Physiotherapist, Wellspring cancer exercise program developer and leader Jan Park Dorsay

Transcription

1 Jodi Steele Physiotherapist, Wellspring cancer exercise program developer and leader Jan Park Dorsay Nurse Practitioner, Rehabilitation Oncology Program, Hamilton Health Sciences Oren Cheifetz Physiotherapist, Hematology/Oncology Program, Hamilton Health Science 1

2 What is the evidence?... Oren Myth buster!. Jan Time to move!. Jodi OK also time for questions and answers What is the Evidence? Factors To Consider Effects of Exercise Effects of Chemotherapy Tumor Size No Effect Shrink (and hopefully clear) Affect metastases No Effect Shrink (and hopefully clear) Pain Nausea and Vomiting Increase Quality of Life initially, and hopefully improve with longer life Blood Counts (red/white Initially reduce and hopefully improve blood cells and platelets) over time Bone mass density Cardiac function Prevent cancer s risk of Increases risk of developing some developing some cancers cancers Survival Disease relapse Prevent Prevent Fatigue Increase General function Initially reduce, then hopefully improve General strength Initially reduce and hopefully recover eventually Mood status and sleep Generally reduce 2

3 What is the Evidence? Factors To Consider Pain Nausea and Vomiting Quality of Life Blood Counts (red/white blood cells and platelets) Bone mass density Cardiac function Prevent cancer Survival Disease relapse Fatigue General function General strength Mood status and sleep Effects of Exercise s risk of developing some cancers Prevent Alfano (2007) 545 survivors Evaluated 6, 29, and 36 months after diagnosis Higher activity was associated with reduced pain, improved QOL, and function Household activities were not! (Moderate and vigorous) What is the Evidence? Factors To Consider Pain Nausea and Vomiting Quality of Life Blood Counts (red/white blood cells and platelets) Bone mass density Cardiac function Prevent cancer Survival Disease relapse Fatigue General function General strength Mood status and sleep Effects of Exercise s risk of developing some cancers Prevent Lofti-Jam (2008) Systematic review 77 randomized trials Literature is of moderate quality, however Exercise, distraction, hypnosis, and relaxation may reduce nausea and vomiting Researchers need to do better in conducting studies 3

4 What is the Evidence? Factors To Consider Pain Nausea and Vomiting Quality of Life Blood Counts (red/white blood cells and platelets) Bone mass density Cardiac function Prevent cancer Survival Disease relapse Fatigue General function General strength Mood status and sleep Effects of Exercise s risk of developing some cancers Prevent Lofti-Jam (2008), McNeely (2006) Both systematic reviews 91 studies reviewed Exercise led to significantly better QOL scores, fitness, and fatigue What is the Evidence? Factors To Consider Pain Nausea and Vomiting Quality of Life Blood Counts (red/white blood cells and platelets) Bone mass density Cardiac function Prevent cancer Survival Disease relapse Fatigue General function General strength Mood status and sleep Effects of Exercise s risk of developing some cancers Prevent Drouin (2006) 20 women ages exercised, 10 not Aerobic exercise (20-45 min, 3-5 times a week) 50%-70% maximum HR Exercise group: maintained or improved blood counts during radiation, while reduced blood counts in control 4

5 What is the Evidence? Factors To Consider Pain Nausea and Vomiting Quality of Life Blood Counts (red/white blood cells and platelets) Bone mass density Cardiac function Prevent cancer Survival Disease relapse Fatigue General function General strength Mood status and sleep Effects of Exercise s risk of developing some cancers Prevent Hadji (2008) Systematic review Risk for fractures Some risk factors included Aromatase inhibitors, age, below normal body mass, family history, inactivity/lack of exercise, etc. Exercise can maintain BMD during chemo, or slow deterioration What is the Evidence? Factors To Consider Pain Nausea and Vomiting Quality of Life Blood Counts (red/white blood cells and platelets) Bone mass density Cardiac function Prevent cancer Survival Disease relapse Fatigue General function General strength Mood status and sleep Effects of Exercise s risk of developing some cancers Prevent Knols (2005), Wonders (2009) Systematic reviews Exercise during treatment may reduce dose and duration restrictions of drugs related to heart function Benefits will be different depending on stage of disease, type of treatment, life style but still benefit! 5

6 What is the Evidence? Factors To Consider Pain Nausea and Vomiting Quality of Life Blood Counts (red/white blood cells and platelets) Bone mass density Cardiac function Prevent cancer Survival Disease relapse Fatigue General function General strength Mood status and sleep Effects of Exercise s risk of developing some cancers Prevent Courneya (2007), Barbaric (2010, in press) Systematic (review) Higher levels of moderate physical activities are associated with improved survival, prevention of secondary cancers, and disease relapse Exercise 3-7 times a week, strength, endurance, and relaxation (30-60 min) What is the Evidence? Factors To Consider Pain Nausea and Vomiting Quality of Life Blood Counts (red/white blood cells and platelets) Bone mass density Cardiac function Prevent cancer Survival Disease relapse Fatigue General function General strength Mood status and sleep Effects of Exercise s risk of developing some cancers Prevent Wonders (2009), Alfano (2007), Lofti-Jam (2008), McNeely (2006), Courneya (2007),. All demonstrated significant improvements in all of these areas All demonstrated moderate levels of exercise are safe and effective Light exercise is better than nothing, but 6

