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Strength after Cancer: How to
safely progress with an exercise
program from treatment to
survivorship
Julie Everett DPT, CLT
Laurie Fitz PT, CLT
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Objectives
• Provide an overview of common
physical side effects experienced by
cancer survivors
• Define lymphedema and appropriate
exercise guidelines
• Discuss cancer related fatigue and
management
• Educate on general exercise guidelines
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Cancer Survivor
“Any person who has been diagnosed
with cancer, from the time of diagnosis
through the balance of life”
14.5
million
ACS Facts and Figures 2014-15
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As Physical Therapists
Our goal is to improve
quality of life of cancer
survivors by
managing/reducing
physical side effects of
treatment
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Side Effects of Treatment
•
•
•
•
•
•
Pain
Fatigue
Weakness
Stiffness
Balance
Decreased
endurance
• Lymphedema
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Good News: Positive health
outcomes of an exercise program
• Endurance
• Cardio respiratory
fitness
• Insulin level
• Body composition
and weight
• Bone mass
•
•
•
•
•
•
•
Muscle strength
Balance
Reduced Fatigue
Reduced Nausea
Sleep
Social well being
Decreased risk of
reoccurrence
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Lymphedema
Disruption to system
Arteries
Lymph
vessels
Capillaries
Veins
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Causes
• Surgery
• Node removal
from axilla,
groin, neck
• Radiation
• Scar tissue
http://en.wikipedia.org/wiki/File:Blausen
_0623_LymphaticSystem_Female.png
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Lymphedema Need to Know
Symptoms
Reducing Your Risk
• Visible swelling
• Feeling of
fullness/firmness/heaviness
• Feeling of tightness from
clothes or jewelry
• Avoid:
– Blood Pressure
– Needle Sticks
– Tight/restrictive clothing
• DO:
– Take care of your skin
– Exercise
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If you develop lymphedema:
• Notify your doctor
• Evaluation by a Certified Lymphedema
Therapist (CLT)
• Treatment is called Complete Decongestive
Therapy (CDT)
– Massage, skin care, compression,
education, exercise**
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Exercise and Lymphedema
• Scientific literature
demonstrates safety
• Should be done in a
systematic manner
• May have a
protective benefit
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Exercise Key Points:
• Lymphedema must be stable
• Initial exercise should be
supervised
• Start with lowest possible
weight
• Monitor for symptoms
• Increase weight slowly after
2-4 sessions of no negative
changes
• Wear compression garment
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Compression Garments
• Should be worn with
exercise if diagnosed
with lymphedema
• Enhances lymphatic
return
• Evidence less clear for
women at risk for
lymphedema
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Discussion for Cancer Related
Fatigue
• Cancer pain- what is it?
• Cancer related fatigue- how is this
different?
• Exercise- how can it help?
• Moving forward- what can I do?
Cancer Related Pain
– “An unpleasant sensory and emotional
experience associated with actual or potential
tissue damage”
– Survivors can have pain from surgery,
chemotherapy, or radiation
– 33% of people with cancer will continue to
have pain after curative care (National Cancer
Institute)
– Medication, therapy, exercise and relaxation
techniques are useful treatment options
Pain
Injury
Healthy Movement
Pain
• Healing Through Movement
– Using safe and appropriate exercises to help
increase the healthy movement
– Move the sensation of pain further away from painful
activities
Cancer Related Fatigue
– Most common side-effect complaint
– “Physical, emotional, or cognitive tiredness
or exhaustion that is not proportional to
recent activities and interferes with
functioning. This fatigue does not get
better with rest.”
– 14-96% of people during treatment and 1982% of people after treatment (National
Cancer Institute)
Cancer Related Fatigue
• Other reasons for fatigue
– Anemia
– Medications
– Poor nutrition
– Emotions
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Treatments for Fatigue and Pain
• #1 Treatment?
EXERCISE!
Fatigue and Exercise
• “I’m way too tired to workout today.”
• “I’m scared I’m going to hurt myself.”
• “I need to save what little energy I have to go
home and take care of my family.”
• “I’ll start an exercise program tomorrow.”
• “Everything hurts and you want me to do
WHAT?!?”
Treatments
• Exercise!
–
–
–
–
–
–
–
–
Improved energy level
Appetite stimulation
Increased blood flow to tissues
Decreased pain
Improved quality of life
Increased strength and flexibility
Mood stimulation
Improved outlook on cancer challenges
• 2007 Study: Moderate physical activity after treatment
(not household activities) had decreased fatigue and pain
Exercise Principles
• Speak to your health care provider before
starting an exercise program!
