Day 31 b Cancer Rehab Jones

Exercise & Cancer Rehabilitation Exercise & Cancer Rehabilitation

Lee W. Jones, Ph.D.Lee W. Jones, Ph.D.Lee W. Jones, Ph.D.Lee W. Jones, Ph.D.

Behavioral Medicine Laboratory,Behavioral Medicine Laboratory,Faculty of Physical Education,Faculty of Physical Education,

University of AlbertaUniversity of Alberta

Behavioral Medicine Laboratory,Behavioral Medicine Laboratory,Faculty of Physical Education,Faculty of Physical Education,

University of AlbertaUniversity of Alberta

HE ED 221 (E-121) HE ED 221 (E-121)

November 24, 1.00-2.00pm, 2003November 24, 1.00-2.00pm, 2003

HE ED 221 (E-121) HE ED 221 (E-121)

November 24, 1.00-2.00pm, 2003November 24, 1.00-2.00pm, 2003

Framework PEACEFramework PEACE

PreventionPreventionPreventionPrevention 1.1.Pre-TreatmentPre-Treatment

1.1.Pre-TreatmentPre-Treatment

DIAGNOSISDIAGNOSISDIAGNOSISDIAGNOSIS

2. 2. TreatmentTreatment

2. 2. TreatmentTreatment

4.4.PalliationPalliation

4.4.PalliationPalliation

3.3.RehabilitationRehabilitation

3.3.RehabilitationRehabilitation

5.5.SurvivalSurvival

5.5.SurvivalSurvival

Adapted from Courneya & Friedenreich, Ann Behav Med 2001Adapted from Courneya & Friedenreich, Ann Behav Med 2001

PRE-DIAGNOSISPRE-DIAGNOSISPRE-DIAGNOSISPRE-DIAGNOSIS POST-DIAGNOSISPOST-DIAGNOSISPOST-DIAGNOSISPOST-DIAGNOSIS

Why Exercise?Why Exercise?

Cancer TherapiesCancer TherapiesCancer TherapiesCancer Therapies

SurgerySurgery

Tx for localized tumorsTx for localized tumors

60% pts, 30% cure rate60% pts, 30% cure rate

SurgerySurgery

Tx for localized tumorsTx for localized tumors

60% pts, 30% cure rate60% pts, 30% cure rate

RadiationRadiation

Local – regional txLocal – regional tx

50% patients50% patients

RadiationRadiation

Local – regional txLocal – regional tx

50% patients50% patients

Systemic TherapySystemic Therapy

Advanced solid tumorsAdvanced solid tumorsChemotherapy;hormonal therapy; Chemotherapy;hormonal therapy; biological therapybiological therapy

Systemic TherapySystemic Therapy

Advanced solid tumorsAdvanced solid tumorsChemotherapy;hormonal therapy; Chemotherapy;hormonal therapy; biological therapybiological therapy

Cancer & Quality of LifeCancer & Quality of LifeCancer & Quality of LifeCancer & Quality of Life

- Psychological/physical & functional side-effects- Psychological/physical & functional side-effects- Psychological/physical & functional side-effects- Psychological/physical & functional side-effects

SurgerySurgery

- infection, loss of function, dyspnea, pain, - infection, loss of function, dyspnea, pain, diarrhea, diarrhea, lymphedemalymphedema

SurgerySurgery

- infection, loss of function, dyspnea, pain, - infection, loss of function, dyspnea, pain, diarrhea, diarrhea, lymphedemalymphedema

RadiationRadiation

- - nausea, fatigue, vascular damage (cardiac & nausea, fatigue, vascular damage (cardiac & lung tissue)lung tissue)

RadiationRadiation

- - nausea, fatigue, vascular damage (cardiac & nausea, fatigue, vascular damage (cardiac & lung tissue)lung tissue)

ChemotherapyChemotherapy

- myelosuppression, nausea, weight gain, cardiac - myelosuppression, nausea, weight gain, cardiac toxicity, fatiguetoxicity, fatigue

ChemotherapyChemotherapy

- myelosuppression, nausea, weight gain, cardiac - myelosuppression, nausea, weight gain, cardiac toxicity, fatiguetoxicity, fatigue

Shapiro Shapiro NEJMNEJM 2001 344:1997-2008 2001 344:1997-2008Shapiro Shapiro NEJMNEJM 2001 344:1997-2008 2001 344:1997-2008

Current Quality of Life InterventionsCurrent Quality of Life InterventionsCurrent Quality of Life InterventionsCurrent Quality of Life Interventions

- Cognitive-behavioral therapies, educational - Cognitive-behavioral therapies, educational strategies, grp psychotherapystrategies, grp psychotherapy

- Largely psychological in nature- Largely psychological in nature

- Unlikely to address physical/functional aspects- Unlikely to address physical/functional aspects

- Exercise – not important or appropriate - Exercise – not important or appropriate

- Cognitive-behavioral therapies, educational - Cognitive-behavioral therapies, educational strategies, grp psychotherapystrategies, grp psychotherapy

