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Day 31 b Cancer Rehab Jones
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Transcript of Day 31 b Cancer Rehab Jones
Exercise & Cancer Rehabilitation Exercise & Cancer Rehabilitation
Lee W. Jones, Ph.D.Lee W. Jones, Ph.D.Lee W. Jones, Ph.D.Lee W. Jones, Ph.D.
Behavioral Medicine Laboratory,Behavioral Medicine Laboratory,Faculty of Physical Education,Faculty of Physical Education,
University of AlbertaUniversity of Alberta
Behavioral Medicine Laboratory,Behavioral Medicine Laboratory,Faculty of Physical Education,Faculty of Physical Education,
University of AlbertaUniversity of Alberta
HE ED 221 (E-121) HE ED 221 (E-121)
November 24, 1.00-2.00pm, 2003November 24, 1.00-2.00pm, 2003
HE ED 221 (E-121) HE ED 221 (E-121)
November 24, 1.00-2.00pm, 2003November 24, 1.00-2.00pm, 2003
Framework PEACEFramework PEACE
PreventionPreventionPreventionPrevention 1.1.Pre-TreatmentPre-Treatment
1.1.Pre-TreatmentPre-Treatment
DIAGNOSISDIAGNOSISDIAGNOSISDIAGNOSIS
2. 2. TreatmentTreatment
2. 2. TreatmentTreatment
4.4.PalliationPalliation
4.4.PalliationPalliation
3.3.RehabilitationRehabilitation
3.3.RehabilitationRehabilitation
5.5.SurvivalSurvival
5.5.SurvivalSurvival
Adapted from Courneya & Friedenreich, Ann Behav Med 2001Adapted from Courneya & Friedenreich, Ann Behav Med 2001
PRE-DIAGNOSISPRE-DIAGNOSISPRE-DIAGNOSISPRE-DIAGNOSIS POST-DIAGNOSISPOST-DIAGNOSISPOST-DIAGNOSISPOST-DIAGNOSIS
Why Exercise?Why Exercise?
Cancer TherapiesCancer TherapiesCancer TherapiesCancer Therapies
SurgerySurgery
Tx for localized tumorsTx for localized tumors
60% pts, 30% cure rate60% pts, 30% cure rate
SurgerySurgery
Tx for localized tumorsTx for localized tumors
60% pts, 30% cure rate60% pts, 30% cure rate
RadiationRadiation
Local – regional txLocal – regional tx
50% patients50% patients
RadiationRadiation
Local – regional txLocal – regional tx
50% patients50% patients
Systemic TherapySystemic Therapy
Advanced solid tumorsAdvanced solid tumorsChemotherapy;hormonal therapy; Chemotherapy;hormonal therapy; biological therapybiological therapy
Systemic TherapySystemic Therapy
Advanced solid tumorsAdvanced solid tumorsChemotherapy;hormonal therapy; Chemotherapy;hormonal therapy; biological therapybiological therapy
Cancer & Quality of LifeCancer & Quality of LifeCancer & Quality of LifeCancer & Quality of Life
- Psychological/physical & functional side-effects- Psychological/physical & functional side-effects- Psychological/physical & functional side-effects- Psychological/physical & functional side-effects
SurgerySurgery
- infection, loss of function, dyspnea, pain, - infection, loss of function, dyspnea, pain, diarrhea, diarrhea, lymphedemalymphedema
SurgerySurgery
- infection, loss of function, dyspnea, pain, - infection, loss of function, dyspnea, pain, diarrhea, diarrhea, lymphedemalymphedema
RadiationRadiation
- - nausea, fatigue, vascular damage (cardiac & nausea, fatigue, vascular damage (cardiac & lung tissue)lung tissue)
RadiationRadiation
- - nausea, fatigue, vascular damage (cardiac & nausea, fatigue, vascular damage (cardiac & lung tissue)lung tissue)
ChemotherapyChemotherapy
- myelosuppression, nausea, weight gain, cardiac - myelosuppression, nausea, weight gain, cardiac toxicity, fatiguetoxicity, fatigue
ChemotherapyChemotherapy
- myelosuppression, nausea, weight gain, cardiac - myelosuppression, nausea, weight gain, cardiac toxicity, fatiguetoxicity, fatigue
Shapiro Shapiro NEJMNEJM 2001 344:1997-2008 2001 344:1997-2008Shapiro Shapiro NEJMNEJM 2001 344:1997-2008 2001 344:1997-2008
Current Quality of Life InterventionsCurrent Quality of Life InterventionsCurrent Quality of Life InterventionsCurrent Quality of Life Interventions
- Cognitive-behavioral therapies, educational - Cognitive-behavioral therapies, educational strategies, grp psychotherapystrategies, grp psychotherapy
- Largely psychological in nature- Largely psychological in nature
- Unlikely to address physical/functional aspects- Unlikely to address physical/functional aspects
- Exercise – not important or appropriate - Exercise – not important or appropriate
- Cognitive-behavioral therapies, educational - Cognitive-behavioral therapies, educational strategies, grp psychotherapystrategies, grp psychotherapy
- Largely psychological in nature- Largely psychological in nature
- Unlikely to address physical/functional aspects- Unlikely to address physical/functional aspects
- Exercise – not important or appropriate - Exercise – not important or appropriate
