1. Exercise Management Cancer

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

3. Exercise Management Pathophysiology Cancer is cured when a remission is thought to be permanent, but many cancers are considered cured if the client does not have a recurrence within five years after treatment. Cancer is cured when a remission is thought to be permanent, but many cancers are considered cured if the client does not have a recurrence within five years after treatment. Recurrence of cancer occurs when a few cancer cells escape being eradicated and subsequently grow back over time. Recurrence of cancer occurs when a few cancer cells escape being eradicated and subsequently grow back over time.

4. Exercise Management Effects of the Exercise Response The specific effects of cancer on the exercise response are determined by the tissues affected and by the extent of involvement. The result is often exercise intolerance, but the limiting factors can be varied. The specific effects of cancer on the exercise response are determined by the tissues affected and by the extent of involvement. The result is often exercise intolerance, but the limiting factors can be varied. The side effects of anticancer therapy also affect the exercise response. These can be acute onset with treatment, but are often delayed onset and permanent (see Table 27.1, next slide) The side effects of anticancer therapy also affect the exercise response. These can be acute onset with treatment, but are often delayed onset and permanent (see Table 27.1, next slide)

5. Exercise Management

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

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

8. Exercise Management Effects of Exercise Training Results of exercise studies during and following cancer treatment have shown improvements in: 1. Shoulder range of motion 2. Flexibility 3. Muscle strength 4. Balance 5. Treatment-related side effects 6. Aerobic capacity 7. Weight control 8. Body image 9. Sense of control 10. Depression and mood, and 11. Quality of life

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

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

11. Exercise Management Recommendations for Exercise Testing Recommendations for Exercise Testing (see Table 27.2, follows) Depending on the functional ability of a client, exercise testing can usually be performed using standard protocols. Depending on the functional ability of a client, exercise testing can usually be performed using standard protocols. Submaximal and subjective symptom- limited treadmill tests are well tolerated, even by debilitated clients, and provide information on aerobic capacity. Submaximal and subjective symptom- limited treadmill tests are well tolerated, even by debilitated clients, and provide information on aerobic capacity.

12. Exercise Management Special Considerations for Exercise Testing Among Cancer Patients: 1. Obtain basic history of diagnosis and treatment protocols 2. Assess for adverse acute, chronic, and late effects of cancer treatment 3. Evaluate other comorbidities that may influence ability and safety to exercise 4. Consider how cancer and its treatments may effect balance, agility, speed, flexibility, endurance, and strength and select, modify, and interpret fitness tests accordingly. 5. Determine if medical clearance is required prior to exercise testing. 6. Consider relative and absolute contraindications to exercise testing.

13. Exercise Management

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

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

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

17. Exercise Management Recommendations for Exercise Programming (see Table 27.3, follows) Exercise prescriptions should consider where a patient is in treatment and accommodate for periods of increased fatigue, and for cycles of treatment. Exercise prescriptions should consider where a patient is in treatment and accommodate for periods of increased fatigue, and for cycles of treatment. Because most patients are treated with combinations of surgery, radiation, chemotherapy, and immunotherapy, a Because most patients are treated with combinations of surgery, radiation, chemotherapy, and immunotherapy, a combination of treatment-related problems are likely.

18. Exercise Management Recommendations for Exercise Programming Virtually all anticancer drugs cause fatigue and declines in blood cell counts. Thus, exercise therapy must take into account where a patient is in the treatment cycle and adjust the exercise prescription accordingly Those patients with thrombocytopenia (platelet count, 50,000/mm 3 ) are at a greater risk of bleeding. One should seek to prevent falls and limit exercise to low intensity. Those patients with thrombocytopenia (platelet count, 50,000/mm 3 ) are at a greater risk of bleeding. One should seek to prevent falls and limit exercise to low intensity.

19. Exercise Management Recommendations for Exercise Programming The following are special considerations for exercise programming among cancer patients: 1. Assess client’s current medical condition, functional ability, and general health before each exercise session. 2. Consider relative and absolute contraindications to exercise 3. Develop and exercise program to accommodate to changes from cancer and its treatment that may alter balance, agility, speed, flexibility, endurance, and strength. 4. Know where a patient is in the treatment schedule and adapt the exercise program to the patient’s ability 5. Recognize when to refer the patient back to their physician for evaluation of new or worsening symptoms. 6. Know cancer specific emergencies and plan for handling an emergency situation. (continued on next slide)…

20. Exercise Management Recommendations for Exercise Programming The following are special considerations for exercise programming among cancer patients: 7. Assess risks for adverse late effects of treatment that could increase risks associated with exercise 8. Adjust program for the presence of a central line (catheter, or port) 9. Modify exercise program based on current medical condition if the patient is actively receiving treatment or has complicated treatment.

22. Exercise Management End of Presentation