- Largely psychological in nature- Largely psychological in nature

- Unlikely to address physical/functional aspects- Unlikely to address physical/functional aspects

- Exercise – not important or appropriate - Exercise – not important or appropriate

Courneya, Mackey & Jones Courneya, Mackey & Jones Phys SportsMedPhys SportsMed 2000 2000Courneya, Mackey & Jones Courneya, Mackey & Jones Phys SportsMedPhys SportsMed 2000 2000

Cancer, Quality of Life, & ExerciseCancer, Quality of Life, & ExerciseCancer, Quality of Life, & ExerciseCancer, Quality of Life, & Exercise

Clinical Concerns:Clinical Concerns:

-Immunosuppressive effects-Immunosuppressive effects

-Pathological bone fractures-Pathological bone fractures

- - Cardiotoxicity (RT & CT) Cardiotoxicity (RT & CT)

- Unwillingness of cancer pts- Unwillingness of cancer pts

- Recent research – dispelling myths- Recent research – dispelling myths

Clinical Concerns:Clinical Concerns:

-Immunosuppressive effects-Immunosuppressive effects

-Pathological bone fractures-Pathological bone fractures

- - Cardiotoxicity (RT & CT) Cardiotoxicity (RT & CT)

- Unwillingness of cancer pts- Unwillingness of cancer pts

- Recent research – dispelling myths- Recent research – dispelling myths

Courneya, Mackey & Jones Courneya, Mackey & Jones Phys SportsMedPhys SportsMed 2000 2000Courneya, Mackey & Jones Courneya, Mackey & Jones Phys SportsMedPhys SportsMed 2000 2000

Current Status – Exercise & CancerCurrent Status – Exercise & CancerResearchResearch

Review of LiteratureReview of Literature

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Exercise ModalityExercise ModalityExercise ModalityExercise Modality

Review of LiteratureReview of Literature

Courneya et al. Courneya et al. Phys SportsMedPhys SportsMed 2000;28:49; Courneya 2000;28:49; Courneya ACSMACSM; 2003; 2003Courneya et al. Courneya et al. Phys SportsMedPhys SportsMed 2000;28:49; Courneya 2000;28:49; Courneya ACSMACSM; 2003; 2003

All reported significant benefitsAll reported significant benefits

No Adverse eventsNo Adverse events

Multiple Outcomes…..Multiple Outcomes…..

All reported significant benefitsAll reported significant benefits

No Adverse eventsNo Adverse events

Multiple Outcomes…..Multiple Outcomes…..

Outcomes/ResultsOutcomes/ResultsOutcomes/ResultsOutcomes/Results

Physiologic OutcomesPhysiologic Outcomes - VO - VO2peak, 2peak, body comp, NK body comp, NK

activity, flexibilityactivity, flexibility

Physiologic OutcomesPhysiologic Outcomes - VO - VO2peak, 2peak, body comp, NK body comp, NK

activity, flexibilityactivity, flexibility

Tx-Related SymptomsTx-Related Symptoms – fatigue, pain, nausea, – fatigue, pain, nausea, diarrhea, platelet transfusion, hospital staydiarrhea, platelet transfusion, hospital stayTx-Related SymptomsTx-Related Symptoms – fatigue, pain, nausea, – fatigue, pain, nausea, diarrhea, platelet transfusion, hospital staydiarrhea, platelet transfusion, hospital stay

QOL OutcomesQOL Outcomes – overall, PWB, FWB, SWB, SWL, – overall, PWB, FWB, SWB, SWL, anx/depanx/depQOL OutcomesQOL Outcomes – overall, PWB, FWB, SWB, SWL, – overall, PWB, FWB, SWB, SWL, anx/depanx/dep

Review of LiteratureReview of Literature

Small number of studies (n=47; only 14 RCT’s)Small number of studies (n=47; only 14 RCT’s)

Small sample sizes (heterogeneous)Small sample sizes (heterogeneous)

Self-report measures of exerciseSelf-report measures of exercise

Methodology not well describedMethodology not well described

Small number of studies (n=47; only 14 RCT’s)Small number of studies (n=47; only 14 RCT’s)

Small sample sizes (heterogeneous)Small sample sizes (heterogeneous)

Self-report measures of exerciseSelf-report measures of exercise

Methodology not well describedMethodology not well described

LimitationsLimitationsLimitationsLimitations

Courneya et al. Courneya et al. Phys SportsMedPhys SportsMed 2000;28:49; Courneya 2000;28:49; Courneya ACSMACSM; 2003; 2003Courneya et al. Courneya et al. Phys SportsMedPhys SportsMed 2000;28:49; Courneya 2000;28:49; Courneya ACSMACSM; 2003; 2003

V. Clinical ExerciseV. Clinical ExercisePrescription GuidelinesPrescription Guidelines

Cancer dx affects all aspects of physical Cancer dx affects all aspects of physical functioningfunctioning

