Download Mindful Exercise, Quality of Life, and Cancer

Mindful Exercise, Quality
of Life, and Cancer
A Mindfulness- Based Exercise
Rehabilitation Program for Women
with Breast Cancer
Anna M. Tacon, Ph. D.
Learning Objectives
Learning Objectives
After completing this chapter you should have and
understanding of:
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increased use of mind-body therapies n cancer
breast cancer patients’ use of complementary therapies
the concept of mindfulness as well as the mindfulnessbased stress reduction program
quality-of-life factors in cancer especially cancer-related
fatigue
the benefits of exercise as a complementary therapy in
cancer
Introduction
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Breast Cancer
most common cancer among women, accounting
for nearly 1 in 3 cancers diagnosed in the U.S.
 Considered to elicit greater distress than any other
diagnosis, regardless of the prognosis, including
depression and anxiety
 There is an increase in patients seeking
complementary or mind- body therapies to help
them cope
 Patients must endure harsh treatment effects
 Moderate physical activity is also suggested for
therapy
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Mind-Body Medicine, Integrated
Care, and Mindfulness
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Mind-body medicine should be part of an
evidence based, cost-effective, quality health care
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Psycho-physiological, psychosocial, educational
interventions for patient distress
Mindfulness meditation
Involves including rather than excluding stimuli from
the field of consciousness
 Provides means of self-monitoring and selfregulating one's arousal with detached awareness.
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The Concept of Mindfulness and the Program
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Mindfulness-based stress reduction program (MBSR)
Once/week for 2 hours over 8 weeks
 Mindful awareness, being in the present moment, or just
paying attention to now
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The Concept of Mindfulness and the Program
Cont’
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Training in several basic practices of mindfulness
meditations:
1.
2.
3.
4.
Body scan: journey through geography of he physical form
Hatha yoga: stretches and postures to strengthen and
stretch the musculoskeletal system and develop mindful
movement
Sitting meditation: attention to breath and other
psychophysical perception
Walking meditation: cognitive-behavioral practice of
paying attention to all physical sensations and fluctuations in
a concentrative awareness during walking
Research on MBSR
Effective in reducing levels of stress and anxiety,
chronic pain and fibromyalgia
 Improvements pre-post quality of life, significant
positive shifts in mood, coping, health locus of
control, and mental adjustment to cancer
 Significant positive shift in overall immune profile
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Exercise Therapy for Cancer
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30 minutes of moderate activity 5 or more days
per week can help prevent chronic diseases like
cancer
Exercise is gaining acceptance as a major quality
of life rehab intervention for cancer survivors
Exercise, Quality of Life, and Cancer
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Cancer treatments and the process of cancer can
destroy a persons quality of life
Exercise can increase the quality of life even
during high dose cancer treatments
Exercise, Quality of Life, and Cancer
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Exercises prescription for those with moderateintensity exercise includes:
3 to 5 time a week
 20 to 30 minutes per session
 Walking most preferred
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High-intensity exercise should be avoided during
cancer treatment because of potential
immunosuppressive effects
Cancer-Related Fatigue and
Exercise: Definition and Rationale
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Most common symptom of cancer patients is fatigue
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Fatigue may affect patient’s ability to tolerate
treatments
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which can be even more distressing and disruptive to a
patient’s daily activities than the pain associated cancer
Treatments may be delayed which impacts disease
progression
Exercise training stops the loss and even increases
functional capacity which reduced effort and
decreased fatigue at any level
Summary
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Evidence exists to support that both
Mindfulness-based stress reduction programs
and exercise rehabilitation are two
complementary therapies that can produce
positive effects for those with cancer
Mindfulness-Based Exercise
Rehabilitation Program (MBER)
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Format and Structure
Prior to program, women be cleared by physician
 Baseline physical fitness assessment conducted
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Mindfulness-Based Exercise
Rehabilitation Program (MBER)
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Format and Structure
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First 8 weeks:
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Participants meet 2 hours, 1 night per week for 8 weeks,
where exposed to:
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Same basic format and mindfulness practice of original program
(modified program for cancer patients also)
Didactic, inductive, and experiential modes of learning mindfulness
strategies
6- week exercise program showed improvement
Expected to perform daily “homework” that
emphasizes strategies learned in the sessions
Session Contents
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Weeks 1 & 2
At the first session:
 Reasons for participating are shared and overview of the
intervention is presented
 To ease participants fear about unrealistic expectations
 Let participants know that they will be at a different
place with different abilities and limitations.
 The body scan is introduced laying on mats
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Session Contents
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First Session cont’
Meditation is used to get women reacquainted with their
bodies, especially if treatment has changed the body
landscape
 The assigned homework for the first week:
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to do the guided body scan on the first audiocassette tape (45
min) at least 5 days/week
 15 minutes of walking at a moderate pace at 50-70% of their
maximum heart rate
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Session Contents
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Second Session
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Participants discuss the previous week’s homework and
share their experiences
The women participate in experimental exercise of
mindfulness eating known as the raisin exercise
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Two purposes:
1.
2.
Reinforce idea that meditation is a natural act of paying attention and
that there is nothing mysterious about it
Initiate the topic of food and nutrition in the context of cancer and
exercise
Session Contents
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Second Session Cont’
Sitting meditation is presented
 Mindful walking is then presented where they pay
close attention to all sensations involved during this
daily, routine activity
 The assigned homework for the second session
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continue the body scan as per the previous week
 increase daily walking to 25 minutes
 add 15 minutes of sitting meditation daily at least 5
days/week
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Session Contents
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Weeks 3 & 4
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Week 3
walking mediation is followed by Hatha yoga
 then an increased period of sitting meditation
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Homework assigned for week 3:
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tape 1 of a 45 minute guided yoga routine as daily practice
Session Contents
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Week 4
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the topic of stress and the physiological stress response is
presented with a discussion of mindfully tuning in to the
body’s language
Homework assigned for week 4:
continue tape 1 of yoga
 brisk walking of now 40 minutes per day, at least 5
day/week
 alternate 30 minutes of meditation daily with 30 minutes
of mindfulness eating
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Session Contents
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Weeks 5 & 6
Different yoga asanas introduced
 Homework assigned for weeks 5 & 6
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tape 2 is of a new 45-minute guided yoga routine daily
 Brisk walking is 45 minutes per day at least 5 days/week
 alternate 30 minutes of sitting meditation daily with 30
minutes of mindfulness eating
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Session Contents
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Weeks 7 & 8
Last 2 sessions involve discussing the primary mental
attitudes of coping with cancer and exploring issues
of internal versus external locus of control and
irrational beliefs
 Mindfulness-based strategies are reviewed and
discussed in terms of being applied to stressful, real
life situation and challenges
 The purpose is say that “quality” of life takes work
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Session Contents
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Weeks 7 & 8 cont’
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Homework assigned for weeks 7 & 8:
alternating 45 minutes of daily brisk walking with 45
minutes of yoga
 Alternating 45 minutes of daily sitting meditation with the
body scan or with mindful eating as desired
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Finally, the role of conscious awareness in exercise
motivation and behavioral maintenance are discussed
along with the needed commitment to healthy
lifestyle choices