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McGill Cancer Nutrition and Rehabilitation Program Exercise, Fatigue and Cancer Presented by: Tara Swanson PT,
McGill Cancer Nutrition and Rehabilitation Program Exercise, Fatigue and Cancer Presented by: Tara Swanson PT,
McGill Cancer Nutrition and Rehabilitation Program Exercise, Fatigue and Cancer Presented by: Tara Swanson PT,

McGill Cancer Nutrition and Rehabilitation Program

McGill Cancer Nutrition and Rehabilitation Program Exercise, Fatigue and Cancer Presented by: Tara Swanson PT, MSc

Exercise, Fatigue and Cancer

Presented by:

Tara Swanson PT, MSc (RS) Marta Jelowicki, PT

PRESENTATION OVERVIEW Section One: Overview of Cancer-Related Fatigue Section Two: Findings From Recent Study:
PRESENTATION OVERVIEW Section One: Overview of Cancer-Related Fatigue Section Two: Findings From Recent Study:

PRESENTATION OVERVIEW

PRESENTATION OVERVIEW Section One: Overview of Cancer-Related Fatigue Section Two: Findings From Recent Study:

Section One:

Overview of Cancer-Related Fatigue Section Two:

Findings From Recent Study: Physiological Correlates in Cancer-Related Fatigue Section Three:

Practical Considerations Related to Exercise in Cancer Patients

Section One: Overview of Cancer-Related Fatigue
Section One: Overview of Cancer-Related Fatigue
Section One: Overview of Cancer-Related Fatigue

Section One:

Overview of Cancer-Related Fatigue

WHY FATIGUE Fatigue is often one of the first symptoms, starting at the presentation of
WHY FATIGUE Fatigue is often one of the first symptoms, starting at the presentation of

WHY FATIGUE

WHY FATIGUE Fatigue is often one of the first symptoms, starting at the presentation of a

Fatigue is often one of the first symptoms, starting at the presentation of a cancer diagnosis

This may be due to several factors including:

Tumour being metabolically active

May have decrease in appetite/food intake

May have a decrease in activity levels, leading to de-conditioning

CANCER-RELATED FATIGUE (CRF) “a persistent, subjective sense of tiredness related to cancer or cancer treatment
CANCER-RELATED FATIGUE (CRF) “a persistent, subjective sense of tiredness related to cancer or cancer treatment

CANCER-RELATED FATIGUE (CRF)

CANCER-RELATED FATIGUE (CRF) “a persistent, subjective sense of tiredness related to cancer or cancer treatment that

“a persistent, subjective sense of tiredness related to cancer or cancer treatment that interferes with usual functioning.”

(National Comprehensive Cancer Network 2003)

DIMENSIONS of CRF Affective Dimension (irritability, anxiety, depression) Cognitive Dimension (poor concentration
DIMENSIONS of CRF Affective Dimension (irritability, anxiety, depression) Cognitive Dimension (poor concentration

DIMENSIONS of CRF

DIMENSIONS of CRF Affective Dimension (irritability, anxiety, depression) Cognitive Dimension (poor concentration

Affective Dimension (irritability, anxiety, depression) Cognitive Dimension (poor concentration & memory) Physical Dimension (muscle fatigue & weakness, breathlessness)

MEASUREMENT of CRF May take a multi-dimensional or uni-dimensional approach May use a specific tool
MEASUREMENT of CRF May take a multi-dimensional or uni-dimensional approach May use a specific tool

MEASUREMENT of CRF

MEASUREMENT of CRF May take a multi-dimensional or uni-dimensional approach May use a specific tool or

May take a multi-dimensional or uni-dimensional approach

May use a specific tool or subscale on QOL tools

STATUS OF KNOWLEDGE Fatigue during treatment seems to be related to type of cancer, chemotherapy
STATUS OF KNOWLEDGE Fatigue during treatment seems to be related to type of cancer, chemotherapy

STATUS OF KNOWLEDGE

STATUS OF KNOWLEDGE Fatigue during treatment seems to be related to type of cancer, chemotherapy regimen,

