safely progress with an exercise program from treatment to - PowerPoint PPT Presentation

Strength after Cancer: How to safely progress with an exercise program from treatment to survivorship Julie Everett DPT, CLT Laurie Fitz PT, CLT 1

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 guidelines 2

Cancer Survivor “Any person who has been diagnosed with cancer, from the time of diagnosis through the balance of life” 14.5 million ACS Facts and Figures 2014-15 3

As Physical Therapists Our goal is to improve quality of life of cancer survivors by managing/reducing physical side effects of treatment 4

Side Effects of Treatment • Pain • Fatigue • Weakness • Stiffness • Balance • Decreased endurance • Lymphedema 5

Good News: Positive health outcomes of an exercise program • Endurance • Muscle strength • Cardio respiratory • Balance fitness • Reduced Fatigue • Insulin level • Reduced Nausea • Body composition • Sleep and weight • Social well being • Bone mass • Decreased risk of reoccurrence 6

Lymphedema Disruption to system Arteries Lymph vessels Capillaries Veins 7

Causes • Surgery • Node removal from axilla, groin, neck • Radiation • Scar tissue http://en.wikipedia.org/wiki/File:Blausen 8 _0623_LymphaticSystem_Female.png

Lymphedema Need to Know Symptoms Reducing Your Risk • • Visible swelling Avoid: • – Blood Pressure Feeling of fullness/firmness/heaviness – Needle Sticks • Feeling of tightness from – Tight/restrictive clothing clothes or jewelry • DO: – Take care of your skin – Exercise 9

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** 10

Exercise and Lymphedema • Scientific literature demonstrates safety • Should be done in a systematic manner • May have a protective benefit 11

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 12

Compression Garments • Should be worn with exercise if diagnosed with lymphedema • Enhances lymphatic return • Evidence less clear for women at risk for lymphedema 13

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 Injury Healthy Movement 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

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 18

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 34

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 36 cancer survivors: a prospective analysis. J Cancer Surviv 1 (2):116-28, 2007

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 37

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- ebantug1@jhmi.edu 38