Cancer Exercise programming, recommendations and contraindications

I’m going to present on cancer exercise program so before i started working at made possible i was i did my undergrad in colorado and i the reason i chose to go to the university of northern colorado is for their cancer rehab center i was really interested in helping cancer patients gain strength improve their quality of life so i’m kind of presenting on the idea of a cancer exercise program like what goes into it and then what how we could kind of transition it to be here as well at made possible so um a little bit background about the cancer disease itself it’s the second leading cause of death worldwide 10 million people each year die from cancer and about a third of those deaths are preventable either just eating healthier exercising quitting smoking that kind of stuff and i found this really interesting so a recent study i think it came out in 2022 found that percent of cancer institute like hospitals that treat cancer do not have a link to any cancer rehabilitation services ninety percent that is crazy like a lot of the cardiac rehab like they have access to it the number the percentage is a lot lower and then a reason why there’s not a lot of rehab could be due to a lack of awareness like a lot of times we hear about cardiac rehab but we don’t ever hear anything about cancer rehab and the benefits that you can get from just exercising during before after treatment and they’re overly concentrating on just treating the disease like they’re just focusing on the chemo the radiation nothing about their quality of life and their functional challenges they are going to have with the cancer and the treatment as well so some these are some common cancer types that you we would most likely see here if we started a cancer center lung cancer being the most common cancer and then it’s not on here but pancreatic cancer is actually the most deadly breast cancer is the most common with women as well and then so this is just kind of a overview of how exercise can help so cancer survivors can suffer from a lot of physiological toxicities affecting the cardiovascular pulmonary musculoskeletal immune gi and neuroendocrine system so a lot of the treatments affect all different kinds of our body so many survivors experience not only physiological but psychological impairments as well such as increased fatigue depression and decreased quality of life so what exercise can do is directly attenuate to the toxicities of the cancer and the cancer treatment itself and exercise can help lower the risk of reoccurrences and improve survival compared to those who are inactive so there’s been a lot of studies done on exercising through cancer treatment and how they’re less likely to get breast cancer again or lung cancer again compared to those who aren’t active during or after their treatment all cancer diagnosis can benefit from a cancer exercise program no matter what kind what stage how recent the diagnosis has been everyone can benefit from it there’s been overwhelming research supporting exercise to treat and prevent the negative physical and psychological side effects of cancer treatment again before it during it and after it so this is going to go into some goals and objectives of a cancer exercise program number one increasing their quality of life helping them feel better sleep better be able to go to the grocery store be able to walk their dog play with their kids their grandkids reduce depression a big depression and cancer-related fatigue are two huge side effects psychological side effects that you see with cancer because of the treatment but also because of the diagnosis as well they don’t know how long they have to live just trying to improve their quality of life as well as we know when we exercise everyone feels better that’s what we try and ask here when our clients leave right like how how do you feel after how do you feel before making sure they know that this is good for them this is going to make them feel better another goal is to enhance their muscular strength and endurance as well improve their balance flexibility and mobility i’ll go into this later but a lot of cancer treatments they impact and affect balance neuropathy the tightness of your muscles your mobility which as as we age is super important to prevent falls to keep you mobile and another goal will help to transition patients and clients into a healthier and active lifestyle help them gain confidence to be active and exercise on their own and slowly introduce them the different nutritional strategies as well so before like before you would have someone come in to the to a exercise session you’d want to first do a medical evaluation so get their cancer treatment history how recent it was what kind of cancer treatments they’ve had because if they’ve had chemo versus a radiation versus the surgery will impact what exercise choices you’ll make how far how far and fast to progress them you want to just get their family medical history and their medication lists because of the side effects they could have and how that might increase their blood pressure if they it would make them dizzy that kind of stuff for programming exercises and then like say the first time you see them it’s important to perform an initial physical evaluation just to get a baseline so you can see like how how they progress as they they go so wanting to measure their cardio respiratory especially with lung cancer being the most common