Fatigue during treatment seems to be related to type of cancer, chemotherapy regimen, psychological status, sleep difficulties, pain, activity, anemia Fatigue after treatment seems to be related to age, gender, psychological status, sleep difficulties, pain, activity and shortness of breath

STATUS OF KNOWLEDGE Effective interventions include: – Education (energy conservation, stress reduction, distraction)
STATUS OF KNOWLEDGE Effective interventions include: – Education (energy conservation, stress reduction, distraction)

STATUS OF KNOWLEDGE

STATUS OF KNOWLEDGE Effective interventions include: – Education (energy conservation, stress reduction, distraction)

Effective interventions include:

Education (energy conservation, stress reduction, distraction)

Sleep hygiene

Nutrition

Specific Medications

Exercise

GAPS IN KNOWLEDGE There are many, including a limited understanding how physical factors beyond pain
GAPS IN KNOWLEDGE There are many, including a limited understanding how physical factors beyond pain

GAPS IN KNOWLEDGE

GAPS IN KNOWLEDGE There are many, including a limited understanding how physical factors beyond pain and

There are many, including a limited understanding how physical factors beyond pain and shortness of breath influence the fatigue experience and its impact on function This information is essential to refining our measurements and interventions to address CRF

Section Two: Findings From Recent Study
Section Two: Findings From Recent Study
Section Two: Findings From Recent Study

Section Two:

Findings From Recent Study

PHYSIOLOGICAL CORRELATES OF CANCER-RELATED FATIGUE Swanson T , Dalzell MA, Small D, Kreisman H, MacDonald
PHYSIOLOGICAL CORRELATES OF CANCER-RELATED FATIGUE Swanson T , Dalzell MA, Small D, Kreisman H, MacDonald
PHYSIOLOGICAL CORRELATES OF CANCER-RELATED FATIGUE Swanson T , Dalzell MA, Small D, Kreisman H, MacDonald
PHYSIOLOGICAL CORRELATES OF CANCER-RELATED FATIGUE Swanson T , Dalzell MA, Small D, Kreisman H, MacDonald

PHYSIOLOGICAL CORRELATES OF CANCER-RELATED FATIGUE

Swanson T, Dalzell MA, Small D, Kreisman H, MacDonald N, St-Pierre DMM

McGill University, School of Physical and Occupational Therapy ▪ ▪ Jewish General Hospital, Department of Pulmonary Medicine Montreal, Quebec Canada

OBJECTIVES OBJECTIVE 1: Identify the physical factors contributing to CRF OBJECTIVE 2: Determine to what
OBJECTIVES OBJECTIVE 1: Identify the physical factors contributing to CRF OBJECTIVE 2: Determine to what

OBJECTIVES

OBJECTIVES OBJECTIVE 1: Identify the physical factors contributing to CRF OBJECTIVE 2: Determine to what extent

OBJECTIVE 1:

Identify the physical factors contributing to CRF

OBJECTIVE 2:

Determine to what extent these factors contribute to CRF

MEASUREMENT VARIABLE TOOL Cancer-Related Fatigue Brief Fatigue Inventory (BFI)
MEASUREMENT VARIABLE TOOL Cancer-Related Fatigue Brief Fatigue Inventory (BFI)

MEASUREMENT

MEASUREMENT VARIABLE TOOL Cancer-Related Fatigue Brief Fatigue Inventory (BFI)

VARIABLE

TOOL

Cancer-Related Fatigue

Brief Fatigue Inventory (BFI)

Mendoza et al. Cancer (1999)
Mendoza et al. Cancer (1999)
Mendoza et al. Cancer (1999)

Mendoza et al. Cancer (1999)

Mendoza et al. Cancer (1999)
Mendoza et al. Cancer (1999)
Mendoza et al. Cancer (1999)

Mendoza et al. Cancer (1999)

MEASUREMENT VARIABLE TOOL Exercise Capacity 2-Minute Walk Test (2MWT) O 2 Saturation with Activity
MEASUREMENT VARIABLE TOOL Exercise Capacity 2-Minute Walk Test (2MWT) O 2 Saturation with Activity

MEASUREMENT

MEASUREMENT VARIABLE TOOL Exercise Capacity 2-Minute Walk Test (2MWT) O 2 Saturation with Activity

