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"Local initiatives developing"Local initiatives developing
exercise programmes forexercise programmes for
cancer patients"cancer patients"
Louise BallagherLouise Ballagher
Senior PhysiotherapistSenior Physiotherapist
Oncology and HaematologyOncology and Haematology
RD&E Foundation TrustRD&E Foundation Trust
July 21July 21stst
20112011
Aims
 To establish exercise programmes forTo establish exercise programmes for
patients receiving treatment for cancerpatients receiving treatment for cancer

Jones & Courneya 2002Jones & Courneya 2002
 To review the use of a PhysiotherapyTo review the use of a Physiotherapy
Technical Instructor in the prescribing andTechnical Instructor in the prescribing and
monitoring of exercise programmes formonitoring of exercise programmes for
Haematology patients in isolationHaematology patients in isolation
Common Symptoms ofCommon Symptoms of
cancer treatmentcancer treatment
 Fatigue / decreased energy levelsFatigue / decreased energy levels

70%70%
 Decreased muscle strengthDecreased muscle strength
 Decreased functional statusDecreased functional status
 NauseaNausea
 PainPain
 Body image problemsBody image problems
 Sleep disturbancesSleep disturbances
 Depression and anxietyDepression and anxiety

20-50%20-50%
Positive effects of exercisePositive effects of exercise
 Reduces stress on the heart andReduces stress on the heart and
blood vesselsblood vessels
 Increases ability of heart and lungsIncreases ability of heart and lungs
to deliver oxygen efficiently to theto deliver oxygen efficiently to the
working tissuesworking tissues
 Increases muscular strength andIncreases muscular strength and
enduranceendurance
 Improves immune systemImproves immune system
 Improves mood, body image andImproves mood, body image and
sleep patternssleep patterns
 Improves quality of life bothImproves quality of life both
physically and emotionallyphysically and emotionally
Benefits of exercise for cancerBenefits of exercise for cancer
patientspatients
““Evidence is accumulating that exerciseEvidence is accumulating that exercise
is beneficial for cancer sufferersis beneficial for cancer sufferers””
Cancer Level of
Evidence
Strength of
evidence
Colon High Strong
Rectal Medium No effect
Breast High Moderate
Lung Low Moderate
Prostate Medium Equivocal
Overall Medium Moderate
Others Low Equivocal
Research - Fatigue
 Speck et al (2010)Speck et al (2010)

Meta analysis – Concluded that physicalMeta analysis – Concluded that physical
activity significantly reduced fatigue post Rx.activity significantly reduced fatigue post Rx.
14 studies- 93% positive, 50% statistically14 studies- 93% positive, 50% statistically
significantsignificant
 Dimeo et al (2008)Dimeo et al (2008)

32 pts; 3 week programme of endurance32 pts; 3 week programme of endurance
trainingtraining  25%25%  in fatigue; 28%in fatigue; 28%  inin
exercise capacityexercise capacity
ResearchResearch
Quality of LifeQuality of Life
 Courneya et al (2005)Courneya et al (2005)

studies concluded that exercise had significantstudies concluded that exercise had significant
positive effects on the QOL of cancer patientspositive effects on the QOL of cancer patients
NauseaNausea
 Lee et al (2008)Lee et al (2008)

Moderate aerobic exercise is related to less intenseModerate aerobic exercise is related to less intense
nauseanausea
ResearchResearch
Neutropenia / thrombocytopeniaNeutropenia / thrombocytopenia
 Dimeo et al (1997)Dimeo et al (1997)

RCT on bone marrow transplant patients undergoingRCT on bone marrow transplant patients undergoing
high-dose chemotherapyhigh-dose chemotherapy

Duration of neutropenia and thrombocytopenia wasDuration of neutropenia and thrombocytopenia was
reduced in the exercise groupreduced in the exercise group
Recurrence / survivalRecurrence / survival
 Meyerhardt et al (2006)Meyerhardt et al (2006)

