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Exercise oncology

Exercise oncology. Kate Bolam SFO-V Postdoctoral Research Fellow Clinical Exercise Physiologist Karolinska Institutet. Who am I? What is happening in Australia? What is happening in Sweden OptiTrain RCT Why exercise? Exercise guidelines for cancer Future directions. Who am I?.

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Exercise oncology

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  1. Exercise oncology Kate BolamSFO-V Postdoctoral Research Fellow Clinical Exercise Physiologist KarolinskaInstitutet

  2. Whoam I? • What is happening in Australia? • What is happening in Sweden • OptiTrain RCT • Why exercise? • Exerciseguidelines for cancer • Futuredirections

  3. Who am I? Clinical exercise physiologist • 4-year university qualified allied-health professionals • Specialise in exercise for the prevention and management of chronic diseases and injuries.

  4. ↑ Cardiovascular fitness ↑ Physical function ↑ HR Quality of life Attenuate cancer related fatigue Alleviate psychological distress ↓ Risk of treatment related toxicities ↑ Muscle strength ↓ Risk of developing co-morbid conditions e.g. CVD, diabetes, osteoporosis Protective effect against cancer specific and all-cause mortality Protective effect against recurrence Cormie et al, Epidemiol Rev, 2017

  5. Name Surname

  6. Name Surname

  7. Name Surname

  8. Name Surname

  9. OptiTrainexercise trial Name Surname

  10. 240 women with breast cancer, stage I-III receiving chemotherapy 38% Baseline testing Exercise intervention twice a week for 16 wks UC Usual care AT-HIIT MICT 20 min RPE13-15 HIIT: 3 x 3 min RPE 16-18 RT-HIIT RT: 9-10 exercises: 2-3 sets, 8-12 reps 80% of 1RM HIIT: 3 x 3 min RPE 16-18 Post intervention testing (16 weeks) PaP and 3 motivation and exercise seminars UC Testing at 12 months post-baseline n=173

  11. Cancer related fatigue

  12. Muscle strength

  13. Muscle strength

  14. Fitness

  15. Symptoms and qualityoflife • 16 weeks • RT-HIIT and AT-HIIT • QoL • RT-HIIT • Symptoms • 12 months • RT-HIIT and AT-HIIT • Symptoms • AT-HIIT • QoL

  16. Sick leave

  17. Patient experiencesofexercise • Physicalactivityhelped to takecontrolofphysical, psychological and social health • Focus on healthnot sickness

  18. Cancer and exercise

  19. 292 exercise interventions 194 during treatment Christensen JF, Simonsen C, Hojman P. ExerciseTraining in Cancer Control and Treatment. Compr Physiol. 2018 Dec 13;9(1):165-205. .

  20. How does exercise help? Scott JM, Nilsen TS, Gupta D, Jones LW. Exercisetherapy and cardiovasculartoxicityin cancer. Circulation 137(11): 1176-1191, 2018. De Backer IC, Schep G, Backx FJ, Vreugdenhil G, Kuipers H. Resistancetraining in cancer survivors: A systematicreview. Int J Sports Med 30(10): 703-712, 2009 • Cardiovascular fitness • Increases in VO2peak following endurance training1 • Mechanisms need more work • Muscle strength and hypertrophy • Resistance-based training, has been shown to increase muscle strength2 • Fewer to examine and see effects on muscle mass • Responses damped during chemotherapy

  21. How does exercise help? MishraSI, Scherer RW, Snyder C, Geigle PM, Berlanstein DR, Topaloglu O. Exercise interventions on health-relatedqualityoflife for peoplewith cancer duringactivetreatment. CochraneDatabaseSyst Rev (8): Newby TA, Graff JN, Ganzini LK, McDonagh MS. Interventions thatmayreduce depressive symptoms amongprostate cancer patients: A systematicreview and meta-analysis. Psychooncology 24(12): 1686- 1693, 2015. • Health related quality of life • Small to moderate beneficial effects • beneficial effects were more pronounced in moderate to vigorous activities v milder exercise programs and supervised v non supervised1 • Depression • May be beneficial for improving symptoms of depression2

  22. How does exercise help? MishraSI, Scherer RW, Snyder C, Geigle PM, Berlanstein DR, Topaloglu O. Exercise interventions on health-relatedqualityoflife for peoplewith cancer duringactivetreatment. CochraneMustianKM, Alfano CM, Heckler C, Kleckner AS, Kleckner IR, Leach CR, Mohr D, Palesh OG, Peppone LJ, Piper BF, Scarpato J, Smith T, Sprod LK, Miller SM. Comparisonofpharmaceutical, psychological, and exercisetreatments for cancer-relatedfatigue: A meta-analysis. JAMA Oncol 3(7): 961-968, 2017. • Cancer related fatigue • exercise superior to pharmaceutical or psychological interventions1 • Mechanisms still uncertain • Fat/body weight • Limited effects of exercise alone • Multi-modal interventions (diet) needed • Effect of body fat on treatment dose?

  23. Exercise Guidelines- Sverige

  24. New general guidelinesoutearly 2019! Guidelines for peoplewithbonemetastasesout later 2019! Schmitz et al, Med Sci Sports Exerc, 2010

  25. Aerobic exercise 150 min of moderate to vigorous physical activity each week

  26. Resistance exercise 2-3 sessions/ week, 2 sets of 10-12 RM

  27. Flexibility and balance Hold 30 secs Balance challenging

  28. JSassoJP1, Eves ND2, Christensen JF3, Koelwyn GJ4, Scott J5, Jones LW1. A framework for prescription in exercise-oncologyresearch. CachexiaSarcopeniaMuscle. 2015 Jun;6(2):115-24.

  29. Future directions Implementation 700 exercise studies from 292 exercise trials Practice based evidence It’s time for exercise as standard care in cancer Ethical and equal care Evidence based Sustainability

  30. Denmark- Body in Cancer

  31. Copenhagen model • Men and women undergoing adjuvant chemotherapy or treatment for advanced disease • Group based multimodal Intervention • Supervised by clinical nurse specialists and physiotherapists • Participants per group: 7-10 AdamsenL, Midtgaard J, Rørth M, Borregaard N, Andersen C, Quist M, Møller T, Zacho M, Madsen J, Knutsen L. Supportive Care in Cancer, 2003 Morten Quist EEBC Heidelberg 2010

  32. Exercise intervention Weekly schedule 6 weeks, 9 hours weekly

  33. Who? • 18-65 years. • Diagnosis of cancer (given at least one month prior). • Out patient chemotherapy • One series of chemotherapy Exclusion • Documented brain metastases • Weight bearing bone metastases • Cardiac disease • Dementia, terminal care

  34. Screening Basic health indicators Blood pressure at rest Diastolic ‹45 or ›95 Resting pulse ›100 Temperature ›38C Resting respiratory frequency ›20 Infection (antibiotics) Blood samples Thrombocytes ‹50 x 109/l Leucocytes ‹10 x 109/l

  35. Main points Exercise beneficial for many important health outcomes Safe for the majority Implementation studies needed Evidence based practice and practice based evidence Exercise as standard of care

  36. Thank you @katebolamkate.bolam@ki.se Group leader: Yvonne Wengström@Ywengstrm Helene Rundqvist @HHeleneru Sara Mijwel @saramijwel Anna Jervaeus @anna_jervaeus

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