Courneya, Mackey & Jones Courneya, Mackey & Jones Phys SportsMedPhys SportsMed 2000 2000Courneya, Mackey & Jones Courneya, Mackey & Jones Phys SportsMedPhys SportsMed 2000 2000
Cancer, Quality of Life, & ExerciseCancer, Quality of Life, & ExerciseCancer, Quality of Life, & ExerciseCancer, Quality of Life, & Exercise
Clinical Concerns:Clinical Concerns:
-Immunosuppressive effects-Immunosuppressive effects
-Pathological bone fractures-Pathological bone fractures
- - Cardiotoxicity (RT & CT) Cardiotoxicity (RT & CT)
- Unwillingness of cancer pts- Unwillingness of cancer pts
- Recent research – dispelling myths- Recent research – dispelling myths
Clinical Concerns:Clinical Concerns:
-Immunosuppressive effects-Immunosuppressive effects
-Pathological bone fractures-Pathological bone fractures
- - Cardiotoxicity (RT & CT) Cardiotoxicity (RT & CT)
- Unwillingness of cancer pts- Unwillingness of cancer pts
- Recent research – dispelling myths- Recent research – dispelling myths
Courneya, Mackey & Jones Courneya, Mackey & Jones Phys SportsMedPhys SportsMed 2000 2000Courneya, Mackey & Jones Courneya, Mackey & Jones Phys SportsMedPhys SportsMed 2000 2000
Current Status – Exercise & CancerCurrent Status – Exercise & CancerResearchResearch
Review of LiteratureReview of Literature
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Exercise ModalityExercise ModalityExercise ModalityExercise Modality
Review of LiteratureReview of Literature
Courneya et al. Courneya et al. Phys SportsMedPhys SportsMed 2000;28:49; Courneya 2000;28:49; Courneya ACSMACSM; 2003; 2003Courneya et al. Courneya et al. Phys SportsMedPhys SportsMed 2000;28:49; Courneya 2000;28:49; Courneya ACSMACSM; 2003; 2003
All reported significant benefitsAll reported significant benefits
No Adverse eventsNo Adverse events
Multiple Outcomes…..Multiple Outcomes…..
All reported significant benefitsAll reported significant benefits
No Adverse eventsNo Adverse events
Multiple Outcomes…..Multiple Outcomes…..
Outcomes/ResultsOutcomes/ResultsOutcomes/ResultsOutcomes/Results
Physiologic OutcomesPhysiologic Outcomes - VO - VO2peak, 2peak, body comp, NK body comp, NK
activity, flexibilityactivity, flexibility
Physiologic OutcomesPhysiologic Outcomes - VO - VO2peak, 2peak, body comp, NK body comp, NK
activity, flexibilityactivity, flexibility
Tx-Related SymptomsTx-Related Symptoms – fatigue, pain, nausea, – fatigue, pain, nausea, diarrhea, platelet transfusion, hospital staydiarrhea, platelet transfusion, hospital stayTx-Related SymptomsTx-Related Symptoms – fatigue, pain, nausea, – fatigue, pain, nausea, diarrhea, platelet transfusion, hospital staydiarrhea, platelet transfusion, hospital stay
QOL OutcomesQOL Outcomes – overall, PWB, FWB, SWB, SWL, – overall, PWB, FWB, SWB, SWL, anx/depanx/depQOL OutcomesQOL Outcomes – overall, PWB, FWB, SWB, SWL, – overall, PWB, FWB, SWB, SWL, anx/depanx/dep
Review of LiteratureReview of Literature
Small number of studies (n=47; only 14 RCT’s)Small number of studies (n=47; only 14 RCT’s)
Small sample sizes (heterogeneous)Small sample sizes (heterogeneous)
Self-report measures of exerciseSelf-report measures of exercise
Methodology not well describedMethodology not well described
Small number of studies (n=47; only 14 RCT’s)Small number of studies (n=47; only 14 RCT’s)
Small sample sizes (heterogeneous)Small sample sizes (heterogeneous)
Self-report measures of exerciseSelf-report measures of exercise
Methodology not well describedMethodology not well described
LimitationsLimitationsLimitationsLimitations
Courneya et al. Courneya et al. Phys SportsMedPhys SportsMed 2000;28:49; Courneya 2000;28:49; Courneya ACSMACSM; 2003; 2003Courneya et al. Courneya et al. Phys SportsMedPhys SportsMed 2000;28:49; Courneya 2000;28:49; Courneya ACSMACSM; 2003; 2003
V. Clinical ExerciseV. Clinical ExercisePrescription GuidelinesPrescription Guidelines
Cancer dx affects all aspects of physical Cancer dx affects all aspects of physical functioningfunctioning
Unique manifestationsUnique manifestations
- Tumor- Tumor
- Treatment- Treatment
- Side effects- Side effects
- Demographic profile- Demographic profile
ACSM guidelines (3-5d/wk, 30-60mins, moderate ACSM guidelines (3-5d/wk, 30-60mins, moderate intensity)intensity)
Optimal guidelines – not yet establishedOptimal guidelines – not yet established
Cancer dx affects all aspects of physical Cancer dx affects all aspects of physical functioningfunctioning
Unique manifestationsUnique manifestations
- Tumor- Tumor
- Treatment- Treatment
