Exercise at-rde

Editor's Notes

• #3: Our work at the RD&E has been to ………. So as to help overcome or reduce many of the side effects of cancer and it’s Rx. And to ……… Cancer pts tend to decrease ttheir physical activity levels after diagnosis and during and after Rx, and many do not return to their pre Rx activity levels.This trend is enforced as pts are often advised to limit activity and get plenty of rest. . A study by Jones and Courneya 2002 of 311 cancer survivors found that 82% felt that their oncologist should initiate discussion of ecercise and physical activity as part of their oncology consultation and the study concluded that exercise should be recommended both during and after Rx to pts with early stage cancer.
• #5: So why should pts undergoing Rx consider exercise to help them? The reason is the benefit of exercise to the human system. Regular exercise reduces the risk of heart disease, improves lung function, increases mm strength and endurance, helps mood, the immune system and generally increases QOL both physically and emotionally. The message be active ,Stay active applies as much to cancer and Haematology pts as to anyone else, perhaps even more. So should we be encouraging pts to run or cycle marathons during their Rx like Jane Tomlinson and Lance Armstrong Thankfully not
• #7: The majority of studies of exercise and cancer have been conducted with women with early stage breast cancer, which then limits the generalizability of these studies to other cancers. However there is still a convincing amount of research that has been performed in most cancer areas , looking at specific cancer treatment side effects that benefit from exercise.
• #8: Dimeo 1996 About 30 days after bone marrow transplant and followed 6 week treadmill walking program
• #9: Quality of Life Courneya & colleagues (2001) reviewed studies and concluded that exercise had significant positive effects on the QOL of cancer patients. The studies include self reported exercise prorammes and supervised interventions, studies of a variety of cancers and studies of the effects of aerobic exercise and mm strengh programmes. ( The exercise interventions ranged from 2- 20 weeks but most about 12 ). The Qol improvements included enhanced functional capacity , increased mm strength, reduced fatigue , improved self image, improved energy and reduced anxiety and depression Nausea Lee et al 2008 in a study of 112 women with breast cancer receiving adjuvant cancer Rx found that those who exercised for the equivalent of 20 mins moderate intensity aerobic exercise 3 x’s a week experienced less intense nausea at the end of their Rx
• #13: Haematology pts often face problems that other cancer pts do not. Their treatment usually involves intensive and lengthy chemo regimes, often with HSCT. This means frequent hospital admissions often in protective isolation. The Rx often brings horrible side effects. The isolation in a small room leads to deconditioning. And not surprisingly this all leads to reduced QOL for the pt and low morale and lack of motivation. Treatment regimes – including stem cell transplants (Auto ) and continuing the care of patients of pts following allogenic SCT and the common disabilitating condition GVHD
• #15: The Wii Nintendo has caused an explosion of interest in the physiotherapy world as an adjunct to treatment and is beginning to be used in more specialised areas of rehabilitation.
• #16: The Exeter Leukaemia Fund in dec 2008 kindly donated the money for the Haematology Unit to purchase two Wii consoles with Wii sport and 2 wii fit balance boards.. We began our 6 month study in Jan 09 Pts referred where assessed by myself and then invited to complete an initial assessment form. Here they reported how much exercise they were currently doing and then scored their mood, motivation, energy levels, physical activity and overall well being. A goal of 30 mins accumulated exercise of any sort on a roughly daily basis was set, dependent on chemo regimes. This is as per government and WCRF guidelines and now the 2010 American ACSM guidelines. A follow up questionairre was completed by the pt on discharge or end of intervention Pts were monitored and given advice as much as possible throughout.
• #22: And as for the goal set. 85% of pts reported that they had achieved the goal of 30 mins accumulated exercise on most of their days. But best of all was probably the positive feedback from pts. Read out : Many pts commented on how great it was that they could hve fun and be interactive with their family- children and grandchildren. They were exercising but also the children were being entertained during visits where they often got bored!
• #23: So what happened next? Well following the study’s success and seeing that limited staffing was a primary difficulty , I put in a proposal to ELF forr funding of a 6 month Physio Technical Instructor post. The role would be prescribing and monitoring of exercise plans for pts whilst in isolation on Yarty. ELF very kindly agreed to fund a 6 month pilot and lovely Hannah was appointed as the successful candidate , contracted for 8 hours a week So the pilot began in April 2010
• #24: Pts were referred by MDT and then assessed and invited onto the study by Hannah.An individual exercise folder would be given to the pt which included our information leaflet on the importance of exercise through Rx as well as a copy of bed and seated exercises. Pts also had an exercise diary to complete. An individual exercise programme would then be prescribed which could include the Wii, static bike and therabands for resistance work. Hannahs 8 hours were split over 3 mornings where she would spend time with each pt discussing their programme – monitoring and motivating and often working out with them! You can often tell which pt Hannah is with by the laughter coming from the room! On discharge the pt would be asked to complete the questionairre to see if there had been any change in mood/ motivation etc as in the initial study and invited to answer a few questions about the physio tech role.
