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Haem-Fit: an exercise and wellness program
Casey HutchinsonClinical Nurse Educator
Oncology/HaematologyCalvary Mater Newcastle
Difference between activity and exercise‘Physical activity’ is defined as any bodily movement produced by skeletal muscles that results in energy expenditure.
‘Exercise’ is a subset of physical activity that is planned, structured, and repetitive. The objective is to improve or maintain physical fitness.
Impact of exercise for patients
• Quicker recovery• Decrease length of hospital stay• Reduce muscle wastage• Maintain independence• Return to normal activities• Increased quality of life• Lower risk of falls• Lower risk of re-admission• Improved treatment completion
Giovannucci EL. Physical activity as a standard cancer treatment. J Natl Cancer Inst. 2012;104(11):797–9
Gap between evidence and practice
Within the Haematology inpatient ward education and promotion of exercise is not widely included as a component of usual care and referrals to supportive services are made on a ‘reactive’ rather than ‘proactive’ basis.
Investigators Lisa Lincz (Senior Research Officer)Ben Britton (Senior Clinical & Health Psychologist)Kerrie Clover (Research Manager, Clinical Psychologist Conjoint Associate Professor)Casey Hutchinson (Clinical Nurse Educator)Louisa Brown (Bone Marrow Transplant coordinator)Jackie Wykes (Lymphoma Care Coordinator)Megan Jackson (Dietician)Judy Holland (Physiotherapist)Alix Hall (Research Associate)Phil Rowlings (Director Haematology)
FundingApplied for funding HCRA Implementation Science Flagship Program 2017
HNE Priority Research Area that the project addressed: • Evidence-based exercise program for people
undergoing cancer treatment • Evaluating the utility of a hospital follow-up for cancer
patients post-discharge or post-treatment • Embedding PROMs or distress screening into patient
care
Wellness and Exercise ProgramPhase 1: Wellness and Exercise Survey (WES)Survey of haematology in-patients during a 3 month pre-implementation phase (Aug – Oct 2017; HNEHREC 17/06/21/5.07)
Phase 2: Implementation of Haem-FitHaem-Fit: Exercise and Wellness Program for Haematology Cancer Patients (Feb- May 2018; HNEHREC 17/12/13/5.15)
Eligibility Inclusion criteriaAll haematology cancer patient admissions with ≥7 days anticipated length of stay
Exclusion criteriaPeople with artificial electrical implants such as a defibrillator or pacemaker will be excluded from inBody570 testing
Phase 1: WESOn admission patients complete:
a) Inbody570 testingb) Questionnaires (QLQ-C30 & HADS)
At discharge patients complete:a) Inbody570 testingb) Questionnaires (QLQ-C30 & HADS) c) Survey to self-report mobility status and provide feedback about the
exercise program
*All participants received current standard of care without addition of a structured exercise program.
Phase 2: Haem-FitOn admission patients complete:
a) Inbody570 testingb) Questionnaires (QLQ-C30 & HADS) c) Consultation with physiotherapistd) Consultation with Dietician
During admission patients: a) Complete daily exercise goals, record activity in exercise diary
At discharge patients complete:a) Inbody570 testingb) Questionnaires (QLQ-C30 & HADS) c) Survey to self-report mobility status and provide feedback about the
exercise program
Follow up phone call 7-10 days post
OutcomesImplementation OutcomesPrimary: • Rate of patient adherence (patient diaries)Secondary:• Rate of patient accrual (#eligible vs #consented)• Patient satisfaction with the program (patient questionnaire and follow up
phone call)• Rate of patient continuation of program at 1 week post discharge (self report
by follow up phone call)Patient outcomes (evaluation of the program)Primary: • Difference in lean muscle mass between admission and discharge (inBody
570)Secondary:• admission vs discharge levels of mobility and QoL (HADS, QLQ-C30, self
reported mobility scales)
ExercisesTricep dips
Easy: 2 x 5 reps daily
Lying down use hand weights or water bottles. Lift arms above head (as shown) and slowly bend elbows so the hands come down next to your head. Then slowly raise again to above head. Recommended level if you have a PICC or port-a-cath
Moderate: 2 x 10 reps daily
Sitting down, position your hands shoulder width apart on the arm of a stable chair. Straighten your arms, pushing your bottom up off the chair. Slowly bend your elbows to lower your bottom back towards the chair.
Difficult: 1 x 20 reps daily
Place your arms shoulder width apart on a stable seat (as shown). Shift your bottom forward off the seat with arms straight. Bending elbows to lower your body towards the ground until elbows are about 90 degrees then push up again until the arms are straight. Keep your back close to the seat throughout.
Punching in front
Easy: 1 x 10 reps each arm.
Sit comfortably with legs shoulder width apart. Holding arms like you are going to punch someone. Reaching out one arm at a time and then back in repeat action with the other arm. Repeat action. No weight
Moderate: 2 x 10 reps each arm.
Stand or sit comfortably with legs shoulder width apart. Hold a light weight – 600ml bottle of water. Holding arms like you are going to punch someone. Reaching out one arm at a time and then back in repeat action with the other arm. Repeat action.