their muscular strength and endurance their mobility their balance is it’s important for those coming in to see where they started and the progress they’ve made i like to make it a point and i know a lot of our coaches do to show right you started chest pressing 10 pounds now you’re chest pressing 15 pounds for 12 reps only in a month like how cool is that kind of thing and and just builds their confidence too which will help with the depression and all of the side effects um so two different ways you could do like have you you’ve heard of the like vo2 max so there’s um not the vo2 access um no so it’s just a model it’s a modified version of like that inclined test it’s it’s slower pace basically are you taking heart rate um just just heart rate and blood pressure um and then you can do you know those spirometers that you can breathe in and out of to test the lung capacity that too so you can do and you could do like um the one mile walk test or something like for this facility here we don’t have access to like a treadmill or um cart so you can do like the the walk test time how fast they do like how far they get in six minutes kind of thing um yeah so for mobility we did um we did like the where you sit reach for your hamstrings on the box we also did you took the like the pvc and you did like this one where you tried to like reach your hands um behind each other i think for the distance yeah you measured the you measure the distance between their hands um i think we could also add in like our own like we do the ankle mobility one the wall angel one just that like shoulder this one that kind of stuff and then balance i think we i can’t remember exactly what we did i think we did a single leg stand just to see how long they could do it um oh actually there was this it was a machine you were hooked up to you had a belt but it was a platform first you had like no shoes on flat surface eyes open and then you close your eyes and then it kind of measured like how much you wobbled yeah and then they did a foam pad and on the phone pad they measured that it was some yeah some technology thing i can’t remember the name but i could look it up for you and then so after the the evaluation you input all of that information take into consideration their their cancer type what treatment they had all of the information from the evaluation and then you would break it up into four different components and so this is based off of the phase program that i learned at the cancer institute i worked at um so first cardiovascular exercise for about 20 minutes strength training you want to get to all the major muscle muscle groups and then incorporate balance flexibility and mobility into each session and then as i said all exercise prescriptions are set at a certain level based on the cancer type treatment and physical condition how you treat chemo versus radiation yeah um so this is going into the phase program so the phase program is four different phases phase one are cancer survivors who are undergoing chemotherapy and or radiation treatments or have a reoccurrence to cancer each phase is 12 weeks long so you’ll only be in phase one if you’re currently going through chemo radiation the goal of this phase is to just alleviate the side effects of chemotherapy in radiation treatment keeping the training intensity very low just wanting to get them to feel better after their chemo radiation treatments these two are either those who who have completed phase one or patients who have had surgery or a hormonal treatment they have not had chemotherapy or radiation so you can either enter the program at a phase one or phase two so this phase these treatments aren’t as harmful to the body as chemo radiation so the training intensity can be a little bit more intense depending again on their cancer type the goal reduced physical functional and structural limitations created by the cancer treatment in a low to moderate intensity phase three are only those who have completed the phase two so 12 weeks in that phase and that you feel like okay they can progress to moderate they could do another 12 weeks in phase 2 2 just depending on what you think or how they’re feeling the goal is to improve physiological and psychological values beyond baseline it’s important to do both as a as a coach you’re not only an exercise coach but people spill everything to you they just want to be your friend they want to talk to you they want to get things off your chest especially with a diagnosis with cancer it’s important to build up their psychological well-being as well another goal is to get them back to functional health after completing this phase they can now move up to moderate high intensity about 60 to 85 percent of their heart rate reserve or one rep max which could be measured by like a heart rate monitor or an apple watch or something like that um phase four those who’ve completed phase two this is the last phase of the program so it’s again improving their physiological psychological function so improving their strength wanting to see their weights go up you might not necessarily see that in the phase one phase two they might just stay body weight they might not even touch a weight and then you’re kind of trying to transition them into being able to do something as a group like the semis we do here or even encourage them to exercise outside of the facility themselves and they can get up to a pretty high intensity after this um about 95 percent of their heart rate