Flexibility Training

• Gentle, stretching movements

• Performed separately or after aerobic/resistance training

• Lengthens connective tissue surrounding muscle

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How much and how hard?

Same guidelines as healthy population:

Aerobic: 150 mins/wk Moderate-Vigorous

Intensity

Resistance Training: Exercises involving all major muscle

groups at least 2 days/wk

Flexibility: 7x/wk Static stretch or yoga-based

Pelvic Floor:

As recommended by a physiotherapist

How are we empowering survivors?

RESEARCH TEAM - CALGARY

Co-Principle Investigator University of Calgary

Dr. Nicole Culos-Reed, PhD

Tanya Williamson, BKin, CSEP-CEP Research Coordinator/Certified Exercise Physiologist (CEP), University of Calgary

RESEARCH TEAM - EDMONTON

Co-Principle Investigator University of Alberta

Dr. Margaret McNeely, PhD, PT

Dr. Chris Sears, PhD, CSEP-CEP Research Coordinator/Certified Exercise Physiologist (CEP), and Post-doctoral Fellow, University of Alberta

Alberta Cancer Exercise (ACE) Program

ACE is for all cancer survivors • Up to 3 years post-treatment N=1000 Hybrid implementation and effectiveness study Cost analysis Exercise as standard cancer care

KEY FEATURES

Screening & Referral • Screening cancer survivors for safety • Triage to appropriate programming

Community Integration • Close to survivor’s home • Supported programming • Address barriers and facilitators

Professional Training •Provide cancer specific training to community-based exercise specialists

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SCREENING PROCESS

• Screening for safety (Intake form) • Physician approval / notification • Once into ACE Program:

o Physical Fitness Assessment o Triage to appropriate programming in community,

bridging or rehab services o 12-week FREE exercise program

Maintenance programming Follow-up assessments: 12 weeks, 24 weeks and 1 year

(option for yearly follow-up)

PATIENT ELIGIBILITY

Able to participate in low-intensity PA at minimum

Patients beyond the three years post treatment may be accepted if physician deemed them appropriate as still struggling with cancer-related side effects

Diagnosis of cancer (all tumor groups included)

Pretreatment, or receiving active cancer treatment, or have received cancer treatment within the past three years

Over the age of 18 years and able to provide written informed consent in English

CALGARY PROGRAM OFFERINGS

ACE (Free Programs) • City of Calgary - Killarney • City of Calgary - Sir Winston Churchill • City of Calgary - Southland Leisure Centre • City of Calgary - Village Square • YMCA – South Health Campus • Holy Cross Campus REACH Centre • Wellspring Carma House NW • Wellspring Fountain Court SE Drop-In Programs (Free Classes) • Wellspring Exercise and Educate UofC Thrive Centre (Free Open Gym) • Contact for hours • Free fitness facility for survivors at the University of

Calgary Southland

Killarney

Village Square

S&S PCC

SHC YMCA

Winston Churchill

Wellspring

Holy Cross

UofC Thrive

Wellspring

RURAL SITES

• Red Deer • Medicine Hat • Lethbridge • Grande Prairie • Fort McMurray • Other sites: partnering with AHS, Active Living, PCNs and Community Rehab

Yoga Thrive is 12 week, research based, yoga program for cancer survivors and their support persons. No previous yoga experience is required. We offer a Level 1 and a Level 2 class and the classes are progressive. Classes are 75 minutes and held at various locations throughout Calgary.


Summary • Get Moving!

• Start slowly and take precautions

• Some is better than none!

• Try to incorporate all 4 types of activity into your life:

•Aerobic, Strength, and Flexibility Exercises

• Find ways to make everyday routines more active

• Remember, a gradual increase in activity = HUGE health benefits!

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Seek out community programs, like ACE, to help start and maintain a healthy lifestyle

CONNECT WITH US thriveforcancersurvivors.com E: [email protected] T: 403-210-8482 Twitter | Instagram | Facebook: @WellnessLabUofC

www.albertacancerexercise.com (coming soon!) E: [email protected] T: 403-210-8482 Twitter | Instagram | Facebook: @AlbertaSurvivor

Dr. S. Nicole Culos-Reed | E: [email protected] | Twitter: @NCulosReed

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CLINIC TO COMMUNITY PROGRAMS

THANK YOU

Funding for the ACE Program is provided by Alberta Innovates Health Solutions (AIHS), in partnership with the University of Calgary and the University of Alberta

https://app2.connectedwellness.com/start/pcc-i4/about.html

canadian blood and marrow transplant group patient and ... · s. nicole culos -reed, phd . june 10,...

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