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Exeter exercise and cancer oct 13

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  • 2m expected to rise by 3% each year (Maddams, 2009)
  • More likely to contract cv and diabetes disease
  • 5%  in survival rate same as chemo
  • 1/3 or more of physical decloine attributed to inactivityInactivity also leads to joint imobility, osteoporosis, balance loweed pain threshold
  • Unlike many other cancers, prostate cancers can be there for years before they are found. This type of cancer can often grow very slowly indeed and may not cause any symptoms at all during a man's lifetime. By the age of 80, about half of all men will have some cancer cells in their prostate, but only 1 in 25 of them will actually die from prostate cancer. On the other hand, some types of prostate cancer are faster growing and can spread to other parts of the body.
  • FatigueThe most commonly reported side effect of cancer treatment is fatigue. Some considerationsPlan a progressive programme and try to stick to it, this means that youshould try to avoid overdoing it at times when you feel at your best. Make a list of chores that you need doing, prioritise them and then ask friends and family to help you out. This will prevent you from becoming unnecessarily tired and from being unable to complete your exercise programme. NauseaOn their own, or in combination, chemotherapy and radiation can cause nausea and/or sickness which is why it is important for survivors to take anti-nausea medication if it is prescribed. If this medication is not working then it is important to let the healthcare team know so they might make adjustments to the dose or prescription. Some other tips that might work are as follows:Hot foods can have stronger odours, so eating cold or room temperature foods can sometimes help. Drink lots of fluids and try a range of flavours as some may be more palatable than others. Avoid fatty, spicy, fried or excessively sweet foods as these may increase the feeling of nausea. Bland foods such as crackers, rice and pasta may help. Keeping the mouth clean by brushing twice a day and rinsing the mouth with salt water can help.Mouth SoresMany of treatments used in chemotherpay and immunotherapy are unable to target only the Cancer cells and target a broad range of rapidly dividing cells in the body. This can result in the hair follicles and lining of the mouth and stomach from being damaged leaving the digestive tract red and painful. Some tips for managing this side effect are as follows:Gently brush the gums, tongue and top of the mouth. Keep the lips coated with a water-based lip moisturiser. LymphedemaLymph nodes are important in the proper functioning of the immune system and are found all over the body. They act as filters or traps for foreign particles and are packed full of white blood cells. Lymphedema is caused by a blockage of the lymph nodes and is a swelling that is usually found in the armpit or groin area. It's a good idea to monitor any changes by measuring the extremity in question regularly. Any swollen extremity can be elevated at least 20 minutes, 3 to 4 times a day. Exercise, self-massage and gentle stretching can move the fluid toward the body. Unaccustomed heavy lifting should be avoided although with careful exercise programming on a cautious timescale, lifting weights can still be possible. Peripheral NeuropathyThis is a loss of sensation that usually occurs in the fingers, hands, toes and feet and can make tasks such as dressing, eating and walking difficult.  Radiation DermititisRadiation therapy can result in skin irritation, itchiness, redness and peeling. If an exerciser has patches of dermititis then activity can result in sweat aggravating these areas. It may be beneficial to take steps to avoid sweating excessively such as exercising outdoors or in shorter bouts, or to cover the area with a gauze.ConstipationWhilst some medications can cause constipation, it can be a result of reduced activity levels, dietary changes or decreased fluid intake. Some ideas for avoiding constipation are below:Eat foods that are high in fibre, and lots of fruit and vegetables. Try to develop a daily routine so there is a regular time for bowel movements. Drink plenty of fluidsDiarrhoeaRadiation therapy to the bowel area or certain forms of chemotherapy can cause diarrhoea. There are some actions one can take to reduce the incidence of diarrhoea below:Avoid eating foods high in fibre, fatty foods, rich desserts, or other foods that increase boewl activity. If diarrhoea occurs after meals, plan activities accordingly. Increase the intake of fluids.Infectionchemotherapy and immunotherapy can cause low blood counts and immunosupression. At times where the blood count is low it may be sensible to ensure high levels of personal hygiene are maintained and that large group situations, or classes, are avoided.Mode of activityAs a result of disease, some patients may have weakness to their bones. Those with disease to the pelvis or lower legs should avoid high-impact exercise and may benefit from seated exercise such as cycling or chair exercises. Exercising in the water may also be an option for these individuals. Water-based activities will be suitable for some and not for others. Those with intravenous catheters, nephrostomy tubes, and urinary bladder catheters may not be able to use a pool but those with indwelling central venous catheters, continent urinary devices, or colostomies may be able to. (Ehrman, 2009)Additional considerationsAn exercise buddy system that pairs up a novice survivor/exerciser with a more experienced partner can provide support and improve initial adherence to any programme. Identifying barriers to exercise and jointly devising some strategies to overcome these barriers can be an efficient use of time at the start of any exercise programme.