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8 Resting, or getting g more sleep is the best way to treat cancer and treatment related fatigue Exercise will increase fatigue Energy levels will return to normal with out any intervention once treatment is finished The evidence is that exercise does not increase cancer related fatigue, in fact, even moderate exercise may help to decrease fatigue There will be times when rest is needed, but on those days even a small amount of exercise may be helpful Reconditioning, i i or returning to previous levels of functioning, will not occur with out intervention-exercise 8

9 Exercise will make you feel more tired. You could catch an infection from exercising e in a public place Exercising when you are experiencing side effects of treatment (nausea, vomiting) will make you feel worse 9

10 Moderate exercise may help to decrease fatigue There may be times when you are on chemotherapy that it may be better to limit your exercise: Low red blood cell count (Anemia) Low platelet count (Thrombocytopenia) Low white blood cell count (Neutropenia) fever of 38 or greater, chills, and or shakes Severe nausea and vomiting Anemia: recommend minimal exertion with hemoglobin (red blood cells) less than 80. Red blood cells carry oxygen to the body. Symptoms of anemia/low red blood cells include: Shortness of breath at rest, or with exertion Fatigue Heart palpitations ti 10

11 Thrombocytopenia: minimal exertion with platelet less than 50 Platelets are needed for normal clotting Symptoms of low platelet count include: Unusual bleeding Unusual bruising Neutropenia: White blood cells or absolute neutrophils 1.0 or less White blood cells fight infection Risk of acquiring an infection is greater with low white cell count 11

12 Avoid exercising if you have: Fever of 38 or greater Severe nausea and vomiting, potential for electrolyte imbalance (sodium and potassium) Probably won t feel like exercising! Working your body too hard is not recommended Risk of dehydration Exercising while on chemotherapy can be safe Need to pay attention to what your body is telling you If red blood cells are low, exercise is not as effective as oxygen not being carried to the body. May feel light-headed, dizzy, increase risk of falls If platelets are low, may bruise more Should always thoroughly clean equipment before use to limit risk of infection 12

13 My PICC will fall out I ll lose PICC access, the PICC will go out of position My PICC will become infected My PICC will become painful 13

14 Movements should be controlled and smooth Increase activity ty slowly once PICC insertion location is healed Lifting heavy objects with the arm PICC is inserted into is not recommended Do not swim Do not play contact sports Avoid repetitive motions such as snow shoveling, vacuuming, raking, and golfing 14

15 Lifting anything heavy with the affected arm (children,g groceries, weights) should be avoided because it can increase the risk of developing lymphedema It can also make lymphedema worse if I already have it A recent study by Schmitz and others (August, 2009) reported that weight lifting in a slowly progressive program, while wearing a compressive garment, did not significantly affect the severity of lymphedema In addition, weight lifting: reduced the number and severity of arm and hand symptoms Increased muscle strength d the number of lymphedema flare-ups 15

16 If I exercise my bones will break There eeae are no otypeso of exercise ecsethat ataesae are safer than others 16

17 Exercising with bone metasteses (breast cancer that has spread to the bones) can be safe, with modifications i Avoid high impact activities (jumping) Movements should be low impact (water aerobics is excellent) Avoid activities with a higher risk of falling or jarring (e.g. treadmill on incline), especially if balance is an issue because of changes in sensation 17

18 If I wasn t physically fit before I developed breast cancer, I can t become physically y fit afterwards I won t be able to tell the difference between a normal pain, and a pain I should be worried about 18

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20 Must strike a balance: reasonable monitoring vs. needless anxiety Muscles that haven t been used for a while will complain! Report any new, or unrelenting bone, or other pain to your health care provider Many cancer survivors report they are more physically fit after their diagnosis than before Exercise after breast cancer is safe, and has many benefits Exercise activities may need to be modified depending on where you are at in the breast cancer experience 20

21 Shoulder Dysfunction Postural problems Cord Syndrome Scar tightness Joint Pain 21

22 Treatment Medial Nerve Dural Tension Stretch Manual vs self stretch Massage content.answers.com Scar Massage g PROM AAROM Side lying stretches (advance to ball) 22

23 Hormone replacement drugs and Herceptin have been know to cause joint pain Presents like OA Treatment Heat Exercise (ROM, non weight bearing) Acupucture Postural exercises Range of motion o of the shoulder Core Stability Large muscle groups 23

24 Chin Tuck Scapular a Retractions External Rotation Sit and Twist Seated row Lat Pull Down Crawl up the wall Wand Exercises Pendulum PNF patterns: Diagonal 1 and Diagonal 2 24

25 Bicep Curl Tricep Extension Squat Lunge Toe Raises Many, many, more. 25

26 Pelvic Floor Transverse se Abdominus Rectus Abdominus Floor Exercises Ball Exercises 26

27 Increases muscle mass Increases ceasespulmonary ayventilation ato and perfusion s insulin resistance Regulates Hormones Increases feelings of control Social interaction 27

28 Combination of strength training and aerobic exercise (interval training) 2 x/week supervised, 1 or more X/week on their own Intensity should be moderate 50-75% of Maximum Heart Rate Duration should start at 35 minutes and then progress up to one hour Progression should start with increased duration then increase intensity 28