strength after cancer: how to safely progress with an exercise program from treatment to · 1...
TRANSCRIPT
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Strength after Cancer: How to
safely progress with an exercise
program from treatment to
survivorship
Julie Everett DPT, CLT
Laurie Fitz PT, CLT
Objectives
• Provide an overview of common
physical side effects experienced by
cancer survivors
• Define lymphedema and appropriate
exercise guidelines
• Discuss cancer related fatigue and
management
• Educate on general exercise guidelines2
Cancer Survivor
“Any person who has been diagnosed
with cancer, from the time of diagnosis
through the balance of life”
3ACS Facts and Figures 2014-15
14.5
million
As Physical Therapists
Our goal is to improve
quality of life of cancer
survivors by
managing/reducing
physical side effects of
treatment
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Side Effects of Treatment
• Pain
• Fatigue
• Weakness
• Stiffness
• Balance
• Decreased
endurance
• Lymphedema
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Good News: Positive health
outcomes of an exercise program
• Endurance
• Cardio respiratory
fitness
• Insulin level
• Body composition
and weight
• Bone mass
• Muscle strength
• Balance
• Reduced Fatigue
• Reduced Nausea
• Sleep
• Social well being
• Decreased risk of
reoccurrence
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Lymphedema
Disruption to system
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Arteries
Veins
Capillaries
Lymph
vessels
Causes
• Surgery
• Node removal
from axilla,
groin, neck
• Radiation
• Scar tissue
http://en.wikipedia.org/wiki/File:Blausen
_0623_LymphaticSystem_Female.png
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Lymphedema Need to Know
Symptoms
• Visible swelling
• Feeling of
fullness/firmness/heaviness
• Feeling of tightness from
clothes or jewelry
Reducing Your Risk
• Avoid:
– Blood Pressure
– Needle Sticks
– Tight/restrictive clothing
• DO:
– Take care of your skin
– Exercise
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If you develop lymphedema:
• Notify your doctor
• Evaluation by a Certified Lymphedema
Therapist (CLT)
• Treatment is called Complete Decongestive
Therapy (CDT)
– Massage, skin care, compression,
education, exercise**
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Exercise and Lymphedema
• Scientific literature
demonstrates safety
• Should be done in a
systematic manner
• May have a
protective benefit
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Exercise Key Points:
• Lymphedema must be stable
• Initial exercise should be
supervised
• Start with lowest possible
weight
• Monitor for symptoms
• Increase weight slowly after
2-4 sessions of no negative
changes
• Wear compression garment
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Compression Garments
• Should be worn with
exercise if diagnosed
with lymphedema
• Enhances lymphatic
return
• Evidence less clear for
women at risk for
lymphedema
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Discussion for Cancer Related
Fatigue
• Cancer pain- what is it?
• Cancer related fatigue- how is this
different?
• Exercise- how can it help?
• Moving forward- what can I do?
Cancer Related Pain
– “An unpleasant sensory and emotional experience associated with actual or potential tissue damage”
– Survivors can have pain from surgery, chemotherapy, or radiation
– 33% of people with cancer will continue to have pain after curative care (National Cancer Institute)
– Medication, therapy, exercise and relaxation techniques are useful treatment options
Pain
• Healing Through Movement
– Using safe and appropriate exercises to help
increase the healthy movement
– Move the sensation of pain further away from painful
activities
Healthy Movement
Pain
Injury
Cancer Related Fatigue
– Most common side-effect complaint
– “Physical, emotional, or cognitive tiredness
or exhaustion that is not proportional to
recent activities and interferes with
functioning. This fatigue does not get
better with rest.”
– 14-96% of people during treatment and 19-
82% of people after treatment (National
Cancer Institute)
Cancer Related Fatigue
• Other reasons for fatigue
– Anemia
– Medications
– Poor nutrition
– Emotions
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Treatments for Fatigue and Pain
• #1 Treatment?
EXERCISE!
Fatigue and Exercise
• “I’m way too tired to workout today.”
• “I’m scared I’m going to hurt myself.”
• “I need to save what little energy I have to go
home and take care of my family.”
• “I’ll start an exercise program tomorrow.”
• “Everything hurts and you want me to do
WHAT?!?”
