Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Chapter 15 Resistance-Training...

Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Chapter 15

Resistance-Training Strategies for Individuals with Cancer


Cancer

• Disease family marked by unregulated cell growth and proliferation

• Can affect virtually any bodily organ or system


Cancer

• New treatments and rehabilitation making some cancers less likely to be fatal

• Rehabilitation involves adverse effects of disease, plus effects of radiation/chemotherapy and/or surgery side effects


Prevalence of Cancer

• Second leading cause of death in US

• Lifetime risk:– Males = 50 percent

– Females = 33 percent

• Overall death rate has declined

• Risks of developing increase with age


Prevalence of Cancer

• Most common cancers per 100,000 people:– Prostate = 72

– Breast = 68.5

– Lung = 63.9

– Colorectal = 50.6


Economic Impact

• Growing steadily

• In 1996, total direct cost = $42.39 billion– In 1963, $1.28 billion

• Accounts for approximately 5 percent of total health expenditures over time

• Includes loss of person-years of life and corresponding income potential


Etiology of Cancer

• More than 100 forms identified

• Genesis multi-step process resulting in aggregate proliferation of abnormal cells

• Triggered by exposure to intrinsic or environmental carcinogens

• Carcinogens damage deoxyribonucleic acid (DNA) and invade tissue anywhere in body


Etiology of Cancer

• Process under genetic control

• Dysregulated growth site-specific or systemic

• Treatment specific to site and cancer type

• Metastasis may cause cancer to spread to other sites


Cancer Staging

• Assesses range and severity of progression

• TNM staging system one of most widely used– Evaluates tumor (T), lymph node (N), and metastasis

(M)


Benefits of Resistance Training

• Physical activity:– Aids recovery process

– Is key to prevention

– Maintains strength

– Slows rate of age-related decline


Research Supports Resistance Training

• May help alleviate physical and psychological symptoms of cancer

• Helps manage depression

• Improves physical status and quality of life

• May be used alone or in conjunction with aerobic exercise

• Refer to Table 15.1


Individualization Key to Program Design

• Stage of illness– Pre-, during, or post-treatment

• Prior exercise experience

• Age and general physical status

• Physical conditioning level

• Goals, aspirations, and motivation


Consider Side Effects of Treatment

• Treatment may include surgery, radiation, bone marrow transplantation, and systemic interventions– May include chemo-, hormone, and immunotherapy

• Web sites have updated information on treatment agents and side effects– E.g., www.cancer.org, www.cancer.gov


Possible Concerns of Cancer Patients

• Exercise may:– Promote/Hasten spread of cancer

– Further weaken already compromised immune system

– Increase fatigue

– Make physical impairments related to disease worse

– Cause additional impairment or injury


Response of Exercise Professional

• Address all concerns as part of training design and implementation

• Encourage individual’s active participation in program design

• Be aware of psychological issues related to having life-threatening condition


Training During Treatment

• Treatment may place limitations on individual’s ability, ROM, or energy levels

• Identify individualized goals

• Steady, regular progress may be unrealistic


Training During Treatment

• Multiple assessments useful for measuring performance improvement/decrements

• Consider individual’s cancer staging


Exercise Testing Considerations

• Health and medical history evaluation

• Physical fitness assessment

• Lifestyle/Activity evaluation

• Due to disease and treatment limitations on individual’s performance, 1 RM may be inadvisable


Exercise Testing Considerations

• RPE ratings based on Borg scale may be more useful

• Assess ROM– Refer to Table 15.2

• ACSM guidelines advocate 1 RM to 3 RM


Comorbidities of Older Adults with Cancer

• May include:– Sarcopenia

– Decreased metabolic rate

– Reduced bone density

– Reduced insulin sensitivity

– Decreased aerobic capacity


Comorbidities of Older Adults with Cancer

• May include:– Obesity

– Diabetes

– High cholesterol

– Hypertension

– Heart disease


Side Effects of Cancer Treatments

• Toxic impact of chemotherapy or radiation on body

• Pain

• Fatigue

• Sleep problems


Side Effects of Cancer Treatments

• Lymphedema

• Psychological issues– E.g., depression


Involve Individual in Goal Planning

• Progress may be variable based on treatment and progress of disease

• Provide individual with structure and level of control

• Show positive benefits of being physically active


Involve Individual in Goal Planning

• Develop short-term, manageable goals– Instead of long-term goals

• Consider using “intention” instead of “goal”


Program Components

• Emphasize improvements in functional capabilities

• Highlight trunk and extremity strength

• Initially, prescribe 50 percent of 1 RM– Two to three times per week

• 2 to 3 sets of repetitions– Ranging from 3 to 12


Program Components

• Use Borg RPE scale

• Refer to Table 15.3 for recommended guidelines

• Refer to Table 15.4 for muscle group exercises

• Review sample 24-Week Program


ACSM Recommendations

• Keep intensity levels low

• Perform repetitions slowly through full ROM

• Sustain ECC phase longer than CON phase

• Adapt training protocols to novice, intermediate, and advanced levels



• Teach correct form and breathing with minimal resistance

• Control ECC and CON contractions to avoid bouncing and promote smooth, deliberate movements



• Perform all movements in pain-free manner, making adjustments as needed

• Begin with minimal resistance to allow for adaptation and ROM assessment


Modify Guidelines as Needed

• Use “beginner” to “advanced” approach– Refer to Table 15.5

Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Chapter 15 Resistance-Training...

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