for the most part phase one to three is one person number yeah yeah phase four would just be when you introduce them to a semi so kind of like here like introducing them so these are some very common toxicities symptoms side effects from cancer and cancer treatment mainly chemo so a chemotoxicity occurs with all kinds of chemos different types it causes cancer-related fatigue which i’ll talk about next about balance issues weakness and chemo-induced peripheral neuropathy which i’ll go into so has anyone heard of cancer-related fatigue before you know what it is so it’s different than your normal fatigue you’ll get if you don’t sleep or if you get sick it’s a combination of all of the physiological toxicities affecting the body that i talked about earlier right the heart the lungs the gi muscular and in the brain it’s persistent sense of tiredness or exhaustion that is related to the cancer or its treatment it’s out of proportion to the level of recent activity and interferes with functioning and it occurs without exertion so they could wake up exhausted not wanting to get out of bed and it doesn’t have to do with if they exercise the day before if they slept well it’s just this persisting fatigue and from the studies i’ve read the only thing that really helps it is exercise is after they exercise they may not want to come in and do it but once they’re here once they get moving it’s the only thing that seems to help and it’s very common with a lot of cancers yeah and it can last after the treatment too it’s not just during it yeah it can last for a long time um and then chemo induced peripheral neuropathy have you guys heard of neuropathy before yeah it’s common with like diabetes right so it’s tingling pain burning in your hands mainly your hands and your feet loss of feeling and then you’ll be you’ll get sensitive to the heat or cold which is important to take into consideration when exercising too especially in florida although it doesn’t get too cold but even touching like cold metal things can be uncomfortable so you have to pay attention to that so now i’m going to go into like the differences in radiation and chemo and kind of how you’ll want to adjust for both so a radiation is there’s two different kinds i won’t get go into that but basically it’s a laser right um trying to decrease the size of the tumor um it can limit your range of motion and cause cause your muscles to stiffen and i’m not sure exactly i know there’s different ways on how doctors choose either to give chemo or radiation i know they try to avoid chemo as much as they can um so i don’t know where it’s going with that but um so radiation causes your muscle muscles to stiffen um so if you have a patient with radiation you’ll want to incorporate a lot of mobility work with the radiation so say for example they had breast cancer they had radiate radiation to their chest their chest muscle their shoulder is going to be really tight so you’ll want to incorporate a lot of mobility with that which we already do with a lot of our clients because of we’re at we’re like this all day typing sitting at desk so we already do a lot of that it’s also um important to do longer stretches and work on really breathing into it they should do it more than just when they come in here they should do it right when they start their radiation treatment um manual therapy so like either massaging it yourself or using like the lacrosse ball on the wall to help roll it out um help with the scar tissue increase their mobility range of motion and then radiation can cause the induced peripheral neuropathy which i have a slide on and i’ll go into more detail about what that is and how to how we can use it and work around it in a clinical setting hormonal therapies these are more common for breast chronological and prostate cancers they can still cause joint stiffness same as radiation um but exercise can help decrease the pain the joint stiffness and increase their strength while increasing quality of life with hormonal therapies because it’s messing with your hormone levels you have a higher risk of osteoporosis which is why it’s important to do weight-bearing exercises not just swimming not just walking but helping them build their bones up using weights and that kind of stuff and then pain and joint stiffness is really common with hormonal therapies as well um so keep so going into chemotherapies and kind of how they affect the body and what exercise is going to do to help that so in red is going to be the chemotoxicity so what chemo is doing to the body and then the green is how exercise is going to help that so for example a chemotherapy like doxorubicin or taxol that’s going to increase the resting heart rate and exercise as we know helps decrease that chemotherapies can break down skeletal muscle exercise helps increase protein synthesis it slows motor function it can kill a lot of nerve endings which is why you again get peripheral neuropathy and then exercise helps improve neurochemical availability and increases motor unit recruitment it decreases total lung capacity and exercise can help strengthen your inner costal muscles strengthen your breathing muscles improves your ventilation you lose your appetite with chemotherapy um a lot of people lose weight with it too so exercise helps you feel hungrier the more you’re moving helps you build your muscle back too and then it can chemo can also inhibit your bone marrow function and chemotherapy helps i’m sorry exercise will help