Resistance Training for Cancer Patients: Improving Physical Status and Quality of Life

1. Chapter 15 Resistance-Training Strategies for Individuals with Cancer

2. Cancer • Disease family marked by unregulated cell growth and proliferation • Can affect virtually any bodily organ or system

3. Cancer • New treatments and rehabilitation making some cancers less likely to be fatal • Rehabilitation involves adverse effects of disease, plus effects of radiation/chemotherapy and/or surgery side effects

4. Prevalence of Cancer • Second leading cause of death in US • Lifetime risk: • Males = 50 percent • Females = 33 percent • Overall death rate has declined • Risks of developing increase with age

5. Prevalence of Cancer • Most common cancers per 100,000 people: • Prostate = 72 • Breast = 68.5 • Lung = 63.9 • Colorectal = 50.6

6. Economic Impact • Growing steadily • In 1996, total direct cost = $42.39 billion • In 1963, $1.28 billion • Accounts for approximately 5 percent of total health expenditures over time • Includes loss of person-years of life and corresponding income potential

7. Etiology of Cancer • More than 100 forms identified • Genesis multi-step process resulting in aggregate proliferation of abnormal cells • Triggered by exposure to intrinsic or environmental carcinogens • Carcinogens damage deoxyribonucleic acid (DNA) and invade tissue anywhere in body

8. Etiology of Cancer • Process under genetic control • Dysregulated growth site-specific or systemic • Treatment specific to site and cancer type • Metastasis may cause cancer to spread to other sites

9. Cancer Staging • Assesses range and severity of progression • TNM staging system one of most widely used • Evaluates tumor (T), lymph node (N), and metastasis (M)

10. Benefits of Resistance Training • Physical activity: • Aids recovery process • Is key to prevention • Maintains strength • Slows rate of age-related decline

11. Research Supports Resistance Training • May help alleviate physical and psychological symptoms of cancer • Helps manage depression • Improves physical status and quality of life • May be used alone or in conjunction with aerobic exercise • Refer to Table 15.1

12. Individualization Key to Program Design • Stage of illness • Pre-, during, or post-treatment • Prior exercise experience • Age and general physical status • Physical conditioning level • Goals, aspirations, and motivation

13. Consider Side Effects of Treatment • Treatment may include surgery, radiation, bone marrow transplantation, and systemic interventions • May include chemo-, hormone, and immunotherapy • Web sites have updated information on treatment agents and side effects • E.g., www.cancer.org, www.cancer.gov

14. Possible Concerns of Cancer Patients • Exercise may: • Promote/Hasten spread of cancer • Further weaken already compromised immune system • Increase fatigue • Make physical impairments related to disease worse • Cause additional impairment or injury

15. Response of Exercise Professional • Address all concerns as part of training design and implementation • Encourage individual’s active participation in program design • Be aware of psychological issues related to having life-threatening condition

16. Training During Treatment • Treatment may place limitations on individual’s ability, ROM, or energy levels • Identify individualized goals • Steady, regular progress may be unrealistic

17. Training During Treatment • Multiple assessments useful for measuring performance improvement/decrements • Consider individual’s cancer staging

18. Exercise Testing Considerations • Health and medical history evaluation • Physical fitness assessment • Lifestyle/Activity evaluation • Due to disease and treatment limitations on individual’s performance, 1 RM may be inadvisable

19. Exercise Testing Considerations • RPE ratings based on Borg scale may be more useful • Assess ROM • Refer to Table 15.2 • ACSM guidelines advocate 1 RM to 3 RM

20. Comorbidities of Older Adults with Cancer • May include: • Sarcopenia • Decreased metabolic rate • Reduced bone density • Reduced insulin sensitivity • Decreased aerobic capacity

21. Comorbidities of Older Adults with Cancer • May include: • Obesity • Diabetes • High cholesterol • Hypertension • Heart disease

22. Side Effects of Cancer Treatments • Toxic impact of chemotherapy or radiation on body • Pain • Fatigue • Sleep problems

23. Side Effects of Cancer Treatments • Lymphedema • Psychological issues • E.g., depression

24. Involve Individual in Goal Planning • Progress may be variable based on treatment and progress of disease • Provide individual with structure and level of control • Show positive benefits of being physically active

25. Involve Individual in Goal Planning • Develop short-term, manageable goals • Instead of long-term goals • Consider using “intention” instead of “goal”

26. Program Components • Emphasize improvements in functional capabilities • Highlight trunk and extremity strength • Initially, prescribe 50 percent of 1 RM • Two to three times per week • 2 to 3 sets of repetitions • Ranging from 3 to 12

27. Program Components • Use Borg RPE scale • Refer to Table 15.3 for recommended guidelines • Refer to Table 15.4 for muscle group exercises • Review sample 24-Week Program

28. ACSM Recommendations • Keep intensity levels low • Perform repetitions slowly through full ROM • Sustain ECC phase longer than CON phase • Adapt training protocols to novice, intermediate, and advanced levels

29. ACSM Recommendations • Teach correct form and breathing with minimal resistance • Control ECC and CON contractions to avoid bouncing and promote smooth, deliberate movements

30. ACSM Recommendations • Perform all movements in pain-free manner, making adjustments as needed • Begin with minimal resistance to allow for adaptation and ROM assessment

31. Modify Guidelines as Needed • Use “beginner” to “advanced” approach • Refer to Table 15.5