Physical Activity & Cancer

Macmillan Activity Promotion Programme (MAPP)

South East Wales

Helen Tyler

Macmillan Therapies Manager Velindre Cancer Centre

Acknowledgements

• Siobhan Harkin

– Macmillan Physical Activity Lead (0.5 wte)

• Claire Jones

– Macmillan Physical Activity Physiotherapist (0.6 wte)

• Margretta Davies

– Macmillan Physical Activity Physiotherapist (O.4 wte)

• Patrick Palmer

– Macmillan Physical Activity Support Worker (1 wte)

Improves health and wellbeing outcomes Effect size

Helping people take control

‘Keeping active has helped me, and my family, through a really difficult time. It’s helped me return to a more normal way of life and has

given me a real sense of achievement’.

Reduction in the relevant risk of recurrence of breast cancer: •Adjuvant physical activity 40- 50% •Adjuvant radiotherapy 59% •Adjuvant hormone treatment 29% (after 10 years of treatment)

Physical activity guidelines

2 million People Living with Cancer PA levels

1.6 Million not achieving

recommend level of PA

1.1 million are

65years and over

0.4 million achieving recommended level of PA

Meeting Patients Needs

Specific needs

Additional support

requirements

Self management 10 Top tips

NERS

MAPP

Physiotherapy Outpatients

MAPP Aims

Promote Physical Activity

Promote Healthy Living

Promote Self management of

Cancer related side effects

To promote peer support

To empower patients to use

NERS/independent

Activity

MAPP setting up process

Promote

Champion

Develop

Develop

• Variety of PA sessions

• Modify/enhance dependent on patient feedback

• Referral pathways-

• Professional/self referral

• Gateway session

• Current PA schemes

• NERs /Walking groups

• Resources needed to run MAPP, staff, equipment

• Suitable facilities

• Referral pathways

• Stage of cancer care pathway

• Patient Measurement tool- EQ5D,FACIT,

• VAS,TUG

Evaluate Identify

Expand Establish

Promoting

• Collaborate CNS link in with Cancer support groups

• Attended support group meetings

• Seminars for GPs MAPP

• Written to GPs

• Meet them

• F/U regularly

• Emailed referrals

• Health and social care staff emailed

• Learn at lunch

• Intra net VCC

• Raise awareness NERS/activities local

• Hospitals-promotional stand

• GP-leaflets

• Health and well being days for family/carer /HCP

• VCC patient portal

Patient

Family

Carers

MDT

Community Secondary

care

Championing

• Brief intervention

• HNA

• Motivational interviewing

• Right type of activity

• Facilitate sessions

• Welcoming, friendly

• Environment

• Facilitate peer support

• Varied menu of PA

• Within sports, leisure providers, community room

• Carrying pre and post MAPP assessments

• F/u in person/phone

• Sign posting Advice

Education

Support

Behavioural change model

Patient Centred

Physical activity

MAPP 6 week course 2 hours Health & wellbeing talk +

Physical activity session

DIY-

Home based PA

Walking

NERs

Tai chi

Relaxation

Mindfulness

Beginning of the journey” – why now?

Pacing, planning,

energy diaries

Healthy Eating

Coping thoughts

Confidence in moving

forward with PA

Local opportunities & resources

Macmillan Activity Promotion Programme Inclusion criteria

• All patients will be screened by a physiotherapist prior to commencement on the MAPP.

• All tumour sites

• All ages 18+

• All stages of the cancer care pathway

• Patient has identified a desire to improve their physical activity levels

Macmillan Activity Promotion Programme Exclusion criteria

• Patients who are already physically active (we will refer directly on to NERS)

• Acute infection • Febrile illness with

temperature >38 °c • Symptomatic severe aortic

stenosis • Acute myocarditis/pericarditis • Acute uncontrolled psychiatric

illness • Diarrhoea and vomiting • Acute chest pain • Dizziness and light-

headedness • Disorientation

• Blurred vision • Unstable angina • Unstable/ Acute heart failure • Unstable diabetes • New/ Uncontrolled arrhythmias • Hypertension with a resting SBP > 180mmHg or DBP > 100mmHg • Symptomatic hypotension • <24 hrs since last chemotherapy session • Low blood counts (neutropenia or thrombocytopenia) • Acute PE • Acute MI/ Cardiac event • On antibiotics for active cellulitis • Patients with known MSCC to be discussed with MAPP team on an individual basis.

Many of these exclusions will only be temporary but all must be considered

MAPP Aims/Evaluation

Promote Physical Activity

90% attendance

1 non starter due to illness

Promote Healthy Living

Patients completed ‘Move More’ packs reporting

additional activity

Promote Self management of Cancer related side

effects

Health and wellbeing talk

To promote peer support

See patient feedback

To empower patients to use NERS/independent

Activity

All patients referred to NERS

Patient Feedback – MAPP 1

It has motivated me to examine how active I am. To realize that just increasing normal daily activities count too.

Given me help to do more exercise and advice on other activities that could help me

made me more aware of the need for exercise

Made me realize doing something a little is better than nothing at all. Something has clicked and I now feel more motivated

reassurance to do activities I thought might be damaging or hurt

Helped me to think outside the box about physical activity and the restraints of my life

“Tremendous. I have been able to improve my fatigue level through planning and using some of the activities and ideas gained from the course

Session locations

MAPP future developments

Tuesday 2 – 3.30pm Whitchurch Rugby Club

Friday 11am -1pm Cwmbran Stadium

Monday am Pont Newydd Medical Centre, Porth

THANKS Diolch

Any questions?