Lung cancer exercise
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LUNG CANCER & EXERCISE. Cindy Maruna PT. Goals of Today’s Discussion. Benefits of Exercise General Exercise Recommendations Contraindications/Precautions Breathing Techniques. Benefits of Exercise. Decreases emotional stress, BP, duration of neutropenia & thrombocytopenia, and pain

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LUNG CANCER & EXERCISE

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Lung cancer exercise

LUNG CANCER & EXERCISE

Cindy Maruna PT


Goals of today s discussion

Goals of Today’s Discussion

  • Benefits of Exercise

  • General Exercise Recommendations

  • Contraindications/Precautions

  • Breathing Techniques


Benefits of exercise

Benefits of Exercise

  • Decreases emotional stress, BP, duration of neutropenia & thrombocytopenia, and pain

  • Increases/improves quality of life (QOL), max O2 uptake during exertion, sleep patterns & cognition

  • QOL issues – weight gain, muscle atrophy & cancer related fatigue


Stricker et al 2004

Stricker, et al 2004

  • Exercise training at moderate levels were reported to improve cardiorespiratory response, increase cardiac output, improve mood state & sleep quality; decrease HR & fatigue


Cancer related fatigue

Cancer Related Fatigue

  • Definition: “a persistent, subjective sense of tiredness related to cancer or cancer treatment that interferes with usual functioning” (National Comprehensive Cancer Network)

  • Described as intense, chronic & disruptive symptom unrelieved by rest


Causes of crf

Causes of CRF

  • Partially by decreased neuromuscular efficiency

  • Further exacerbated by physical inactivity

  • Inactivity & deconditioning clearly NOT sole primary cause of CRF


Treatment of crf

Treatment of CRF

  • Passive approaches used most frequently

  • Exercise to break the cycle

  • Drugs


General exercise recommendations

General Exercise Recommendations

  • Recommends individual program adapted for individual safety

  • Interventions tailored to individual’s specific disease & treatment characteristics & health status

  • Obtain permission of Oncologist


General exercise cont

General Exercise cont.

  • Substantial ambiguity in type, duration & intensity of recommended exercise interventions

  • Aerobic interval training & low to moderate intensity aerobic exercise programs best supported by evidence for application to diverse oncology populations


Exercise cont

Exercise cont.

  • Stricker, et al 2004 – at least 15 min of exercise 3-5x/wk to reduce or stabilize fatigue levels

  • Walk at mod intensity 15-45 min for 4-5x/wk with 5 min warm-up & cool down; increase duration by 2-3 min every 1-2 wks

  • If deconditioned at baseline, start at 5 min brisk walking 2x/day


Duke energizing exercise program

Duke Energizing Exercise Program

  • Periods of exercise several times/day

  • Intensity & duration equal to half of what can comfortably be performed


Karvonen formula

Karvonen Formula

  • 220 – age – resting heartrate (RHR) x ___% work + RHR = Target HR

  • Example: age of 60 RHR 60

  • 220 – 60 = 160 160 – 60 = 100 100 x 50% = 50 + RHR of 60 = 110 Target exercise HR

  • Low intensity = 20-40%

  • Mod intensity = 40-60%

  • High intensity = 70-80%


Exercise cont1

Exercise cont.

  • Exercise > 60 min per session, more likely to report increased level of fatigue

  • ACSM had no guidelines for patients with cancer

  • Walking & biking were used for most exercise programs


Contraindications to exercise

Contraindications to Exercise

  • In one study: platelets < 20,000, fever, uncontrolled infection or multiple complications

  • Exercise that needs significant oxygen transport if Hgb < 8 g/dl, temp > 38, dyspnea, severe nausea, ataxia, dizziness or peripheral sensory neuropathy


Contraindications cont

Contraindications cont.

  • Course: acute infection, fever, Hgb < 7, platelets < 10,000, bony mets > 50% cortex involved, increased RHR, cachexia

  • Exclusion to one study: symptomatic bone mets, Hbg < 10, resting pain > 2


Other

Other

  • Precaution – loss of sensation in lower extremities (peripheral neuropathy)

  • High Risk: acetabular mets, intertrochanteric mets, 2-3 column spinal mets

  • Avoid bone stress with metastatic bone disease – avoid therabands, weights, lifting BUT weightbearing is good


Specific info on lung cancer

Specific Info on Lung Cancer

  • Study by Nagamatsu 2007 on long-term recovery of exercise capacity & pulmonary function after lobectomy

  • Ongoing studies for seated exercise programs on fatigue & QOL while receiving chemo

  • Fatigue complaints


Breathing techniques strategies

Breathing Techniques/Strategies

  • Strategy to decrease dyspnea in lung cancer pts – relaxation techniques, breathing exercise & self-management techniques

  • Diaphragmatic breathing

  • Pursed lip breathing

  • PNF pattern to open chest

  • Posture


Breathing cont

Breathing cont.

  • Increase oxygen for exercise?

  • Appropriate intensity of exercise


Questions

Questions??


Lung cancer exercise

REFERENCES

Benzo, R. (2007). Pulmonary Rehabilitation in Lung Cancer: A Scientific Opportunity. Journal of Cardiopulmonary Rehabilitation and Prevention. 27(2), 61-64.

Kirschbaum, M. (2006). A review of the benefits of whole body exercise during and after treatment for breast cancer. Journal of Clinical Nursing. 16, 104-121.

Losito, JM., Murphy, SO. & Thomas, ML. (2006). The Effects of Group Exercise on Fatigue and Quality of Life During Cancer Treatment. Oncology Nursing Forum. 33(4), 821-825.

Mutrie, N., Campbell, AM., Whyte, F., McConnachie, A., Emslie, C., Lee, L., Kearney, N., Walker, A. & Ritchie, D. (2007). Benefits of supervised group exercise programme for women being treated for early stage breast cancer: pragmatic randomized controlled trial. BMJ. 334:517.

Nagamatsu, Y., Maeshiro, K., Kimura, NY, Nishi, T, Shima, I, Yamana, H., Shirouzu, K. (2007). Long-term recovery of exercise capacity and pulmonary function after lobectomy. J Thorac Cardiovasc Surg. Nov; 134(5), 1273-8.

Tompkins Stricker, C., Drake, D., Hoyer, KA, & Mock, V. (2004). Evidence-Based Practice for Fatigue Management in Adults with Cancer: Exercise as an Intervention. Oncology Nursing Forum. 31(5), 963-974.

Visovsky, C., Schneider, SM. (2003). Cancer-related Fatigue. Online Journal of Issues in Nursing. 8(3).

Visovsky, C. & Dvorak, C. (2005). Exercise and Cancer Recovery. Online Journal of Issues in Nursing. 10(2), 148-170.

Treatment of Cancer Related Weakness and Fatigue presented by Sharon Konecne, MHS, PT.


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