Lexi Harlow, DPT, CLT Physical Therapy Department Seattle ...

Lexi Harlow, DPT, CLT
Physical Therapy Department
Seattle Cancer Care Alliance
June 26 th , 2010

Presentation Topics
1) What are the benefits of exercise?
2) How can exercise help cancer survivors?
3) What does research on survivors tell us about the
importance of exercise?
4) How much and what should I do for exercise?
5) How can physical therapy help me?
6) What exercise programs are available for cancer
survivors?

General Benefits of Exercise
PHYSICAL
Cardiovascular fitness
Building muscle
strength
Cancer and chronic
disease prevention
Weight loss
Improve balance
Osteoporosis
prevention
EMOTIONAL
Decrease depression
Energy boost
Improve sleep quality
lifestyleguide.us

How Can Exercise Help Cancer
Survivors?
The benefits of exercise and physical
activity can help survivors to address some
of the side effects of surgery, chemotherapy,
and radiation.

Possible Side Effects of Surgery
Scar tissue restrictions
Limited range of motion or flexibility

Possible Side Effects of
Chemotherapy
Change of body image
‐Hair loss
‐Weight gain or loss
Diarrhea or malnutrition
Peripheral edema
Fever, risk of infection
Orthostatic hypotension
Peripheral neuropathy
Balance loss

Possible Side Effects of Radiation
Fatigue
Osteopenia
Neutropenia
Radiation induced
fibrosis contracture
Fragile skin or tissue

What Do Survivors Notice?
“I can’t get my shoes on anymore.”
(Edema or swelling in feet)
“I can’t lift what I used to be able to.”
(Decreased strength or muscle mass)
“I catch myself stumbling or reaching for the
wall.”
(Decreased balance and safety)
“I need someone to help me do chores around the
house.”
(Decreased independence)
“I have to rest when going upstairs or on inclines.”
(Decreased endurance)

Do Survivors Need Exercise?

Research: Survivors and Exercise
“Survivors tend to
decrease their physical
activity levels after their
diagnosis of cancer, and
most continue lower levels
of activity through
treatment and beyond,
rarely returning to their
pre‐diagnosis levels of
activity.”
Irwin, Crumley, McTiernan, et al. 2003;
Courneya & Friedenreich 1997
www.examiner.com

Summary of Exercise Research
What types of cancer
have been studied?
Prostate
Breast
Lung
Colorectal
Gynecologic
Head/Neck
Lymphoma
Leukemia
What has exercise
improved in cancer
survivors?
Aerobic fitness
Muscle strength
Body composition
Pain
Depression
Fatigue
Quality of Life
Chance of Recurrence
Mortality

New Cancer Exercise Guidelines
New recommendations made after expert panel reviewed
and evaluated literature on the safety and outcomes of
exercise training during and after cancer therapy.
Cancer patients and survivors should get the same 150
minutes per week of moderate‐intensity aerobic exercise
that is recommended for the general public.
Health care providers should tailor exercise
recommendations to individual patients based on fitness
level and side effects from treatment.
University of Pennsylvania School of Medicine (2010, June 1). New cancer guidelines: Exercise
during and after treatment is now encouraged. Science Daily.

World Cancer Research Fund:
Physical Activity Recommendations for
Survivors
Be physically active as part of everyday life
Be moderately physically active, equivalent to
brisk walking, for at least 30 minutes every day
As fitness improves, aim for 60 minutes or more
of moderate, or for 30 minutes or more of
vigorous, physical activity every day
Limit sedentary habits such as watching television

General Exercise
Recommendations
US Dept of Health and Human Services:
2008 Physical Activity Guidelines for Adult Americans
2.5 hours/week of moderate intensity or 1.25
hours/week of vigorous intensity
Should increase to 5 hours/week of moderate
intensity or 2.5 hours/week of vigorous intensity
2x/week of strengthening of major muscle groups

General Exercise
Recommendations
Cardiovascular
Daily if possible,
minimum of 30 minutes
Warm‐up/Cool‐down
Target HR Zone

General Exercise
Recommendations
Strength training
2‐3x/week
For arms, abdominals,
and legs
Slow, steady
progression

General Exercise
Recommendations
Stretching
2‐3x/week
Avoiding injury
Importance of technique
Yoga
www.emzr.com

Exercise Precautions
Always consult with your MD or other
practitioner to clear you for exercise
Seek advice from a trained professional (PT)
Blood lab values (platelets, Hct, Hgb)
Metastases
Heart conditions
Lymphedema
Chronic orthopedic injuries

Other Considerations
Gradually increase time and intensity
Proper hydration and rest
Cross training
Use of appropriate equipment
Dressing properly

HELP!
Join a team
(accountability)
Get your spouse, best
friend, children, or
animals to join in
Exercise journal or log
Local classes or support
groups
Join a gym
www.foreverfitwomen.com

PHYSICAL THERAPY!
Survivors should get consultation as soon as possible
after diagnosis
Focus on education, especially exercise precautions
and safety
Manual therapy (stretching, scar tissue mobility, etc.)

PHYSICAL THERAPY!
Exercise prescription and consultation for managing
fatigue and improving endurance
Comprehensive individually tailored exercise program
prescription which includes cardiovascular
conditioning, strength training, and flexibility
exercises

Seattle Area Exercise Programs
Cancer Lifeline
(www.cancerlifeline.org)
‐Stretch and Strengthen, Yoga, Lebed
Team Survivor Northwest
(www.teamsurvivornw.org)
‐Women only; yoga, fitness training, swimming, hiking, dragon boating and
canoeing, biking
Gilda’s Club
(www.gildasclubseattle.org)
‐Yoga, Pilates, Tai Chi
YMCA Exercise and Thrive
(www.seattleymca.org)
‐10 week fitness program; need medical clearance

Exercise and Thrive Program
12‐week, 2x/week, 90 min. strength
and fitness program for survivors
Training provided by Y and the
SCCA / Hutchinson Center
Content foci: resistance exercise
didactic/support
13 locations, 26 sessions to date
www.fhcrc.org/exerciseandthrive

EXERCISE!
Exercise is something you have control over before,
during, and after treatment…this doesn’t change.
You may not have control over many factors during
treatment…but you do have a say in helping yourself
recover faster, making yourself feel better, and
ensuring a great quality of life as a cancer survivor!

Acknowledgements and References
“Clinical Implications for Therapists Working with
Oncology Patients”, 11/06, Andrea Leiserowitz, MPT
Rachel Douglas, MPT
American Cancer Society
Nutrition and Physical Activity During and After Cancer
Treatment: An American Cancer Society Guide for Informed
Choices; Doyle et. al; CA Cancer J Clin 2006;56;323‐353.
World Cancer Research Fund/American Institute for Cancer
Research. Food, Nutrition, Physical Activity, and the
Prevention of Cancer: a Global Perspective. Washington,
DC: AICR, 2007.
US Department of Health and Human Services: 2008
Physical Activity Guidelines for Americans

ANY QUESTIONS?