Evidence Update: Exercise Guidelines for Cancer Survivors
TurningPoint was thrilled to welcome Kristin Campbell, PT, PhD to Atlanta as the guest speaker at our annual rehabilitation course on Prescribing Exercise as Medicine for Breast Cancer on October 25th and 26th. Kristin was a leader at the international multidisciplinary roundtable for the new 2019 Exercise Guidelines for Cancer Patients. The new guidelines provide a description of patients and information on evaluation, prescription and programming for exercise. The most important message of the new guidelines is to avoid inactivity and continue to exercise. They concluded that exercise training is safe for cancer survivors. The new guidelines report on the expected benefits of aerobic exercise, resistance exercise and aerobic plus resistance exercise. Aerobic exercise helps cancer patients reduce anxiety and depression symptoms, with https://nygoodhealth.com/product/ambien/ decrease fatigue and increase quality of life and perceived physical function. The recommendations for aerobic exercise are to perform the exercise at a moderate intensity, three times per week for 30 minute sessions. Resistance exercise can help decrease fatigue, increase quality of life and increase perceived physical function. The guidelines report that performing resistance exercises has no risk of exacerbating lymphedema. The recommendations for resistive exercise are a frequency of two times per week for 2-3 sets using the large muscle groups. These recommendations will serve as guide for professionals working with cancer survivors to help identify a specific exercise prescription to address common side effects of cancer. Exercise Guidelines for Cancer Survivors Consensus Statement from International Multidisciplinary Roundtable CAMPBELL, KRISTIN L.1; WINTERS-STONE, KERRI M.2; WISKEMANN, JOACHIM3; MAY, ANNE M.4; SCHWARTZ, ANNA L.5; COURNEYA, KERRY S.6; ZUCKER, DAVID S.7; MATTHEWS, CHARLES E.8; LIGIBEL, JENNIFER A.9; GERBER, LYNN H.10,11; MORRIS, G. STEPHEN12; PATEL, ALPA V.13; HUE, TRISHA F.14; PERNA, FRANK M.15; SCHMITZ, KATHRYN H.16 Medicine & Science in Sports & Exercise: November 2019 – Volume 51 – Issue 11 – p 2375–2390 doi: 10.1249/MSS.0000000000002116 https://journals.lww.com/acsm-msse/Fulltext/2019/11000/Exercise_Guidelines_for_Cancer_Survivors_.23.aspx#pdf-link
Evidence Update: Therapeutic horseback riding in breast cancer survivors
Breast cancer treatments often negatively impact upper extremity function and the overall perceived quality of an individual’s life. A 2014 pilot study published in the Journal of Alternative and Complimentary Medicine evaluated the physiologic and psychological effects of an equine-assisted therapy protocol in breast cancer survivors. This study consisted of 20 breast cancer survivors who participated in a 16-week equine assisted therapy protocol consisting of 2 hours/sessions of activity per week. All patients were tested before and after the intervention for maximal oxygen consumption, fat mass percentage, total body water percentage, strength of principal muscular groups and quality of life. The therapeutic riding setting included the patient, the horse and the therapist specialized in equestrian rehabilitation. Each riding session consisted of three phases: 1) warm up, horse caring, and grooming, 2) riding, 3) unsaddling and grooming activity. Sessions 1–3 were required to establish the human–horse relationship and to gain a deeper understanding of basic horse management and behavior. Sessions 4–8 provided patients with riding basic elements: mounting and dismounting; position and control on the horse with exercises that help participants to create balance and correct postural lines necessary for mounted work. Sessions 9–20 allowed patients to consolidate the acquired position ability and horse control at walk while sessions 21–32 were structured to improve the ability of autonomous horse management during higher level tasks and with the horse moving at a faster pace. After intervention, the intervention group showed an improvement in oxygen consumption, a decrease in fat mass percentage, and an increase in strength as well as an improved quality of life as measured by the FACIT-F. These results demonstrate the positive effects of equine assisted therapy on both physiological and psychological factors and suggest a new method for rehabilitation intervention strategies after cancer in a nonmedical environment. Cerulli, C., Minganti, C., Santis, C. D., Tranchita, E., Quaranta, F., & Parisi, A. (2014). Therapeutic Horseback Riding in Breast Cancer Survivors: A Pilot Study. The Journal of Alternative and Complementary Medicine, 20(8), 623–629. doi: 10.1089/acm.2014.0061 https://www.ncbi.nlm.nih.gov/pubmed/24963599
Evidence Update: Mat Based Exercises Improve Bone Density