Cancer specific death was 60% lower in women whoCancer specific death was 60% lower in women who
exercised 6 or more hours a week (walking atexercised 6 or more hours a week (walking at
average pace)average pace)
If there is oneIf there is one
message from themessage from the
evidence it is:evidence it is:
Rest is NOT alwaysNOT always best
““STAY ACTIVE”STAY ACTIVE”
What has been happening at theWhat has been happening at the
RD&E !RD&E !
Problems facing haematologyProblems facing haematology
patientspatients
 Intensive and lengthyIntensive and lengthy
chemotherapy regimes,chemotherapy regimes,
often HSCT.often HSCT.
 Frequent hospitalFrequent hospital
admissions often inadmissions often in
isolationisolation
 Side effects of RxSide effects of Rx
 De-conditioningDe-conditioning

Reduced QOLReduced QOL

Low morale / lowLow morale / low
motivationmotivation
RD&E Haematology UnitRD&E Haematology Unit
PastPast
PresentPresent
The Wii!
““ There is growing evidenceThere is growing evidence
of the benefits of the Wii,of the benefits of the Wii,
and physiotherapists areand physiotherapists are
looking into outcomeslooking into outcomes
with their patients. Therewith their patients. There
is definitely evidence thatis definitely evidence that
they are of benefit”they are of benefit”
Professional Adviser
Chartered Society of
Physiotherapy 2008
The introduction of the Wii
 ELF donationELF donation
 Wii sport and Wii fitWii sport and Wii fit
 Study Jan 09- July 09Study Jan 09- July 09
 Patient SatisfactionPatient Satisfaction
SurveySurvey

Initial assessmentInitial assessment

Goal settingGoal setting

Exercise diaryExercise diary

Follow up questionnaireFollow up questionnaire

GuidelinesGuidelines
The ResultsThe Results
Wii Study 2009Wii Study 2009
Initial AssessmentInitial Assessment
Type ofType of
exerciseexercise
% of patients% of patients
No exerciseNo exercise 40 %40 %
BedBed
exercisesexercises
15%15%
SeatedSeated
exercisesexercises
31%31%
Static bikeStatic bike 15%15%
ResistanceResistance
exerciseexercise
0%0%
0
0.5
1
1.5
2
2.5
3
Patients
1 2 3 4 5 6 7 8 9 10
1=Very Happy 10=Very Depressed
Mood
Start Patients Follow up Patients
0
1
2
3
4
5
1 2 3 4 5 6 7 8 9 10
1=VeryMotivate 10=V.De-motivated
Motivation
Start Patients Follow up Patients
0
1
2
3
4
1 2 3 4 5 6 7 8 9 10
1=VeryActive 10=VeryInactive
Physical Activity
Start Patients Follow up Patients
Results
 85% study reported85% study reported
average of 30 minsaverage of 30 mins
accumulated exerciseaccumulated exercise
 Positive feedback !Positive feedback !
 Difficulties!Difficulties!
 Access to equipmentAccess to equipment
 StaffingStaffing

Availability of staffAvailability of staff

Increased referralsIncreased referrals
What happened next!What happened next!
• Proposal for fundingProposal for funding
of Physiotherapyof Physiotherapy
Technical instructorTechnical instructor
postpost
• 6 month pilot agreed6 month pilot agreed
8 Hrs/week8 Hrs/week
Evaluation of PilotEvaluation of Pilot
 Patients identified byPatients identified by
MDTMDT
 New diagnosis, newNew diagnosis, new
physio referralphysio referral
 QuestionnaireQuestionnaire
completed.completed.
““Was it useful having a Technical InstructorWas it useful having a Technical Instructor
monitor your exercise programme?”monitor your exercise programme?”
0
20
40
60
80
100
Yes No
0
20
40
60
80
100
Mood
Motivation
Energy Levels
Physical
Activity
Overall Well
Being
ResultsResults
How would you rate theHow would you rate the
improvement ?improvement ?
0
2
4
6
8
10
Mood
Motivation
Energy Levels
Physical levels
Overall Well
Being
‘‘Are there any other comments you wouldAre there any other comments you would
like to make?’like to make?’
 ““Feel good factor andFeel good factor and
gets you motivated togets you motivated to
push yourself”push yourself”
 ““Without technicalWithout technical
instructor I wouldn’t haveinstructor I wouldn’t have
been able to do it !been able to do it !
 ““Great motivation by aGreat motivation by a
smiley instructor ! ”smiley instructor ! ”
 ““Exercises to suitExercises to suit
personal needs”personal needs”
 ““An excellent programme”An excellent programme”
 ““This should be regardedThis should be regarded
as an essential serviceas an essential service
What is going well ?What is going well ?
Many Thanks to ELFMany Thanks to ELF
• Permanent TechnicalPermanent Technical
Instructor PostInstructor Post
• Increased to 12Increased to 12
hrs/weekhrs/week
 ““ The Way Forward ”The Way Forward ”
GroupGroup
 Advice and informationAdvice and information