• Become knowledgeable about the resources
out there:
– Physical Therapists
– Occupational Therapists
– Personal Trainers
• “Start LOW and go SLOW”
Exercise Principles
• Heart rate targets
– Stay between 50-80% of maximal heart rate
– Maximal Heart rate: 220 minus age (ex: 220- 32=
188)
– 188 X .5 = 94 188 x .8= 154
• Breathing
– You should be able to have a conversation while
working out.
• You can start exercising during treatment!
• Know your exercise level BEFORE
diagnosis/treatment
Fatigue and Exercise
• Beginners
– Sedentary lifestyle and/or low level of exercise
– Able to complete household chores and family
obligations
• Intermediates
– 2-4 x a week to the gym
– Exercises classes and/or “weekend warrior”
• Experts
– 4-5 x week at the gym
– Competitive athlete and/or active lifestyle
Exercise for Beginners
• Start with 3-4 days a week building up
• Start with smaller bouts (10 minutes) and
building up the time (45 minutes)
• Choose an activity that interests you:
– Walking, swimming, biking, hiking
• Have buddy that will encourage you
• Balanced program:
– cardio, stretching, and weight training
6 Exercises Daily
1. Shoulder and Pec Stretch
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–
–
–
Lie on your back
Hold a broom or umbrella in both hands
Reach overhead until you feel the stretch
Hold for 15 seconds
6 Exercises Daily
2. External Rotation
– Standing with arms bent and at side
– Rotate arms outward with elbows still at side
– Slowly return to standing position
6 Exercises Daily
3. Shoulder Flexion
– Start with arms at your
side
– Keep elbows straight and
raise arms to shoulder
height
– Can do with palm down
(as shown) or thumbs up
– Slowly lower arms to
starting position
6 Exercises Daily
4. Abdominals
–
–
–
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Lay on your back with knees bent
Slight press your low back into the floor
Keeping back flat, slowly raise one knee to chest
Maintaining control in the back, slowly return
6 Exercises Daily
5. Bridging
–
–
–
–
Lay on your back with knees bent
Squeeze buttock
Lift buttock off the floor
Slowly return back to floor
6 Exercises Daily
6. Clamshells
– Lay on side with knees bent, keeping feet together
– Lift top knee up, not allowing body to roll
backwards
– Slowly lower to starting position
– Repeat on other side
Intermediates and Experts
• Don’t be concerned if you need to scale back your
previous activities during treatment- YOU WILL GET
BACK!
• Consider joining group fitness challenges to stay
motivated
• Certified Personal Trainers to help you reach your
goals
– Cancer Exercise Specialist
Additional Exercise Tips:
• Aerobic exercise
– Walking
– Stationary bike
• Circuit Training
– Work large muscle
groups
• Flexibility
– Stretching
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Exercise Alternatives
• Yoga
• Tai Chi
• Qigong
References:
• http://www.lymphnet.org/
• http://www.hopkinsmedicine.org/kimmel_cancer_cent
er/centers/cancer_rehab
• http://www.hopkinsmedicine.org/physical_medicine_r
ehabilitation/index.html
•
•
•
www.thecancerspecialist.com/ceti-new/default.aspx
National Cancer Institute (www.cancer.gov)
AlfanoCm, Smith AW, Irwin ML, et al. Physical activity, long-term
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symptoms, and physical health related quality of life among breast
cancer survivors: a prospective analysis. J Cancer Surviv 1 (2):116-28,
References
• www.thecancerspecialist.com/ceti-new/default.aspx
• National Cancer Institute (www.cancer.gov)
• Alfano CM, Smith AW, Irwin ML, et al. Physical
activity, long-term symptoms, and physical health
related quality of life among breast cancer survivors:
a prospective analysis. J Cancer Surviv 1 (2):116-28,
2007
• Garcia, DO, Thomson, CA. Physical Activity and
Cancer Survivorship. Nutrition in Clin Practice 29 (6):
768-779, 2014
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Thank you!
• To learn more about our program, visit our websitehttp://bit.ly/JHBreastCaSurvivorship
• To view this webinar and previous webinars, check
out our media libraryhttp://bit.ly/JHBreastCaSurvivorshipWebinars
• Questions or concerns, please contact Elissa [email protected]
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