Mindful Exercise, Mindful Exercise, Quality of Life, and Quality of Life, and

CancerCancerA Mindfulness- Based A Mindfulness- Based

Exercise Rehabilitation Exercise Rehabilitation Program for Women with Program for Women with

Breast CancerBreast Cancer

Anna M. Tacon, Ph. D. Anna M. Tacon, Ph. D.

Learning ObjectivesLearning Objectives

Learning ObjectivesLearning Objectives After completing this chapter you should After completing this chapter you should

have and understanding of:have and understanding of: increased use of mind-body therapies n increased use of mind-body therapies n

cancercancer breast cancer patients’ use of complementary breast cancer patients’ use of complementary

therapiestherapies the concept of mindfulness as well as the the concept of mindfulness as well as the

mindfulness-based stress reduction programmindfulness-based stress reduction program quality-of-life factors in cancer especially quality-of-life factors in cancer especially

cancer-related fatiguecancer-related fatigue the benefits of exercise as a complementary the benefits of exercise as a complementary

therapy in cancertherapy in cancer

IntroductionIntroduction Breast CancerBreast Cancer

most common cancer among women, most common cancer among women, accounting for nearly 1 in 3 cancers accounting for nearly 1 in 3 cancers diagnosed in the U.S.diagnosed in the U.S.

Considered to elicit greater distress than Considered to elicit greater distress than any other diagnosis, regardless of the any other diagnosis, regardless of the prognosis, including depression and anxietyprognosis, including depression and anxiety

There is an increase in patients seeking There is an increase in patients seeking complementary or mind- body therapies to complementary or mind- body therapies to help them copehelp them cope

Patients must endure harsh treatment Patients must endure harsh treatment effectseffects

Moderate physical activity is also suggested Moderate physical activity is also suggested for therapy for therapy

Mind-Body Medicine, Mind-Body Medicine, Integrated Care, and Integrated Care, and

MindfulnessMindfulness Mind-body medicine should be part of an Mind-body medicine should be part of an

evidence based, cost-effective, quality evidence based, cost-effective, quality health carehealth care Psycho-physiological, psychosocial, Psycho-physiological, psychosocial,

educational interventions for patient distresseducational interventions for patient distress Mindfulness meditationMindfulness meditation

Involves including rather than excluding Involves including rather than excluding stimuli from the field of consciousnessstimuli from the field of consciousness

Provides means of self-monitoring and self-Provides means of self-monitoring and self-regulating one's arousal with detached regulating one's arousal with detached awareness.awareness.

The Concept of Mindfulness and The Concept of Mindfulness and the Programthe Program

Mindfulness-based stress reduction Mindfulness-based stress reduction program (MBSR)program (MBSR) Once/week for 2 hours over 8 weeksOnce/week for 2 hours over 8 weeks Mindful awareness, being in the present Mindful awareness, being in the present

moment, or just paying attention to nowmoment, or just paying attention to now

The Concept of Mindfulness and the The Concept of Mindfulness and the Program Cont’Program Cont’

Training in several basic practices of Training in several basic practices of mindfulness meditations:mindfulness meditations:

1.1. Body scanBody scan: journey through geography of he : journey through geography of he physical formphysical form

2.2. Hatha yogaHatha yoga: stretches and postures to strengthen : stretches and postures to strengthen and stretch the musculoskeletal system and develop and stretch the musculoskeletal system and develop mindful movement mindful movement

3.3. Sitting meditationSitting meditation: attention to breath and other : attention to breath and other psychophysical perceptionpsychophysical perception

4.4. Walking meditationWalking meditation: cognitive-behavioral practice : cognitive-behavioral practice of paying attention to all physical sensations and of paying attention to all physical sensations and fluctuations in a concentrative awareness during fluctuations in a concentrative awareness during walkingwalking

Research on MBSRResearch on MBSR

Effective in reducing levels of stress Effective in reducing levels of stress and anxiety, chronic pain and and anxiety, chronic pain and fibromyalgiafibromyalgia

Improvements pre-post quality of life, Improvements pre-post quality of life, significant positive shifts in mood, significant positive shifts in mood, coping, health locus of control, and coping, health locus of control, and mental adjustment to cancermental adjustment to cancer

Significant positive shift in overall Significant positive shift in overall immune profileimmune profile

Exercise Therapy for Exercise Therapy for CancerCancer

30 minutes of moderate activity 5 or 30 minutes of moderate activity 5 or more days per week can help more days per week can help prevent chronic diseases like cancerprevent chronic diseases like cancer

