Physical Activity & Cancer
Macmillan Activity Promotion
Programme (MAPP)
South East Wales
Helen Tyler
Macmillan Therapies Manager
Velindre Cancer Centre
Acknowledgements
• Siobhan Harkin
– Macmillan Physical Activity Lead (0.5 wte)
• Claire Jones
– Macmillan Physical Activity Physiotherapist (0.6 wte)
• Margretta Davies
– Macmillan Physical Activity Physiotherapist (O.4 wte)
• Patrick Palmer
– Macmillan Physical Activity Support Worker (1 wte)
Improves health and wellbeing outcomes
Effect size
Reduction in the relevant risk of recurrence of
breast cancer:
•Adjuvant physical activity 40- 50%
•Adjuvant radiotherapy 59%
•Adjuvant hormone treatment 29% (after 10
years of treatment)
Physical activity guidelines
Helping people take control
‘Keeping active has helped me, and my family,
through a really difficult time. It’s helped me
return to a more normal way of life and has
given me a real sense of achievement’.
2 million People Living with Cancer
PA levels
1.6 Million not
achieving
recommend level
of PA
1.1 million are
65years and over
0.4 million
achieving
recommended
level of PA
Meeting Patients Needs
Specific
needs
Physiotherapy
Outpatients
Additional
support
requirements
Self management
MAPP
NERS
10 Top tips
MAPP Aims
Promote Physical
Activity
Promote Healthy
Living
To promote peer
support
Promote Self
management of
Cancer related side
effects
To empower patients
to use
NERS/independent
Activity
MAPP setting up process
Develop
Promote
Champion
Develop
• Referral pathways
• Stage of cancer care
pathway
• Patient Measurement
tool- EQ5D,FACIT,
• VAS,TUG
• Referral pathways• Professional/self referral
• Gateway session
Evaluate
Identify
Establish
Expand
• Current PA schemes
• NERs /Walking groups
• Resources needed to
run MAPP, staff,
equipment
• Suitable facilities
• Variety of PA sessions
• Modify/enhance
dependent on patient
feedback
Promoting
• Hospitalspromotional stand
• GP-leaflets
• Health and well
being days for
family/carer /HCP
• VCC patient portal
Patient
Family
MDT
Carers
• Seminars for GPs
MAPP
• Written to GPs
• Meet them
• F/U regularly
• Emailed referrals
Secondary
care
• Health and
social care staff
emailed
• Learn at lunch
• Intra net VCC
• Raise awareness
NERS/activities
local
Community
• Collaborate CNS
link in with Cancer
support groups
• Attended support
group meetings
Championing
• Varied menu of PA
• Within sports,
leisure providers,
community
room
• Carrying pre and post
MAPP assessments
• F/u in person/phone
• Sign posting
Advice
Support
Behavioural
change
model
Physical
activity
Patient
Centred
Education
•
•
•
•
Facilitate sessions
Welcoming, friendly
Environment
Facilitate peer
support
• Brief intervention
• HNA
• Motivational
interviewing
• Right type of activity
MAPP 6 week course
2 hours Health & wellbeing talk +
Physical activity session
Beginning of
the journey”
– why now?
Local
opportunities
& resources
DIYHome based PA
Pacing,
planning,
energy
diaries
Walking
NERs
Tai chi
Confidence in
moving
forward with
PA
Relaxation
Mindfulness
Coping
thoughts
Healthy
Eating
Macmillan Activity Promotion Programme
Inclusion criteria
• All patients will be screened by a
physiotherapist prior to commencement on
the MAPP.
• All tumour sites
• All ages 18+
• All stages of the cancer care pathway
• Patient has identified a desire to improve their
physical activity levels
Macmillan Activity Promotion Programme
Exclusion criteria
Many of these exclusions will only be temporary but all must be considered
• Patients who are already
physically active (we will refer
directly on to NERS)
• Acute infection
• Febrile illness with
temperature >38 °c
• Symptomatic severe aortic
stenosis
• Acute myocarditis/pericarditis
• Acute uncontrolled psychiatric
illness
• Diarrhoea and vomiting
• Acute chest pain
• Dizziness and lightheadedness
• Disorientation
• Blurred vision
• Unstable angina
• Unstable/ Acute heart failure
• Unstable diabetes
• New/ Uncontrolled arrhythmias
• Hypertension with a resting SBP > 180mmHg
or DBP > 100mmHg
• Symptomatic hypotension
• <24 hrs since last chemotherapy session
• Low blood counts (neutropenia or
thrombocytopenia)
• Acute PE
• Acute MI/ Cardiac event
• On antibiotics for active cellulitis
• Patients with known MSCC to be discussed
with MAPP team on an individual basis.
MAPP Aims/Evaluation
Promote Physical Activity
Promote Healthy Living
90% attendance
Patients completed ‘Move
More’ packs reporting
additional activity
1 non starter due to illness
To promote peer support
See patient feedback
Promote Self management
of Cancer related side
effects
Health and wellbeing talk
To empower patients to use
NERS/independent
Activity
All patients referred to
NERS
Patient Feedback – MAPP 1
“Tremendous. I have been
able to improve my fatigue
level through planning and
using some of the
activities and ideas gained
from the course
Given me help to do
more exercise and
advice on other
activities that could
help me
reassurance to do
activities I thought
might be damaging or
hurt
Helped me to think
outside the box
about physical
activity and the
restraints of my life
It has motivated me to
examine how active I am. To
realize that just increasing
normal daily activities count
too.
made me more
aware of the need
for exercise
Made me realize doing something
a little is better than nothing at
all. Something has clicked and I
now feel more motivated
MAPP future developments
Session locations
Friday 11am -1pm
Cwmbran Stadium
Monday am
Pont Newydd Medical
Centre, Porth
Tuesday 2 – 3.30pm
Whitchurch Rugby Club
THANKS
Diolch
Any questions?