- Side effects- Side effects
- Demographic profile- Demographic profile
ACSM guidelines (3-5d/wk, 30-60mins, moderate ACSM guidelines (3-5d/wk, 30-60mins, moderate intensity)intensity)
Optimal guidelines – not yet establishedOptimal guidelines – not yet established
General GuidelinesGeneral Guidelines
Prescription GuidelinesPrescription Guidelines
ModeMode
Walking / cycle ergometry natural Walking / cycle ergometry natural choicechoice
Account for specific impairments Account for specific impairments (e.g., colorectal, breast cancer)(e.g., colorectal, breast cancer)
Resistance/upper body – Resistance/upper body – lymphedema concerns - lymphedema concerns - unfoundedunfounded
Combined program optimalCombined program optimal
Walking / cycle ergometry natural Walking / cycle ergometry natural choicechoice
Account for specific impairments Account for specific impairments (e.g., colorectal, breast cancer)(e.g., colorectal, breast cancer)
Resistance/upper body – Resistance/upper body – lymphedema concerns - lymphedema concerns - unfoundedunfounded
Combined program optimalCombined program optimal
Prescription GuidelinesPrescription Guidelines
Frequency & IntensityFrequency & Intensity
At least 3-5d/wkAt least 3-5d/wk
Daily for deconditioned patientsDaily for deconditioned patients
Moderate IntensityModerate Intensity
50-70% VO50-70% VO2max2max
60-80% HR60-80% HRmaxmax
RPE 11-14RPE 11-14
At least 3-5d/wkAt least 3-5d/wk
Daily for deconditioned patientsDaily for deconditioned patients
Moderate IntensityModerate Intensity
50-70% VO50-70% VO2max2max
60-80% HR60-80% HRmaxmax
RPE 11-14RPE 11-14
Prescription GuidelinesPrescription Guidelines
Duration & ProgressionDuration & Progression
20-30mins (continuous)20-30mins (continuous)
Intermittment bouts (5-10 mins)Intermittment bouts (5-10 mins)
Initially in frequency & duration - Initially in frequency & duration - then intensitythen intensity
Progression slower for Progression slower for deconditioned pts & those deconditioned pts & those suffering severe side effectssuffering severe side effects
20-30mins (continuous)20-30mins (continuous)
Intermittment bouts (5-10 mins)Intermittment bouts (5-10 mins)
Initially in frequency & duration - Initially in frequency & duration - then intensitythen intensity
Progression slower for Progression slower for deconditioned pts & those deconditioned pts & those suffering severe side effectssuffering severe side effects
General GuidelinesGeneral Guidelines
No evidence that one type of exercise is superiorNo evidence that one type of exercise is superior
Safety is the primary concernSafety is the primary concern
Optimal program may combine resistance & Optimal program may combine resistance &
aerobic training aerobic training
Key point is to be flexible - modify prescription Key point is to be flexible - modify prescription
based on response to treatment(s)based on response to treatment(s)
No evidence that one type of exercise is superiorNo evidence that one type of exercise is superior
Safety is the primary concernSafety is the primary concern
Optimal program may combine resistance & Optimal program may combine resistance &
aerobic training aerobic training
Key point is to be flexible - modify prescription Key point is to be flexible - modify prescription
based on response to treatment(s)based on response to treatment(s)
ComplicationComplication PrecautionPrecaution• Hemoglobin <8.0 g/dlHemoglobin <8.0 g/dl Avoid high intensity exerciseAvoid high intensity exercise• Absolute neutrophil countAbsolute neutrophil count Avoid exercises that may Avoid exercises that may
increase increase chance of infection chance of infection (swimming)(swimming)
• Fever > 38Fever > 38ooCC Avoid exercise Avoid exercise • Ataxia/dizzinessAtaxia/dizziness Avoid exercises that require Avoid exercises that require
significant balance & significant balance & coordination coordination (treadmill)(treadmill)
• Severe cachexiaSevere cachexia Loss of muscle mass limits Loss of muscle mass limits exercise exercise intensity - modify intensity - modify program program accordinglyaccordingly
• Bone painBone pain Avoid high impact exercisesAvoid high impact exercises• Extreme fatigueExtreme fatigue Exercise at lower power output, Exercise at lower power output,
avoid maximal testsavoid maximal tests
ComplicationComplication PrecautionPrecaution• Hemoglobin <8.0 g/dlHemoglobin <8.0 g/dl Avoid high intensity exerciseAvoid high intensity exercise• Absolute neutrophil countAbsolute neutrophil count Avoid exercises that may Avoid exercises that may