Exercise is gaining acceptance as a Exercise is gaining acceptance as a major quality of life rehab major quality of life rehab intervention for cancer survivorsintervention for cancer survivors

Exercise, Quality of Life, Exercise, Quality of Life, and Cancerand Cancer

Cancer treatments and the process Cancer treatments and the process of cancer can destroy a persons of cancer can destroy a persons quality of lifequality of life

Exercise can increase the quality of Exercise can increase the quality of life even during high dose cancer life even during high dose cancer treatmentstreatments

Exercise, Quality of Life, Exercise, Quality of Life, and Cancerand Cancer

Exercises prescription for those with Exercises prescription for those with moderate-intensity exercise includes:moderate-intensity exercise includes: 3 to 5 time a week3 to 5 time a week 20 to 30 minutes per session20 to 30 minutes per session Walking most preferred Walking most preferred

High-intensity exercise should be High-intensity exercise should be avoided during cancer treatment avoided during cancer treatment because of potential because of potential immunosuppressive effectsimmunosuppressive effects

Cancer-Related Fatigue and Cancer-Related Fatigue and Exercise: Definition and Exercise: Definition and

RationaleRationale Most common symptom of cancer patients is Most common symptom of cancer patients is

fatigue fatigue which can be even more distressing and disruptive which can be even more distressing and disruptive

to a patient’s daily activities than the pain to a patient’s daily activities than the pain associated cancerassociated cancer

Fatigue may affect patient’s ability to tolerate Fatigue may affect patient’s ability to tolerate treatmentstreatments Treatments may be delayed which impacts disease Treatments may be delayed which impacts disease

progressionprogression Exercise training stops the loss and even Exercise training stops the loss and even

increases functional capacity which reduced increases functional capacity which reduced effort and decreased fatigue at any leveleffort and decreased fatigue at any level

SummarySummary

Evidence exists to support that both Evidence exists to support that both Mindfulness-based stress reduction Mindfulness-based stress reduction programs and exercise rehabilitation programs and exercise rehabilitation are two complementary therapies are two complementary therapies that can produce positive effects for that can produce positive effects for those with cancerthose with cancer

Mindfulness-Based Exercise Mindfulness-Based Exercise Rehabilitation Program Rehabilitation Program

(MBER)(MBER) Format and StructureFormat and Structure

Prior to program, women be cleared by Prior to program, women be cleared by physicianphysician

Baseline physical fitness assessment Baseline physical fitness assessment conductedconducted

Mindfulness-Based Exercise Mindfulness-Based Exercise Rehabilitation Program Rehabilitation Program

(MBER)(MBER) Format and StructureFormat and Structure

First 8 weeks:First 8 weeks: Same basic format and mindfulness practice of original Same basic format and mindfulness practice of original

program (modified program for cancer patients also)program (modified program for cancer patients also) Participants meet 2 hours, 1 night per week for 8 Participants meet 2 hours, 1 night per week for 8

weeks, where exposed to:weeks, where exposed to: Didactic, inductive, and experiential modes of learning Didactic, inductive, and experiential modes of learning

mindfulness strategiesmindfulness strategies

6- week exercise program showed 6- week exercise program showed improvementimprovement

Expected to perform daily “homework” that Expected to perform daily “homework” that emphasizes strategies learned in the emphasizes strategies learned in the sessionssessions

Session ContentsSession Contents

Weeks 1 & 2Weeks 1 & 2 At the first session:At the first session: Reasons for participating are shared and Reasons for participating are shared and

overview of the intervention is presentedoverview of the intervention is presented To ease participants fear about unrealistic To ease participants fear about unrealistic

expectationsexpectations Let participants know that they will be at a Let participants know that they will be at a

different place with different abilities and different place with different abilities and limitations. limitations.

