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Exercise For The Cancer Survivor
ELISABETH TOMERE, PT, DPT, CLT
SCCA PHYSICAL THERAPY
Presentation Topics
• Benefits of Exercise
• Guidelines and Recommendations for Exercise
• Strategies for Exercise Participation
• Community Resources
• Closing Comments and Questions
“Lack of activity destroys the good condition of
every human being, while movement and methodical
physical exercise save it and preserve it.”
--Plato (427-347 BC)
The Relevance Of The Holidays
• Expectations
• Time Constraints
• Environmental Barriers
• New Beginnings
• Life Long Commitment
Deep Breathing Exercise
Exercise?
What Are The Benefits?
• Prevention of cancer and recurrence
• Improved aerobic fitness and muscular strength
• Normal body weight/insulin regulation
• Increased BMD and decreased injuries
• Improved energy, reduced fatigue, better sleep
• Cognitive gains and elevated mood
• Improved balance and agility
ACSM Cancer Exercise Guidelines (2009)
1) Exercise training is safe during and after cancer treatments.
2) Improvements in physical functioning, quality of life, and cancer-related fatigue in several CA groups (breast, prostate, colon, blood, stem cell transplant, and gynecologic).
3) Survivors should follow the 2008 Physical Activity Guidelines for Americans and ACSM recommendations with specific individualized exercise prescription based on their disease and treatment related side effects.
Courtesy of Lexi Harlow, PT, DPT, CLT
How Much And What Kind Of
Exercise Do I Need?
US Dept Of Health And Human Services: 2008 Physical Activity Guidelines For Americans
Adults:
-2.5 hours/week of moderate
intensity or 1.25 hours/week of
vigorous intensity
-Should increase to 5 hours/week of
moderate intensity or 2.5 hours/week of
vigorous intensity
-2x/week of strengthening of major muscle groups
Courtesy of Lexi Harlow, PT, DPT, CLT
ACSM Guidelines
Cardiorespiratory Exercise
• Adults should get at least >/=150 minutes of moderate-
intensity exercise per week.
• Exercise recommendations can be met through 30-60
minutes of moderate-intensity exercise (five days per week)
or 20-60 minutes of vigorous-intensity exercise (three days
per week).
• One continuous session and multiple shorter sessions (of at
least 10 minutes) are both to accumulate desired amount of
daily exercise.
Higher all cause mortality rates for sitters
Distinct health risk
Physical activity outside of sedentary time was not protective
ACSM Guidelines
Resistance Exercise
• Adults should train each major muscle group two or three days
each week using a variety of exercises and equipment.
• Two to four sets of each exercise will help adults improve strength
and power.
• For each exercise, 8-12 repetitions improve strength and power, 10-
15 repetitions improve strength in middle-age and older persons
starting exercise, and 15-20 repetitions improve muscular
endurance.
Other Considerations For Exercise
Cardiovascular
• Warm-up/Cool-down
• Target HR Zone
• RPE (Rating of Perceived Exertion)
Strength training
• 2-3x/week
• For arms, abdominals, and legs
• Slow, steady progression
• 10 repetition maximum
Balance
• ACSM recommends 2-3 days per week
• Important to train with age
• Fall prevention
Stretching
• 2-3x/week
• Avoiding injury
• Importance of technique
• Yoga
Triangle Stretch
Safety Guidelines
• Gradual increase in exercise intensity, volume
• Heed warning signs of injury
• Proper attire, equipment in good working order
• Tape, braces, compression garments
• Protect against the elements, especially heat—
HYDRATE!
Precautions
• Physician Clearance
• Lymphedema
•Neuropathies
• Severe fatigue
•Heart conditions
•Metastases
What Else Can I Do To Improve My
Fitness?
DON’T SIT!!!
• Cardiovascular disease
•Depression
•High blood pressure
•Worsening metabolic biomarkers
MINI SQUAT
Challenges Along the Way
Immediate and Late Effects of:
• Chemotherapy
• Radiation
• Surgery
• Hormonal Changes
• Disease specific barriers
• Lack of time, enjoyment and social
support
• Filling multiple roles; caretaking
• Medical appointments
• Change in physical appearance
• Concerns about safety
Solutions!