increase increase chance of infection chance of infection (swimming)(swimming)
• Fever > 38Fever > 38ooCC Avoid exercise Avoid exercise • Ataxia/dizzinessAtaxia/dizziness Avoid exercises that require Avoid exercises that require
significant balance & significant balance & coordination coordination (treadmill)(treadmill)
• Severe cachexiaSevere cachexia Loss of muscle mass limits Loss of muscle mass limits exercise exercise intensity - modify intensity - modify program program accordinglyaccordingly
• Bone painBone pain Avoid high impact exercisesAvoid high impact exercises• Extreme fatigueExtreme fatigue Exercise at lower power output, Exercise at lower power output,
avoid maximal testsavoid maximal tests
Special PrecautionsSpecial Precautions
VI. Current Clinical Trials & Forthcoming VI. Current Clinical Trials & Forthcoming StudiesStudies
Breast Cancer Breast Cancer
REHAB Trial REHAB Trial
REHAB REHAB ((RRehabilitation ehabilitation EExercise for xercise for HHealth ealth AAfter fter BBreast reast Cancer) TrialCancer) Trial
REHAB REHAB ((RRehabilitation ehabilitation EExercise for xercise for HHealth ealth AAfter fter BBreast reast Cancer) TrialCancer) Trial
PurposePurpose
Determine the effects of exercise Determine the effects of exercise training on cardiopulmonary, QOL, training on cardiopulmonary, QOL, and biologic outcomes in and biologic outcomes in postmenopausal b/c survivorspostmenopausal b/c survivors
PurposePurpose
Determine the effects of exercise Determine the effects of exercise training on cardiopulmonary, QOL, training on cardiopulmonary, QOL, and biologic outcomes in and biologic outcomes in postmenopausal b/c survivorspostmenopausal b/c survivors
OutcomesOutcomes
QOL, VOQOL, VO2peak2peak, metabolic , metabolic
hormones (insulin, IGF-1), sex hormones (insulin, IGF-1), sex steroid hormones (estradiol, steroid hormones (estradiol, estrogen), biomarkers of CVD estrogen), biomarkers of CVD (CRP, lipids, etc.)(CRP, lipids, etc.)
OutcomesOutcomes
QOL, VOQOL, VO2peak2peak, metabolic , metabolic
hormones (insulin, IGF-1), sex hormones (insulin, IGF-1), sex steroid hormones (estradiol, steroid hormones (estradiol, estrogen), biomarkers of CVD estrogen), biomarkers of CVD (CRP, lipids, etc.)(CRP, lipids, etc.)
REHAB TrialREHAB TrialREHAB TrialREHAB Trial
MethodMethod
53 participants EG (n=25) or CG 53 participants EG (n=25) or CG (n=28)(n=28)
Cycle ergometry 3x/wk, 15-Cycle ergometry 3x/wk, 15-35mins, 15wks, 70-75% 35mins, 15wks, 70-75% VOVO2peak2peak
ResultsResults
52 participants completed trial52 participants completed trial
98.4% adherence (44.3/45 98.4% adherence (44.3/45 sessions)sessions)
53 participants EG (n=25) or CG 53 participants EG (n=25) or CG (n=28)(n=28)
Cycle ergometry 3x/wk, 15-Cycle ergometry 3x/wk, 15-35mins, 15wks, 70-75% 35mins, 15wks, 70-75% VOVO2peak2peak
ResultsResults
52 participants completed trial52 participants completed trial
98.4% adherence (44.3/45 98.4% adherence (44.3/45 sessions)sessions)
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VOVO2peak2peakVOVO2peak2peak QOLQOLQOLQOL
Courneya et al. JCO 2003Courneya et al. JCO 2003
Breast CancerBreast Cancer
START START ((SSupervised upervised TTrial of rial of AAerobic vs erobic vs RResistance esistance TTraining)raining)
START START ((SSupervised upervised TTrial of rial of AAerobic vs erobic vs RResistance esistance TTraining)raining)
ObjectivesObjectives
1.1. Compare AET Vs RET on fitness & QOLCompare AET Vs RET on fitness & QOL
2.2. Explore individual characteristics of these effectsExplore individual characteristics of these effects
3.3. Compare adherence ratesCompare adherence rates
4.4. Investigate psychosocial determinantsInvestigate psychosocial determinants
ObjectivesObjectives
1.1. Compare AET Vs RET on fitness & QOLCompare AET Vs RET on fitness & QOL
2.2. Explore individual characteristics of these effectsExplore individual characteristics of these effects
3.3. Compare adherence ratesCompare adherence rates
4.4. Investigate psychosocial determinantsInvestigate psychosocial determinants
Courneya, et al. Funded by CBCRACourneya, et al. Funded by CBCRA
PurposePurpose
Determine the effects of aerobic vs. resistance training on Determine the effects of aerobic vs. resistance training on QOL in early stage b/c patients on chemotherapyQOL in early stage b/c patients on chemotherapy
PurposePurpose