LeafletsLeaflets

Out-patients/ DaycareOut-patients/ Daycare
unitunit
 Cancer RehabilitationCancer Rehabilitation
ProgrammesProgrammes

Campbell 2007Campbell 2007
Cancer Rehabilitation ProgrammesCancer Rehabilitation Programmes
 Pilot agreed !Pilot agreed !
 Two 8 week programmesTwo 8 week programmes
 The programme format :The programme format :

Pre assessment /Pre assessment /
screeningscreening

Exercise programme –Exercise programme –
warm-up, aerobics,warm-up, aerobics,
relaxation/cool downrelaxation/cool down

Educational componentEducational component
 One meeting to takeOne meeting to take
place at Fitness Firstplace at Fitness First
Leisure CentreLeisure Centre
The FutureThe Future
 More Promotion of InformationMore Promotion of Information
 Fly fishing / Dragon Boat racing!Fly fishing / Dragon Boat racing!
 More ResearchMore Research
 More Hannahs !More Hannahs !
AnyAny
Questions?Questions?
ReferencesReferences
 Campbell, A.Campbell, A. (2007)(2007) Exercise after cancerExercise after cancer
diagnosis. Available at:diagnosis. Available at: www.canrehab.co.ukwww.canrehab.co.uk
 Courneya, K. (2005)Courneya, K. (2005) Exercise can improveExercise can improve
breast cancer survival.breast cancer survival. CA: A Cancer JournalCA: A Cancer Journal
for Cliniciansfor Clinicians 55:5: 265-26655:5: 265-266
 Dimeo, F., Bertz, H., Finke, S., Mertlesmann,Dimeo, F., Bertz, H., Finke, S., Mertlesmann,
R., Keul, J. (1996)R., Keul, J. (1996) An Aerobic ExerciseAn Aerobic Exercise
Programme for patients with haematologicalProgramme for patients with haematological
malignancies after bone marrow Transplant.malignancies after bone marrow Transplant.
Bone Marrow TransplantBone Marrow Transplant, 18:1157-60, 18:1157-60  
    
  
 Jones, L and Courneya, K. (2002)Jones, L and Courneya, K. (2002)
Exercise discussions during cancerExercise discussions during cancer
treatment consultations.treatment consultations. Cancer PracticeCancer Practice
10(2):66-7410(2):66-74
 Lee, J., Dodd, S., Dibbles, D., Abrams, D.Lee, J., Dodd, S., Dibbles, D., Abrams, D.
(2008)(2008) Nausea at the end of adjuvantNausea at the end of adjuvant
cancer treatment in relation to exercisecancer treatment in relation to exercise
during treatment in patients with breastduring treatment in patients with breast
cancer.cancer. Oncology Nursing ForumOncology Nursing Forum 35(5):35(5):
830-835830-835
 Meyerhardt, J., Giovannucci, E., Holmes,Meyerhardt, J., Giovannucci, E., Holmes,
M. (2006)M. (2006) Physical activity and survivalPhysical activity and survival
after colorectal cancer diagnosis.after colorectal cancer diagnosis. JournalJournal
of Clinical Oncologyof Clinical Oncology 24(22): 3527-353424(22): 3527-3534
 Winningham, M. (1992)Winningham, M. (1992) The Role ofThe Role of
Exercise in Cancer TherapyExercise in Cancer Therapy. In: Watson,. In: Watson,
R., Eisinger, M. (eds)R., Eisinger, M. (eds) Exercise andExercise and
Disease.Disease. Boca Raton: CRC PressBoca Raton: CRC Press

