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.
Evidence Update: The Effectiveness of Physical Exercise on Bone Density in Osteoporotic Patients
Physical exercise is considered an effective means to help prevent osteoporosis and to increase bone strength in osteoporotic individuals. Breast cancer treatments, medications and surgery have a considerable impact on bone health, and patients may experience a loss of ovarian function, or if premenopausal before cancer treatment, may go through menopause earlier. The research supports that a combined aerobic and resistance training improves bone health in female cancer survivors. The authors in the 2019 article “The Effectiveness of Physical Exercise on Bone Density in Osteoporotic Patients” reported the most appropriate features of an exercise program for increasing bone density in osteoporotic patients. The first type of exercise that is effective for individuals with osteoporosis is weight-bearing aerobic exercises which include walking, stair climbing, and Tai Chi. The second type of exercise is strength and resistance exercises which can be performed with weights/resistive bands or swimming. Multicomponent exercises were also reviewed and deemed appropriate for the patient population. Multicomponent exercises consist of a combination of different methods including aerobics, strengthening, balance, dancing and progressive resistance. For the multicomponent exercise to be effective, the exercise must contain a proportion of strength and resistance training. Determining an appropriate and safe exercise program that helps to build strength, improve balance and posture and maintain bone mass is important to help minimize the risk of falling and fracture. Benedetti MG, Furlini G, Zati A, & Letizia Mauro G. (2018). The Effectiveness of Physical Exercise on Bone Density in Osteoporotic Patients. Biomed Res Int. Daly, RM., Dalla Via, J., Duckham, RL., Fraser, SF., Helge, EW. (2019). Exercise for the prevention of osteoporosis in postmenopausal women: an evidence-based guide to the optimal prescription. Braz J Phys Ther, 2019 Mar – Apr;23(2):170-180. https://www.bones.nih.gov/health-info/bone/osteoporosis/conditions-behaviors/osteoporosis-breast-cancer https://journals.lww.com/cancernursingonline/Citation/2019/03000/Changes_in_Bone_Mineral_Density_in_Women_With.9.aspx
