Slide 1Cancer timeline & PA interventionPhysical activity and cancer treatment/rehabilitationPhysical activity and cancer treatment/rehabilitationACS Guidelines – April 2012ACSM Guidelines – 2011ACSM Guidelines – 2011Physical activity and cancer treatment/rehabilitationSlide 9Physical activity and cancer treatment/rehabilitationPhysical activity and cancer treatment/rehabilitationPhysical activity and cancer treatment/rehabilitationPhysical activity and cancer treatment/rehabilitationLivestrong program and cancer survivorsSlide 15Slide 16Slide 17Slide 18Strength Training and SurvivorsCancerSection 3Part ACancer timeline & PA interventionSchmitz, et al. 2010 ACSM Roundtable on Exercise Guidelines for Cancer SurvivorsPhysical activity and cancer treatment/rehabilitation•Cancer treatment–Surgery•minor or major–Radiation treatment•ionizing radiation (5 appointments/wk, 6 weeks)•before or after surgery•alone or in combination with chemotherapy–Chemotherapy•oral or IV•duration varies–Hormone therapy–Tumor-specific (targeted) therapyPhysical activity and cancer treatment/rehabilitation•Side-effects to treatment (Physical and emotional)•Low red blood cells•Loss of appetite•Easy to bruise and bleed•Hair loss•Compromised immune system (Infection)•Memory lapses•Pain•Anxiety•Fear•DepressionACS Guidelines – April 20121. Achieve and maintain a healthy weight2. Be physically active – avoid inactivityexercise is safeimproves muscle strength, balance, fatigue, depression3. Eat a healthy dietfruits, veggies, whole grainsACSM Guidelines – 20111. To the extent they are able, cancer patients and survivors should adhere to the 2008 federal Physical Activity Guidelines for Americans, which recommend at least 150 minutes per week of moderate-intensity aerobic activity or 75’ of vigorous plus 2 dats of muscle strengthening.2. Clinicians should advise cancer survivors to avoid inactivity, even for patients with existing disease or who are undergoing difficult treatments.3. Exercise recommendations should be tailored to the individual cancer survivor to account for exercise tolerance and specific diagnosis.ACSM Guidelines – 20114. Clinicians and fitness professionals should pay close attention to cancer survivors’ responses to physical activity, in order to safely progress exercise programs and avoid injuries.5. Although more research should be done on the effects of strength training on cancer survivors, the practice generally appears to be beneficial.Physical activity and cancer treatment/rehabilitation•Quality of Life–Inability to function at the same level as before disease and treatment–Incorporating physical activity during cancer treatment/rehabilitation can diminish side-effects and improve quality of life•Other effects–fatigue, fitness, mood, body composition, cancer biomarkers•Multi-faceted intervention may be necessary–To tackle multiple side-effectsPhysical activity and cancer treatment/rehabilitationAndersen C, et al. European Journal of Oncology Nursing (2006) 10, 247–262•77 participants •Cancer patients diagnosed in the last 1 month•Received at least 1 cycle of chemotherapy•18 to 65 years of age•Intervention lasted for 6 weeks•1 hr 30 min/day•3x/wkPhysical activity and cancer treatment/rehabilitation•Intervention–Multi-faceted•Resistance (85% of maximum strength) •Fitness training (80% of VO2max)•Relaxation techniques: Massage and Muscle relaxation•Balance and co-ordination–Change in 12 side-effects recorded between baseline and 6 weeksPhysical activity and cancer treatment/rehabilitationPhysical activity and cancer treatment/rehabilitation•Change in side-effectsPhysical activity and cancer treatment/rehabilitation•Conclusions–About 70% participants reported significant improvements in side-effects–Increased daily functional ability–Greater adherence to intervention–Desire to do better higher in these patients–Cancer can be a life altering experience–Outlook towards life changesLivestrong program and cancer survivors•Created in 2008 – largest scale program for PA and cancer•Community based program for cancer survivors•Free or low cost, often families also given membership•Served > 37,000•12 week program•small groups•2x/ week supervised exercise (endurance and strength)•Information/community engagement•Irwin, 2016: Evaluation of LiveStrong program–effectiveness, safety–Livestrong participants vs. Waitlist control• –Assessments•QOL (FATCG) and fatigue•PA questionnaire•6MWT•DXA•Biomarkers•Injury questionnaire•Lymphedema questionnaire (breast cancer only)Livestrong program and cancer survivorsLivestrong program and cancer survivorsLivestrong program and cancer survivorsLivestrong program and cancer survivors•No injuries reported•Similar number reporting lymphedema in both groups•Therefore:–The program is efficacious in improving fitness, physical activity, reducing fatigue, improving QOL–It is safe and does not lead to increased adverse events including lymphedemaStrength Training and Survivors•Robust improvement in strength 20-50% increase–variety of different cancer types•improvements in functional tests–i.e. up and go, chair stand, 6min walk•No improvements in body composition •No improvements in psychosocial