Promoting Breast Health through Physical Activity

Transcription

1 Promoting Breast Health through Physical Activity Joy Kiviat, FNP-BC, PhD, MSN University of Arizona College of Nursing ACSM certified Cancer Exercise Trainer and Group Exercise Instructor Educational Series

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3 Program Purpose The educational series provides information about a variety of evidencebased intervention strategies that can be used with persons diagnosed with cancer and other chronic diseases

4 Learning Objectives 1. Describe the state of the practice for various integrative approaches to cancer treatment that improve wellbeing among people affected by this illness 2. Compare and contrast critically available treatments for cancer and its complications and side effects 3. Describe the evidence available for integrative approaches that will improve wellbeing and quality of life among persons affected by cancer and other chronic diseases 4. Discuss possible applications of this therapy in individual practice

5 CME Disclosure All Faculty, CME Planning Committee Members, and the CME Office Reviewer have disclosed that they have no financial relationships with commercial interests that would constitute a conflict of interest concerning this CME activity

6 Nursing Evaluations & Disclosures Criteria for successful completion: Attendance requirements YOU MUST SIGN IN AND OUT You must be present by 12:10 PM Complete online NURSING evaluation Available online at cne.nursing.arizona.edu/evaluations/ The planners and presenters have no relevant financial relationship to declare

7 Additional Disclosures The following organizations have provided support for this educational activity: Susan G. Komen Foundation The following organizations are coproviders for this educational activity: Arizona Telemedicine Program The University of Arizona Cancer Center The University of Arizona College of Nursing

8 Physical Activity and Health We all know this active lifestyles are associated with lower risk for: Diabetes Heart Disease, hypertension, stroke Vascular disorders, thrombi Osteoporosis and fractures Cognitive decline and dementia Falls and fall-related injurie (Medscape Nurse,2009. Health Benefits of Physical Activity in Older Patients: A Review)

9 Physical Activity and Cancer Prevention Large body of evidence that physical activity protects against breast and colon cancers *30% reduction in incidence of breast cancer with ANY level of intensity compared to no exercise (McCullough et al., 2012) Even among overweight people, active folks had 25% reduction in risk compared to those who were inactive. Mechanism not fully understood, but we know: Immune system stimulated => increased anti-tumor activity Reduced inflammatory mediators => less tissue damage Decreased reproductive hormone levels=> less stimulation of breast tissue activity(aicr, Food, Nutrition, Physical Activity and the Prevention of Cancer: A Global Perspective. World Cancer Research Fund)

10 Physical Activity & Recovery Research indicates that cancer patients who exercise: report less fatigue require fewer blood transfusions are hospitalized less frequently are less likely to fall have better outcomes and improved sense of well-being

11 How does exercise help? Increased lean body mass, decreased fat Improved cardiovascular condition (lowers risk of embolism, heart attack and stroke) Increased bone density and improved balance (reduces risk of falls and injury) Immune system stimulation (reduces risk for infection and recurrence) Release of endorphins and other stimulatory neurotransmitters (elevates mood)

12 Consensus: Exercise is Beneficial, During and After Cancer Treatment 2008: Exercise during cancer treatment should become part of the standard of care (Wiskemann & Huber, 2008). 2012: American Cancer Society guidelines for nutrition and physical activity strongly support exercise as an important part of survivorship care planning (Rock et al., 2012).

13 Activity promotes Recovery, AND. Reduces overall mortality among survivors Evidence is mounting that moderate activity and a healthy weight can help prevent cancer recurrence Strongest evidence in breast and colon cancer; recent studies suggest exercise reduces risk for prostate and brain cancer recurrence too. (Loprinzi et al., 2012; Fong et al., 2012)

14 What s the evidence? 2012 Review of evidence on lifestyle factors and mortality: After breast cancer treatment, physical activity and weight maintenance have biggest impacts on survival most active women have 50% lower mortality risk than least active each 10 lbs of weight gain increases risk of recurrence by 13% (Ellsworth,R., Valente,A.., Shriver,C. Bittman,B. & Ellsworth,D.(2012). Impact of lifestyle factors on prognosis among breast cancer survivors in the USA. Expert Reviews in Pharmacoeconomics Outcomes Research. 12(4): )

15 Body Fat & Cancer-What s the link? Higher energy (calorie) intake leads to: Insulin & insulin-related growth factors Free Estrogen & Androgens Leptin, adiponectin => tumor growth Inflammatory chemical messengers Result: more fuel available for cancer cell growth, excess hormones, and weaker immune response to abnormal cells Source: Annual Report to the Nation on the status of cancer, ,. (CDC, 2012)

16 Improving Balance

17 Provider Guidelines: Activity recommendations Exercise is beneficial, during and after cancer treatment Exercise is safe for cancer survivors. Exercise should be standard care after cancer. Nutrition and physical activity guidelines for cancer survivors. CA: A Cancer Journal for Clinicians. (2012) American College of Sports Medicine Roundtable on Exercise Guidelines for Cancer Survivors. Medicine & Science in Sports & Exercise (2010).

18 And yet. A national survey found only 1/3 of patients received advice on physical activity from their health care providers (Loprinzi et al., 2012) Among cancer patients, only 21% reported having counseling on exercise from their health care providers (Sabatino, Coates, Uhler, et al.,2007)

19 Moreover Survey of 2700 female cancer survivors found they were significantly: More likely to smoke More likely to report weight gain Less likely to exercise regularly Less likely to report health as excellent compared to matched control group (Rausch et al., 2012)

20 Overcoming Barriers Provider education: most oncologists aware of exercise benefits, but primary care providers may not be informed*. Exercise prescription pads for oncologists Include exercise in Survivor Care Plan Patient education: convince survivors of immediate and long-term benefits Community presentations, brochures Coaching at each healthcare encounter *Provider counseling about health behaviors among cancer survivors in the United States. Journal of Clinical Oncology (2007)

21 Increased Flexibility 21

22 Common Concerns of Survivors Fatigue: Just want to rest Safety: Am I ready to exercise? Could I get injured, will this interfere with recovery, risk for infection many concerns Cost: fitness center membership, personal trainers, may be out of reach for some Access: location, transportation, time of day. What do YOU recommend?