Osteoporosis and osteopenia affect up to 35.5 million women in the United States, with numbers likely to grow with our aging population. Women who have had breast cancer treatment may be at increased risk for osteoporosis and fracture. Estrogen has a protective effect on bone, and reduced levels of the hormone trigger bone loss. Because of treatment medications or surgery, many breast cancer survivors experience a loss of ovarian function and, consequently, reduced estrogen levels. The benefits of engaging in weight bearing exercises on a mat (like yoga) include better posture, improved balance, enhanced coordination, greater range of motion, higher strength, reduced levels of anxiety, and better gait. Improved posture directly addresses spinal fractures, while all these documented benefits of yoga reduce the risk of falling, which is the main cause of all other osteoporotic fractures. A 2016 article published in the Topics in Geriatric Rehabilitation titled “Twelve- Minute Daily Yoga Regimen Reverses Osteoporotic Bone Loss” evaluated the effectiveness of selected yoga postures in raising bone mineral density (BMD). The study was conducted over a 10-year time frame and consisted of 741 internet-recruited volunteers comparing pre-yoga BMD changes with post-yoga BMD changes. Bone mineral density improved in spine, hips, and femur of the 227 moderately and fully compliant patients. Study participants completed a 12-minute DVD of 12 yoga poses that were designed to stimulate increased BMD in the lumbar vertebrae, the hip, and the femoral neck. Monthly gain in BMD was found to be significant in spine and femur, suggesting the 12 selected yoga poses studied here appear to be a safe and effective means to reverse bone loss in the spine and the femur. Lu, Y. H., Rosner, B., Chang, G., & Fishman, L. M. (2016). “Twelve-Minute Daily Yoga Regimen Reverses Osteoporotic Bone Loss.” Topics in geriatric rehabilitation, 32(2), 81–87. doi:10.1097/TGR.0000000000000085. For more information and to see the 12 Yoga poses: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4851231/
Evidence Update: The Effectiveness of Music Therapy in Decreasing Anxiety, Depression and Length of Hospital Stay in Breast Cancer Patients
It is well documented that patients undergoing breast cancer treatment report increased levels of anxiety and depression, both of which are known to increase cortisol levels in the body. Cortisol, also known as the stress hormone, serves an important physiological role in protecting one from imminent danger. However, when cortisol levels are chronically elevated in the body, health problems can occur, such as high blood sugar, high blood pressure, insomnia, weight gain, memory and concentration impairments, poor wound healing, decreased libido, and bone loss. Due to the widespread negative effect on the body caused by chronically elevated cortisol levels, it is clear why reducing stressors such as anxiety and depression during breast cancer treatment is an area of focus for researchers. The authors of the 2017 article “The Impact of Music Therapy on Anxiety in Cancer Patients Undergoing Simulation for Radiation Therapy” found that breast, as well as head/neck, cancer patients who met with a music therapist to assist in selecting patient preferred prerecorded music to be played during their radiation therapy simulation experienced significantly less distress and anxiety compared to those who did not. The authors of the 2015 article “A Clinical Randomized Controlled Trial of Music Therapy and Progressive Muscle Relaxation Training in Female Breast Cancer Patients After Radical Mastectomy: Results on Depression, Anxiety and Length of Hospital Stay” found that patients hospitalized following radical mastectomies, who received music therapy and progressive muscle relaxation training twice per day while admitted, experienced significant reductions in feelings of depression and anxiety as well as significantly shorter hospital stays compared to the control group that received regular nursing care only, https://www.pharmacybc.com/xanax-alprazolam/. Music therapy touches all aspects of the mind, body, brain and behavior. Music can be used as a distraction for the mind and it can influence behavior. Our August 2019 Education Event features music therapy, provided by a certified music therapist who plays instruments and will employ a variety of activities including listening to melodies and guided imagery. Music therapy is appropriate for people of all ages who may be struggling with illness or totally healthy. Rossetti, Andrew, et al. “The Impact of Music Therapy on Anxiety in Cancer Patients Undergoing Simulation for Radiation Therapy.” International Journal of Radiation Oncology*Biology*Physics, vol. 99, no. 1, 2017, pp. 103–110., doi:10.1016/j.ijrobp.2017.05.003. Zhou, Kaina, et al. “A Clinical Randomized Controlled Trial of Music Therapy and Progressive Muscle Relaxation Training in Female Breast Cancer Patients after Radical Mastectomy: Results on Depression, Anxiety and Length of Hospital Stay.” European Journal of Oncology Nursing, vol. 19, no. 1, 2015, pp. 54–59., doi:10.1016/j.ejon.2014.07.010.