Unique manifestationsUnique manifestations

- Tumor- Tumor

- Treatment- Treatment

- Side effects- Side effects

- Demographic profile- Demographic profile

ACSM guidelines (3-5d/wk, 30-60mins, moderate ACSM guidelines (3-5d/wk, 30-60mins, moderate intensity)intensity)

Optimal guidelines – not yet establishedOptimal guidelines – not yet established

Cancer dx affects all aspects of physical Cancer dx affects all aspects of physical functioningfunctioning

Unique manifestationsUnique manifestations

- Tumor- Tumor

- Treatment- Treatment

- Side effects- Side effects

- Demographic profile- Demographic profile

ACSM guidelines (3-5d/wk, 30-60mins, moderate ACSM guidelines (3-5d/wk, 30-60mins, moderate intensity)intensity)

Optimal guidelines – not yet establishedOptimal guidelines – not yet established

General GuidelinesGeneral Guidelines

Prescription GuidelinesPrescription Guidelines

ModeMode

Walking / cycle ergometry natural Walking / cycle ergometry natural choicechoice

Account for specific impairments Account for specific impairments (e.g., colorectal, breast cancer)(e.g., colorectal, breast cancer)

Resistance/upper body – Resistance/upper body – lymphedema concerns - lymphedema concerns - unfoundedunfounded

Combined program optimalCombined program optimal

Walking / cycle ergometry natural Walking / cycle ergometry natural choicechoice

Account for specific impairments Account for specific impairments (e.g., colorectal, breast cancer)(e.g., colorectal, breast cancer)

Resistance/upper body – Resistance/upper body – lymphedema concerns - lymphedema concerns - unfoundedunfounded

Combined program optimalCombined program optimal

Prescription GuidelinesPrescription Guidelines

Frequency & IntensityFrequency & Intensity

At least 3-5d/wkAt least 3-5d/wk

Daily for deconditioned patientsDaily for deconditioned patients

Moderate IntensityModerate Intensity

50-70% VO50-70% VO2max2max

60-80% HR60-80% HRmaxmax

RPE 11-14RPE 11-14

At least 3-5d/wkAt least 3-5d/wk

Daily for deconditioned patientsDaily for deconditioned patients

Moderate IntensityModerate Intensity

50-70% VO50-70% VO2max2max

60-80% HR60-80% HRmaxmax

RPE 11-14RPE 11-14

Prescription GuidelinesPrescription Guidelines

Duration & ProgressionDuration & Progression

20-30mins (continuous)20-30mins (continuous)

Intermittment bouts (5-10 mins)Intermittment bouts (5-10 mins)

Initially in frequency & duration - Initially in frequency & duration - then intensitythen intensity

Progression slower for Progression slower for deconditioned pts & those deconditioned pts & those suffering severe side effectssuffering severe side effects

20-30mins (continuous)20-30mins (continuous)

Intermittment bouts (5-10 mins)Intermittment bouts (5-10 mins)

Initially in frequency & duration - Initially in frequency & duration - then intensitythen intensity

Progression slower for Progression slower for deconditioned pts & those deconditioned pts & those suffering severe side effectssuffering severe side effects

General GuidelinesGeneral Guidelines

No evidence that one type of exercise is superiorNo evidence that one type of exercise is superior

Safety is the primary concernSafety is the primary concern

Optimal program may combine resistance & Optimal program may combine resistance &

aerobic training aerobic training

Key point is to be flexible - modify prescription Key point is to be flexible - modify prescription

based on response to treatment(s)based on response to treatment(s)

No evidence that one type of exercise is superiorNo evidence that one type of exercise is superior

Safety is the primary concernSafety is the primary concern

Optimal program may combine resistance & Optimal program may combine resistance &

aerobic training aerobic training

Key point is to be flexible - modify prescription Key point is to be flexible - modify prescription

based on response to treatment(s)based on response to treatment(s)

ComplicationComplication PrecautionPrecaution• Hemoglobin <8.0 g/dlHemoglobin <8.0 g/dl Avoid high intensity exerciseAvoid high intensity exercise• Absolute neutrophil countAbsolute neutrophil count Avoid exercises that may Avoid exercises that may

increase increase chance of infection chance of infection (swimming)(swimming)

• Fever > 38Fever > 38ooCC Avoid exercise Avoid exercise • Ataxia/dizzinessAtaxia/dizziness Avoid exercises that require Avoid exercises that require

significant balance & significant balance & coordination coordination (treadmill)(treadmill)

• Severe cachexiaSevere cachexia Loss of muscle mass limits Loss of muscle mass limits exercise exercise intensity - modify intensity - modify program program accordinglyaccordingly

• Bone painBone pain Avoid high impact exercisesAvoid high impact exercises• Extreme fatigueExtreme fatigue Exercise at lower power output, Exercise at lower power output,

avoid maximal testsavoid maximal tests

ComplicationComplication PrecautionPrecaution• Hemoglobin <8.0 g/dlHemoglobin <8.0 g/dl Avoid high intensity exerciseAvoid high intensity exercise• Absolute neutrophil countAbsolute neutrophil count Avoid exercises that may Avoid exercises that may

increase increase chance of infection chance of infection (swimming)(swimming)