Determine the effects of aerobic vs. resistance training on Determine the effects of aerobic vs. resistance training on QOL in early stage b/c patients on chemotherapyQOL in early stage b/c patients on chemotherapy
START TrialSTART Trial
Study DesignStudy DesignStudy DesignStudy Design 210 Early 210 Early Stage B/C Stage B/C PatientsPatients
VancouverVancouverN=70N=70
OttawaOttawaN=70N=70
Procedure Procedure Procedure Procedure
EdmontonEdmontonN=70N=70
Tax/Non-TaxTax/Non-Tax Tax/Non-TaxTax/Non-Tax Tax/Non-TaxTax/Non-Tax
LMLM RTRT AEAE LMLM RTRT AEAE LMLM RTRT AEAE
Eligible Pts Eligible Pts Approached by Approached by
OncologistOncologist
Baseline Baseline Assessment > 1Assessment > 1stst CT CT
Intervention Intervention Concurrent with CTConcurrent with CT
Post-Test 3wkPost-Test 3wk> Last CT> Last CT
Courneya, et al. Funded by CBCRACourneya, et al. Funded by CBCRA
START TrialSTART Trial
OutcomesOutcomes
Primary:Primary: QOL QOL
Secondary:Secondary: Fatigue; VO Fatigue; VO2peak2peak; Muscular Strength; ; Muscular Strength;
Body Composition; Lymphedema; Bio-markers Body Composition; Lymphedema; Bio-markers (Cancer Recurrence & CV Risk Factors)(Cancer Recurrence & CV Risk Factors)
OutcomesOutcomes
Primary:Primary: QOL QOL
Secondary:Secondary: Fatigue; VO Fatigue; VO2peak2peak; Muscular Strength; ; Muscular Strength;
Body Composition; Lymphedema; Bio-markers Body Composition; Lymphedema; Bio-markers (Cancer Recurrence & CV Risk Factors)(Cancer Recurrence & CV Risk Factors)
ProgressProgress
Edmonton (n=21; 83%)Edmonton (n=21; 83%)
Ottawa (n=18)Ottawa (n=18)
Vancouver (n=3)Vancouver (n=3)
ProgressProgress
Edmonton (n=21; 83%)Edmonton (n=21; 83%)
Ottawa (n=18)Ottawa (n=18)
Vancouver (n=3)Vancouver (n=3)
Courneya, et al. Funded by CBCRACourneya, et al. Funded by CBCRA
Prostate Cancer Prostate Cancer
Prostate Trial Prostate Trial
Prostate and Resistance Exercise Training TrialProstate and Resistance Exercise Training Trial
Purpose
Determine the effects of resistance exercise on fatigue & HRQOL in prostate cancer patients receiving ADT.
Outcomes
HRQOL, fatigue, body composition, muscular fitness (strength, cardiopulmonary fitness)
Purpose
Determine the effects of resistance exercise on fatigue & HRQOL in prostate cancer patients receiving ADT.
Outcomes
HRQOL, fatigue, body composition, muscular fitness (strength, cardiopulmonary fitness)
Segal et al. JCO 2003Segal et al. JCO 2003
REHAB TrialREHAB TrialProstate TrialProstate Trial
Method
155 RET (n=83) or CG (n=73)
Resistance Training 3x/wk, 12wks, 9 exercises, 2 sets of 8-12 reps @ 60-70% 1 RM
Results
135 participants completed
76.2% adherence (27/36 sessions)
Method
155 RET (n=83) or CG (n=73)
Resistance Training 3x/wk, 12wks, 9 exercises, 2 sets of 8-12 reps @ 60-70% 1 RM
Results
135 participants completed
76.2% adherence (27/36 sessions)
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FatigueFatigueFatigueFatigue
Leg PressLeg PressLeg PressLeg Press
QOLQOLQOLQOL
Colorectal Cancer Colorectal Cancer
CAN-HOPE RCTCAN-HOPE RCT
Colorectal RCT (CAN-HOPE)Colorectal RCT (CAN-HOPE)
• To determine if exercise can To determine if exercise can improve QOL in colorectal improve QOL in colorectal cancer survivorscancer survivors
• Submaximal fitness test/QOL Submaximal fitness test/QOL at baseline & 16 weeksat baseline & 16 weeks
• Moderate intensity, home-Moderate intensity, home-based exercise program based exercise program (F=3-5/wk; D=20-30)(F=3-5/wk; D=20-30)
• Randomized 102 patients (33 Randomized 102 patients (33 Control /69 EX)Control /69 EX)
Colorectal RCT (CAN-HOPE)Colorectal RCT (CAN-HOPE)
• To determine if exercise can To determine if exercise can improve QOL in colorectal improve QOL in colorectal cancer survivorscancer survivors
• Submaximal fitness test/QOL Submaximal fitness test/QOL at baseline & 16 weeksat baseline & 16 weeks
• Moderate intensity, home-Moderate intensity, home-based exercise program based exercise program (F=3-5/wk; D=20-30)(F=3-5/wk; D=20-30)
• Randomized 102 patients (33 Randomized 102 patients (33 Control /69 EX)Control /69 EX)
Courneya et al. Courneya et al. EJCCEJCC, in press, in pressCourneya et al. Courneya et al. EJCCEJCC, in press, in press
CAN-HOPE RCTCAN-HOPE RCT
Participant CharacteristicsParticipant CharacteristicsParticipant CharacteristicsParticipant CharacteristicsParticipant CharacteristicsParticipant Characteristics
DemographicDemographic
Age: 60; 59% maleAge: 60; 59% male
74% married; 40% university74% married; 40% university
60% >$40k60% >$40k
Participant CharacteristicsParticipant Characteristics
DemographicDemographic