• #25: As to the results! Pts were asked if it was useful The results coud not have been better – All responded yes
• #26: 100% of pts felt there had been a change in mood, energy levels and physical activity with 92% in motivation and overall well being
• #27: And when asked to rate this improvement, 100% scored 7 or 8 , where in this study, just to confuse you , the higher numbers are the more positive results.
• #29: So where are we now There is now great interest in the role of exercise for haematology patients during and after Rx and as a preventative strategy for those undergoing SCT Evidence shows that exercise is safe, feasible and beneficial I am now participating in the Exeter “ The way Forward “ group where I provide advice and information of the benefits of exercise to pts that have completed their cancer Rx We now feel confident that our message regarding the importance of exercise during Rx is reaching all our pts that become in-pts, providing them with information and Hannah’s exercise programmes. However we are aware that we are still missing a large number of pts that are seen only in Daycase and yet go on for HSCT.. So we now are displaying posters and have information about how pts can be referred tp physio for advice about exercise ,maintaining fitness or getting pts fitter prior to transplantation. Cancer care is taking its time to catch up with cardiovascular medicine in understanding the benefits of exercise. For 20 years there have been cardiac and pulmonary rehabilitation programmes for patients with heart and lung disorders Dr Anna Campbell in Scotland has undertaken research into the effects of exercise classes for breast cancer pts during Rx and found that not only the pt themseves have improvements in side effects and general well being but was also able to demonstrate cost savings with reduced hospital admissions and less frequent visits to GPs. She now runs seminars and training programmes for Health care Professionals across the UK, focused on developing exercise based rehabilitation programmes for all cancer pts. Having attended one of her seminars last year, together with Exeter’s FORCE cancer Charity we have just had a proposal accepted to run a pilot study of 2 Cancer rehabilitation programmes to start later this year- one for pts still undergoing Rx and the other for those who have completed Rx.. Very exciting times And Well what can we say about the Wiis and Hannah’s role. They have been a huge success on Yarty. The exercise is fun and interactive and Hannah is so motivationing for pts, producing fantastic results as shown in the study. So what else does the future hold? More Research More Hannahs! Thank you very Much
• #31: So where are we now There is now great interest in the role of exercise for haematology patients during and after Rx and as a preventative strategy for those undergoing SCT Evidence shows that exercise is safe, feasible and beneficial I am now participating in the Exeter “ The way Forward “ group where I provide advice and information of the benefits of exercise to pts that have completed their cancer Rx We now feel confident that our message regarding the importance of exercise during Rx is reaching all our pts that become in-pts, providing them with information and Hannah’s exercise programmes. However we are aware that we are still missing a large number of pts that are seen only in Daycase and yet go on for HSCT.. So we now are displaying posters and have information about how pts can be referred tp physio for advice about exercise ,maintaining fitness or getting pts fitter prior to transplantation. Cancer care is taking its time to catch up with cardiovascular medicine in understanding the benefits of exercise. For 20 years there have been cardiac and pulmonary rehabilitation programmes for patients with heart and lung disorders Dr Anna Campbell in Scotland has undertaken research into the effects of exercise classes for breast cancer pts during Rx and found that not only the pt themseves have improvements in side effects and general well being but was also able to demonstrate cost savings with reduced hospital admissions and less frequent visits to GPs. She now runs seminars and training programmes for Health care Professionals across the UK, focused on developing exercise based rehabilitation programmes for all cancer pts. Having attended one of her seminars last year, together with Exeter’s FORCE cancer Charity we have just had a proposal accepted to run a pilot study of 2 Cancer rehabilitation programmes to start later this year- one for pts still undergoing Rx and the other for those who have completed Rx.. Very exciting times And Well what can we say about the Wiis and Hannah’s role. They have been a huge success on Yarty. The exercise is fun and interactive and Hannah is so motivationing for pts, producing fantastic results as shown in the study. So what else does the future hold? More Research More Hannahs! Thank you very Much Pink Champagne encourages women who have been diagnosed with breast cancer to lead full and active lives through the sport of dragon boat racing. How flyfishing can help women with breast cancerNot many people with breast cancer would think of picking up a fishing rod and heading off to their nearest lake and river. But that’s just what a group of women have started doing as a way of helping women who’ve had the disease. The scheme is called ‘Casting For Recovery’ and the idea is that fly fishing can help women with breast cancer – the physical action of casting is similar to the physiotherapy exercises prescribed post-surgery. And there are psychological benefits too – fishing is well known as a relaxing pursuit. Louise Adamson met up with Sue Hunter, a member of the National Ladies’ Fly Fishing Team who's also the person responsible for introducing ‘Casting For Recovery’ to this country.