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Exercise at-rde

  • 1. "Local initiatives developing"Local initiatives developing exercise programmes forexercise programmes for cancer patients"cancer patients" Louise BallagherLouise Ballagher Senior PhysiotherapistSenior Physiotherapist Oncology and HaematologyOncology and Haematology RD&E Foundation TrustRD&E Foundation Trust July 21July 21stst 20112011
  • 2. Aims  To establish exercise programmes forTo establish exercise programmes for patients receiving treatment for cancerpatients receiving treatment for cancer  Jones & Courneya 2002Jones & Courneya 2002  To review the use of a PhysiotherapyTo review the use of a Physiotherapy Technical Instructor in the prescribing andTechnical Instructor in the prescribing and monitoring of exercise programmes formonitoring of exercise programmes for Haematology patients in isolationHaematology patients in isolation
  • 3. Common Symptoms ofCommon Symptoms of cancer treatmentcancer treatment  Fatigue / decreased energy levelsFatigue / decreased energy levels  70%70%  Decreased muscle strengthDecreased muscle strength  Decreased functional statusDecreased functional status  NauseaNausea  PainPain  Body image problemsBody image problems  Sleep disturbancesSleep disturbances  Depression and anxietyDepression and anxiety  20-50%20-50%
  • 4. Positive effects of exercisePositive effects of exercise  Reduces stress on the heart andReduces stress on the heart and blood vesselsblood vessels  Increases ability of heart and lungsIncreases ability of heart and lungs to deliver oxygen efficiently to theto deliver oxygen efficiently to the working tissuesworking tissues  Increases muscular strength andIncreases muscular strength and enduranceendurance  Improves immune systemImproves immune system  Improves mood, body image andImproves mood, body image and sleep patternssleep patterns  Improves quality of life bothImproves quality of life both physically and emotionallyphysically and emotionally
  • 5. Benefits of exercise for cancerBenefits of exercise for cancer patientspatients
  • 6. ““Evidence is accumulating that exerciseEvidence is accumulating that exercise is beneficial for cancer sufferersis beneficial for cancer sufferers”” Cancer Level of Evidence Strength of evidence Colon High Strong Rectal Medium No effect Breast High Moderate Lung Low Moderate Prostate Medium Equivocal Overall Medium Moderate Others Low Equivocal
  • 7. Research - Fatigue  Speck et al (2010)Speck et al (2010)  Meta analysis – Concluded that physicalMeta analysis – Concluded that physical activity significantly reduced fatigue post Rx.activity significantly reduced fatigue post Rx. 14 studies- 93% positive, 50% statistically14 studies- 93% positive, 50% statistically significantsignificant  Dimeo et al (2008)Dimeo et al (2008)  32 pts; 3 week programme of endurance32 pts; 3 week programme of endurance trainingtraining  25%25%  in fatigue; 28%in fatigue; 28%  inin exercise capacityexercise capacity
  • 8. ResearchResearch Quality of LifeQuality of Life  Courneya et al (2005)Courneya et al (2005)  studies concluded that exercise had significantstudies concluded that exercise had significant positive effects on the QOL of cancer patientspositive effects on the QOL of cancer patients NauseaNausea  Lee et al (2008)Lee et al (2008)  Moderate aerobic exercise is related to less intenseModerate aerobic exercise is related to less intense nauseanausea
  • 9. ResearchResearch Neutropenia / thrombocytopeniaNeutropenia / thrombocytopenia  Dimeo et al (1997)Dimeo et al (1997)  RCT on bone marrow transplant patients undergoingRCT on bone marrow transplant patients undergoing high-dose chemotherapyhigh-dose chemotherapy  Duration of neutropenia and thrombocytopenia wasDuration of neutropenia and thrombocytopenia was reduced in the exercise groupreduced in the exercise group Recurrence / survivalRecurrence / survival  Meyerhardt et al (2006)Meyerhardt et al (2006)  Cancer specific death was 60% lower in women whoCancer specific death was 60% lower in women who exercised 6 or more hours a week (walking atexercised 6 or more hours a week (walking at average pace)average pace)