VARIABLE

TOOL

Exercise Capacity

2-Minute Walk Test (2MWT)

O 2 Saturation with Activity

Pulse Oxymeter

Muscular Strength

30 second Chair Rise (CR) Hand Grip Dynamometer

Muscular Endurance

Hand Grip Dynamometer

Hemoglobin & C-Reactive Protein (CRP) Levels

Routine Blood Testing

MEASUREMENT VARIABLE TOOL Overall Breathlessness Visual Analogue Scale (0-10) Weakness Visual Analogue
MEASUREMENT VARIABLE TOOL Overall Breathlessness Visual Analogue Scale (0-10) Weakness Visual Analogue

MEASUREMENT

MEASUREMENT VARIABLE TOOL Overall Breathlessness Visual Analogue Scale (0-10) Weakness Visual Analogue

VARIABLE

TOOL

Overall Breathlessness

Visual Analogue Scale (0-10)

Weakness

Visual Analogue Scale (0-10)

Sleep

Visual Analogue Scale (0-10)

Pain

Visual Analogue Scale (0-10)

STATISTICAL ANALYSIS UNIVARIATE REGRESSION between variables and cancer-related fatigue (as assessed by the BFI)
STATISTICAL ANALYSIS UNIVARIATE REGRESSION between variables and cancer-related fatigue (as assessed by the BFI)

STATISTICAL ANALYSIS

STATISTICAL ANALYSIS UNIVARIATE REGRESSION between variables and cancer-related fatigue (as assessed by the BFI)

UNIVARIATE REGRESSION between variables and cancer-related fatigue (as assessed by the BFI)

MULTIVARIATE REGRESSION to determine a predictive model of cancer-related fatigue

STUDY POPULATION INCLUDED – Stage III or IV non small cell lung cancer – Referred
STUDY POPULATION INCLUDED – Stage III or IV non small cell lung cancer – Referred

STUDY POPULATION

STUDY POPULATION INCLUDED – Stage III or IV non small cell lung cancer – Referred to

INCLUDED

Stage III or IV non small cell lung cancer

Referred to McGill Cancer Nutrition and Rehabilitation Program

EXCLUDED

Unable to complete questionnaires

Unable to complete the assessment tasks due to pain or safety reasons

PATIENT CHARACTERISTICS (n=58) AGE 68 yrs (42-88) MALE/FEMALE 30/28 STAGE AT ASSESSMENT Stage IIIA 5
PATIENT CHARACTERISTICS (n=58) AGE 68 yrs (42-88) MALE/FEMALE 30/28 STAGE AT ASSESSMENT Stage IIIA 5

PATIENT CHARACTERISTICS (n=58)

PATIENT CHARACTERISTICS (n=58) AGE 68 yrs (42-88) MALE/FEMALE 30/28 STAGE AT ASSESSMENT Stage IIIA 5

AGE

68 yrs (42-88)

MALE/FEMALE

30/28

STAGE AT ASSESSMENT

Stage IIIA

5

Stage IIIB

18

Stage IV

35

CURRENTLY RECEIVING TREATMENT

Chemotherapy

22

Chest Radiation

3

RESULTS: PREVALENCE OF CRF 90% reported some degree of fatigue in the past 24hrs
RESULTS: PREVALENCE OF CRF 90% reported some degree of fatigue in the past 24hrs

RESULTS: PREVALENCE OF CRF

RESULTS: PREVALENCE OF CRF 90% reported some degree of fatigue in the past 24hrs

90% reported some degree of fatigue in the past

24hrs

50 40 30 20 10 0 1-4 5-7 8-10 % Respondents Worst Fatigue Score
50 40 30 20 10 0 1-4 5-7 8-10 % Respondents Worst Fatigue Score
50 40 30 20 10 0 1-4 5-7 8-10 % Respondents Worst Fatigue Score
50 40 30 20 10 0 1-4 5-7 8-10 % Respondents
50
40
30
20
10
0
1-4
5-7
8-10
% Respondents

