Exercise Management Cancer. Pathophysiology Cancer is not a single disease; it is a collection of hundreds of diseases that share the common feature of.

Exercise ManagementExercise Management

CancerCancer

Exercise ManagementExercise ManagementPathophysiologyPathophysiologyCancer is not a single disease; it is a Cancer is not a single disease; it is a collection of hundreds of diseases that collection of hundreds of diseases that share the common feature of excessive, share the common feature of excessive, uncontrolled cellular proliferation and the uncontrolled cellular proliferation and the potential for these cells to spread to potential for these cells to spread to distant anatomical sites (e.g., distant anatomical sites (e.g., metastasis).metastasis).Treatment of cancer can include Treatment of cancer can include surgery, radiation, chemotherapy, and surgery, radiation, chemotherapy, and immunotherapy, either singly or in immunotherapy, either singly or in combination, and can be designed to combination, and can be designed to attempt a cure or remission, or for attempt a cure or remission, or for control of disease and relief of control of disease and relief of symptoms.symptoms.

Exercise ManagementExercise ManagementPathophysiologyPathophysiology

Cancer is cured when a remission is Cancer is cured when a remission is thought to be permanent, but many thought to be permanent, but many cancers are considered cured if the client cancers are considered cured if the client does not have a recurrence does not have a recurrence within five within five yearsyears after treatment. after treatment.

Recurrence of cancer occurs when a few Recurrence of cancer occurs when a few cancer cells escape being eradicated and cancer cells escape being eradicated and subsequently grow back over time.subsequently grow back over time.

Exercise ManagementExercise ManagementEffects of the Exercise ResponseEffects of the Exercise ResponseThe specific effects of cancer on the The specific effects of cancer on the exercise response are determined by the exercise response are determined by the tissues affected and by the extent of tissues affected and by the extent of involvement. The result is involvement. The result is often exercise often exercise intoleranceintolerance, but the limiting factors can , but the limiting factors can be varied.be varied.

The side effects of anticancer therapy The side effects of anticancer therapy also affect the exercise response. These also affect the exercise response. These can be acute onset with treatment, but can be acute onset with treatment, but are often delayed onset and permanent are often delayed onset and permanent (see Table 27.1, next slide)(see Table 27.1, next slide)

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Exercise ManagementExercise Management

Effects of Exercise TrainingEffects of Exercise TrainingFor patients undergoing therapy for For patients undergoing therapy for cancer, exercise training should have cancer, exercise training should have the objectives of maintaining the objectives of maintaining strength, endurance, and level of strength, endurance, and level of function. function. For cancer survivors who have For cancer survivors who have completed treatment, exercise completed treatment, exercise training should have the objective of training should have the objective of returning returning patients to their former level patients to their former level of physical and psychological function.of physical and psychological function.

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Effects of Exercise TrainingEffects of Exercise Training

Regular, moderate-intensity aerobic Regular, moderate-intensity aerobic exercise during cancer therapy results exercise during cancer therapy results in reduced levels of fatigue, improves in reduced levels of fatigue, improves aerobic capacity, mood, and promotes aerobic capacity, mood, and promotes a higher quality of life.a higher quality of life.

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Effects of Exercise TrainingEffects of Exercise TrainingResults of exercise studies during and following Results of exercise studies during and following

cancer treatment have shown improvements cancer treatment have shown improvements in:in:

1.1. Shoulder range of motionShoulder range of motion

2.2. FlexibilityFlexibility

3.3. Muscle strengthMuscle strength

4.4. BalanceBalance

5.5. Treatment-related side effectsTreatment-related side effects

6.6. Aerobic capacityAerobic capacity

7.7. Weight controlWeight control

8.8. Body imageBody image

9.9. Sense of controlSense of control

10.10. Depression and mood, andDepression and mood, and

11.11. Quality of lifeQuality of life

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Recommendations for Exercise Recommendations for Exercise TestingTestingExercise testing is appropriate for Exercise testing is appropriate for persons actively receiving therapy persons actively receiving therapy and persons whose cancer is in and persons whose cancer is in remission.remission.Formal exercise testing should be Formal exercise testing should be individualized to the client with individualized to the client with attention to the disease, type of attention to the disease, type of treatment, and physical limitations treatment, and physical limitations (see (see Management and Medications section, text).Management and Medications section, text).

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Effects of Exercise TrainingEffects of Exercise TrainingA concern with adult cancer survivors A concern with adult cancer survivors is that they are more likely to have is that they are more likely to have co-morbid conditions such as coronary co-morbid conditions such as coronary artery disease, high blood pressure, artery disease, high blood pressure, diabetes, or high blood lipids.diabetes, or high blood lipids.These conditions may actually These conditions may actually influence exercise management more influence exercise management more than the history of cancer does.than the history of cancer does.

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Recommendations for Exercise Recommendations for Exercise Testing Testing (see Table 27.2, follows)

Depending on the functional ability Depending on the functional ability of a client, exercise testing can of a client, exercise testing can usually be performed using standard usually be performed using standard protocols.protocols.Submaximal and subjective Submaximal and subjective symptom- limited treadmill tests are symptom- limited treadmill tests are well tolerated, even by debilitated well tolerated, even by debilitated clients, and provide information on clients, and provide information on aerobic capacity.aerobic capacity.

Exercise ManagementExercise ManagementSpecial Considerations for Exercise Testing Special Considerations for Exercise Testing

Among Cancer Patients:Among Cancer Patients:

1.1. Obtain basic history of diagnosis and treatment protocolsObtain basic history of diagnosis and treatment protocols

2.2. Assess for adverse acute, chronic, and late effects of Assess for adverse acute, chronic, and late effects of cancer treatment cancer treatment

3.3. Evaluate other comorbidities that may influence ability Evaluate other comorbidities that may influence ability and safety to exerciseand safety to exercise

4.4. Consider how cancer and its treatments may effect Consider how cancer and its treatments may effect balance, agility, speed, flexibility, endurance, and balance, agility, speed, flexibility, endurance, and strength and select, modify, and interpret fitness tests strength and select, modify, and interpret fitness tests accordingly.accordingly.

