"Local initiatives developing
exercise programmes for
cancer patients"
Louise Ballagher
Senior Physiotherapist
Oncology and Haematology
RD&E Foundation Trust
July 21st 2011
Aims
 To
establish exercise programmes for
patients receiving treatment for cancer

Jones & Courneya 2002
 To
review the use of a Physiotherapy
Technical Instructor in the prescribing and
monitoring of exercise programmes for
Haematology patients in isolation
Common Symptoms of
cancer treatment

Fatigue / decreased energy levels








70%
Decreased muscle strength
Decreased functional status
Nausea
Pain
Body image problems
Sleep disturbances
Depression and anxiety

20-50%
Positive effects of exercise

Reduces stress on the heart and
blood vessels
 Increases ability of heart and lungs
to deliver oxygen efficiently to the
working tissues
 Increases muscular strength and
endurance
 Improves immune system
 Improves mood, body image and
sleep patterns
 Improves quality of life both
physically and emotionally
Benefits of exercise for cancer
patients
“Evidence is accumulating that exercise
is beneficial for cancer sufferers”
Cancer
Level of
Evidence
Strength of
evidence
Colon
High
Strong
Rectal
Medium
No effect
Breast
High
Moderate
Lung
Low
Moderate
Prostate
Medium
Equivocal
Overall
Medium
Moderate
Others
Low
Equivocal
Research - Fatigue

Speck et al (2010)
 Meta analysis – Concluded that physical
activity significantly reduced fatigue post Rx.
14 studies- 93% positive, 50% statistically
significant

Dimeo et al (2008)
 32 pts; 3 week programme of endurance
training  25%  in fatigue; 28%  in
exercise capacity
Research
Quality of Life

Courneya et al (2005)

studies concluded that exercise had significant
positive effects on the QOL of cancer patients
Nausea

Lee et al (2008)

Moderate aerobic exercise is related to less intense
nausea
Research
Neutropenia / thrombocytopenia

Dimeo et al (1997)


RCT on bone marrow transplant patients undergoing
high-dose chemotherapy
Duration of neutropenia and thrombocytopenia was
reduced in the exercise group
Recurrence / survival

Meyerhardt et al (2006)

Cancer specific death was 60% lower in women who
exercised 6 or more hours a week (walking at
average pace)
If there is one
message from the
evidence it is:
Rest is NOT always best
“STAY ACTIVE”
What has been happening at the
RD&E !
Problems facing haematology
patients

Intensive and lengthy
chemotherapy regimes,
often HSCT.

Frequent hospital
admissions often in
isolation


Side effects of Rx


De-conditioning
Reduced QOL
Low morale / low
motivation
RD&E Haematology Unit
Past
Present
The Wii!
“ There is growing evidence
of the benefits of the Wii,
and physiotherapists are
looking into outcomes
with their patients. There
is definitely evidence that
they are of benefit”
Professional Adviser
Chartered Society of
Physiotherapy 2008
The introduction of the Wii

ELF donation
 Wii sport and Wii fit
 Study Jan 09- July 09
 Patient Satisfaction
Survey





Initial assessment
Goal setting
Exercise diary
Follow up questionnaire
Guidelines
The Results
Wii Study 2009
Initial Assessment
Type of
exercise
% of patients
No exercise
40 %
Bed
exercises
15%
Seated
exercises
Static bike
31%
Resistance
exercise
0%
15%
Mood
Start Patients
Follow up Patients
3
2.5
2
Patients 1.5
1
0.5
0
1
2
3
4
5
6
7
8
9
1=Very Happy 10=Very Depressed
10
Motivation
Start Patients
Follow up Patients
5
4
3
2
1
0
1
2
3 4
5
6
7
8 9 10
1=Very Motivate 10=V.De-motivated
Physical Activity
Start Patients
Follow up Patients
4
3
2
1
0
1
2
3
4
5
6
7
8
9 10
1=Very Active 10=Very Inactive
Results


85% study reported
average of 30 mins
accumulated exercise
Positive feedback !

Difficulties!

Access to equipment
Staffing
 Availability of staff
 Increased referrals

What happened next!
•
Proposal for funding
of Physiotherapy
Technical instructor
post
•
6 month pilot agreed
8 Hrs/week
Evaluation of Pilot

Patients identified by
MDT

New diagnosis, new
physio referral

Questionnaire
completed.
“Was it useful having a Technical Instructor
monitor your exercise programme?”
100
80
60
40
20
0
Yes
No
Results
100
80
60
40
20
0
Mood
Motivation
Energy Levels
Physical
Activity
Overall Well
Being
How would you rate the
improvement ?
10
Mood
8
Motivation
6
4
2
0
Energy Levels
Physical levels
Overall Well
Being
‘Are there any other comments you would
like to make?’






“Feel good factor and
gets you motivated to
push yourself”
“Without technical
instructor I wouldn’t have
been able to do it !
“Great motivation by a
smiley instructor ! ”
“Exercises to suit
personal needs”
“An excellent programme”
“This should be regarded
as an essential service
What is going well ?

“ The Way Forward ”
Group

Advice and information
 Leaflets
 Out-patients/ Daycare
unit

Cancer Rehabilitation
Programmes
 Campbell 2007
Many Thanks to ELF
•
•
Permanent Technical
Instructor Post
Increased to 12
hrs/week
Cancer Rehabilitation Programmes



Pilot agreed !
Two 8 week programmes
The programme format :




Pre assessment /
screening
Exercise programme –
warm-up, aerobics,
relaxation/cool down
Educational component
One meeting to take
place at Fitness First
Leisure Centre
The Future

More Promotion of Information

Fly fishing / Dragon Boat racing!

More Research

More Hannahs !
Any
Questions?
References



Campbell, A. (2007) Exercise after cancer
diagnosis. Available at: www.canrehab.co.uk
Courneya, K. (2005) Exercise can improve
breast cancer survival. CA: A Cancer Journal
for Clinicians 55:5: 265-266
Dimeo, F., Bertz, H., Finke, S., Mertlesmann,
R., Keul, J. (1996) An Aerobic Exercise
Programme for patients with haematological
malignancies after bone marrow Transplant.
Bone Marrow Transplant, 18:1157-60
 Jones,
L and Courneya, K. (2002)
Exercise discussions during cancer
treatment consultations. Cancer Practice
10(2):66-74
 Lee, J., Dodd, S., Dibbles, D., Abrams, D.
(2008) Nausea at the end of adjuvant
cancer treatment in relation to exercise
during treatment in patients with breast
cancer. Oncology Nursing Forum 35(5):
830-835
 Meyerhardt,
J., Giovannucci, E., Holmes,
M. (2006) Physical activity and survival
after colorectal cancer diagnosis. Journal
of Clinical Oncology 24(22): 3527-3534
 Winningham,
M. (1992) The Role of
Exercise in Cancer Therapy. In: Watson,
R., Eisinger, M. (eds) Exercise and
Disease. Boca Raton: CRC Press