Worst Fatigue Score

RESULTS: PREVALENCE OF CRF 84% reported fatigue to have interfered with at least one function
RESULTS: PREVALENCE OF CRF 84% reported fatigue to have interfered with at least one function

RESULTS: PREVALENCE OF CRF

RESULTS: PREVALENCE OF CRF 84% reported fatigue to have interfered with at least one function in

84% reported fatigue to have interfered with at least one function in the past 24 hrs

Mendoza et al. Cancer (1999)
Mendoza et al. Cancer (1999)
Mendoza et al. Cancer (1999)

Mendoza et al. Cancer (1999)

RESULTS: IMPACT OF CANCER- RELATED FATIGUE 100 80 60 40 20 Walking General Normal Mood
RESULTS: IMPACT OF CANCER- RELATED FATIGUE 100 80 60 40 20 Walking General Normal Mood

RESULTS: IMPACT OF CANCER- RELATED FATIGUE

RESULTS: IMPACT OF CANCER- RELATED FATIGUE 100 80 60 40 20 Walking General Normal Mood Relations
100 80 60 40 20 Walking General Normal Mood Relations with Others Ability activity Work
100
80
60
40
20
Walking
General
Normal
Mood
Relations
with Others
Ability
activity
Work
Enjoyment
Of Life
% Respondents

DIMENSION OF FUNCTIONING

50 40 30 20 10 0 1-3 4-6 7-10 % Respondents General Activity Score
50 40 30 20 10 0 1-3 4-6 7-10 % Respondents General Activity Score
50 40 30 20 10 0 1-3 4-6 7-10 % Respondents General Activity Score
50 40 30 20 10 0 1-3 4-6 7-10 % Respondents
50
40
30
20
10
0
1-3
4-6
7-10
% Respondents

General Activity Score

FACTORS RELATED TO CRF: UNIVARIATE ANALYSIS FACTOR R 2 Weakness (VAS) 0.45** Overall Breathlessness
FACTORS RELATED TO CRF: UNIVARIATE ANALYSIS FACTOR R 2 Weakness (VAS) 0.45** Overall Breathlessness

FACTORS RELATED TO CRF:

UNIVARIATE ANALYSIS

FACTORS RELATED TO CRF: UNIVARIATE ANALYSIS FACTOR R 2 Weakness (VAS) 0.45** Overall Breathlessness

FACTOR

R

2

Weakness (VAS)

0.45**

Overall Breathlessness (VAS)

0.30**

Pain (VAS)

0.29**

Lower Limb Strength (CR)

0.21**

Exercise Capacity (2MWT)

0.18**

** p<0.01 level

FACTORS UNRELATED TO CRF: UNIVARIATE ANALYSIS FACTOR R 2 Upper Limb Strength 0.07 Upper Limb
FACTORS UNRELATED TO CRF: UNIVARIATE ANALYSIS FACTOR R 2 Upper Limb Strength 0.07 Upper Limb

FACTORS UNRELATED TO CRF:

UNIVARIATE ANALYSIS

FACTORS UNRELATED TO CRF: UNIVARIATE ANALYSIS FACTOR R 2 Upper Limb Strength 0.07 Upper Limb Endurance

FACTOR

R

2

Upper Limb Strength

0.07

Upper Limb Endurance

0.04

O 2 Saturation - Exercise

0.03

Hemoglobin

0.07

C-Reactive Protein (CRP)

0.02

Sleep (VAS)

0.03

MODEL BY MULTIPLE REGRESSION Weakness (VAS) Overall breathlessness (VAS) Measurement of lower limb strength (CR
MODEL BY MULTIPLE REGRESSION Weakness (VAS) Overall breathlessness (VAS) Measurement of lower limb strength (CR

MODEL BY MULTIPLE REGRESSION

MODEL BY MULTIPLE REGRESSION Weakness (VAS) Overall breathlessness (VAS) Measurement of lower limb strength (CR

Weakness (VAS) Overall breathlessness (VAS) Measurement of lower limb strength (CR performance):

Combined R 2 value 0.62

(p<0.01)

CONCLUSIONS Cancer-related fatigue is prevalent and interferes with function of NSCLC patients Lower limb strength
CONCLUSIONS Cancer-related fatigue is prevalent and interferes with function of NSCLC patients Lower limb strength

