![Exercise Research in Cancer
Year
# of publica&ons
• QOL
• Physical func&on
• Appe&te
• Immune system func&on
• Cardio-pulmonary func&on
• Depression & anxiety
• Sleep
• Bone Health
• Body Composi&on
• Hospitaliza&on
• Treatment Comple&on
• Fa&gue
• Pain
• Postopera&ve LOS
• Social roles
• Self-efficacy
• Coping
• Tumour cell growth
• Insulin sensi&vity
• Concentra&on
• Lymphedema
• Func&onal mobility
• Sexual func&on
• Survival
SEARCH: ("physical activity"[Title]) OR "exercise"[Title]) AND "cancer"[Title]
…150 in 2016 so far
0
50
100
150
200
250
300 1945
1960
1963
1967
1969
1976
1977
1983
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
275 in 2015](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)
Empfohlen
Empfohlen
Weitere ähnliche Inhalte
Was ist angesagt?
Was ist angesagt? (20)
Andere mochten auch
Andere mochten auch (18)
Ähnlich wie Cancer & Exercise - Summer Research Program
Ähnlich wie Cancer & Exercise - Summer Research Program (20)
Mehr von Global Institute GIPPEC
Mehr von Global Institute GIPPEC (8)
Kürzlich hochgeladen
Kürzlich hochgeladen (20)
Cancer & Exercise - Summer Research Program
- 2. Exercise Research in Cancer Year # of publica&ons • QOL • Physical func&on • Appe&te • Immune system func&on • Cardio-pulmonary func&on • Depression & anxiety • Sleep • Bone Health • Body Composi&on • Hospitaliza&on • Treatment Comple&on • Fa&gue • Pain • Postopera&ve LOS • Social roles • Self-efficacy • Coping • Tumour cell growth • Insulin sensi&vity • Concentra&on • Lymphedema • Func&onal mobility • Sexual func&on • Survival SEARCH: ("physical activity"[Title]) OR "exercise"[Title]) AND "cancer"[Title] …150 in 2016 so far 0 50 100 150 200 250 300 1945 1960 1963 1967 1969 1976 1977 1983 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 275 in 2015
- 5. Cancer Type # of Studies Risk Reduction Comment Colon 60 20-25% Occupational PA = Recreational PA; Dose-response relationship; no relationship with rectal cancer Breast 73 25% Dose-response relationship; PA after age 50 is more beneficial Endometrial 20 20-30% Effects are independent of adiposity; dose-response; high-intensity may be more beneficial Prostate 20+ 10-20% Increased protection from advanced/aggressive Ca; Obesity may increase risk of aggressive PCa; vigorous PA may be most beneficial Lung 20+ 20-40% Studies did not always control for smoking status; PA benefit particularly seen in smokers; Rec PA > Occ PA Ovarian 20+ 20% ? Vigorous PA Increase/decreases risk Haematological ~20 -- Some benefit for NHL and Leukaemia, but not for MM or lymphoma; minimal evidence/inconclusive (Friedenreich, 2010; 2002;’ (Giavannucci et al, 2005, AIM; (Hsing et al, 2006, Frontiers in Bioscience; Freedland, 2006, Ca Causes & Control Preven&on
- 6. Detec&on Exercise may indirectly affect cancer detec&on by improving a^en&on to health behaviours, including screening. (Larson et al, BMC Gastroenterology, 2006; Courneya & Friedenreich, 2007, Sem Oncol Nursing)
- 9. Benefits of Prehabilita&on in Cancer • Reduce hospital stay • Reduce surgical complications • Improve activities of daily living function • Improve treatment candidacy • Improve coping skills and reduce emotional distress • Reduce recovery time • Reduce treatment & post- treatment side effects
- 11. Benefits of exercise during treatment (Surgery, Radiation, Chemotherapy and Hormone Therapy) • Improve physical fitness – Aerobic & musculoskeletal – Muscle and fat propor&ons • Lower blood pressure • Reduce treatment side effects – E.g. Pain, nausea, poor sleep • Treatment tolerance • Improved energy • Reduced fa&gue • Improve quality of life Exercise Does NOT: • Worsen treatment or disease-related symptoms • Undermine treatment efficacy
- 13. Benefits of exercise ader treatment • Improved fitness • Improved energy • Improved cognitive function • Reduced risk of lymphedema (swelling) • Reduced impact on ADLs • Reduce fatigue (tiredness) • Improved bone health • Improve body composition
- 14. Exercise & Survival & Biomarkers • 27 Observa&onal Studies: PA associated w/ reduced all-cause, breast & colon cancer mortality • 13 RCTs: beneficial effects on biomarkers – insulin and related pathways – inflamma&on – immunity (Ballard-Barbash et al, JNCI, 2012)
- 15. How physically acKve are cancer survivors? • Survey 703 Kidney Cancer Survivors – ~70 months post-dx • Assessed PA and QOL Results: • ~56% were completely sedentary • ~76% were below the Health Canada/CSEP guidelines • Kidney symptom index posi&vely associated with PA (Trinh et al, 2011, Ca Epidemiol, Biomark, Prev)
