wellspring cancer exercise lay presdsantamina

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Prepared by: Daniel Santa Mina, PhD (Cand); CEP/CES Exercise for Cancer Patients: Evidence and Benefits

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Page 1: Wellspring Cancer Exercise Lay PresDSantaMina

Prepared by:Daniel Santa Mina, PhD (Cand); CEP/CES

Exercise for Cancer Patients: Evidence and Benefits

Page 2: Wellspring Cancer Exercise Lay PresDSantaMina

When do the benefits start?

Now!•

Extensive research has shown that exercise at any 

point during the cancer journey is beneficial

Prevention/

Pre‐D

iagnosis

During Treatment

Pre‐Treatment

Post‐Treatment

Page 3: Wellspring Cancer Exercise Lay PresDSantaMina

Research at All Levels of Life

QOL

Physical

Emotional

Cellular

Page 4: Wellspring Cancer Exercise Lay PresDSantaMina

Cancer and Associated Treatments  Can Cause:

Weight gain•

Fatigue•

Bone loss•

Muscle Loss•

Appetite Loss•

Depression•

Anxiety•

Poor sleep•

Pain•

Stiffness•

Confusion•

Reduced Quality of Life

Exercise Can Help!

Page 5: Wellspring Cancer Exercise Lay PresDSantaMina

Exercise for Prevention / Pre‐Diagnosis

Prevention/

Pre‐D

iagnosis

Page 6: Wellspring Cancer Exercise Lay PresDSantaMina

Physical Activity Can Help Prevent Some  Cancers

Colon Cancer 

(20‐25% risk reduction)•

Breast Cancer 

(25% risk reduction)

Endometrial Cancer (20‐30% risk reduction)

Prostate Cancer 

(10‐20% risk reduction)•

Lung Cancer

(20‐40% risk reduction)

Ovarian Cancer

(20% risk reduction)

((FriedenreichFriedenreich, 2010; 2002), 2010; 2002)

Page 7: Wellspring Cancer Exercise Lay PresDSantaMina

How exercise can protect us from  cancer

Exercise can improve:•

Immune system function•

Body fat %•

Hormone regulations (e.g. insulin, testosterone, 

estrogen)•

Overall healthier lifestyle (quit smoking, better diet, 

cancer screening)

Page 8: Wellspring Cancer Exercise Lay PresDSantaMina

Exercise Before Cancer Treatment 

Prevention / 

Pre‐D

iagnosis

Pre‐Treatment

Page 9: Wellspring Cancer Exercise Lay PresDSantaMina

Preparing for Treatment

Exercise can help you prepare for your treatment  by improving your fitness levels, so you can:

Tolerate your treatment better•

Proceed with difficult treatments•

Reduce treatment complications•

Reduce hospitalization duration•

Maintain minimum levels of strength, even after 

long periods of bed rest•

Keep you calm•

Recover more quickly

Page 10: Wellspring Cancer Exercise Lay PresDSantaMina

Exercise During Treatment

Prevention / 

Pre‐D

iagnosis

During Treatment

Pre‐Treatment

Page 11: Wellspring Cancer Exercise Lay PresDSantaMina

Exercise During Treatment IS possible!

Exercise can be safely done during:•

Radiation•

Chemotherapy•

Hormone therapy•

Before surgery (and after recovery)•

Bone marrow/Stem cell transplant•

Immunotherapy

…For stage I‐IV cancers

(Young-McCaughan & Arzola, 2007)

Page 12: Wellspring Cancer Exercise Lay PresDSantaMina

What Exercise Does NOT Do…

Exercise Does NOT:

Worsen treatment or disease‐related symptoms

Compromise treatment effectiveness

Page 13: Wellspring Cancer Exercise Lay PresDSantaMina

Exercise During Treatment: The Benefits  

Improves fatigue•

Improves physical 

function•

Decreases weight and 

body fat•

Improves immune 

system function•

Improves cardio‐

pulmonary function•

Improves upper 

extremity lymphedema

Improves quality of life•

Reduces depression & 

anxiety•

Regulates bowel movements•

Improves appetite•

Improves sleep•

Preserves bone health•

Reduces hospitalization 

duration

(Systematic Reviews: Galvao & Newton, 2005; Schmitz et al, 2005; Knols et al, 2008)

Page 14: Wellspring Cancer Exercise Lay PresDSantaMina

Fatigue

Fatigue is the most common side effect of cancer and its  treatment, affecting 70‐100% of patients

Fatigue is the most

distressing treatment‐related  symptom

94% of oncologists treat pain; only 5% treat fatigue

May cause patients to discontinue/reduce treatment

(Mock et al, 2001, Cancer Practice)

(National Cancer Institute, 2007)

Page 15: Wellspring Cancer Exercise Lay PresDSantaMina

Cancer‐Related Fatigue (CRF):