CONCLUSIONS

CONCLUSIONS Cancer-related fatigue is prevalent and interferes with function of NSCLC patients Lower limb strength (CR),

Cancer-related fatigue is prevalent and interferes with function of NSCLC patients

Lower limb strength (CR), weakness (VAS) and overall breathlessness (VAS) explain 62% of the variance in cancer-related fatigue scores

CLINICAL SIGNIFICANCE Management of breathlessness may improve CRF in this population Weakness, especially in the
CLINICAL SIGNIFICANCE Management of breathlessness may improve CRF in this population Weakness, especially in the

CLINICAL SIGNIFICANCE

CLINICAL SIGNIFICANCE Management of breathlessness may improve CRF in this population Weakness, especially in the lower

Management of breathlessness may improve CRF in this population

Weakness, especially in the lower limbs, contributed to CRF in this population

Strength training programs, in combination with cardiovascular training, may lead to improvement in CRF and ultimately enhance patient QOL

Section Three: Practical Considerations Related to Exercise in Cancer Patients
Section Three: Practical Considerations Related to Exercise in Cancer Patients
Section Three: Practical Considerations Related to Exercise in Cancer Patients

Section Three:

Practical Considerations Related to Exercise in Cancer Patients

Outline Why exercise? Practical considerations related to exercise in cancer patients Motivation and resources
Outline Why exercise? Practical considerations related to exercise in cancer patients Motivation and resources

Outline

Outline Why exercise? Practical considerations related to exercise in cancer patients Motivation and resources

Why exercise? Practical considerations related to exercise in cancer patients Motivation and resources

Why Exercise Exercise training is safe and feasible for cancer survivors following the completion of
Why Exercise Exercise training is safe and feasible for cancer survivors following the completion of

Why Exercise

Why Exercise Exercise training is safe and feasible for cancer survivors following the completion of primary

Exercise training is safe and feasible for cancer survivors following the completion of primary therapy [Exercise]…may be associated with potentially clinically meaningful improvements in exercise capacity and overall QOL

Demark-Wahnefried, W. and Jones, L., Hematol Oncol Clin N Am 22 (2008)

Why Exercise “Physical activity interventions may reduce the risk of developing some cancers, help cancer
Why Exercise “Physical activity interventions may reduce the risk of developing some cancers, help cancer

Why Exercise

Why Exercise “Physical activity interventions may reduce the risk of developing some cancers, help cancer survivors

“Physical activity interventions may reduce the risk of developing some cancers, help cancer survivors cope with and recover from treatments, improve the health of long-term cancer survivors, and possibly even reduce the risk of recurrence and extend survival after a cancer diagnosis”

Courneya, K.S. and Friedenreich, C.M., Seminars in Oncology Nursing, 2007

Why Exercise Physical Activity and Survival After Breast Cancer Diagnosis Prospective observational study 2987 women
Why Exercise Physical Activity and Survival After Breast Cancer Diagnosis Prospective observational study 2987 women

Why Exercise

Why Exercise Physical Activity and Survival After Breast Cancer Diagnosis Prospective observational study 2987 women

Physical Activity and Survival After Breast Cancer Diagnosis

Prospective observational study 2987 women diagnosed with stage I-III breast cancer from the Nurses’ Health Study cohort Patients were divided into groups depending on how engaged they were in physical activity Physical activity was measured in MET-hrs per week

Holmes et al. JAMA, 2005

Why Exercise Physical Activity and Survival After Breast Cancer Diagnosis Results: “Any category of activity
Why Exercise Physical Activity and Survival After Breast Cancer Diagnosis Results: “Any category of activity

Why Exercise

Why Exercise Physical Activity and Survival After Breast Cancer Diagnosis Results: “Any category of activity higher

Physical Activity and Survival After Breast Cancer Diagnosis

Results:

“Any category of activity higher than the reference category of less than 3 MET-hrs per week was associated with a decreased risk of an adverse breast cancer outcome”

“Absolute unadjusted mortality risk reduction was 6% at 10 yrs for women who engaged in 9 or more MET-hrs per week”

