copyright © 2010 delmar, cengage learning. all rights reserved. chapter 15 resistance-training...
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Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Chapter 15
Resistance-Training Strategies for Individuals with Cancer
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Cancer
• Disease family marked by unregulated cell growth and proliferation
• Can affect virtually any bodily organ or system
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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
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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
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Prevalence of Cancer
• Most common cancers per 100,000 people:– Prostate = 72
– Breast = 68.5
– Lung = 63.9
– Colorectal = 50.6
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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
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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
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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
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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)
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Benefits of Resistance Training
• Physical activity:– Aids recovery process
– Is key to prevention
– Maintains strength
– Slows rate of age-related decline
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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
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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
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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
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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
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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
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Training During Treatment
• Treatment may place limitations on individual’s ability, ROM, or energy levels
• Identify individualized goals
• Steady, regular progress may be unrealistic
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Training During Treatment
• Multiple assessments useful for measuring performance improvement/decrements
• Consider individual’s cancer staging
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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
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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
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Comorbidities of Older Adults with Cancer
• May include:– Sarcopenia
– Decreased metabolic rate
– Reduced bone density
– Reduced insulin sensitivity
– Decreased aerobic capacity
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Comorbidities of Older Adults with Cancer
• May include:– Obesity
– Diabetes
– High cholesterol
– Hypertension
– Heart disease
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Side Effects of Cancer Treatments
• Toxic impact of chemotherapy or radiation on body
• Pain
• Fatigue
• Sleep problems
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Side Effects of Cancer Treatments
• Lymphedema
• Psychological issues– E.g., depression
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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
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Involve Individual in Goal Planning
• Develop short-term, manageable goals– Instead of long-term goals
• Consider using “intention” instead of “goal”
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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
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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
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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
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ACSM Recommendations
• Teach correct form and breathing with minimal resistance
• Control ECC and CON contractions to avoid bouncing and promote smooth, deliberate movements
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ACSM Recommendations
• Perform all movements in pain-free manner, making adjustments as needed
• Begin with minimal resistance to allow for adaptation and ROM assessment