- 16. Changes in PA for AYA Ader a cancer diagnosis, significant reduc&ons in: • % mee&ng the PA guidelines – (150 min/wk of moderate to vigorous PA) • Total PA minutes • Sport PA minutes 68% would like an AYA exercise program 300 250 200 150 100 50 0 (Murnane et al, 2015, Support Care Cancer)
- 17. Cancer Survivors Preferences for PA QuesKon Response (%) Would like to receive PA info ader diagnosis? Yes =44 Maybe = 31 Able to do a PA program for kidney cancer survivors? Yes = 48 Maybe = 33 Interested in doing a PA program for kidney cancer survivors? Yes = 34 Maybe = 37 When to start a PA program? During tx = 5 3-6 mon > tx = 37 Where to do a PA program Cancer Centre = 7 Home = 52 Supervised/instructed or unsupervised/self-paced? Supervised = 41 Unsupervised = 59 Walking Summer = 69 Winter = 48 Intensity Moderate = 58 Light = 35 Would like to receive PA info from? Oncologist = 22 Trainer w/ Ca (Trinh et al, 2011, Ca Epidemiol, Biomark, Prev) *Kidney cancer survivors
- 18. Top 10 PrioriKes in Exercise & Cancer 1. Does PA reduce the risk for cancer recurrence and/or improve survival? 2. Does PA influence cancer tx decisions, comple&on rates, and/or response? 3. What is the op&mal PA prescrip&on for cancer survivors? 4. What is the role of sedentary behavior in cancer survivorship? 5. What are the most effec&ve PA behavior change interven&ons for cancer survivors? 6. Which cancer variables modify the PA response? 7. What are the safety issues concerning PA in cancer survivors 8. Which specific cancer symptoms can be managed by PA? 9. Is there a role for PA in advanced cancer? 10. How do we translate PA research into clinical and community oncology pracKce? (Courneya et al, 2015, Res Quart Ex Sport)
- 19. THE LATEST RESEARCH SHOWS THAT WE REALLY SHOULD DO SOMETHING WITH ALL THIS RESEARCH
- 20. Exercise IS Recommended after a Cancer Diagnosis
- 21. Cancer Care Ontario • Ontario government’s (MOHLTC) advisor on cancer – Plans cancer services to meet current and future pa&ent needs, and works with healthcare providers in every Local Health Integra&on Network (LHIN) to con&nually improve cancer care for the people they serve. – Conducts research and rapidly transfers knowledge of new research into improvements and innova&ons in clinical prac&ce and cancer service delivery. • CCO leads mul&-year system planning, contracts for services with hospitals and providers, develops and deploys informa&on systems, establishes guidelines and standards, and tracks performance targets to ensure system-wide improvements in cancer management
- 23. Program in Evidence-Based Care • CCO’s Program in Evidence-Based Care (PEBC) is an interna&onally recognized guideline development program that works to improve the quality of cancer care by helping clinicians and policy makers to apply the best scien&fic evidence in prac&ce and policy decisions. • Uses the AGREE II methodology to assess the quality and repor&ng of prac&ce guidelines. – Used to establish the CCO Cancer-Exercise Guidelines
- 24. Review of Literature and Expert Inquiry Literature Search Yields: - 3 Guidelines - 18 Systema&c Reviews - Primary Literature
- 25. CCO Recommenda&ons 1. People living with cancer can safely engage in moderate amounts of exercise while on ac&ve treatment or post comple&on of therapy. 2. Moderate amounts of exercise are recommended to improve QoL as well as the muscular and aerobic fitness of people living with cancer 3. Clinicians should advise their pa&ents to engage in exercise consistent with the recommenda&ons outlined by CSEP & ACSM 4. Pre-exercise assessment for all people living with cancer before star&ng an exercise interven&on is recommended to evaluate for any effects of disease, treatments and/or co-morbidi&es 5. It is recommended, where possible, that people living with cancer exercise in a group or supervised sesng as it may provide a superior benefit/outcome in QoL and muscular and aerobic fitness. 6. It is recommended, where possible, that people living with cancer perform exercise at a moderate intensity (three to six &mes baseline res&ng state) on an ongoing basis, as a part of their lifestyle so that improvements in QoL and muscular and aerobic fitness can be maintained for the long term.