• Fever > 38Fever > 38ooCC Avoid exercise Avoid exercise • Ataxia/dizzinessAtaxia/dizziness Avoid exercises that require Avoid exercises that require

significant balance & significant balance & coordination coordination (treadmill)(treadmill)

• Severe cachexiaSevere cachexia Loss of muscle mass limits Loss of muscle mass limits exercise exercise intensity - modify intensity - modify program program accordinglyaccordingly

• Bone painBone pain Avoid high impact exercisesAvoid high impact exercises• Extreme fatigueExtreme fatigue Exercise at lower power output, Exercise at lower power output,

avoid maximal testsavoid maximal tests

Special PrecautionsSpecial Precautions

VI. Current Clinical Trials & Forthcoming VI. Current Clinical Trials & Forthcoming StudiesStudies

Breast Cancer Breast Cancer

REHAB Trial REHAB Trial

REHAB REHAB ((RRehabilitation ehabilitation EExercise for xercise for HHealth ealth AAfter fter BBreast reast Cancer) TrialCancer) Trial

REHAB REHAB ((RRehabilitation ehabilitation EExercise for xercise for HHealth ealth AAfter fter BBreast reast Cancer) TrialCancer) Trial

PurposePurpose

Determine the effects of exercise Determine the effects of exercise training on cardiopulmonary, QOL, training on cardiopulmonary, QOL, and biologic outcomes in and biologic outcomes in postmenopausal b/c survivorspostmenopausal b/c survivors

PurposePurpose

Determine the effects of exercise Determine the effects of exercise training on cardiopulmonary, QOL, training on cardiopulmonary, QOL, and biologic outcomes in and biologic outcomes in postmenopausal b/c survivorspostmenopausal b/c survivors

OutcomesOutcomes

QOL, VOQOL, VO2peak2peak, metabolic , metabolic

hormones (insulin, IGF-1), sex hormones (insulin, IGF-1), sex steroid hormones (estradiol, steroid hormones (estradiol, estrogen), biomarkers of CVD estrogen), biomarkers of CVD (CRP, lipids, etc.)(CRP, lipids, etc.)

OutcomesOutcomes

QOL, VOQOL, VO2peak2peak, metabolic , metabolic

hormones (insulin, IGF-1), sex hormones (insulin, IGF-1), sex steroid hormones (estradiol, steroid hormones (estradiol, estrogen), biomarkers of CVD estrogen), biomarkers of CVD (CRP, lipids, etc.)(CRP, lipids, etc.)

REHAB TrialREHAB TrialREHAB TrialREHAB Trial

MethodMethod

53 participants EG (n=25) or CG 53 participants EG (n=25) or CG (n=28)(n=28)

Cycle ergometry 3x/wk, 15-Cycle ergometry 3x/wk, 15-35mins, 15wks, 70-75% 35mins, 15wks, 70-75% VOVO2peak2peak

ResultsResults

52 participants completed trial52 participants completed trial

98.4% adherence (44.3/45 98.4% adherence (44.3/45 sessions)sessions)

53 participants EG (n=25) or CG 53 participants EG (n=25) or CG (n=28)(n=28)

Cycle ergometry 3x/wk, 15-Cycle ergometry 3x/wk, 15-35mins, 15wks, 70-75% 35mins, 15wks, 70-75% VOVO2peak2peak

ResultsResults

52 participants completed trial52 participants completed trial

98.4% adherence (44.3/45 98.4% adherence (44.3/45 sessions)sessions)

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Courneya et al. JCO 2003Courneya et al. JCO 2003

Breast CancerBreast Cancer

START START ((SSupervised upervised TTrial of rial of AAerobic vs erobic vs RResistance esistance TTraining)raining)

START START ((SSupervised upervised TTrial of rial of AAerobic vs erobic vs RResistance esistance TTraining)raining)

ObjectivesObjectives

1.1. Compare AET Vs RET on fitness & QOLCompare AET Vs RET on fitness & QOL

2.2. Explore individual characteristics of these effectsExplore individual characteristics of these effects

3.3. Compare adherence ratesCompare adherence rates

4.4. Investigate psychosocial determinantsInvestigate psychosocial determinants

ObjectivesObjectives

1.1. Compare AET Vs RET on fitness & QOLCompare AET Vs RET on fitness & QOL

2.2. Explore individual characteristics of these effectsExplore individual characteristics of these effects

3.3. Compare adherence ratesCompare adherence rates

4.4. Investigate psychosocial determinantsInvestigate psychosocial determinants

Courneya, et al. Funded by CBCRACourneya, et al. Funded by CBCRA

PurposePurpose

Determine the effects of aerobic vs. resistance training on Determine the effects of aerobic vs. resistance training on QOL in early stage b/c patients on chemotherapyQOL in early stage b/c patients on chemotherapy

PurposePurpose

Determine the effects of aerobic vs. resistance training on Determine the effects of aerobic vs. resistance training on QOL in early stage b/c patients on chemotherapyQOL in early stage b/c patients on chemotherapy