23 Addressing Concerns Readiness test Motivating Preparing Persisting Evaluating

24 Exercise Readiness Test* Answer yes or no to the following questions: Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor? Do you feel pain in your chest when you do physical activity? In the past month, have you had chest pain when you were not doing physical activity? Do you lose your balance because of dizziness or do you ever lose consciousness? Do you have a bone or joint problem that could be made worse by a change in your physical activity? Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition? Do you know of any other reason why you should not do physical activity? *Adapted from Physical Activity Readiness Questionnaire (PAR-Q) developed by the British Columbia Ministry of Health & Multidisciplinary Board on Exercise

25 Readiness Results If you answered yes to any question: consult a physician before increasing physical activity. ask for a medical clearance and any exercise limitations. in most cases, you will still be able to do any type of activity you want as long as you adhere to some guidelines. If you answered no to all: you can be confident that you can exercise safely. Important: start slow, increase gradually

26 How soon after BC Surgery? First week: normal daily activities like combing hair, brushing teeth, plus elevation of affected arm and gentle fist pumping After first week (with MD approval): stretches and ROM exercises See descriptions and diagrams at formation/exercises-after-breast-surgery

27 What about Lymphedema? Recent study showed upper body resistance exercise does not increase swelling and was associated with 50% decrease in exacerbations (Schmitz et al., 2009). 141 women with stable lymphedema and no previous hx of weightlifting, randomized to 2x/wk weight training or control group for 1 year. NLN 2011 guidelines: Start with low resistance, incremental increase with regular measurements; advise compression garment if lymphedema already present No controlled studies on value of compression garments during exercise for prevention of lymphedema

28 Strategies for Providers Promote self-efficacy: identify role models, positive self talk, recognize small steps Counter-conditioning: substitute a positive behavior for a problem behavior Motivational interviewing: help patient identify conflicts between her goals and behaviors (Loprinzi et al, 2012)

29 Resistance bands

30 Exercise options Group classes (YMCA, community centers, fitness clubs, Pima Council on Aging) Personal trainer (some make house calls) Walking (suggest finding walking buddy or dog for companionship and motivation) Swimming (good for persons with neuropathy, joint or bone pain) Exercise videos and FitTV channel Better than Ever program at UA Cancer Center

31 How Much is Enough? ACS & ACSM roundtable concluded cancer survivors should strive for: 150 minutes/week aerobic exercise (aim for 30 minutes, 5 days a week; try brisk walk, run, swim, dance) 2-3 sessions/week resistance exercise (weights, bands, water bottles 1-2 days off between sessions) Daily stretching/toning Source: Schmitz et al., 2010

32 S-t-r-r-e-e-e-t-c-h!

33 . References Dobek, J., Winters-Stone, K.M. et al (2013). Musculoskeletal changes after 1 year of exercise in older breast cancer survivors, Journal of Cancer Survivorship. DOI /s Fong, D.Y.T., Ho J.W.C., Hui B.P.H., Lee A.M., Macfarlane D.J., Leung S.S.K., Cerin E.,..., Cheng K.-K. (2012). Physical activity for cancer survivors: Meta-analysis of randomised controlled trials. BMJ (Online344 (7844), 17 doi: /bmj.e70. Hacker, E. (2009). Exercise and quality of life: Strengthening the connections. Clinical Journal of Oncology Nursing 13(1) doi: /09 Loprinzi,P., Cardinal, B., Winters-Stone,K., Smit, E. & Loprinzi, L. (2012). Physical activity and the risk of breast cancer recurrence: A literature review. Oncology Nursing Forum 39 (3), Loprinzi,P., Cardinal, B., Si,Q., Bennett,J.& Winters-Stone,K., (2012). Theory-based predictors of follow-up exercise behavior after a supervised exercise intervention in older breast cancer survivors. Supportive Care in Cancer 20 (10), McCullough, L., Eng, S., Bradshaw, P., C., Teitelbaum, S., Neugut, A., Gammon, M.(201 ). Fat or fit: The joint effects of physical activity, weight gain, and body size on breast cancer risk. Cancer 118(19) DOI: /cncr.27433

34 References, cont. Rausch, S., Millay, S., Scott, C.,Pruthi, S., Clark, M., Patten, C.,.Vachon, C. (2012). Health behaviors among cancer survivors receiving screening mammography. American Journal of Clinical Oncology. 35(1), Rock,C.L., Doyle,C., Demark-Wahnefried,W., Meyerhardt, J., Courneya,K. S., Schwartz, A. L., Bandera, E. V.,, & Gansler,T. (2012), Nutrition and physical activity guidelines for cancer survivors. CA: A Cancer Journal for Clinicians. doi: /caac Sabatino, S., Coates, R., Uhler R., Pollack, L., Alley, L., & Zauderer, L. (2007). Provider counseling about health behaviors among cancer survivors in the United States. Journal of Clinical Oncology 25(15) Schmitz, K., Courneya, K., Matthews, C, Demark-Wahnefried, W, Galvao, D.,, & Schwartz, A. (2010). American College of Sports Medicine Roundtable on Exercise Guidelines for Cancer Survivors. Medicine & Science in Sports & Exercise 42,