1. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Chapter 15 Resistance-Training Strategies for Individuals with Cancer

2. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Cancer Disease family marked by unregulated cell growth and proliferation Can affect virtually any bodily organ or system

3. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. 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. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. 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. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Prevalence of Cancer Most common cancers per 100,000 people: –Prostate = 72 –Breast = 68.5 –Lung = 63.9 –Colorectal = 50.6

6. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. 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. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. 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. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. 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. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. 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. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Benefits of Resistance Training Physical activity: –Aids recovery process –Is key to prevention –Maintains strength –Slows rate of age-related decline

11. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. 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. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. 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. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. 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. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. 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. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. 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. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. 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. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Training During Treatment Multiple assessments useful for measuring performance improvement/decrements Consider individual’s cancer staging

18. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. 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. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. 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. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Comorbidities of Older Adults with Cancer May include: –Sarcopenia –Decreased metabolic rate –Reduced bone density –Reduced insulin sensitivity –Decreased aerobic capacity

21. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Comorbidities of Older Adults with Cancer May include: –Obesity –Diabetes –High cholesterol –Hypertension –Heart disease

22. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Side Effects of Cancer Treatments Toxic impact of chemotherapy or radiation on body Pain Fatigue Sleep problems

23. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Side Effects of Cancer Treatments Lymphedema Psychological issues –E.g., depression

24. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. 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. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Involve Individual in Goal Planning Develop short-term, manageable goals –Instead of long-term goals Consider using “intention” instead of “goal”

26. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. 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. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. 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. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. 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. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. ACSM Recommendations Teach correct form and breathing with minimal resistance Control ECC and CON contractions to avoid bouncing and promote smooth, deliberate movements

30. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. 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. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Modify Guidelines as Needed Use “beginner” to “advanced” approach –Refer to Table 15.5