Age: 60; 59% maleAge: 60; 59% male
74% married; 40% university74% married; 40% university
60% >$40k60% >$40k
MedicalMedical
Mths Sx: 2Mths Sx: 2
80% III/IV; 100% Sx; 20% RT; 65% 80% III/IV; 100% Sx; 20% RT; 65% CTCT
MedicalMedical
Mths Sx: 2Mths Sx: 2
80% III/IV; 100% Sx; 20% RT; 65% 80% III/IV; 100% Sx; 20% RT; 65% CTCT
CAN-HOPE ResultsCAN-HOPE Results
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108
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64
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70
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Fitness
Fitness
Courneya et al. Courneya et al. EJCC,EJCC, in press in pressCourneya et al. Courneya et al. EJCC,EJCC, in press in press
Lung Cancer Lung Cancer
Exercise Capacity & NSCLCExercise Capacity & NSCLC
PurposePurpose
Determine the Prognostic Value of Symptom-Limited Determine the Prognostic Value of Symptom-Limited Exercise Testing on Survival in Inoperable NSCLC Exercise Testing on Survival in Inoperable NSCLC PatientsPatients
PurposePurpose
Determine the Prognostic Value of Symptom-Limited Determine the Prognostic Value of Symptom-Limited Exercise Testing on Survival in Inoperable NSCLC Exercise Testing on Survival in Inoperable NSCLC PatientsPatients
MethodMethod
New Patient Rounds via Medical New Patient Rounds via Medical Record ReviewRecord Review
Blood draw/PFT/GXTBlood draw/PFT/GXT
MethodMethod
New Patient Rounds via Medical New Patient Rounds via Medical Record ReviewRecord Review
Blood draw/PFT/GXTBlood draw/PFT/GXT
Jones et al. Jones et al. In ProcessIn ProcessJones et al. Jones et al. In ProcessIn Process
Exercise Capacity & NSCLCExercise Capacity & NSCLC
OutcomesOutcomes
Primary:Primary: Survival Survival
Secondary:Secondary:
-Association with traditional Association with traditional predictorspredictors
-VOVO2peak2peak & Tx response/tolerability & Tx response/tolerability
OutcomesOutcomes
Primary:Primary: Survival Survival
Secondary:Secondary:
-Association with traditional Association with traditional predictorspredictors
-VOVO2peak2peak & Tx response/tolerability & Tx response/tolerability
Jones et al. Jones et al. In ProcessIn ProcessJones et al. Jones et al. In ProcessIn Process
Exercise Capacity & NSCLCExercise Capacity & NSCLC
ProgressProgressProgressProgressTotal Number of Total Number of
Patients ScreenedPatients Screened
N=49N=49
Total Number of Total Number of Patients EligiblePatients Eligible
N=20 (20/49 = 41%)N=20 (20/49 = 41%)
Total Number of Total Number of Patients InterestedPatients Interested
N=12 (12/20 = 65%)N=12 (12/20 = 65%)
Total Number of Total Number of Patients TestedPatients Tested
N=10 (10/12 = 83%)N=10 (10/12 = 83%)
Reasons for Non-Eligibility Reasons for Non-Eligibility (n=29)(n=29)
Recent CHD (n=4)Recent CHD (n=4)Physically Disabled (n=7)Physically Disabled (n=7)TB (n=1)TB (n=1)Age (n=2)Age (n=2)O2 Dependent (n=5)O2 Dependent (n=5)Extensive Met Disease (n=4)Extensive Met Disease (n=4)Psychological Distress (n=2)Psychological Distress (n=2)Co-morbidities (n=4)Co-morbidities (n=4)Non Lung Cancer (n=1)Non Lung Cancer (n=1)No Treatment (n=1)No Treatment (n=1)
Reasons for Non-recruitment Reasons for Non-recruitment (n=8)(n=8)
Does Not Believe in Exercise Does Not Believe in Exercise (n=1)(n=1)Exercise Test Too Risky (n=1)Exercise Test Too Risky (n=1)Too Sick (n=3)Too Sick (n=3)Too Much On (n=3)Too Much On (n=3)
Jones et al. In Process
Jones et al. In Process
Exercise Capacity & NSCLCExercise Capacity & NSCLC
ResultsResults
Age: 71 Age: 71 Range: 64 - 83Range: 64 - 83
VOVO2peak2peak: 16.2: 16.2 Range: 9.4 – 24.3Range: 9.4 – 24.3 RER: 1.2RER: 1.2
BMI: 27BMI: 27 Range: 21 – 35Range: 21 – 35
ResultsResults
Age: 71 Age: 71 Range: 64 - 83Range: 64 - 83
VOVO2peak2peak: 16.2: 16.2 Range: 9.4 – 24.3Range: 9.4 – 24.3 RER: 1.2RER: 1.2
BMI: 27BMI: 27 Range: 21 – 35Range: 21 – 35
Aims:Aims:
Accurate prognostic informationAccurate prognostic information
‘‘Optimal’ therapeutic approachOptimal’ therapeutic approach
Feasibility & safety - RCTFeasibility & safety - RCT
Aims:Aims:
Accurate prognostic informationAccurate prognostic information
‘‘Optimal’ therapeutic approachOptimal’ therapeutic approach
Feasibility & safety - RCTFeasibility & safety - RCT
Pre Surgery Exercise RCTPre Surgery Exercise RCT
Jones et al. Jones et al. In ProgressIn ProgressJones et al. Jones et al. In ProgressIn Progress
OutcomesOutcomes
Primary: Perioperative Complications (infection, OPrimary: Perioperative Complications (infection, O22
utilization, etc.)utilization, etc.)