you improve your red blood cell production um oops wrong one so these are some special considerations for exercise and a different treatment so if a recent client has a surgery right if they had um a tumor taken out of their breast though they might have a recent incision on their side you might have to be cautious of what positions you put them in either laying on a bench on the floor you don’t they probably won’t feel comfortable putting their chests on them fat on the ground or on a bench um quartz that’s more of like a chemotherapy but it’s still a surgery getting it in but the place of the placement of the port being mindful of what position the client’s in if they’re if they’re twisting and they feel the port um being uncomfortable any pains with movements near the surgery area changes with body image especially with breast cancers edema so swelling of your limbs and then extreme fatigue and extreme fatigue is going to be a special consideration for all exercise incorporating maybe more breaks radiation during the treatment they can get acute or chronic skin reactions just to that site so they really need to be careful put or they want to put lotion on at home but um just being mindful of that and positions they’re in leukopenia is decreased white blood cells so they might be more prone to infection so making sure the gym the clinical setting is extremely clean everything’s wiped down with radiation you get you get dehydrated but nausea vomiting diarrhea are common side effects of that edema is again another side effect and then the extreme fatigue so chemotherapy this one’s the more most intensive type of treatment leukopenia again so being careful with like maybe wearing masks cleaning low white blood cells and then the thumb thrombocytopenia i think that’s how you say it is low platelets um bruising is really common earth with chemo nausea vomiting diarrhea again dehydration extreme fatigue and then drug delivery in systems so meaning what type of drug is like how it’s delivered is it a pill do they take it every day when do they have it what type of chemo is it and then the symptoms from that specific chemo because different chemos will have different side effects some affect the heart more some will affect the muscles more i know the the ones with breast cancer at their taxol and toxic tier they are more common to cause peripheral neuropathy well i think the lung cancer one more is impactful on your heart but i think they’re still researching that so lymphedema is a chronic condition both in males and females that causes swelling in either your limbs or your trunk and is really common with cancer and cancer treatments so what exercise can do to help this is increase the flow of blood and lymph fluid lymph fluid relies on the contraction of your muscles to move fluid around the body and there’s research that exercise and the water is actually extremely helpful in this because of the pressure from the water i’m not exactly sure why or how but there’s been a few research studies on that so i forgot to mention that lymphedema is extremely or it’s more common with like breast cancers i would say so you have a lot of lymph nodes located in your core and then there’s some um they’re located throughout the whole body but a lot are in your core and so you’re wanting to get those muscles firing using them and a lot of the times we don’t use those muscles every day for just sitting around so getting blood flow to those muscles will help the lymph fluid move around decrease the swelling so like pelvic tilting doing anterior anti-rotation exercises dead bugs hip thrusts just to get the core working so peripheral neuropathy like i mentioned it’s tingling numbness weakness in your hands fingers and toes you have sensitivity to the cold um to touch and then it also decreases your balance because you don’t have a lot of awareness in your feet anymore because it’s um your nerve endings aren’t firing or they’re misfiring and that’s why you have that pain so you’ll have problems walking so if a client comes in with peripheral neuropathy especially in their feet it’ll be really important to work on balance on different surfaces making sure they take off their shoes work on walking up and back depending on how bad their pro their neuropathy is some days they may not want to stand on their feet so doing more seated exercises doing the bike instead of walking that kind of thing depending on how they feel that day so i have a picture of a i guess it’s called a neuropathy ball but what it does it help you can roll your foot on it or you can roll it in your hands and it helps kind of get the nerves firing to help get more sensitivity to your foot so if someone has that i would probably have them do that either as a warm-up or at the end of the session just to make sure i would encourage them to do it at home too so as i mentioned depending on the severity if they have peripheral neuropathy you’ll want to incorporate balance exercises light massage to those areas because sometimes even just touching a a dumbbell or a bench or a band will be really painful to them so just lightly kind of trying to get feelings to their hands their feet practice guiding walking biking as i mentioned instead of walking depending on how they’re feeling that day um and then again it’s helping to stimulate the nervous system so this is kind of like an example if someone came in and they had peripheral not within their feet what you could start with are laying down