Difficult: 3 x 10 reps each arm.
Stand comfortably with legs shoulder width apart. Make the weight heavier. At home, fill the bottle with sand or rice.
Patient demographicsWES (N=16) Haem-Fit (N=11) p-value
M:F 10:6 6:5 0.6794
Age (years) 58.13 ± 13.26 49.91 ± 16.84 0.1685
Smokers 0 0
Haematological condition AML 5 (31%) 4 (36%) 0.7818
NHL 4 (25%) 2 (18%) 0.6754
MM 2 (12%) 2 (18%) 0.6830
T-ALL 1 (<10%) 1 (<10%) 0.7818
B-ALL 1 (<10%) 0 0.3981
CMML 1 (<10%) 0 0.3981
AMML 1 (<10%) 0 0.3981
CLL 1 (<10%) 0 0.3981
HD 0 1 (<10%) 0.2191
MDS/AML 0 1 (<10%) 0.2191
Length of hospital stay 21.3 ± 12.3 22.9 ± 6.3 0.6621
Prior admission within last 28 days 10 (63%) 1 (<10%) 0.0055
Results
WES (N=16) Haem-Fit (N=11)
Mean ± stdev Mean ± stdev p-value
Weight (kg) 79.14 ± 21.45 84.98 ± 26.29 0.5313
BMI 27.54 ± 5.42 29.24 ± 11.20 0.6480
Skeletal muscle mass (kg)
28.32 ± 6.4032.32 ± 9.06 0.1900
Segmental muscle mass:
trunk 23.14 ± 5.08 25.29 ± 6.66 0.3492
right arm 2.87 ± 0.84 3.24 ± 1.13 0.3292
Left arm 2.83 ± 0.82 3.17 ± 1.09 0.3766
Right leg 8.16 ± 2.27 9.02 ± 2.34 0.3480
Left leg 8.04 ± 2.15 9.00 ± 2.28 0.2776
% body fat 32.20 ± 10.24 28.68 ± 12.27 0.4259
QLQ30 summary score
66.35 ± 13.53 66.46 ± 17.24 0.9849
Anxiety score (HADS)
5.44 ± 3.20 6.81 ± 2.40 0.2370
Depression score (HADS)
4.50 ± 3.08 5.91 ± 4.09 0.3159
WES (N=16) Haem-Fit (N=10)
Mean ± stdev Mean ± stdev p-value
Weight (kg) -2.07 ± 3.78* -3.25 ± 2.19** 0.3814
BMI -2.14 ± 3.78* -3.25 ± 2.19** 0.4091
Skeletal muscle
mass (kg)
-3.88 ± 6.21* -4.62 ± 3.12** 0.6920
Segmental muscle
mass:
trunk -3.39 ± 6.77* -3.96 ± 4.15* 0.8126
right arm -4.19 ± 10.75 -5.60 ± 5.09** 0.6569
Left arm -4.66 ± 13.10 -5.11 ± 6.71* 0.9104
Right leg -2.66 ± 6.52 -2.72 ± 4.44 0.9804
Left leg -1.23 ± 8.07 -2.02 ± 2.94 0.7244
% body fat 2.19 ± 10.44 1.43 ± 6.10 0.8374
QLQ30 summary
score
-3.81 ± 19.30 -11.11 ± 25.35 0.4133
Anxiety score
(HADS)
38.65 ± 215.30 -18.8 ± 43.00 0.3152
Depression score
(HADS)
5.82 ± 60.69 61.41 ± 297.72 0.5736
Patient status at discharge compared to admission (% change)Patient status at time of admission
* p<0.05, **p<0.01
-10
-5
0
5% change in skeletal muscle mass
-15
-10
-5
0
5
10
15% change in skeletal muscle mass
Patient feedback• It was good motivation to get up and complete set activities. Helpful for both physical and mental health• My last visit to hospital I got quite a bit of fluid. I feel because of exercise program, this was not a major problem this visit.• The program gives you something to focus on each day as a positive, and after doing program you feel like you have accomplished something for yourself.• Something to focus on and maintain strength.• I think it is a great idea and gives patients that little push to do something extra.
• Muscles weren't as weak compared to first admission. • Felt in much better condition when he was d/c
Have you been able to integrate the exercise program into your daily routine at home?
• Patient been walking and other activities. Plan to reinstate program
on next admission. • Normally active person. Returned to normal activities. Incorporated resistance exercise with weights. Likes to swim, go to gym. • Not the same program but has been keeping active. Normally active in day-day work. Doesn't participate in dedicated/gym based exercise.• Walking and stretching, lunges, push-ups, yoga. Not specifically the program.• Continued with normal activities when got home.• Resumed normal activities - work physically active. Normal behaviours - doesn't do dedicated exercise.
Would you recommend this program to other patients?
100% answered YES
• Routine (provides). Something patient could do for self. Motivation. Good for physical and mental health.• Importance for focus on being well.• Found helpful - wasn't damaging.• Good for young pts.• Definitely. Gives motivation and obviously beneficial.
Exercise promotioninitiatives