• Increase your knowledge
• Join a team or group
• Get your spouse, best friend, children, or animals to join in
• Exercise journal or log
• Local classes or support groups
• Do something that you enjoy
• Set realistic goals
Modifications to slide courtesy of Lexi Harlow, PT, DPT, CLT
EXERCISE AND THRIVE™ PROGRAM
• YMCA, LIVESTRONG and Hutchinson Center
collaboration
• 12-week, 2x/week, 90 min. strength
and fitness program for survivors
• Training provided by Y, FHCRC and SCCA
• Assessment Pre and Post class
• Content foci: resistance exercise
aerobic exercise
support, nutrition
Rajotte et al. J Cancer Survivorship, 2012
Seattle Area Exercise Programs
Cancer Lifeline www.cancerlifeline.org Team Survivor Northwest www.teamsurvivornw.org Gilda’s Club www.gildasclubseattle.org YMCA Exercise and Thrive www.seattleymca.org
Holiday Exercise Strategies
• Walk as much as possible
• Do extra laps at the mall
• Take stairs
• Park further away from doors
• Involve family, loved ones, and friends in fitness activity
• Suggest a walk or other physical activity after eating a
meal
• Play with kids or grandkids
• While watching football games, get on floor and do some
exercise or think of exercises to do while seated on the
couch
Courtesy of Lexi Harlow, PT, DPT, CLT
What’s New For Cancer Survivors
• Low intensity exercise regimens may not be effective
• 150 minutes per week of walking—is it enough?
• Not all exercise is equal
• New studies on brief, high intensity exercise
The Scientific 7-minute Work-out
High-intensity circuit training (HICT) using body
weight as resistance.
Combines aerobic and resistance training into a
single exercise bout lasting approximately 7
minutes.
Participants can repeat the 7-minute bout 2 to 3
times, depending on the amount of time they
have. As body weight provides the only form of
resistance, the program can be done anywhere.”
The 7-minute Work-out
1. Jumping jacks
2. Wall sit
3. Push-up
4. Abdominal crunch
5. Step-up onto chair
6. Squat
7. Triceps dip on chair
8. Plank
9. High knees
10. Lunge
11. Push-up and rotation
12. Side plank
EXERCISE!
• “By exercising regularly, you are helping yourself to heal, potentially preventing new cancers from developing and preventing previous cancers from recurring, and at the same time lowering your risk of developing the most common life threatening medical condition – heart disease. The benefits of exercise are enormous.”
-Dr. Julie K. Silver
Courtesy of Lexi Harlow, PT, DPT, CLT
Knowledge IS Power!
Best wishes for an amazing holiday
season. Be well!
REFERENCES
1. Lamanne, D. Cassileth, B, Gubili, I. The Role of Physical Activity in Cancer Prevention,
Treatment Recovery and Survivorship. CancerNetwork.
http://www.cancernetwork.com/survivorship/role-physical-activity-cancer-prevention-
treatment-recovery-and-survivorship. Published July 18, 2013. Accessed October 10, 2013
2. Schmitz, KH, Courneya, KS, Matthews, C. American College of Sports Medicine
Roundtable on Exercise Guidelines for Cancer Survivors. Medicine & Science in Sports &
Exercise. 2010; 1409-1428. doi: 10.1249/MSS. 0b013e3181e0c112
4. US Department of Health and Human Services. 2008 Physical Activity Guidelines for Americans. www.hhs.gov. http://www.health.gov/paguidelines/guidelines/default.aspx. Published October 2008. Accessed November 10, 2013. 5. Garber, CE, Blissmer, B, Deschutes MR, et al. Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory, Musculoskeletal, and Neuromotor Fitness in Apparently Healthy Adults: Guidelines for Prescribing Exercise. Medicine & Science in Sports & Exercise. 2011; 43: 1334-1359. doi:10:1249/MSS.0b013e318213fefb
REFERENCES CONT’D
6. Mustian, K., Sprod, L, Janelsins, M, et al. Multicenter, Randomized Controlled Trial of Yoga for Sleep Quality Among Cancer Survivors. J of Clinc Oncol. 2012; 31: 3233-3243 7. Owen, N, Healy GN, Howard, B, Dunstan, DW. Too Much Sitting: Health Risks of Sedentary Behavior and Opportunities for Change. President’s Council on Fitness, Sports & Nutrition. 2012; 13:1-11
.8. Pekmezi, D. Martin, M, Kvale, E, Meneses, K, Demark-Wahnefreid, W. Enhancing Exercise Adherence for the Breast Cancer Survivor. ACSMs Health Fitness Journal. 2013: 16; 8-13 9. Klika, B, Jordan, L. High Intensity Circuit Training Using Body Weight: Maximum Results With Minimum Investment. ACSMs Health & Fitness Journal. 2013; 8-13. doi: 10:1249/FIT.0b013e31828cble8 10. Silver, JK. After Cancer Treatment: Heal faster, Better, Stronger,. MD. Baltimore: John Hopkins University Press; 2006.
SUGGESTED RESOURCES
• American College of Sports Medicine. ACSM.org
• Dept of Health and Human Services. hhs.org
• CancerNetwork. cancernetwork.org
• President’s Council on Fitness, Sports & Nutrition. fitness.gov