  • 10. If there is oneIf there is one message from themessage from the evidence it is:evidence it is: Rest is NOT alwaysNOT always best ““STAY ACTIVE”STAY ACTIVE”
  • 11. What has been happening at theWhat has been happening at the RD&E !RD&E !
  • 12. Problems facing haematologyProblems facing haematology patientspatients  Intensive and lengthyIntensive and lengthy chemotherapy regimes,chemotherapy regimes, often HSCT.often HSCT.  Frequent hospitalFrequent hospital admissions often inadmissions often in isolationisolation  Side effects of RxSide effects of Rx  De-conditioningDe-conditioning  Reduced QOLReduced QOL  Low morale / lowLow morale / low motivationmotivation
  • 13. RD&E Haematology UnitRD&E Haematology Unit PastPast PresentPresent
  • 14. The Wii! ““ There is growing evidenceThere is growing evidence of the benefits of the Wii,of the benefits of the Wii, and physiotherapists areand physiotherapists are looking into outcomeslooking into outcomes with their patients. Therewith their patients. There is definitely evidence thatis definitely evidence that they are of benefit”they are of benefit” Professional Adviser Chartered Society of Physiotherapy 2008
  • 15. The introduction of the Wii  ELF donationELF donation  Wii sport and Wii fitWii sport and Wii fit  Study Jan 09- July 09Study Jan 09- July 09  Patient SatisfactionPatient Satisfaction SurveySurvey  Initial assessmentInitial assessment  Goal settingGoal setting  Exercise diaryExercise diary  Follow up questionnaireFollow up questionnaire  GuidelinesGuidelines
  • 16. The ResultsThe Results Wii Study 2009Wii Study 2009
  • 17. Initial AssessmentInitial Assessment Type ofType of exerciseexercise % of patients% of patients No exerciseNo exercise 40 %40 % BedBed exercisesexercises 15%15% SeatedSeated exercisesexercises 31%31% Static bikeStatic bike 15%15% ResistanceResistance exerciseexercise 0%0%
  • 18. 0 0.5 1 1.5 2 2.5 3 Patients 1 2 3 4 5 6 7 8 9 10 1=Very Happy 10=Very Depressed Mood Start Patients Follow up Patients
  • 19. 0 1 2 3 4 5 1 2 3 4 5 6 7 8 9 10 1=VeryMotivate 10=V.De-motivated Motivation Start Patients Follow up Patients
  • 20. 0 1 2 3 4 1 2 3 4 5 6 7 8 9 10 1=VeryActive 10=VeryInactive Physical Activity Start Patients Follow up Patients
  • 21. Results  85% study reported85% study reported average of 30 minsaverage of 30 mins accumulated exerciseaccumulated exercise  Positive feedback !Positive feedback !  Difficulties!Difficulties!  Access to equipmentAccess to equipment  StaffingStaffing  Availability of staffAvailability of staff  Increased referralsIncreased referrals
  • 22. What happened next!What happened next! • Proposal for fundingProposal for funding of Physiotherapyof Physiotherapy Technical instructorTechnical instructor postpost • 6 month pilot agreed6 month pilot agreed 8 Hrs/week8 Hrs/week
  • 23. Evaluation of PilotEvaluation of Pilot  Patients identified byPatients identified by MDTMDT  New diagnosis, newNew diagnosis, new physio referralphysio referral  QuestionnaireQuestionnaire completed.completed.
  • 24. ““Was it useful having a Technical InstructorWas it useful having a Technical Instructor monitor your exercise programme?”monitor your exercise programme?” 0 20 40 60 80 100 Yes No
  • 26. How would you rate theHow would you rate the improvement ?improvement ? 0 2 4 6 8 10 Mood Motivation Energy Levels Physical levels Overall Well Being