START TrialSTART Trial

Study DesignStudy DesignStudy DesignStudy Design 210 Early 210 Early Stage B/C Stage B/C PatientsPatients

VancouverVancouverN=70N=70

OttawaOttawaN=70N=70

Procedure Procedure Procedure Procedure

EdmontonEdmontonN=70N=70

Tax/Non-TaxTax/Non-Tax Tax/Non-TaxTax/Non-Tax Tax/Non-TaxTax/Non-Tax

LMLM RTRT AEAE LMLM RTRT AEAE LMLM RTRT AEAE

Eligible Pts Eligible Pts Approached by Approached by

OncologistOncologist

Baseline Baseline Assessment > 1Assessment > 1stst CT CT

Intervention Intervention Concurrent with CTConcurrent with CT

Post-Test 3wkPost-Test 3wk> Last CT> Last CT

Courneya, et al. Funded by CBCRACourneya, et al. Funded by CBCRA

START TrialSTART Trial

OutcomesOutcomes

Primary:Primary: QOL QOL

Secondary:Secondary: Fatigue; VO Fatigue; VO2peak2peak; Muscular Strength; ; Muscular Strength;

Body Composition; Lymphedema; Bio-markers Body Composition; Lymphedema; Bio-markers (Cancer Recurrence & CV Risk Factors)(Cancer Recurrence & CV Risk Factors)

OutcomesOutcomes

Primary:Primary: QOL QOL

Secondary:Secondary: Fatigue; VO Fatigue; VO2peak2peak; Muscular Strength; ; Muscular Strength;

Body Composition; Lymphedema; Bio-markers Body Composition; Lymphedema; Bio-markers (Cancer Recurrence & CV Risk Factors)(Cancer Recurrence & CV Risk Factors)

ProgressProgress

Edmonton (n=21; 83%)Edmonton (n=21; 83%)

Ottawa (n=18)Ottawa (n=18)

Vancouver (n=3)Vancouver (n=3)

ProgressProgress

Edmonton (n=21; 83%)Edmonton (n=21; 83%)

Ottawa (n=18)Ottawa (n=18)

Vancouver (n=3)Vancouver (n=3)

Courneya, et al. Funded by CBCRACourneya, et al. Funded by CBCRA

Prostate Cancer Prostate Cancer

Prostate Trial Prostate Trial

Prostate and Resistance Exercise Training TrialProstate and Resistance Exercise Training Trial

Purpose

Determine the effects of resistance exercise on fatigue & HRQOL in prostate cancer patients receiving ADT.

Outcomes

HRQOL, fatigue, body composition, muscular fitness (strength, cardiopulmonary fitness)

Purpose

Determine the effects of resistance exercise on fatigue & HRQOL in prostate cancer patients receiving ADT.

Outcomes

HRQOL, fatigue, body composition, muscular fitness (strength, cardiopulmonary fitness)

Segal et al. JCO 2003Segal et al. JCO 2003

REHAB TrialREHAB TrialProstate TrialProstate Trial

Method

155 RET (n=83) or CG (n=73)

Resistance Training 3x/wk, 12wks, 9 exercises, 2 sets of 8-12 reps @ 60-70% 1 RM

Results

135 participants completed

76.2% adherence (27/36 sessions)

Method

155 RET (n=83) or CG (n=73)

Resistance Training 3x/wk, 12wks, 9 exercises, 2 sets of 8-12 reps @ 60-70% 1 RM

Results

135 participants completed

76.2% adherence (27/36 sessions)

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QOLQOLQOLQOL

Colorectal Cancer Colorectal Cancer

CAN-HOPE RCTCAN-HOPE RCT

Colorectal RCT (CAN-HOPE)Colorectal RCT (CAN-HOPE)

• To determine if exercise can To determine if exercise can improve QOL in colorectal improve QOL in colorectal cancer survivorscancer survivors

• Submaximal fitness test/QOL Submaximal fitness test/QOL at baseline & 16 weeksat baseline & 16 weeks

• Moderate intensity, home-Moderate intensity, home-based exercise program based exercise program (F=3-5/wk; D=20-30)(F=3-5/wk; D=20-30)

• Randomized 102 patients (33 Randomized 102 patients (33 Control /69 EX)Control /69 EX)

Colorectal RCT (CAN-HOPE)Colorectal RCT (CAN-HOPE)

• To determine if exercise can To determine if exercise can improve QOL in colorectal improve QOL in colorectal cancer survivorscancer survivors

• Submaximal fitness test/QOL Submaximal fitness test/QOL at baseline & 16 weeksat baseline & 16 weeks

• Moderate intensity, home-Moderate intensity, home-based exercise program based exercise program (F=3-5/wk; D=20-30)(F=3-5/wk; D=20-30)

• Randomized 102 patients (33 Randomized 102 patients (33 Control /69 EX)Control /69 EX)

Courneya et al. Courneya et al. EJCCEJCC, in press, in pressCourneya et al. Courneya et al. EJCCEJCC, in press, in press