- 26. Guidelines 150 minutes of moderate- to vigorous- intensity aerobic PA/week Same! Muscle and bone strengthening ac&vi&es using major muscle groups, at least 2 days per week. Same! More daily PA provides greater health benefits. Avoid inactivity Return to daily activities as quickly as possible after surgery Continue normal daily activities as much as possible during and after nonsurgical treatments
- 27. Year OrganizaKon Frequency Intensity Time 2003 ACS > 5 days/week Moderate to vigorous > 30 min 2009 ESSA (A) 3-5 days/week (R) 1-3 days/week (A) RPE 11-14, 60-80% HRmax (R)50-80% 1RM (A) 20-30min (R) 1-4 sets x 6-10 exercises 2010 ACSM (A) 150 min/week of moderate or 75min/week of vigorous physical acKvity ; Strength training 2 days/week 2011 CCCN > 5 days/week At least moderate intensity > 30 min 2012 ACS 150 minutes of physical ac&vity/week; strength training 2 days/week 2012 BASES 150 minutes/week of moderate to vigorous physical ac&vity; strength training 2 days/week Buffart et al. (2014) Cancer Treatment Reviews 40 (2014) 327–340 Exercise prescription guidelines in cancer
- 28. Screening
- 31. eCancer
- 32. Health & Fitness Assessment • Cancer history • Treatment history • Social & func&onal history • Fa&gue • Pain & paraesthesias • Lymphedema Health Assessment Fitness Assessment • Body composi&on • Musculoskeletal fitness • Aerobic Fitness • Physical ac&vity volume • Balance • Flexibility • Adapta&ons & accommoda&ons • Exercise intolerance?
- 33. Exercise-Related Cancer Toxicity Central / Systemic • Chemo-related… – Bradycardia, myocardial ischemia, myocardial infarc&on, CHF • MAB/TKI related… – CHF, cardiomyopathy, thrombosis • Hormone treatment related… – Central adiposity, increased BF%, hyperinsulinemia, procoagulant changes, hypertension • Surgery/Radia&on localized dysfunc&on Peripheral / Musculoskeletal • Chemo-related… – Peripheral neuropathy/ parasthesias, • Hormone treatment related… – Bone degrada&on, decreased muscle mass/strength • Surgery/Radia&on localized dysfunc&on
- 34. Exercise tolerance in persons with cancer (Jones et al. Lancet Oncology, 2009) ~25-40% reduc&on in VO2 for cancer survivors compared to age/sex-matched controls
- 37. Cancer Survivor Func&on Con&nuum Severe Impairment Highly Func&oning Impairment Driven Exercise • Primary Clinician: MD/PT/OT Exercise for Performance Op&miza&on • Primary Clinician: RKin / Ex Phys Interprofessional Approach
- 38. Impairment Examples Impairment Severity Breast Prostate Lung Sarcoma H&N Lymphedema Frozen Shoulder Body Image Erec&le dysfunc&on Urinary Incon&nence SOB Limb dysfunc&on Amputa&on Dysphagia Speech impairment Fa&gue, Pain, Neuropathy, Psycho-social dysfunc&on, muscle atrophy, secondary osteoporosis
- 40. 150 mins per week of moderate to vigorous PA per week; bouts of 10+ mins Adapted from Warburton et al; Canada’s Physical Activity Guide to Healthy Living; ACSM's Guidelines for Exercise Testing and Prescription; and Howley et al. HR= Heart Rate; HRR = Heart rate reserve. Aerobic Training Recommenda&ons
- 41. Resistance Training Recommenda&on %1RM, percentage of one repetition maximum. Adapted from Warburton, adapted from information provided by Warburton et al. and ACSM Intensity Classifica&on % 1-Repe&&on Maximum Example Ac&vi&es Very Light Effort <30 Watering the lawn or garden Light Effort 30-49 General house cleaning, Ironing Moderate Effort 50-69 Raking leaves, Vacuuming Hard Effort 70-84 Wood splisng, Shoveling snow Very Hard Effort >84 Carrying groceries upstairs Maximal Effort 100 Liding a heavy load that you can only lid once 2 days per week, targe&ng major muscle groups
- 43. Adap&ng PA Prescrip&ons • Metasta&c disease (bone mets) • Secondary osteoporosis • Infec&on • Dehydra&on • Bleeding • Fa&gue • Lymphedema • Drains & Lines • Paresthesias • Brain fog
- 45. Not your average personal trainer Training: • ACSM – “Cancer Exercise Trainer” (Webinar + Exam, must have based ACSM cer&fica&on) • U. of Northern Colorado Cancer Rehab Inst. – “Cancer Exercise Specialist” • Wellspring – “CancerSmart Exercise” (exercise and rehabilita&on focus) • University of Calgary / Thrive – Cancer & Exercise Experience: • Volunteer • Student Internships Ongoing Learning: • Rounds, workshops, webinars, mentors
- 48. Internal MD Referral Interdisciplinary Intake Assessment RKin Fitness Assessment 8-Wk Group- Exercise & EducaKon Follow-up (12-wks post) Cancer Rehab & Survivorship EducaKonal Topics • Goal Sesng • Exercise Tips & Safety • Diet • Brain Health • Fa&gue • Mood • Relaxa&on / Stress Mgmt
- 49. Other cancer exercise programs • Wellspring (Several Sites in GTA) – www.wellspring.ca • Gilda’s Club – http://www.gildasclubtoronto.org/ • UW WELL-FIT (Waterloo) – www.uwaterloo.ca/uw-fitness/uw-well-fit • CANWELL (Hamilton) – www.canwellprogram.ca