Decreased

Functional &

Fitness

Anxiety/

Depression

Other

illnesses

Sleep

Disturbance

Treatment

Tumour

CRF

Page 16: Wellspring Cancer Exercise Lay PresDSantaMina

Sedentary

Behaviour

Physical

Deconditioning

Fatigue Cycle

ExerciseFatigue

Better Sleep

& Functional Capacity

RECONDITIONING

Reduced functional capacity/

Increased work for routine tasks

Many research studies have shown that exercise improves  cancer‐related fatigue

Page 17: Wellspring Cancer Exercise Lay PresDSantaMina

Fat and Cancer

May be lifestyle or treatment induced

Obesity increases risk for several cancers:•

Colon, breast (post‐menopausal), 

endometrial, kidney, esophageal

Obesity negatively affects:•

Cancer progression (by hormone changes)

Other illnesses (cardiovascular disease, diabetes, etc.)•

Joint pain / dysfunction•

Treatments (e.g. surgical risk)•

Mortality

Page 18: Wellspring Cancer Exercise Lay PresDSantaMina

Cancer‐Related Osteopenia

& Osteoporosis

Bone loss during cancer and treatment can be due to:•

The tumour

itself (osteosarcoma, metastatic

lesions)

Chemotherapy•

Radiation•

Steroids •

Surgery•

Hormone therapy•

Reduced calcium and Vitamin D absorbance•

Resultant sedentary lifestyle from fatigue & malaise

Page 19: Wellspring Cancer Exercise Lay PresDSantaMina

Exercise and Bone Density in Cancer

Only a few (8) studies have assessed the effect of  exercise on bone health for cancer patients

Research shows that exercise can help maintain bone  health

Exercise may add to the benefits of bone maintaining  medications (bisphosphonates)

Resistance training and possibly high‐impact exercise  may be best for stimulating bone development

Waltman , 2010

Newton et al , 2010, ACPCRA Conference

Page 20: Wellspring Cancer Exercise Lay PresDSantaMina

Lymphedema

Lymphedema is an accumulation of lymphatic  fluid, often in the extremities.

It can cause:•

Swelling•

Pain•

Loss of Function•

Increased Risk of Infection•

Hardening/Thickening of the skin•

Ulcers

Page 21: Wellspring Cancer Exercise Lay PresDSantaMina

Exercise and Lymphedema

Research shows that exercise does not worsen upper  extremity lymphedema; but may actually help it

Persons with lymphedema should exercise with  caution (consult with your doctor, a physiotherapist, 

or trained Wellspring Cancer Exercise leader)

The relationship between lower limb lymphedema  and exercise is not well understood

(Schmitz, 2010, NEJM, Harris, 2000, J Surg Onc; McKenzie & Kalda, 2003, JCO, Ahmed et al, 2006, JCO; Lacomba, 2010, BMJ; Katz, 2010)

Page 22: Wellspring Cancer Exercise Lay PresDSantaMina

Exercise Can Improve Emotional and  Cognitive Well‐being

In many cancers, exercise has shown to improve: •

Quality of Life•

Confusion / Mental Function•

Mood disturbance•

Anger/ Hostility•

Body Image•

Weight Concerns•

Sexual Attractiveness•

Self‐Esteem

Page 23: Wellspring Cancer Exercise Lay PresDSantaMina

Exercise Post‐Treatment

Post‐Treatment

Prevention / 

Pre‐D

iagnosis

Pre‐Treatment

During Treatment

Page 24: Wellspring Cancer Exercise Lay PresDSantaMina

Physical Activity Post‐Treatment... Continued Benefits

From systematic reviews…

Cardiovascular &  musculoskeletal fitness

Vigor•

Mental Clarity•

Lymphedema•

Physical functioning•

Fatigue•

Bone mineral density•

Body composition

Joint mobility•

Immune factors•

Quality of Life•

Reduced Risk of comorbidities•

Reduced chronic treatment‐

related side‐effects•

Improved body image and 

self‐esteem•

Survival

(Schmitz et al, 2005, Ca Epi, Bio, Prev; Galvao et al, 2006, JCO)

Page 25: Wellspring Cancer Exercise Lay PresDSantaMina

Exercise and Post‐Treatment Pain

Concern that exercise will cause pain

Highly sensitive to changes in pain

Exercise has been associated with reduced pain  in cancer patients

(Alfano et al, 2007; J of Cancer Survivorship; McNeely, 2004, Head & Neck)

Page 26: Wellspring Cancer Exercise Lay PresDSantaMina

Exercise and Survival After Cancer

New research is demonstrating that survival can be  improved with exercise for 

Breast Cancer•

Colorectal Cancer•

Prostate Cancer

Benefits include cancer and non‐cancer survival  improvement

Holmes, 2005, JAMA; Meyerhardt, 2006, JCO; Kenfield, 2011, JCO)

Page 27: Wellspring Cancer Exercise Lay PresDSantaMina

Physical Activity Post‐Treatment / Palliation

In late stage cancer, Exercise is associated with:•

Improved tolerance of symptoms•

Improved mobility•

Improved coping•

Maintenance of physical function•

Maintenance of quality of life

… and is generally well tolerated

(Courneya & Friedenreich, 2007, Seminars in Nursing Oncology;

Oldervoll et al, 2004/2005)

Page 28: Wellspring Cancer Exercise Lay PresDSantaMina

Again…When do the benefits start?