  • Anger, hostility, depression, helplessness, tension, anxiety

Exeter exercise and cancer oct 13 Exeter exercise and cancer oct 13 Presentation Transcript

  • SHSM022/ BJ EXERCISE AND CANCER
  • Overview Primary Cancer Prevention  Rationale for using exercise  Exercise as a form of treatment   Contraindications  Implications  The use of interventions SHSM022/ BJ Exercise and Cancer Survivorship
  • Cancer  Cancer is a general term for a number of conditions in which cells grow out of control.  Partial or complete lack of structural organisation  Lacks functional coordination with the normal tissue  Usually forms a distinct mass of tissue that may be either benign or malignant    2 million survivors in UK 46% female C breast/31% male C prostate Colon, hematological, endometrial each 10% SHSM022/ BJ Exercise and Cancer Survivorship
  • Stem Cells Image from: http://stemcells.nih .gov/info/Regenera tive_Medicine/pag es/2006chapter9.a spx SHSM022/ BJ Exercise and Cancer Survivorship
  • Primary Prevention  Colorectal Cancer (Thune & Furberg, 2001)  40,000 patients; 10%-70% reduction in incidence  Decreased bowel transit time  Breast Cancer (Thune & Furberg, 2001)   Endometrial   108,000 patients; 30% risk reduction (In 26/41 studies) 8/12 studies show 20-80% reduction Prostate, Ovarian, Testicular  Possible inconclusive reductions SHSM022/ BJ Exercise and Cancer Survivorship
  • Potential Mechanisms       Modulation of reproductive hormone levels Decrease in body weight and adiposity Changes in levels of IGFs and binding proteins Decrease in inflammation Decrease in intestinal transit time Enhanced immune function (Bouchard et al 2012) SHSM022/ BJ Exercise and Cancer Survivorship
  • Breast Cancer Menarche, 1st pregnancy, Menopause, Postmenopa use SHSM022/ BJ Exercise and Cancer Survivorship
  • PA & Cancer: after diagnosis SHSM022/ BJ Exercise and Cancer Survivorship
  • Cancer Treatments     Surgery Radiation Therapy Chemotherapy Immunotherapy (Durstine et al, 2009 SHSM022/ BJ Exercise and Cancer Survivorship
  • Cancer Effects (cancer or treatment)             Fatigue Weight changes Urinary bowel problems Peripheral neuropathy Osteoporosis Cardiotoxicity Lymphoedema Hot flushes Night sweats Anxiety Depression Difficulty with memory SHSM022/ BJ Exercise and Cancer Survivorship
  • Exercise and survival   Evidence that Cancer survivors die of noncancer causes at a higher rate than general population. Those that exercise...  Breast Cancer  24-67% reduction in total deaths  50-53% reduction in risk of breast cancer deaths  Colon Cancer  50-63% reduction in risk of total deaths  39-59% decrease risk of colon cancer deaths (see Irwin, 2009) SHSM022/ BJ Exercise and Cancer Survivorship
  • Exercise as a treatment (Speck, 2010) SHSM022/ BJ Exercise and Cancer Survivorship
  • Biological Markers Insulin  Insulin levels linked to risk of death  25% in insulin levels = 5% in survival rate Overweight  Breast and prostate may be overweight  Head, neck, gastric may be underweight SHSM022/ BJ Exercise and Cancer Survivorship
  • Fatigue   Up to 70% of patients report loss of energy. 1/3 of survivors experience fatigue for years  (Dimeo,  1999) Multi-faceted  Tumour-related  Conditional-related  Disease-related SHSM022/ BJ Exercise and Cancer Survivorship
  • Evidence by site of cancer
  • Breast Cancer      Large number of studies Lymphedema... Caution taken with pain in arm or shoulder Compression garments Increased risk of fracture SHSM022/ BJ Exercise and Cancer Survivorship
  • Breast Cancer SHSM022/ BJ Exercise and Cancer Survivorship
  • Prostate Cancer     By the age of 80, about half of all men will have some cancer cells in their prostate Only 1 in 25 of them will die from prostate cancer. Leading cause of death in prostate is Cardiovascular disease Screening SHSM022/ BJ Exercise and Cancer Survivorship
  • Prostate Cancer and exercise       Aerobic Fitness Muscular Strength Body Size and composition QOL Fatigue Physical Function – Pelvic Floor Exercises  Sexual  function Fracture Potential SHSM022/ BJ Exercise and Cancer Survivorship
  • Considerations for interventions
  • Physical Activity Levels in survivors      Many not be active enough pre-cancer Reduction in activity levels on diagnosis Intuitive/medical advice to “take it easy” Less than ½ return to pre-diagnosis levels A teachable moment?? (Demark-Wahnefried et al, 2005) SHSM022/ BJ Exercise and Cancer Survivorship
