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 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 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’.
2 million People Living with Cancer PA levels 0.4 million achieving recommended 1.6 Million not level of PA achieving recommend level of PA 1.1 million are 65years and over
Meeting Patients Needs Specific Physiotherapy needs Outpatients Additional MAPP support NERS requirements Self management 10 Top tips
MAPP Aims Promote Self Promote Physical Promote Healthy management of Activity Living Cancer related side effects To empower patients to use To promote peer NERS/independent support Activity
MAPP setting up process Develop Promote Champion
Develop • Referral pathways • Current PA schemes • Stage of cancer care • NERs /Walking groups pathway • Resources needed to • Patient Measurement run MAPP, staff, tool- EQ5D,FACIT, equipment • VAS,TUG • Suitable facilities Evaluate Identify Expand Establish • Variety of PA sessions • Referral pathways- • Modify/enhance • Professional/self referral dependent on patient feedback • Gateway session
Promoting • Hospitals- • Health and social care staff promotional stand emailed • GP-leaflets • Learn at lunch • Health and well being days for Patient • Intra net VCC family/carer /HCP • Raise awareness MDT Family • VCC patient portal NERS/activities local Carers Secondary Community care • Seminars for GPs • Collaborate CNS MAPP link in with Cancer • Written to GPs support groups • Meet them • Attended support • F/U regularly group meetings • Emailed referrals
Championing • Varied menu of PA • Carrying pre and post • Within sports, MAPP assessments leisure providers, • F/u in person/phone community • Sign posting room Advice Behavioural Education change model Support Physical Patient activity Centred • Brief intervention • Facilitate sessions • HNA • Welcoming, friendly • Motivational • Environment interviewing • Facilitate peer • Right type of activity support
MAPP 6 week course 2 hours Health & wellbeing talk + Physical activity session Beginning of the journey” – why now? Pacing, Local planning, opportunities DIY- energy & resources diaries Home based PA Walking NERs Tai chi Relaxation Confidence in moving Mindfulness Healthy forward with Eating PA Coping thoughts
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 Many of these exclusions will only be temporary but all must be considered • Blurred vision • Patients who are already • Unstable angina physically active (we will refer directly on to NERS) • Unstable/ Acute heart failure • • Unstable diabetes Acute infection • New/ Uncontrolled arrhythmias • Febrile illness with • Hypertension with a resting SBP > 180mmHg temperature >38 °c • or DBP > 100mmHg Symptomatic severe aortic • Symptomatic hypotension stenosis • <24 hrs since last chemotherapy session • Acute myocarditis/pericarditis • Low blood counts (neutropenia or • Acute uncontrolled psychiatric thrombocytopenia) illness • Acute PE • Diarrhoea and vomiting • Acute MI/ Cardiac event • Acute chest pain • On antibiotics for active cellulitis • Dizziness and light- • Patients with known MSCC to be discussed headedness with MAPP team on an individual basis. • Disorientation
MAPP Aims/Evaluation Promote Healthy Living Promote Self management Promote Physical Activity of Cancer related side Patients completed ‘Move 90% attendance effects More’ packs reporting 1 non starter due to illness additional activity Health and wellbeing talk To empower patients to use NERS/independent To promote peer support Activity See patient feedback All patients referred to NERS
Patient Feedback – MAPP 1 “ Tremendous. I have been able to improve my fatigue It has motivated me to level through planning and examine how active I am. To using some of the realize that just increasing activities and ideas gained normal daily activities count from the course too. Given me help to do Helped me to think more exercise and made me more outside the box advice on other aware of the need about physical activities that could for exercise activity and the help me restraints of my life reassurance to do Made me realize doing something activities I thought a little is better than nothing at might be damaging or all. Something has clicked and I hurt now feel more motivated
MAPP future developments Session locations Friday 11am -1pm Cwmbran Stadium Monday am Pont Newydd Medical Centre, Porth Tuesday 2 – 3.30pm Whitchurch Rugby Club
THANKS Diolch Any questions?
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