on the floor just getting movement to their feet doing ankle circles either seated or on the floor and then you can go into like toe heel raises depending on how they feel getting blood flow to their feet and then progressing the single leg balance so now i’m gonna go into the just some specific types of cancer and some considerations um so starting with prostate and gynological cancers they can have bowel bladder and sexual dysfunction so being mindful of them having maybe to go the bathroom more they might have a um what are those um like the bag the bag like a urine bag yeah is that yeah i think so um so they might have that same i have to work around that and if clients could have diabetes too and have that um bag as well um depending on the type of treatment and side effects biking may be uncomfortable for them so finding different ways to get their cardio in um and then incorporating because of like sitting on the bike seat depending if they have radiation in that area and then kegel’s pelvic floor core to help strengthen that back up because of the where the um where the treatment was that portion of the body will be really it won’t be as strong it’ll be weaker considerations for breast cancer so a lot of times it’s common in breast cancer patients to not have as much abduction in the shoulder they lose that range of motion so working on this um working on scapular weakness so working on opening up our shoulders fighting against tightness in the front of your chest so a lot of chest opening mobility and exercises we have a few clients that have had breast cancer here so a lot of the things they like to do is like on the wall doing a gentle stretch they like to roll out with like lacrosse ball on their chest um one of our clients likes to do this one too where you’re you kind of assist yourself to get up as high as you can and come back down especially on that if are struggling with that range of motion um and then scapular weakness is a huge thing we see not only breast cancer but it’s important for everyone because we’ve found that out that a lot of times that people aren’t using those muscles and to help with their posture [Music] and then some psychological aspects of cancer so i mentioned in the beginning it’s very common for cancer patients to go through a depression um so exercise can help not only motivate clients but to um to survive to thrive not only to survive but thrive so exercise can help reduce anxiety improve depression reduce their cancer-related fatigue and improve their quality of life during and after cancer treatment and it’s important to know do they have a support system at home are they living alone are we their support system um the gym can be a community for them they’re gonna meet people going through similar experiences they’re going to get a social interaction that might only be their their only social interaction a day and just to help them feel better know they’re safe that they’re doing what they can to help improve themselves so this is kind of where we’re headed next right how do we get involved how can we make this happen how can we help and be less than that 90 number um so one option is to partner with a cancer treatment center moffett cancer center is really big here and then florida cancer specialists it’s can we show them what we’re doing how we’re changing people’s lives already and how important it is for cancer patients to have this rehabilitation starting right when they get their diagnosis and how it can help improve their quality of life decrease their medical bills and then getting in contact with doctors for referrals for them to send their patients here you have to kind of figure out will insurance be able to cover it how would that work kind of thing and then another way is to partner with the university to get funding that’s kind of how where i worked before it was partnered with the university but there were also doctors that would refer their clients their patients to the clinic [Music] i don’t think so i think it would be i think it would be cool like to partner with an exercise science program and then to do it like that way um like you usf downtown or like tampa um yeah and then if you guys have any questions that was it and i went through that kind of quick but uh so question for me are there even though there’s lots of benefits for exercise with cancer have you seen anything where there’s like a lot of potential risk like during exercise portion because obviously when you exercise i assume your heart rate’s still going to increase but it also means treatment i know you mentioned like more breaks and stuff but is there anything like if extra extra cautious work would be problematic repeated questions okay um so he asked like is there any is there yeah it’s a risk of exercising during cancer treatment and i would probably say no as long as you’re constantly communicating with them making sure they’re feeling okay they’re not dizzy i mean maybe they’re feeling crappy that day and the only thing you do is bike 10 minutes and they you talk to them the rest of the time or you do a few stretches it’s good for them just to talk to you too it doesn’t always have to be you don’t always have to get everything done it’s just yeah so i would say no just if you’re paying attention to how they’re feeling i wouldn’t see anything wrong with it hey guys thanks for watching our video make sure you share subscribe like and comment below and i’ll try and answer any of your questions