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Exercise Based Rehabilitation. Mike Grisenthwaite Director and Founder. About me…. Diagnosed 2000 – Lymphatic Cancer NHL Ironman Triathlon 2001 Numerous other endurance events Relapse 2005 Donor stem cell transplant or BMT. 2007 Tour de France 2200 miles in 19 days - PowerPoint PPT Presentation
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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: [email protected]:www.cyclistsfc.org.ukwww.nacer.org.uk
Thank you.
Get Set, Ready, Go!