Secondary: VOSecondary: VO2peak2peak, QOL, length of hospital stay, QOL, length of hospital stay
OutcomesOutcomes
Primary: Perioperative Complications (infection, OPrimary: Perioperative Complications (infection, O22
utilization, etc.)utilization, etc.)
Secondary: VOSecondary: VO2peak2peak, QOL, length of hospital stay, QOL, length of hospital stay
MethodMethod
Surgeon ReferralSurgeon Referral
Two-armed RCT – Exercise Training (n=25) vs. Two-armed RCT – Exercise Training (n=25) vs. Usual Care (n=25)Usual Care (n=25)
AET 4/5x/wk, 10-45mins, 50-75% VOAET 4/5x/wk, 10-45mins, 50-75% VO2peak2peak for 6 wks for 6 wks
MethodMethod
Surgeon ReferralSurgeon Referral
Two-armed RCT – Exercise Training (n=25) vs. Two-armed RCT – Exercise Training (n=25) vs. Usual Care (n=25)Usual Care (n=25)
AET 4/5x/wk, 10-45mins, 50-75% VOAET 4/5x/wk, 10-45mins, 50-75% VO2peak2peak for 6 wks for 6 wks
Timing of Assessments: Timing of Assessments: baseline, pre-sx, 5-7d post sxbaseline, pre-sx, 5-7d post sxTiming of Assessments: Timing of Assessments: baseline, pre-sx, 5-7d post sxbaseline, pre-sx, 5-7d post sx
Other Cancers Other Cancers
Exercise & Anemia Trial Exercise & Anemia Trial
Mackey, Courneya, Jones et al. Funded by Amgen IncMackey, Courneya, Jones et al. Funded by Amgen IncMackey, Courneya, Jones et al. Funded by Amgen IncMackey, Courneya, Jones et al. Funded by Amgen Inc
EXTRA EXTRA ((EXEXercise ercise TRTRaining & aining & AAnemia) Trialnemia) TrialEXTRA EXTRA ((EXEXercise ercise TRTRaining & aining & AAnemia) Trialnemia) Trial
OutcomesOutcomes
Primary: QOL (FACT-An)Primary: QOL (FACT-An)
Secondary: VOSecondary: VO2peak2peak, Hb Response, Blood Markers, Hb Response, Blood Markers
OutcomesOutcomes
Primary: QOL (FACT-An)Primary: QOL (FACT-An)
Secondary: VOSecondary: VO2peak2peak, Hb Response, Blood Markers, Hb Response, Blood Markers
PurposePurpose
Determine if a 12-wk exercise program can improve QOL Determine if a 12-wk exercise program can improve QOL in anemic patients receiving Aranespin anemic patients receiving Aranesp
PurposePurpose
Determine if a 12-wk exercise program can improve QOL Determine if a 12-wk exercise program can improve QOL in anemic patients receiving Aranespin anemic patients receiving Aranesp
MethodMethod
Two-armed RCT – Aranesp Alone (n=50) vs. Aranesp + Two-armed RCT – Aranesp Alone (n=50) vs. Aranesp + Exercise (n=50)Exercise (n=50)
Periodized Cycle Ergometry 3x/wk, 30-45mins, 60-75% Periodized Cycle Ergometry 3x/wk, 30-45mins, 60-75% VOVO2peak2peak for 12 wks for 12 wks
MethodMethod
Two-armed RCT – Aranesp Alone (n=50) vs. Aranesp + Two-armed RCT – Aranesp Alone (n=50) vs. Aranesp + Exercise (n=50)Exercise (n=50)
Periodized Cycle Ergometry 3x/wk, 30-45mins, 60-75% Periodized Cycle Ergometry 3x/wk, 30-45mins, 60-75% VOVO2peak2peak for 12 wks for 12 wks
EXTRA Trial EXTRA Trial
ResultsResults
Age: 51 Age: 51 Range: 25 - 71Range: 25 - 71
VOVO2peak2peak: 16.5: 16.5 Range: 11 – 25.3Range: 11 – 25.3 RER: 1.23RER: 1.23
Hb: 100Hb: 100 Range: 91 - 107Range: 91 - 107
ResultsResults
Age: 51 Age: 51 Range: 25 - 71Range: 25 - 71
VOVO2peak2peak: 16.5: 16.5 Range: 11 – 25.3Range: 11 – 25.3 RER: 1.23RER: 1.23
Hb: 100Hb: 100 Range: 91 - 107Range: 91 - 107
PurposePurpose
Examine the Potential Role of Exercise in Multiple Examine the Potential Role of Exercise in Multiple Myeloma Cancer PatientsMyeloma Cancer Patients
PurposePurpose
Examine the Potential Role of Exercise in Multiple Examine the Potential Role of Exercise in Multiple Myeloma Cancer PatientsMyeloma Cancer Patients
ObjectivesObjectives
1.1. Exercise preferences/level of interestExercise preferences/level of interest