Holmes et al. JAMA, 2005

Practical Considerations Treatment Side-effects – Chemo-induced – Radiation-induced – Surgical – Other
Practical Considerations Treatment Side-effects – Chemo-induced – Radiation-induced – Surgical – Other

Practical Considerations

Practical Considerations Treatment Side-effects – Chemo-induced – Radiation-induced – Surgical – Other

Treatment Side-effects

Chemo-induced

Radiation-induced

Surgical

Other treatments: eg: Stem-Cell Transplant, steroids

Disease-Related

Site of tumor

Metastases

Nutritional status

Psychosocial impact

Chemo-Induced Fatigue Thrombocytopenia Anemia Neutropenia Loss of hair
Chemo-Induced Fatigue Thrombocytopenia Anemia Neutropenia Loss of hair

Chemo-Induced

Chemo-Induced Fatigue Thrombocytopenia Anemia Neutropenia Loss of hair

Fatigue Thrombocytopenia Anemia Neutropenia Loss of hair

Chemo-Induced Decreased appetite Nausea and vomiting Changes in bowel function Neuropathy Altered mentation,
Chemo-Induced Decreased appetite Nausea and vomiting Changes in bowel function Neuropathy Altered mentation,

Chemo-Induced

Chemo-Induced Decreased appetite Nausea and vomiting Changes in bowel function Neuropathy Altered mentation,

Decreased appetite Nausea and vomiting Changes in bowel function Neuropathy Altered mentation, “Chemo-brain” Cardiotoxicity

Radiation-Induced Burns Fibrosis Fatigue
Radiation-Induced Burns Fibrosis Fatigue

Radiation-Induced

Radiation-Induced Burns Fibrosis Fatigue

Burns Fibrosis Fatigue

Surgical Pain Anatomical changes Scar mobility Added management difficulties if followed closely by radiation
Surgical Pain Anatomical changes Scar mobility Added management difficulties if followed closely by radiation

Surgical

Surgical Pain Anatomical changes Scar mobility Added management difficulties if followed closely by radiation

Pain Anatomical changes Scar mobility Added management difficulties if followed closely by radiation Foot drop Post-op restrictions due to type of surgery Post-op restrictions suggested by surgeon

Other Treatments Stem Cell Transplant (SCT) – Decreased Immunity Avoid public pools, lakes, and crowded
Other Treatments Stem Cell Transplant (SCT) – Decreased Immunity Avoid public pools, lakes, and crowded

Other Treatments

Other Treatments Stem Cell Transplant (SCT) – Decreased Immunity Avoid public pools, lakes, and crowded areas

Stem Cell Transplant (SCT)

Decreased Immunity

Avoid public pools, lakes, and crowded areas

Graft vs Host Disease (allogeneic-SCT)

Sun exposure precautions Sclerodermatic tissue changes with skin GvHD

Corticosteroids:

Used in many treatment regimens

Site of Tumor Gastroesophageal Breast Prostate Hepatobiliary Lung Hematologic Other
Site of Tumor Gastroesophageal Breast Prostate Hepatobiliary Lung Hematologic Other

Site of Tumor

Site of Tumor Gastroesophageal Breast Prostate Hepatobiliary Lung Hematologic Other

Gastroesophageal Breast Prostate Hepatobiliary Lung Hematologic Other

Metastases Liver Lung Brain Bone
Metastases Liver Lung Brain Bone

Metastases

Metastases Liver Lung Brain Bone

Liver Lung Brain Bone

Nutritional Status
Nutritional Status

Nutritional Status

Nutritional Status
Nutritional Status
Psychosocial Impact
Psychosocial Impact

Psychosocial Impact

Psychosocial Impact
Psychosocial Impact
Psychosocial Impact
Psychosocial Impact
Psychosocial Impact
Psychosocial Impact
Psychosocial Impact
Psychosocial Impact
Psychosocial Impact
Psychosocial Impact
Psychosocial Impact
Psychosocial Impact
Psychosocial Impact
Psychosocial Impact
Psychosocial Impact
Psychosocial Impact
Psychosocial Impact
Psychosocial Impact
Psychosocial Impact
Psychosocial Impact
Psychosocial Impact
Psychosocial Impact
Psychosocial Impact
Some Guidelines from Cancer Exercise Specialist Training Course Individualize Moderate intensity activity level
Some Guidelines from Cancer Exercise Specialist Training Course Individualize Moderate intensity activity level

