TITLE G. Stephen Morris, PT, PhD., FACSM Distinguished Professor - - PowerPoint PPT Presentation

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
• Cancer survivors can adapt

to exercise training

• Lower risk of all-cause

mortality

• Lower risk of CV disease
• Lower risk of hypertension
• Lower risk of type-2

diabetes

• Lower risk of adverse blood

lipid profile

• Improved cognition
• Improved quality of life
• Reduced anxiety
• Reduced risk of depression
• Improved sleep
• Slowed or reduced weight

gain

• Weight loss
• Improved bone health
• Improved physical function
• Lower risk of falls
• Lower risk of fall-related

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: Frequency, Intensity, Time (duration),

Type

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

• f 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

• f 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

2018 Roundtable

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

• f 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

• f the lectern!

Questions/ Comments