CAN-HOPE RCTCAN-HOPE RCT

Participant CharacteristicsParticipant CharacteristicsParticipant CharacteristicsParticipant CharacteristicsParticipant CharacteristicsParticipant Characteristics

DemographicDemographic

Age: 60; 59% maleAge: 60; 59% male

74% married; 40% university74% married; 40% university

60% >$40k60% >$40k

Participant CharacteristicsParticipant Characteristics

DemographicDemographic

Age: 60; 59% maleAge: 60; 59% male

74% married; 40% university74% married; 40% university

60% >$40k60% >$40k

MedicalMedical

Mths Sx: 2Mths Sx: 2

80% III/IV; 100% Sx; 20% RT; 65% 80% III/IV; 100% Sx; 20% RT; 65% CTCT

MedicalMedical

Mths Sx: 2Mths Sx: 2

80% III/IV; 100% Sx; 20% RT; 65% 80% III/IV; 100% Sx; 20% RT; 65% CTCT

CAN-HOPE ResultsCAN-HOPE Results

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Courneya et al. Courneya et al. EJCC,EJCC, in press in pressCourneya et al. Courneya et al. EJCC,EJCC, in press in press

Lung Cancer Lung Cancer

Exercise Capacity & NSCLCExercise Capacity & NSCLC

PurposePurpose

Determine the Prognostic Value of Symptom-Limited Determine the Prognostic Value of Symptom-Limited Exercise Testing on Survival in Inoperable NSCLC Exercise Testing on Survival in Inoperable NSCLC PatientsPatients

PurposePurpose

Determine the Prognostic Value of Symptom-Limited Determine the Prognostic Value of Symptom-Limited Exercise Testing on Survival in Inoperable NSCLC Exercise Testing on Survival in Inoperable NSCLC PatientsPatients

MethodMethod

New Patient Rounds via Medical New Patient Rounds via Medical Record ReviewRecord Review

Blood draw/PFT/GXTBlood draw/PFT/GXT

MethodMethod

New Patient Rounds via Medical New Patient Rounds via Medical Record ReviewRecord Review

Blood draw/PFT/GXTBlood draw/PFT/GXT

Jones et al. Jones et al. In ProcessIn ProcessJones et al. Jones et al. In ProcessIn Process

Exercise Capacity & NSCLCExercise Capacity & NSCLC

OutcomesOutcomes

Primary:Primary: Survival Survival

Secondary:Secondary:

-Association with traditional Association with traditional predictorspredictors

-VOVO2peak2peak & Tx response/tolerability & Tx response/tolerability

OutcomesOutcomes

Primary:Primary: Survival Survival

Secondary:Secondary:

-Association with traditional Association with traditional predictorspredictors

-VOVO2peak2peak & Tx response/tolerability & Tx response/tolerability

Jones et al. Jones et al. In ProcessIn ProcessJones et al. Jones et al. In ProcessIn Process

Exercise Capacity & NSCLCExercise Capacity & NSCLC

ProgressProgressProgressProgressTotal Number of Total Number of

Patients ScreenedPatients Screened

N=49N=49

Total Number of Total Number of Patients EligiblePatients Eligible

N=20 (20/49 = 41%)N=20 (20/49 = 41%)

Total Number of Total Number of Patients InterestedPatients Interested

N=12 (12/20 = 65%)N=12 (12/20 = 65%)

Total Number of Total Number of Patients TestedPatients Tested

N=10 (10/12 = 83%)N=10 (10/12 = 83%)

Reasons for Non-Eligibility Reasons for Non-Eligibility (n=29)(n=29)

Recent CHD (n=4)Recent CHD (n=4)Physically Disabled (n=7)Physically Disabled (n=7)TB (n=1)TB (n=1)Age (n=2)Age (n=2)O2 Dependent (n=5)O2 Dependent (n=5)Extensive Met Disease (n=4)Extensive Met Disease (n=4)Psychological Distress (n=2)Psychological Distress (n=2)Co-morbidities (n=4)Co-morbidities (n=4)Non Lung Cancer (n=1)Non Lung Cancer (n=1)No Treatment (n=1)No Treatment (n=1)

Reasons for Non-recruitment Reasons for Non-recruitment (n=8)(n=8)

Does Not Believe in Exercise Does Not Believe in Exercise (n=1)(n=1)Exercise Test Too Risky (n=1)Exercise Test Too Risky (n=1)Too Sick (n=3)Too Sick (n=3)Too Much On (n=3)Too Much On (n=3)

Jones et al. In Process

Jones et al. In Process

Exercise Capacity & NSCLCExercise Capacity & NSCLC

ResultsResults

Age: 71 Age: 71 Range: 64 - 83Range: 64 - 83

VOVO2peak2peak: 16.2: 16.2 Range: 9.4 – 24.3Range: 9.4 – 24.3 RER: 1.2RER: 1.2

BMI: 27BMI: 27 Range: 21 – 35Range: 21 – 35

ResultsResults

Age: 71 Age: 71 Range: 64 - 83Range: 64 - 83

VOVO2peak2peak: 16.2: 16.2 Range: 9.4 – 24.3Range: 9.4 – 24.3 RER: 1.2RER: 1.2

BMI: 27BMI: 27 Range: 21 – 35Range: 21 – 35

Aims:Aims:

Accurate prognostic informationAccurate prognostic information

‘‘Optimal’ therapeutic approachOptimal’ therapeutic approach

Feasibility & safety - RCTFeasibility & safety - RCT

Aims:Aims:

Accurate prognostic informationAccurate prognostic information

‘‘Optimal’ therapeutic approachOptimal’ therapeutic approach

Feasibility & safety - RCTFeasibility & safety - RCT

Pre Surgery Exercise RCTPre Surgery Exercise RCT

Jones et al. Jones et al. In ProgressIn ProgressJones et al. Jones et al. In ProgressIn Progress

OutcomesOutcomes

Primary: Perioperative Complications (infection, OPrimary: Perioperative Complications (infection, O22

utilization, etc.)utilization, etc.)

Secondary: VOSecondary: VO2peak2peak, QOL, length of hospital stay, QOL, length of hospital stay

OutcomesOutcomes

Primary: Perioperative Complications (infection, OPrimary: Perioperative Complications (infection, O22

utilization, etc.)utilization, etc.)

Secondary: VOSecondary: VO2peak2peak, QOL, length of hospital stay, QOL, length of hospital stay

MethodMethod

Surgeon ReferralSurgeon Referral

Two-armed RCT – Exercise Training (n=25) vs. Two-armed RCT – Exercise Training (n=25) vs. Usual Care (n=25)Usual Care (n=25)

AET 4/5x/wk, 10-45mins, 50-75% VOAET 4/5x/wk, 10-45mins, 50-75% VO2peak2peak for 6 wks for 6 wks

MethodMethod

Surgeon ReferralSurgeon Referral

Two-armed RCT – Exercise Training (n=25) vs. Two-armed RCT – Exercise Training (n=25) vs. Usual Care (n=25)Usual Care (n=25)

AET 4/5x/wk, 10-45mins, 50-75% VOAET 4/5x/wk, 10-45mins, 50-75% VO2peak2peak for 6 wks for 6 wks

Timing of Assessments: Timing of Assessments: baseline, pre-sx, 5-7d post sxbaseline, pre-sx, 5-7d post sxTiming of Assessments: Timing of Assessments: baseline, pre-sx, 5-7d post sxbaseline, pre-sx, 5-7d post sx

Other Cancers Other Cancers

Exercise & Anemia Trial Exercise & Anemia Trial

Mackey, Courneya, Jones et al. Funded by Amgen IncMackey, Courneya, Jones et al. Funded by Amgen IncMackey, Courneya, Jones et al. Funded by Amgen IncMackey, Courneya, Jones et al. Funded by Amgen Inc

EXTRA EXTRA ((EXEXercise ercise TRTRaining & aining & AAnemia) Trialnemia) TrialEXTRA EXTRA ((EXEXercise ercise TRTRaining & aining & AAnemia) Trialnemia) Trial

OutcomesOutcomes

Primary: QOL (FACT-An)Primary: QOL (FACT-An)

Secondary: VOSecondary: VO2peak2peak, Hb Response, Blood Markers, Hb Response, Blood Markers

OutcomesOutcomes

Primary: QOL (FACT-An)Primary: QOL (FACT-An)

Secondary: VOSecondary: VO2peak2peak, Hb Response, Blood Markers, Hb Response, Blood Markers

PurposePurpose

Determine if a 12-wk exercise program can improve QOL Determine if a 12-wk exercise program can improve QOL in anemic patients receiving Aranespin anemic patients receiving Aranesp

PurposePurpose

Determine if a 12-wk exercise program can improve QOL Determine if a 12-wk exercise program can improve QOL in anemic patients receiving Aranespin anemic patients receiving Aranesp

MethodMethod

Two-armed RCT – Aranesp Alone (n=50) vs. Aranesp + Two-armed RCT – Aranesp Alone (n=50) vs. Aranesp + Exercise (n=50)Exercise (n=50)

Periodized Cycle Ergometry 3x/wk, 30-45mins, 60-75% Periodized Cycle Ergometry 3x/wk, 30-45mins, 60-75% VOVO2peak2peak for 12 wks for 12 wks

MethodMethod

Two-armed RCT – Aranesp Alone (n=50) vs. Aranesp + Two-armed RCT – Aranesp Alone (n=50) vs. Aranesp + Exercise (n=50)Exercise (n=50)

Periodized Cycle Ergometry 3x/wk, 30-45mins, 60-75% Periodized Cycle Ergometry 3x/wk, 30-45mins, 60-75% VOVO2peak2peak for 12 wks for 12 wks