  • Barriers to activity (Irwin, 2009) SHSM022/ BJ Exercise and Cancer Survivorship
  • Cancer & Exercise Guidelines   Broadly the same as population guidelines Avoid inactivity SHSM022/ BJ Exercise and Cancer Survivorship
  • Contraindications (in addition to CV)           Heamoglobin Level < 8.0 g/dL Absolute neutrophil count <0.5 x 109/mL Platelet count <50 x 109/mL Fever>38C (100.4F) Ataxia, dizziness, or peripheral sensory neuropathy Severe cachexia (loss of >35% premorbid weight) Dyspnea Bone Pain Severe Nausea Extreme Fatigue and/or muscle weakness SHSM022/ BJ Exercise and Cancer Survivorship
  • Considerations for exercise programming             Fatigue Pain Nausea Mouth Sores Lymphedema Peripheral Neuropathy Radiation Dermititis Constipation Diarrhoea Infection Mode of activity Falls (Schwartz, 2005) SHSM022/ BJ Exercise and Cancer Survivorship
  • Psychosocial benefits Mood Functional Independence Self-esteem Sense of control SHSM022/ BJ Exercise and Cancer Survivorship
  • Our work  http://vimeo.com/69834141 SHSM022/ BJ Exercise and Cancer Survivorship
  • Health Behaviour Change   Transtheoretical model. What stage? Social Cognitive Theory  Mastery experiences  Modelling  Verbal persuasion  Physiological states and affect SHSM022/ BJ Exercise and Cancer Survivorship
  • Strategies to increase PA (Irwin, 2009) SHSM022/ BJ Exercise and Cancer Survivorship
  • Jones’ experiences  311 survivors (breast, prostate colorectal, lung)  84% would prefer to receive ex counselling during cancer experience.  Only 28% reported that oncologist raised issue of exercise.  14% raised issue themselves.  Of 42%, 14% referred to ex specialist  Only 16% in total reported exercising at recommended level (Jones et al, 2002)  Most want to receive exercise counselling but variety of interventions and methods key SHSM022/ BJ Exercise and Cancer Survivorship
  • Intervention Content  Group v Individual  Adherence  “brothers  rates high in arms” (Adamsen et al, 2001) Home Exercise  Adherence SHSM022/ BJ acceptable Exercise and Cancer Survivorship
  • Adherence  (Vallance et al , 2008) Exercise promotion booklet (n=377)  Random allocation  Booklet  Pedometer  Booklet and pedometer  Standard recommendation to increase PA Click the booklet to go to it online ↑ ~90min/wk in 2 pedometer groups  6 months later  PA ↓ in all groups  Pedo’s ~50 min/wk more than baseline but standard 9 min/wk more (not sign diff.) SHSM022/ BJ Exercise and Cancer Survivorship
  • Implications of evidence    “What can I do to improve my survival?” Improved treatment Return on investment for NHS funding?? SHSM022/ BJ Exercise and Cancer Survivorship
  • Marjon Projects    Prostate Cancer Hematological Cancer Exercise Referral Scheme for Cancer Survivors SHSM022/ BJ Exercise and Cancer Survivorship
  • Conclusions Stage Evidence During Cancer treatment PA improves, or prevents the decline of physical function without increasing After cancer treatment PA helps recover physical function During and after cancer treatment PA can reduce the risk of cancer recurrence and mortality for some cancers and can reduce teh risk of developing other long term conditions Advanced cancer PA can help maintain independence and wellbeing Click here for link SHSM022/ BJ Exercise and Cancer Survivorship
  • Issues with evidence    QoL, fatigue subjectively measured Multiple natures of diagnosis, conditions, ages PA at different stages of life SHSM022/ BJ Exercise and Cancer Survivorship
  • Further reading SHSM022/ BJ Exercise and Cancer Survivorship
  • Further reading  www.benjanefitness.com – Click here for Exercise and Cancer page  Ehrman, J., Gordon, P., Visich, P.S., Keteyianby, S. (2009) Clinical Exercise Physiology (2nd Ed) Champaign IL: Human Kinetics  Durstine, J.L. et al (2009) ACSM's exercise management for persons with chronic diseases and disabilities (3rd Ed) Champaign, IL: Human Kinetics [google books]  Irwin, M.L. (2009) Physical activity interventions for cancer survivors. Br J Sports Med Vol.43, 32-8 [full text]  Schwartz, A.J. (2005) Cancer Fitness: Exercise Programmes for patients and survivors. New York, NY: Fireside [amazon][amazon preview]  Swain, D.P. & Leutholtz, B.C. (2007) Exercise Prescription: A case study approach to the ACSM Guidelines (2nd Ed). Champaign, IL: Human Kinetics. SHSM022/ BJ Exercise and Cancer Survivorship
  • Ted’s story SHSM022/ BJ Exercise and Cancer Survivorship