exercise guidelines and - northside allied health · 2019-04-10 · current state over 1.5 million...
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Anna L. Schwartz, PhD, FNP-BC, FAAN
Exercise Guidelines and Certifications: What’s new?
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Overview Overview Review of Research Evidence
ACSM Cancer Survivor Exercise Guidelines
ACSM/ACS Certification
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CollaboratorsCollaborators
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Current StateCurrent StateOver 1.5 million new cases cancer in 2009
Over 12 million survivors alive in U.S.
Burden of cancerMorbidity, mortality,
Economic cost
Lost work days,
Reduced quality of life,
Family burden
Need for cancer rehabilitation
Need for exercise guidelines
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ACSM RoundtableACSM RoundtableRound table and Consensus meeting
June 2009 Siteman Cancer Center, Washington University, St. Louis, MOOncology Nursing Foundation
International multidisciplinary teamNursingMedicineEpidemiologyExercise physiology
Representation fromNational Cancer Institute (divisions Survivorship & Epidemiology)Lance Armstrong FoundationYMCAAmerican Cancer Society
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Review of EvidenceReview of EvidenceNational Health, Lung, & Blood Institute (1998)
Category A: Overwhelming RCT data
Category B: Few RCTs, small in size and results inconsistent
Category C: Uncontrolled/nonRCTs and/or observational studies
Category D: Panel experts opinion when evidence is insufficient Category
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ConsensusConsensusRecommendations the same as for age appropriate guidelines from the US DHHS Physical Activity Guidelines for Americans
150 minutes/week moderate-intense aerobic exercise or 75 minutes/week of vigorous exercise
Strength training 2-3 time/week, 8-10 exercises of 10-15 repetitions/set, with at least one set per session
Avoid Inactivity!!!
Return to normal daily activities as quickly as possible
Continue normal daily activities and exercise as much as possible during and after non-surgical treatments
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What to do?What to do?
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Avoid InactivityAvoid Inactivity!!!!!!
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Goals of Exercise Goals of Exercise PrescriptionPrescription
Regain and improve physical function, aerobic capacity, strengthand flexibility
Improve quality of life
Improve body composition and body image
Improve cardiorespiratory, endocrine, neurological, muscular, cognitive and psychological outcomes
Potentially reduce or delay recurrence or secondary primary cancer
Reduce, attenuate and prevent long term and late effects of cancer treatment.
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General ContraindicationsGeneral ContraindicationsExtreme anemia or ataxia
Follow ACSM Guidelines for exercise prescription regarding cardiovascular and pulmonary contraindicationsto exercise
Potential for adverse cardiopulmonary event may be higher in cancer survivors than age matched comparisons given toxicity of treatments and long term/late effects of cancer.
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General Injury RisksGeneral Injury RisksOsteoporosis from bone metastasis and bone-wasting drugs
Peripheral neuropathy
Immune function
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Weighty issuesWeighty issues……
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Special ConsiderationsSpecial ConsiderationsBreast Cancer
LymphedemaFracture risk
Prostate CancerFracture riskPelvic floor exercises
Colorectal CancerPhysician recommendation after ostomy if contact sportsStoma herniation riskAvoid excess intra-abdominal pressure
Adult Hematologic CancersOsteoporosis risk (especially with multiple myeloma)
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Special ConsiderationsSpecial Considerations
Gynecologic CancersMorbid obesityLower limb lymphedema
After Bone Marrow TransplantDaily exercise as toleratedImmune statusResistance training may be most important immediately following transplant
Childhood Hematologic CancersPhysician permissionImmune function
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What do we need to do???What do we need to do???
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How to Apply to PracticeHow to Apply to PracticeProvide clear instructions to exercise and avoid inactivity
Reassure patient that exercise is safe
Instruct patient to exercise:At least every other day
Build up to 30 minutes
Start slowly and Progress slowly
Moderate intensity
Choose an activity they enjoy
Aerobic and resistance exercises
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ACSM/ACS CertifiedACSM/ACS Certified Cancer Exercise TrainerCancer Exercise Trainer
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ACSM/ACS Certification:ACSM/ACS Certification: Cancer Exercise Trainer Cancer Exercise Trainer
Train cancer survivors
Provides fitness assessment
Makes exercise recommendations
Has understanding of cancer:Diagnosis
Surgeries
Treatments
Symptoms
Side effects
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Recommended CompetenciesRecommended Competencies
Knowledge and ability to:Discuss cancer diagnosis, treatment and side effects
Discuss effects of exercise
Discuss cancer specific benefits and risks of exercise
Select appropriate exercise program
Understand impact of cancer treatments, risks of injury, complications such as lymphedema
Evaluate adverse responses to exercise training and how to modify exercise program,
Seek clinical consultation for client during or following treatment.
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Resources for CETResources for CETACSM Certification department
acsm.org/CET
Training information
Knowledge Skills & Abilities (KSA’s)
Live Webinar August 12-September 23$240 registration
6 90-minute sessions
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CET ExamCET ExamOnline
Cost:$150 ACSM Certified Professions
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Summary PointsSummary PointsAerobic exercise
150 minutes/wk moderate intensity
75 minutes vigorous exercise/week
Resistance Exercise2-3 days/week
Avoid Inactivity
ACSM/ACS Cancer Exercise TrainerAcsm.org/CET
Study resources and information
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