  • 27. ‘‘Are there any other comments you wouldAre there any other comments you would like to make?’like to make?’  ““Feel good factor andFeel good factor and gets you motivated togets you motivated to push yourself”push yourself”  ““Without technicalWithout technical instructor I wouldn’t haveinstructor I wouldn’t have been able to do it !been able to do it !  ““Great motivation by aGreat motivation by a smiley instructor ! ”smiley instructor ! ”  ““Exercises to suitExercises to suit personal needs”personal needs”  ““An excellent programme”An excellent programme”  ““This should be regardedThis should be regarded as an essential serviceas an essential service
  • 28. What is going well ?What is going well ? Many Thanks to ELFMany Thanks to ELF • Permanent TechnicalPermanent Technical Instructor PostInstructor Post • Increased to 12Increased to 12 hrs/weekhrs/week  ““ The Way Forward ”The Way Forward ” GroupGroup  Advice and informationAdvice and information  LeafletsLeaflets  Out-patients/ DaycareOut-patients/ Daycare unitunit  Cancer RehabilitationCancer Rehabilitation ProgrammesProgrammes  Campbell 2007Campbell 2007
  • 29. Cancer Rehabilitation ProgrammesCancer Rehabilitation Programmes  Pilot agreed !Pilot agreed !  Two 8 week programmesTwo 8 week programmes  The programme format :The programme format :  Pre assessment /Pre assessment / screeningscreening  Exercise programme –Exercise programme – warm-up, aerobics,warm-up, aerobics, relaxation/cool downrelaxation/cool down  Educational componentEducational component  One meeting to takeOne meeting to take place at Fitness Firstplace at Fitness First Leisure CentreLeisure Centre
  • 30. The FutureThe Future  More Promotion of InformationMore Promotion of Information  Fly fishing / Dragon Boat racing!Fly fishing / Dragon Boat racing!  More ResearchMore Research  More Hannahs !More Hannahs !
  • 32. ReferencesReferences  Campbell, A.Campbell, A. (2007)(2007) Exercise after cancerExercise after cancer diagnosis. Available at:diagnosis. Available at: www.canrehab.co.ukwww.canrehab.co.uk  Courneya, K. (2005)Courneya, K. (2005) Exercise can improveExercise can improve breast cancer survival.breast cancer survival. CA: A Cancer JournalCA: A Cancer Journal for Cliniciansfor Clinicians 55:5: 265-26655:5: 265-266  Dimeo, F., Bertz, H., Finke, S., Mertlesmann,Dimeo, F., Bertz, H., Finke, S., Mertlesmann, R., Keul, J. (1996)R., Keul, J. (1996) An Aerobic ExerciseAn Aerobic Exercise Programme for patients with haematologicalProgramme for patients with haematological malignancies after bone marrow Transplant.malignancies after bone marrow Transplant. Bone Marrow TransplantBone Marrow Transplant, 18:1157-60, 18:1157-60          
  • 33.  Jones, L and Courneya, K. (2002)Jones, L and Courneya, K. (2002) Exercise discussions during cancerExercise discussions during cancer treatment consultations.treatment consultations. Cancer PracticeCancer Practice 10(2):66-7410(2):66-74  Lee, J., Dodd, S., Dibbles, D., Abrams, D.Lee, J., Dodd, S., Dibbles, D., Abrams, D. (2008)(2008) Nausea at the end of adjuvantNausea at the end of adjuvant cancer treatment in relation to exercisecancer treatment in relation to exercise during treatment in patients with breastduring treatment in patients with breast cancer.cancer. Oncology Nursing ForumOncology Nursing Forum 35(5):35(5): 830-835830-835
  • 34.  Meyerhardt, J., Giovannucci, E., Holmes,Meyerhardt, J., Giovannucci, E., Holmes, M. (2006)M. (2006) Physical activity and survivalPhysical activity and survival after colorectal cancer diagnosis.after colorectal cancer diagnosis. JournalJournal of Clinical Oncologyof Clinical Oncology 24(22): 3527-353424(22): 3527-3534  Winningham, M. (1992)Winningham, M. (1992) The Role ofThe Role of Exercise in Cancer TherapyExercise in Cancer Therapy. In: Watson,. In: Watson, R., Eisinger, M. (eds)R., Eisinger, M. (eds) Exercise andExercise and Disease.Disease. Boca Raton: CRC PressBoca Raton: CRC Press