2.2. Exercise RatesExercise Rates
3.3. Determinants of exercise (attitudes, perceived Determinants of exercise (attitudes, perceived capability)capability)
4.4. Association with QOL & fatigueAssociation with QOL & fatigue
ObjectivesObjectives
1.1. Exercise preferences/level of interestExercise preferences/level of interest
2.2. Exercise RatesExercise Rates
3.3. Determinants of exercise (attitudes, perceived Determinants of exercise (attitudes, perceived capability)capability)
4.4. Association with QOL & fatigueAssociation with QOL & fatigue
Multiple MyelomaMultiple Myeloma
Jones et al. In Process
Jones et al. In Process
Exercise & Multiple MyelomaExercise & Multiple MyelomaExercise & Multiple MyelomaExercise & Multiple Myeloma
MethodMethod
Cross-sectional provincial survey – ACB registryCross-sectional provincial survey – ACB registry
Oncologist-approval Oncologist-approval
162 sent questionnaire162 sent questionnaire
MethodMethod
Cross-sectional provincial survey – ACB registryCross-sectional provincial survey – ACB registry
Oncologist-approval Oncologist-approval
162 sent questionnaire162 sent questionnaire
ResultsResults
11 returned (6 deceased, 5 moved)11 returned (6 deceased, 5 moved)
87 (87/151 = 58%) completed questionnaire87 (87/151 = 58%) completed questionnaire
ResultsResults
11 returned (6 deceased, 5 moved)11 returned (6 deceased, 5 moved)
87 (87/151 = 58%) completed questionnaire87 (87/151 = 58%) completed questionnaire
Jones et al. In Process
Jones et al. In Process
Exercise & Glioma RCTExercise & Glioma RCT
PurposePurpose
To determine the effect of exercise training on QOL in To determine the effect of exercise training on QOL in newly diagnosed primary glioma cancer patients newly diagnosed primary glioma cancer patients during RTduring RT
PurposePurpose
To determine the effect of exercise training on QOL in To determine the effect of exercise training on QOL in newly diagnosed primary glioma cancer patients newly diagnosed primary glioma cancer patients during RTduring RT
Jones et al. Submitted for Funding CIHR/ACBJones et al. Submitted for Funding CIHR/ACB Jones et al. Submitted for Funding CIHR/ACBJones et al. Submitted for Funding CIHR/ACB
MethodMethod
Two-armed RCT: usual care (n=12) vs. exercise training Two-armed RCT: usual care (n=12) vs. exercise training (n=12)(n=12)
MethodMethod
Two-armed RCT: usual care (n=12) vs. exercise training Two-armed RCT: usual care (n=12) vs. exercise training (n=12)(n=12)
InterventionIntervention
3x/wk; 60-90 minutes, 8wks3x/wk; 60-90 minutes, 8wks
AET: 50-70% VOAET: 50-70% VO2peak2peak
RET: 8-12 repetitions @ 70-80% 1-RM of 8 upper/lower RET: 8-12 repetitions @ 70-80% 1-RM of 8 upper/lower body exercisesbody exercises
InterventionIntervention
3x/wk; 60-90 minutes, 8wks3x/wk; 60-90 minutes, 8wks
AET: 50-70% VOAET: 50-70% VO2peak2peak
RET: 8-12 repetitions @ 70-80% 1-RM of 8 upper/lower RET: 8-12 repetitions @ 70-80% 1-RM of 8 upper/lower body exercisesbody exercises
SummarySummary
ACSM Guidelines – Early Stage PatientsACSM Guidelines – Early Stage PatientsACSM Guidelines – Early Stage PatientsACSM Guidelines – Early Stage Patients
Integral component of comprehensive care Integral component of comprehensive care for cancer patientsfor cancer patients
Integral component of comprehensive care Integral component of comprehensive care for cancer patientsfor cancer patients
Advanced Cancer Pts – More Care Advanced Cancer Pts – More Care Advanced Cancer Pts – More Care Advanced Cancer Pts – More Care
Safety primary concernSafety primary concernSafety primary concernSafety primary concern