5.5. Determine if medical clearance is required prior to Determine if medical clearance is required prior to exercise testing.exercise testing.

6.6. Consider relative and absolute contraindications to Consider relative and absolute contraindications to exercise testing.exercise testing.

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Exercise ManagementExercise ManagementRecommendations for Exercise Recommendations for Exercise ProgrammingProgramming

Recommendations for exercise Recommendations for exercise programming are dependent on programming are dependent on whether the person is actively whether the person is actively receiving cancer treatment, is a receiving cancer treatment, is a survivor cured or in remission, or is survivor cured or in remission, or is being treated for recurrent or being treated for recurrent or metastatic diseasemetastatic disease

Exercise ManagementExercise ManagementRecommendations for Exercise ProgrammingRecommendations for Exercise Programming For cancer patients receiving treatment or For cancer patients receiving treatment or with recurrent, localized disease, the goal is with recurrent, localized disease, the goal is to to preservepreserve and possibly even improve and possibly even improve function.function.For survivors, the goal is to For survivors, the goal is to returnreturn to a to a healthy, active lifestyle and make exercise healthy, active lifestyle and make exercise an integral part of everyday life.an integral part of everyday life.For patients with recurrent or metastatic For patients with recurrent or metastatic disease, the goals need to be tailored to the disease, the goals need to be tailored to the patients current level of function.patients current level of function.

Exercise ManagementExercise ManagementRecommendations for Exercise Recommendations for Exercise ProgrammingProgramming The optimal frequency, duration, and The optimal frequency, duration, and time course of adaptation time course of adaptation are not are not knownknown. There appears to be a . There appears to be a dose dose responseresponse relationship of exercise to relationship of exercise to fatigue, with less fatigue being fatigue, with less fatigue being experienced in persons who exercise experienced in persons who exercise for a duration of more than 10 min, for a duration of more than 10 min, and for clients who exercise at least and for clients who exercise at least every other day.every other day.

Exercise ManagementExercise ManagementRecommendations for Exercise Recommendations for Exercise Programming Programming (see Table 27.3, follows)(see Table 27.3, follows)

Exercise prescriptions should Exercise prescriptions should consider where a patient is in consider where a patient is in treatment and accommodate for treatment and accommodate for periods of increased fatigue, and for periods of increased fatigue, and for cycles of treatment.cycles of treatment.Because most patients are treated Because most patients are treated with combinations of surgery, with combinations of surgery, radiation, chemotherapy, and radiation, chemotherapy, and immunotherapy, aimmunotherapy, a

combination of treatment-related combination of treatment-related problems are likely.problems are likely.

Exercise ManagementExercise ManagementRecommendations for Exercise Recommendations for Exercise Programming Programming

Virtually all anticancer drugs cause Virtually all anticancer drugs cause fatigue and declines in blood cell fatigue and declines in blood cell counts. Thus, exercise therapy must counts. Thus, exercise therapy must take into account where a patient is in take into account where a patient is in the treatment cycle and adjust the the treatment cycle and adjust the exercise prescription accordinglyexercise prescription accordinglyThose patients with thrombocytopenia Those patients with thrombocytopenia (platelet count , 50,000/mm(platelet count , 50,000/mm33)) are at a greater risk of are at a greater risk of bleeding. One should seek to prevent falls bleeding. One should seek to prevent falls and limit exercise to low intensity.and limit exercise to low intensity.

Exercise ManagementExercise ManagementRecommendations for Exercise Recommendations for Exercise

Programming Programming The following are special considerations for The following are special considerations for

exercise programming among cancer patients:exercise programming among cancer patients:1.1. Assess client’s current medical condition, functional ability, Assess client’s current medical condition, functional ability,

and general health before each exercise session.and general health before each exercise session.

2.2. Consider relative and absolute contraindications to exerciseConsider relative and absolute contraindications to exercise

3.3. Develop and exercise program to accommodate to changes Develop and exercise program to accommodate to changes from cancer and its treatment that may alter balance, from cancer and its treatment that may alter balance, agility, speed, flexibility, endurance, and strength.agility, speed, flexibility, endurance, and strength.

4.4. Know where a patient is in the treatment schedule and Know where a patient is in the treatment schedule and adapt the exercise program to the patient’s abilityadapt the exercise program to the patient’s ability

5.5. Recognize when to refer the patient back to their physician Recognize when to refer the patient back to their physician for evaluation of new or worsening symptoms.for evaluation of new or worsening symptoms.

6.6. Know cancer specific emergencies and plan for handling an Know cancer specific emergencies and plan for handling an emergency situation. (continued on next slide)…emergency situation. (continued on next slide)…

Exercise ManagementExercise ManagementRecommendations for Exercise Recommendations for Exercise

Programming Programming The following are special considerations for The following are special considerations for

exercise programming among cancer patients:exercise programming among cancer patients:

7.7. Assess risks for adverse late effects of treatment that could Assess risks for adverse late effects of treatment that could increase risks associated with exerciseincrease risks associated with exercise

8.8. Adjust program for the presence of a central line (catheter, Adjust program for the presence of a central line (catheter, or port)or port)

9.9. Modify exercise program based on current medical Modify exercise program based on current medical condition if the patient is actively receiving treatment or condition if the patient is actively receiving treatment or has complicated treatment.has complicated treatment.

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End of PresentationEnd of Presentation