Treatments
• Exercise!– Improved energy level
– Appetite stimulation
– Increased blood flow to tissues
– Decreased pain
– Improved quality of life
– Increased strength and flexibility
– Mood stimulation
– Improved outlook on cancer challenges
• 2007 Study: Moderate physical activity after treatment (not household activities) had decreased fatigue and pain
Exercise Principles
• Speak to your health care provider before
starting an exercise program!
• Become knowledgeable about the resources
out there:
– Physical Therapists
– Occupational Therapists
– Personal Trainers
• “Start LOW and go SLOW”
Exercise Principles
• Heart rate targets– Stay between 50-80% of maximal heart rate
– Maximal Heart rate: 220 minus age (ex: 220- 32= 188)
– 188 X .5 = 94 188 x .8= 154
• Breathing– You should be able to have a conversation while
working out.
• You can start exercising during treatment!
• Know your exercise level BEFORE diagnosis/treatment
Fatigue and Exercise
• Beginners– Sedentary lifestyle and/or low level of exercise
– Able to complete household chores and family obligations
• Intermediates– 2-4 x a week to the gym
– Exercises classes and/or “weekend warrior”
• Experts– 4-5 x week at the gym
– Competitive athlete and/or active lifestyle
Exercise for Beginners
• Start with 3-4 days a week building up
• Start with smaller bouts (10 minutes) and
building up the time (45 minutes)
• Choose an activity that interests you:
– Walking, swimming, biking, hiking
• Have buddy that will encourage you
• Balanced program:
– cardio, stretching, and weight training
6 Exercises Daily
1. Shoulder and Pec Stretch– Lie on your back
– Hold a broom or umbrella in both hands
– Reach overhead until you feel the stretch
– Hold for 15 seconds
6 Exercises Daily
2. External Rotation– Standing with arms bent and at side
– Rotate arms outward with elbows still at side
– Slowly return to standing position
6 Exercises Daily
3. Shoulder Flexion
– Start with arms at your
side
– Keep elbows straight and
raise arms to shoulder
height
– Can do with palm down
(as shown) or thumbs up
– Slowly lower arms to
starting position
6 Exercises Daily
4. Abdominals– Lay on your back with knees bent
– Slight press your low back into the floor
– Keeping back flat, slowly raise one knee to chest
– Maintaining control in the back, slowly return
6 Exercises Daily
5. Bridging– Lay on your back with knees bent
– Squeeze buttock
– Lift buttock off the floor
– Slowly return back to floor
6 Exercises Daily
6. Clamshells– Lay on side with knees bent, keeping feet together
– Lift top knee up, not allowing body to roll
backwards
– Slowly lower to starting position
– Repeat on other side
Intermediates and Experts
• Don’t be concerned if you need to scale back your
previous activities during treatment- YOU WILL GET
BACK!
• Consider joining group fitness challenges to stay
motivated
• Certified Personal Trainers to help you reach your
goals
– Cancer Exercise Specialist
Additional Exercise Tips:
• Aerobic exercise
– Walking
– Stationary bike
• Circuit Training
– Work large muscle
groups
• Flexibility
– Stretching
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Exercise Alternatives
• Yoga
• Tai Chi
• Qigong
References:
• http://www.lymphnet.org/
• http://www.hopkinsmedicine.org/kimmel_cancer_cent
er/centers/cancer_rehab
• http://www.hopkinsmedicine.org/physical_medicine_r
ehabilitation/index.html
• www.thecancerspecialist.com/ceti-new/default.aspx
• National Cancer Institute (www.cancer.gov)
• AlfanoCm, Smith AW, Irwin ML, et al. Physical activity, long-term
symptoms, and physical health related quality of life among breast
cancer survivors: a prospective analysis. J Cancer Surviv 1 (2):116-28,
2007
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References
• www.thecancerspecialist.com/ceti-new/default.aspx
• National Cancer Institute (www.cancer.gov)
• Alfano CM, Smith AW, Irwin ML, et al. Physical
activity, long-term symptoms, and physical health
related quality of life among breast cancer survivors:
a prospective analysis. J Cancer Surviv 1 (2):116-28,
2007
• Garcia, DO, Thomson, CA. Physical Activity and
Cancer Survivorship. Nutrition in Clin Practice 29 (6):
768-779, 2014
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Thank you!
• To learn more about our program, visit our website-
http://bit.ly/JHBreastCaSurvivorship
• To view this webinar and previous webinars, check
out our media library-
http://bit.ly/JHBreastCaSurvivorshipWebinars
• Questions or concerns, please contact Elissa Bantug-
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