The body scan is introduced laying on matsThe body scan is introduced laying on mats

Session ContentsSession Contents

First Session cont’First Session cont’ Meditation is used to get women Meditation is used to get women

reacquainted with their bodies, especially if reacquainted with their bodies, especially if treatment has changed the body landscapetreatment has changed the body landscape

The assigned homework for the first week:The assigned homework for the first week: to do the guided body scan on the first to do the guided body scan on the first

audiocassette tape (45 min) at least 5 days/weekaudiocassette tape (45 min) at least 5 days/week 15 minutes of walking at a moderate pace at 50-15 minutes of walking at a moderate pace at 50-

70% of their maximum heart rate 70% of their maximum heart rate

Session ContentsSession Contents

Second SessionSecond Session Participants discuss the previous week’s Participants discuss the previous week’s

homework and share their experienceshomework and share their experiences The women participate in experimental The women participate in experimental

exercise of mindfulness eating known as exercise of mindfulness eating known as the raisin exercisethe raisin exercise

Two purposes:Two purposes:1.1. Reinforce idea that meditation is a natural act of Reinforce idea that meditation is a natural act of

paying attention and that there is nothing mysterious paying attention and that there is nothing mysterious about itabout it

2.2. Initiate the topic of food and nutrition in the context of Initiate the topic of food and nutrition in the context of cancer and exercisecancer and exercise

Session ContentsSession Contents

Second Session Cont’Second Session Cont’ Sitting meditation is presentedSitting meditation is presented Mindful walking is then presented where Mindful walking is then presented where

they pay close attention to all sensations they pay close attention to all sensations involved during this daily, routine activityinvolved during this daily, routine activity

The assigned homework for the second The assigned homework for the second sessionsession continue the body scan as per the previous continue the body scan as per the previous

weekweek increase daily walking to 25 minutesincrease daily walking to 25 minutes add 15 minutes of sitting meditation daily at add 15 minutes of sitting meditation daily at

least 5 days/weekleast 5 days/week

Session ContentsSession Contents Weeks 3 & 4Weeks 3 & 4

Week 3Week 3 walking mediation is followed by Hatha yoga walking mediation is followed by Hatha yoga then an increased period of sitting meditationthen an increased period of sitting meditation

Homework assigned for week 3:Homework assigned for week 3: tape 1 of a 45 minute guided yoga routine as tape 1 of a 45 minute guided yoga routine as

daily practicedaily practice

Session ContentsSession Contents

Week 4Week 4 the topic of stress and the physiological the topic of stress and the physiological

stress response is presented with a stress response is presented with a discussion of mindfully tuning in to the discussion of mindfully tuning in to the body’s languagebody’s language

Homework assigned for week 4:Homework assigned for week 4: continue tape 1 of yogacontinue tape 1 of yoga brisk walking of now 40 minutes per day, at brisk walking of now 40 minutes per day, at

least 5 day/weekleast 5 day/week alternate 30 minutes of meditation daily alternate 30 minutes of meditation daily

with 30 minutes of mindfulness eatingwith 30 minutes of mindfulness eating

Session ContentsSession Contents

Weeks 5 & 6Weeks 5 & 6 Different yoga asanas introducedDifferent yoga asanas introduced Homework assigned for weeks 5 & 6Homework assigned for weeks 5 & 6

tape 2 is of a new 45-minute guided yoga tape 2 is of a new 45-minute guided yoga routine dailyroutine daily

Brisk walking is 45 minutes per day at least Brisk walking is 45 minutes per day at least 5 days/week5 days/week

alternate 30 minutes of sitting meditation alternate 30 minutes of sitting meditation daily with 30 minutes of mindfulness eatingdaily with 30 minutes of mindfulness eating

Session ContentsSession Contents

Weeks 7 & 8Weeks 7 & 8 Last 2 sessions involve discussing the Last 2 sessions involve discussing the

primary mental attitudes of coping with primary mental attitudes of coping with cancer and exploring issues of internal cancer and exploring issues of internal versus external locus of control and versus external locus of control and irrational beliefsirrational beliefs

Mindfulness-based strategies are reviewed Mindfulness-based strategies are reviewed and discussed in terms of being applied to and discussed in terms of being applied to stressful, real life situation and challengesstressful, real life situation and challenges

The purpose is say that “quality” of life takes The purpose is say that “quality” of life takes workwork

Session ContentsSession Contents

Weeks 7 & 8 cont’Weeks 7 & 8 cont’ Homework assigned for weeks 7 & 8:Homework assigned for weeks 7 & 8:

alternating 45 minutes of daily brisk walking with alternating 45 minutes of daily brisk walking with 45 minutes of yoga45 minutes of yoga

Alternating 45 minutes of daily sitting meditation Alternating 45 minutes of daily sitting meditation with the body scan or with mindful eating as with the body scan or with mindful eating as desireddesired

Finally, the role of conscious awareness in Finally, the role of conscious awareness in exercise motivation and behavioral exercise motivation and behavioral maintenance are discussed along with the maintenance are discussed along with the needed commitment to healthy lifestyle needed commitment to healthy lifestyle choiceschoices