1. Going Beyond Pink The importance of exercise for survivorship Dr Lynnette M Jones School of Physical Education University of Otago

2.  The evidence mounts!  Search in Scopus: Breast cancer AND exercise 2,028 articles Reviews = 541 495 in English Research areas include genetic, quality of life, physical, cognitive, and physiological responses Exercise and Breast Cancer

3. Body systems affected by exercise and by cancer treatment Exercise  Nervous  Musculoskeletal  Cardiovascular  Respiratory  Metabolic  Endocrine  Immune  Renal  Cognitive function  Psychological health Cancer Treatment  Nervous  Functional changes  Sensation change  Neuropathies  Cognitive function  Musculoskeletal  Cardiovascular  Respiratory  Metabolic  Endocrine  Immune  Renal  Psychological health

4. Benefits of exercise during treatment - ACS  Exercise may: Improve physical abilities Improve balance, reduce falls risk Maintain muscle and bone health Reduce CHD risk Reduce nausea, fatigue, anxiety and depression Maintain independence Improve self-esteem and quality of life Assist weight control

5. Benefits of exercise for survivors Improves:  Aerobic fitness  Muscle strength  Functional capacity  Shoulder function  Bone health  Quality of life  Body image  Self-esteem Decreases:  Lymphedema risk  Lymphedema symptoms/flare ups  Fatigue  Pain  Depression  Anxiety

6. When is exercise important?  As soon as possible!  Preferably during treatment  Evidence that exercise can offset effects of cancer treatment  Some suggestion exercise may also provide support to complete treatment  If unable to exercise during treatment, then as soon as capable post

7. Exercise Challenges  Many women have comorbidities  During treatment programming will differ from that utilised following treatment and time since treatment ended  Women unsure of what they can do  Does the person prescribing the exercise programme understand the effects of treatment?

8. Beyond Pink  The Beyond Pink Exercise Program was established: To meet the specific needs of women, either in active treatment or who have completed treatment, and To provide teaching and learning opportunities for fourth year students of Exercise Prescription

9. How it works  Referrals are initiated at oncology consultation  Some by self-referral or recommendation by others in programme  Consent and information forms sent to each individual  Follow up phone call  Initial consultation  First exercise session

10. Increased self-confidence10 (55%) Improved sleep6 (33%) Increased ROM of affected arm16 (89%) Increased energy12 (67%) Increased strength13 (72%)  physical activity (outside sessions)10 (55%) Decreased fatigue5 (28%) Received positive comments6 (33%) No significant changes1 (5%) Self-reported changes

11. Empowerment through Exercise  “Support and motivation of the trainer means that I have been much more inclined to exercise than I would have if was by myself. Psychologically it is a huge help.”  The psychological benefits gained through this programme have been enormous, at a time when one feels at their ‘lowest’ ebb! Thank you so much for all your encouragement in restoring my confidence.”

12. The Ultimate Challenge!  Need to expand these opportunities  Flexibility in programming required  Thorough knowledge of exercise physiology and treatment effects = safe and effective exercise for patients and survivors  Money needed for training and delivery  Healthy survivorship includes exercise!

13. Questions?