Hinweis der Redaktion

  1. Our work at the RD&E has been to ………. So as to help overcome or reduce many of the side effects of cancer and it’s Rx. And to ……… Cancer pts tend to decrease ttheir physical activity levels after diagnosis and during and after Rx, and many do not return to their pre Rx activity levels.This trend is enforced as pts are often advised to limit activity and get plenty of rest. . A study by Jones and Courneya 2002 of 311 cancer survivors found that 82% felt that their oncologist should initiate discussion of ecercise and physical activity as part of their oncology consultation and the study concluded that exercise should be recommended both during and after Rx to pts with early stage cancer.
  2. So why should pts undergoing Rx consider exercise to help them? The reason is the benefit of exercise to the human system. Regular exercise reduces the risk of heart disease, improves lung function, increases mm strength and endurance, helps mood, the immune system and generally increases QOL both physically and emotionally. The message be active ,Stay active applies as much to cancer and Haematology pts as to anyone else, perhaps even more. So should we be encouraging pts to run or cycle marathons during their Rx like Jane Tomlinson and Lance Armstrong Thankfully not
  3. The majority of studies of exercise and cancer have been conducted with women with early stage breast cancer, which then limits the generalizability of these studies to other cancers. However there is still a convincing amount of research that has been performed in most cancer areas , looking at specific cancer treatment side effects that benefit from exercise.
  4. Dimeo 1996 About 30 days after bone marrow transplant and followed 6 week treadmill walking program
  5. Quality of Life Courneya & colleagues (2001) reviewed studies and concluded that exercise had significant positive effects on the QOL of cancer patients. The studies include self reported exercise prorammes and supervised interventions, studies of a variety of cancers and studies of the effects of aerobic exercise and mm strengh programmes. ( The exercise interventions ranged from 2- 20 weeks but most about 12 ). The Qol improvements included enhanced functional capacity , increased mm strength, reduced fatigue , improved self image, improved energy and reduced anxiety and depression Nausea Lee et al 2008 in a study of 112 women with breast cancer receiving adjuvant cancer Rx found that those who exercised for the equivalent of 20 mins moderate intensity aerobic exercise 3 x’s a week experienced less intense nausea at the end of their Rx
  6. Haematology pts often face problems that other cancer pts do not. Their treatment usually involves intensive and lengthy chemo regimes, often with HSCT. This means frequent hospital admissions often in protective isolation. The Rx often brings horrible side effects. The isolation in a small room leads to deconditioning. And not surprisingly this all leads to reduced QOL for the pt and low morale and lack of motivation. Treatment regimes – including stem cell transplants (Auto ) and continuing the care of patients of pts following allogenic SCT and the common disabilitating condition GVHD
  7. The Wii Nintendo has caused an explosion of interest in the physiotherapy world as an adjunct to treatment and is beginning to be used in more specialised areas of rehabilitation.
  8. The Exeter Leukaemia Fund in dec 2008 kindly donated the money for the Haematology Unit to purchase two Wii consoles with Wii sport and 2 wii fit balance boards.. We began our 6 month study in Jan 09 Pts referred where assessed by myself and then invited to complete an initial assessment form. Here they reported how much exercise they were currently doing and then scored their mood, motivation, energy levels, physical activity and overall well being. A goal of 30 mins accumulated exercise of any sort on a roughly daily basis was set, dependent on chemo regimes. This is as per government and WCRF guidelines and now the 2010 American ACSM guidelines. A follow up questionairre was completed by the pt on discharge or end of intervention Pts were monitored and given advice as much as possible throughout.
  9. And as for the goal set. 85% of pts reported that they had achieved the goal of 30 mins accumulated exercise on most of their days. But best of all was probably the positive feedback from pts. Read out : Many pts commented on how great it was that they could hve fun and be interactive with their family- children and grandchildren. They were exercising but also the children were being entertained during visits where they often got bored!
  10. So what happened next? Well following the study’s success and seeing that limited staffing was a primary difficulty , I put in a proposal to ELF forr funding of a 6 month Physio Technical Instructor post. The role would be prescribing and monitoring of exercise plans for pts whilst in isolation on Yarty. ELF very kindly agreed to fund a 6 month pilot and lovely Hannah was appointed as the successful candidate , contracted for 8 hours a week So the pilot began in April 2010
  11. Pts were referred by MDT and then assessed and invited onto the study by Hannah.An individual exercise folder would be given to the pt which included our information leaflet on the importance of exercise through Rx as well as a copy of bed and seated exercises. Pts also had an exercise diary to complete. An individual exercise programme would then be prescribed which could include the Wii, static bike and therabands for resistance work. Hannahs 8 hours were split over 3 mornings where she would spend time with each pt discussing their programme – monitoring and motivating and often working out with them! You can often tell which pt Hannah is with by the laughter coming from the room! On discharge the pt would be asked to complete the questionairre to see if there had been any change in mood/ motivation etc as in the initial study and invited to answer a few questions about the physio tech role.