Now!Exercise is beneficial during every phase of cancer:

Prevention/

Pre‐D

iagnosis

During Treatment

Pre‐Treatment

Post‐Treatment

Page 29: Wellspring Cancer Exercise Lay PresDSantaMina

Exercise Guidelines

Page 30: Wellspring Cancer Exercise Lay PresDSantaMina

Goals of Exercise Programs for Cancer  Survivors

1.

Regain and improve physical function2.

Improve body image and quality of life

3.

Improve body composition4.

Improve cardiorespiratory, hormone, neurological, 

muscular, cognitive and psychosocial outcomes5.

Reduce or delay recurrence or second primary cancer

6.

Improve coping with recurrence / a second primary 7.

Reduce/prevent long‐term & late effects of treatment

8.

Improve tolerance to current & future treatments

(Schmitz et al, 2010 MSSE, ACSM Roundtable)

Page 31: Wellspring Cancer Exercise Lay PresDSantaMina

Careful Consideration Before Starting An  Exercise Program

Consult with your family doctor or oncologist or trained  Wellspring Cancer Exercise leader before starting an exercise 

program.

Be cautious when exercising if you have:

Recently completed surgery (up to 8 weeks after surgery)•

Extreme fatigue or anemia•

Low blood counts of immune cells or platelets•

Any local restrictions (e.g. lymphedema, scarring, skin 

sensitivity)•

Drains (e.g. JP drains, ostomy, catheters)•

High fracture risk

(Schmitz et al, 2010 MSSE, ACSM Roundtable)

Page 32: Wellspring Cancer Exercise Lay PresDSantaMina

Exercise Guidelines for Cancer  Survivors

General Statement:•

Avoid inactivity•

Return to daily activities as quickly as possible after 

surgery•

Continue normal daily activities as much as possible 

during and after non‐surgical treatments•

Individuals with cardiac conditions may require 

modifications & greater supervision

30‐60 mins

of moderate‐to‐vigorous PA,  >5d/wk

(Schmitz et al, 2010 MSSE, ACSM Roundtable)

Page 33: Wellspring Cancer Exercise Lay PresDSantaMina

Cancer and Exercise Guidelines: FITT Principle

Frequency▫

The number of days per week that you participate in a 

certain activity•

Intensity▫

The amount of effort you put into the exercise

The level of difficulty of the exercise•

Time▫

The duration of the activity

Type▫

The specific activity that you take part in

Page 34: Wellspring Cancer Exercise Lay PresDSantaMina

General Exercise Prescription for  Cancer Patients

Modality Frequency Intensity  Volume (Time)

Aerobic/Cardio 3‐5 50‐90% Max Heart Rate 4‐7/10  Rating of 

Perceived Exertion 

20‐60 mins (continuous or 

intermittent)

Anaerobic/Resistance

1‐3 50‐80%  1 Repetition  Maximum;

4‐7/10 RPE

1‐4 sets per  muscle group

Flexibility 2‐3 ? 2‐4 sets per  muscle group, 

hold for 10‐30s

Galvao & Newton, 2005, JCO

Page 35: Wellspring Cancer Exercise Lay PresDSantaMina

Exercise Adherence: “The extent to which individuals’

exercise behaviours  correspond with the exercise prescription“

Schmitz et al, Can Epi

Bio 2005

Page 36: Wellspring Cancer Exercise Lay PresDSantaMina

Exercise needs to be a long‐term  commitment…

Only 30% of cancer survivors are meeting physical  activity recommendations

Studies have shown that after an exercise program is  discontinued, negative side effects of cancer and 

treatment return

Duration of Exercise = Duration of Benefits

(Culos-Reed et al,2007; Courneya & Friedenreich, 1997)

(Bellizzi et al, 2007)

Page 37: Wellspring Cancer Exercise Lay PresDSantaMina

Barriers to Physical Activity in Cancer  Survivors

Unaware of exercise benefits•

Emotional factors (depression)•

Psychosocial factors (body image, feeling sick)•

Fatigue•

Nausea and vomiting•

Time (vacation, medical appointments)•

Lack of confidence/comfort/familiarity with exercise•

Lack of social support•

Lack of time•

Distance from the exercise centre•

Low motivation•

Worry about injuries, disease progression•

Travel (“Snow Bird Effect”)

Page 38: Wellspring Cancer Exercise Lay PresDSantaMina

Strategies to Facilitate Adherence

Home‐based equipment

Physician Referral & 

Follow‐up

Group Exercise & 

Exercise Support Groups

Goal Setting

Exercise Manuals / 

Educational Documents

Educational seminars

Qualified trainers

Self‐rewards

Problem solving