Some Guidelines from Cancer Exercise Specialist Training Course

Guidelines from Cancer Exercise Specialist Training Course Individualize Moderate intensity activity level Full

Individualize Moderate intensity activity level Full body exercise at each session 3x/wk Monitor blood counts Progress slowly and vary workout with treatment effects

Some Guidelines from Cancer Exercise Specialist Training Course Status Recommended Intensity Level Sedentary, poor
Some Guidelines from Cancer Exercise Specialist Training Course Status Recommended Intensity Level Sedentary, poor

Some Guidelines from Cancer Exercise Specialist Training Course

Guidelines from Cancer Exercise Specialist Training Course Status Recommended Intensity Level Sedentary, poor

Status

Recommended Intensity Level

Sedentary, poor health, low fitness

30-40% HRR (starting); RPE = 1-3

Active, moderate health, average fitness

50-60% HRR (starting); RPE = 4-5

Exercise and Cancer Recovery, Schneider, C. M. et al., 2003

Motivation Some ideas…. – Patients have control: CHOICE – Prevention of complications or secondary problems
Motivation Some ideas…. – Patients have control: CHOICE – Prevention of complications or secondary problems

Motivation

Motivation Some ideas…. – Patients have control: CHOICE – Prevention of complications or secondary problems –

Some ideas….

Patients have control: CHOICE

Prevention of complications or secondary problems

Potential benefits

Sense of achievement

Goal setting

New habit: can take 30-60 times to develop

Exercise can be FUN, really…

Take-Home Message Do not avoid, but be cautious when prescribing Physical Exercise MODERATE INTENSITY, slow
Take-Home Message Do not avoid, but be cautious when prescribing Physical Exercise MODERATE INTENSITY, slow

Take-Home Message

Take-Home Message Do not avoid, but be cautious when prescribing Physical Exercise MODERATE INTENSITY, slow

Do not avoid, but be cautious when prescribing Physical Exercise MODERATE INTENSITY, slow progression Keep in mind the whole person, the individual Exercise is an important and integral part of life prior to, with, and after cancer, have fun with it!

Resources Canadian and American Cancer Societies Comprehensive Health Improvement Program (CHIP) at Atwater Club
Resources Canadian and American Cancer Societies Comprehensive Health Improvement Program (CHIP) at Atwater Club

Resources

Resources Canadian and American Cancer Societies Comprehensive Health Improvement Program (CHIP) at Atwater Club

Canadian and American Cancer Societies Comprehensive Health Improvement Program (CHIP) at Atwater Club Cumming’s Center Jewish Rehabilitation Hospital

McGill’s Cancer Nutrition-Rehabilitation Programs Wellness Center (CDN) Yoga classes (Happy Tree)

Many community activities, gyms, and… outdoors

the great

References Demark-Wahnefried, W. and Jones, L., Hematol Oncol Clin N Am 22 (2008) 319-342 Holmes
References Demark-Wahnefried, W. and Jones, L., Hematol Oncol Clin N Am 22 (2008) 319-342 Holmes

References

References Demark-Wahnefried, W. and Jones, L., Hematol Oncol Clin N Am 22 (2008) 319-342 Holmes et

Demark-Wahnefried, W. and Jones, L., Hematol Oncol Clin N Am 22 (2008) 319-342 Holmes et al., JAMA May 25, 2005, Vol 293, No. 20 Courneya, K.S. and Friedenreich, C.M., Physical Activty and Cancer Control, Seminars in Oncology Nursing, Vol. 23, no. 4 (Nov.) 2007 (pp 242-252) Franklin, D. J. MD, PhD, Phys Med and Rehab Clin of N Am 18 899-924 (2007) Exercise and Cancer Recovery, Schneider, C. M. et al., 2003

marta.jelowicki@muhc.mcgill.ca