  12. As to the results! Pts were asked if it was useful The results coud not have been better – All responded yes
  13. 100% of pts felt there had been a change in mood, energy levels and physical activity with 92% in motivation and overall well being
  14. And when asked to rate this improvement, 100% scored 7 or 8 , where in this study, just to confuse you , the higher numbers are the more positive results.
  15. So where are we now There is now great interest in the role of exercise for haematology patients during and after Rx and as a preventative strategy for those undergoing SCT Evidence shows that exercise is safe, feasible and beneficial I am now participating in the Exeter “ The way Forward “ group where I provide advice and information of the benefits of exercise to pts that have completed their cancer Rx We now feel confident that our message regarding the importance of exercise during Rx is reaching all our pts that become in-pts, providing them with information and Hannah’s exercise programmes. However we are aware that we are still missing a large number of pts that are seen only in Daycase and yet go on for HSCT.. So we now are displaying posters and have information about how pts can be referred tp physio for advice about exercise ,maintaining fitness or getting pts fitter prior to transplantation. Cancer care is taking its time to catch up with cardiovascular medicine in understanding the benefits of exercise. For 20 years there have been cardiac and pulmonary rehabilitation programmes for patients with heart and lung disorders Dr Anna Campbell in Scotland has undertaken research into the effects of exercise classes for breast cancer pts during Rx and found that not only the pt themseves have improvements in side effects and general well being but was also able to demonstrate cost savings with reduced hospital admissions and less frequent visits to GPs. She now runs seminars and training programmes for Health care Professionals across the UK, focused on developing exercise based rehabilitation programmes for all cancer pts. Having attended one of her seminars last year, together with Exeter’s FORCE cancer Charity we have just had a proposal accepted to run a pilot study of 2 Cancer rehabilitation programmes to start later this year- one for pts still undergoing Rx and the other for those who have completed Rx.. Very exciting times And Well what can we say about the Wiis and Hannah’s role. They have been a huge success on Yarty. The exercise is fun and interactive and Hannah is so motivationing for pts, producing fantastic results as shown in the study. So what else does the future hold? More Research More Hannahs! Thank you very Much
  16. So where are we now There is now great interest in the role of exercise for haematology patients during and after Rx and as a preventative strategy for those undergoing SCT Evidence shows that exercise is safe, feasible and beneficial I am now participating in the Exeter “ The way Forward “ group where I provide advice and information of the benefits of exercise to pts that have completed their cancer Rx We now feel confident that our message regarding the importance of exercise during Rx is reaching all our pts that become in-pts, providing them with information and Hannah’s exercise programmes. However we are aware that we are still missing a large number of pts that are seen only in Daycase and yet go on for HSCT.. So we now are displaying posters and have information about how pts can be referred tp physio for advice about exercise ,maintaining fitness or getting pts fitter prior to transplantation. Cancer care is taking its time to catch up with cardiovascular medicine in understanding the benefits of exercise. For 20 years there have been cardiac and pulmonary rehabilitation programmes for patients with heart and lung disorders Dr Anna Campbell in Scotland has undertaken research into the effects of exercise classes for breast cancer pts during Rx and found that not only the pt themseves have improvements in side effects and general well being but was also able to demonstrate cost savings with reduced hospital admissions and less frequent visits to GPs. She now runs seminars and training programmes for Health care Professionals across the UK, focused on developing exercise based rehabilitation programmes for all cancer pts. Having attended one of her seminars last year, together with Exeter’s FORCE cancer Charity we have just had a proposal accepted to run a pilot study of 2 Cancer rehabilitation programmes to start later this year- one for pts still undergoing Rx and the other for those who have completed Rx.. Very exciting times And Well what can we say about the Wiis and Hannah’s role. They have been a huge success on Yarty. The exercise is fun and interactive and Hannah is so motivationing for pts, producing fantastic results as shown in the study. So what else does the future hold? More Research More Hannahs! Thank you very Much Pink Champagne encourages women who have been diagnosed with breast cancer to lead full and active lives through the sport of dragon boat racing. How flyfishing can help women with breast cancerNot many people with breast cancer would think of picking up a fishing rod and heading off to their nearest lake and river. But that’s just what a group of women have started doing as a way of helping women who’ve had the disease. The scheme is called ‘Casting For Recovery’ and the idea is that fly fishing can help women with breast cancer – the physical action of casting is similar to the physiotherapy exercises prescribed post-surgery. And there are psychological benefits too – fishing is well known as a relaxing pursuit. Louise Adamson met up with Sue Hunter, a member of the National Ladies’ Fly Fishing Team who's also the person responsible for introducing ‘Casting For Recovery’ to this country.