EXTRA Trial EXTRA Trial

ResultsResults

Age: 51 Age: 51 Range: 25 - 71Range: 25 - 71

VOVO2peak2peak: 16.5: 16.5 Range: 11 – 25.3Range: 11 – 25.3 RER: 1.23RER: 1.23

Hb: 100Hb: 100 Range: 91 - 107Range: 91 - 107

ResultsResults

Age: 51 Age: 51 Range: 25 - 71Range: 25 - 71

VOVO2peak2peak: 16.5: 16.5 Range: 11 – 25.3Range: 11 – 25.3 RER: 1.23RER: 1.23

Hb: 100Hb: 100 Range: 91 - 107Range: 91 - 107

PurposePurpose

Examine the Potential Role of Exercise in Multiple Examine the Potential Role of Exercise in Multiple Myeloma Cancer PatientsMyeloma Cancer Patients

PurposePurpose

Examine the Potential Role of Exercise in Multiple Examine the Potential Role of Exercise in Multiple Myeloma Cancer PatientsMyeloma Cancer Patients

ObjectivesObjectives

1.1. Exercise preferences/level of interestExercise preferences/level of interest

2.2. Exercise RatesExercise Rates

3.3. Determinants of exercise (attitudes, perceived Determinants of exercise (attitudes, perceived capability)capability)

4.4. Association with QOL & fatigueAssociation with QOL & fatigue

ObjectivesObjectives

1.1. Exercise preferences/level of interestExercise preferences/level of interest

2.2. Exercise RatesExercise Rates

3.3. Determinants of exercise (attitudes, perceived Determinants of exercise (attitudes, perceived capability)capability)

4.4. Association with QOL & fatigueAssociation with QOL & fatigue

Multiple MyelomaMultiple Myeloma

Jones et al. In Process

Jones et al. In Process

Exercise & Multiple MyelomaExercise & Multiple MyelomaExercise & Multiple MyelomaExercise & Multiple Myeloma

MethodMethod

Cross-sectional provincial survey – ACB registryCross-sectional provincial survey – ACB registry

Oncologist-approval Oncologist-approval

162 sent questionnaire162 sent questionnaire

MethodMethod

Cross-sectional provincial survey – ACB registryCross-sectional provincial survey – ACB registry

Oncologist-approval Oncologist-approval

162 sent questionnaire162 sent questionnaire

ResultsResults

11 returned (6 deceased, 5 moved)11 returned (6 deceased, 5 moved)

87 (87/151 = 58%) completed questionnaire87 (87/151 = 58%) completed questionnaire

ResultsResults

11 returned (6 deceased, 5 moved)11 returned (6 deceased, 5 moved)

87 (87/151 = 58%) completed questionnaire87 (87/151 = 58%) completed questionnaire

Jones et al. In Process

Jones et al. In Process

Exercise & Glioma RCTExercise & Glioma RCT

PurposePurpose

To determine the effect of exercise training on QOL in To determine the effect of exercise training on QOL in newly diagnosed primary glioma cancer patients newly diagnosed primary glioma cancer patients during RTduring RT

PurposePurpose

To determine the effect of exercise training on QOL in To determine the effect of exercise training on QOL in newly diagnosed primary glioma cancer patients newly diagnosed primary glioma cancer patients during RTduring RT

Jones et al. Submitted for Funding CIHR/ACBJones et al. Submitted for Funding CIHR/ACB Jones et al. Submitted for Funding CIHR/ACBJones et al. Submitted for Funding CIHR/ACB

MethodMethod

Two-armed RCT: usual care (n=12) vs. exercise training Two-armed RCT: usual care (n=12) vs. exercise training (n=12)(n=12)

MethodMethod

Two-armed RCT: usual care (n=12) vs. exercise training Two-armed RCT: usual care (n=12) vs. exercise training (n=12)(n=12)

InterventionIntervention

3x/wk; 60-90 minutes, 8wks3x/wk; 60-90 minutes, 8wks

AET: 50-70% VOAET: 50-70% VO2peak2peak

RET: 8-12 repetitions @ 70-80% 1-RM of 8 upper/lower RET: 8-12 repetitions @ 70-80% 1-RM of 8 upper/lower body exercisesbody exercises

InterventionIntervention

3x/wk; 60-90 minutes, 8wks3x/wk; 60-90 minutes, 8wks

AET: 50-70% VOAET: 50-70% VO2peak2peak

RET: 8-12 repetitions @ 70-80% 1-RM of 8 upper/lower RET: 8-12 repetitions @ 70-80% 1-RM of 8 upper/lower body exercisesbody exercises

SummarySummary

ACSM Guidelines – Early Stage PatientsACSM Guidelines – Early Stage PatientsACSM Guidelines – Early Stage PatientsACSM Guidelines – Early Stage Patients

Integral component of comprehensive care Integral component of comprehensive care for cancer patientsfor cancer patients

Integral component of comprehensive care Integral component of comprehensive care for cancer patientsfor cancer patients

Advanced Cancer Pts – More Care Advanced Cancer Pts – More Care Advanced Cancer Pts – More Care Advanced Cancer Pts – More Care

Safety primary concernSafety primary concernSafety primary concernSafety primary concern