TITLE G. Stephen Morris, PT, PhD., FACSM Distinguished Professor Dept. of Physical Therapy Wingate University Wingate, North Carolina
Purpose • Briefly review current guidelines available to clinicians seeking to provide exercise programing to cancer survivors. • Attempt to convince those who don’t, to begin doing so!!
Slide courtesy of ACSM 2018
What Have We Learned? • Exercise is safe • Improved quality of life • Cancer survivors can adapt • Reduced anxiety to exercise training • Reduced risk of depression • Lower risk of all-cause • Improved sleep mortality • Slowed or reduced weight • Lower risk of CV disease gain • Lower risk of hypertension • Weight loss • Lower risk of type-2 • Improved bone health diabetes • Improved physical function • Lower risk of adverse blood • Lower risk of falls lipid profile • Lower risk of fall-related • Improved cognition injuries
What Have We Learned?
PAGA I • General Recommendations: • Avoid inactivity • Performing at least 150 minutes of moderate intensity/75 min of vigorous intensity aerobic exercise yields substantial health benefits • Aerobic activity should > 10 min in duration • Engage in muscle strengthening activities that are moderate or high intensity on 2 or more days per week • Did not specifically address the components of the FITT Principle for prescribing exercise
FITT PRINCIPLE • FITT: F requency, I ntensity, T ime (duration), T ype
PAGA I • Recommendations directed at cancer survivors: • Do engage in regular physical activity for its preventive benefits/risk reduction • Meet the activity guidelines for healthy adults. • If that is not possible be as active as possible • Should consult their health-care providers to match their physical activity plan to their abilities and health status
PAGA I • Recommendations for older adults • Be as physically active as their abilities and conditions allow • Engage in activities to preserve and improve balance • Older adults should determine their level of effort for physical activity relative to their level of fitness • Understand whether and how their conditions affect their ability to do regular physical activity safely
Slide courtesy of ACSM 2018
Schmitz KH, et al. Med Sci Sports Exer. 2010: 42:1409
ACSM Roundtable-2010 • Adopted the PAG I activity guidelines • Did not recommend exercise testing for those planning on doing low-moderate intensity activity • Offered specific exercise safety guidelines • Prostate - be aware of increased fracture risk • Stem cell recipients – Avoid overtraining • Colon – Physician recommended permission for those with an ostomy prior to engaging in contact sports
ACSM Roundtable - 2010 • Did not recommend diagnosis specific prescriptive recommendations • Limitations from a rehabilitation perspective: • Ask untrained exercise personnel to do specific functional assessments • Discourages exercise testing • Advocates for prolonged periods of post surgical inactivity • Morris GS. Oncol Rehab. 2014;32:36.
U.S. Department of Health and Human Services. Physical Activity Guidelines for Americans, 2nd edition. Washington, DC: U.S. Department of Health and Human Services; 2018.
PAGA II • Retained the same activity recommendations as PAGA I • Reported that exercise reduced risk of developing cancer at a greater number of sites than previously stated (4 vs. 8). • “cancer survivors can consult a with physical activity specialist to match a physical activity plan to their abilities, health status, and any treatment toxicities.” • Identifies physical activity as a countermeasure to frailty
PAGA II • Same messages: • Adults with chronic conditions or symptoms should be under the care of a health care practitioner. • People with chronic conditions can consult a health care professional or physical activity specialist about the types and amounts of activity appropriate for their abilities and chronic conditions.
PAGA II • New Messages: • “multicomponent physical activity” • Advocates decreased sitting time for adults • Some physical activity is better than none • Advocated for light intensity activity replacing sitting activity • No longer requires physical activity to occur in bouts of at least 10 minutes. • The key message is that any amount of moderate to vigorous physical activity counts
American College of Sports Medicine Roundtable Report on Physical Activity, Sedentary Behavior, and Cancer Prevention and Control • “there is consistent, compelling evidence that physical activity plays a role in preventing many types of cancer and for improving longevity among cancer survivors” • Physical activity is believed to affect the endogenous systemic milieu in a manner that influences cellular processes and tumor-growth Patel AV, et al. Med Sci Sport Ex. 2019 (In Press)
Patel AV, et al. Med Sci Sport Ex. 2019 (In Press)
Exercise Guidelines for Cancer Survivors: Consensus statement from International Multidisciplinary Roundtable •“Enough evidence was available to conclude that specific doses of aerobic, combined aerobic plus resistance training, and/or resistance training could improve common cancer-related health outcomes, including anxiety, depressive symptoms, fatigue, physical functioning, and health- related quality of life.” Campbell, K, Winters-Stone K et al. Med Sci Sport Ex. 2019 (In Press)
Campbell, K, Winters-Stone K et al. Med Sci Sport Ex. 2019 (In Press)
Table 2. Cancer-related health outcome with sufficient evidence for development of FITT prescription. Campbell, K, Winters-Stone K et al. Med Sci Sport Ex. 2019 (In Press)
Exercise Is Medicine in Oncology: Engaging clinicians to help patients move through cancer • Exercise is Medicine program advanced by the American College of Sports Medicine • In an effort to improve patient/survivor activity levels, authors suggest that the oncology care team assess a patient’s exercise levels, advise patients to become more active and to refer patients to specific exercise programming Campbell, K, et al. Med Sci Sport Exer. (in Press)
Exercise Is Medicine in Oncology: Engaging clinicians to help patients move through cancer • Oncology clinicians play a vital role in telling the patient that it is important to exercise and pointing patients in the right direction to make that happen • Oncology clinicians are not expected to give specifics of exercise prescriptions or to do extensive screening and triage to determine where exercise training should be carried out Campbell, K, et al. Med Sci Sport Exer. (in Press)
Challenges! • Lack of physician support for cancer survivors to engage in exercise training programs • Attributed to: • Disagreement with exercise related benefits • Unaware of exercise related benefits • Concern over patient safety • Jones LW, et al. Ann Behav Med. 2004:28:105 • Santa Mina, et al. Curr Oncol. 2015;22:374 • Hardcastle SJ and Cohen PA. JCO 2017;35:3635 • Silver JK, et al. J Cancer Rehabil. 2018;1:1 Ligibel JA, et al. J Oncol Pract. 2019;15:e520
Linking Exercise Capacity to Function Bean JF, et al. J Gerontol: Medical Sciences 2003;58A:728
Linking Exercise Capacity to Function Kim-Ly Bui, et al. Physiotherapy Theory and Practice, DOI: 10.1080/09593985.2 019.1669233
Thank you for the privilege of the lectern! Questions/ Comments
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