Mindful Exercise, Quality of Life, and Cancer

1. Mindful Exercise, Quality of Life, and Cancer A Mindfulness- Based Exercise Rehabilitation Program for Women with Breast Cancer Anna M. Tacon, Ph. D.

2. Learning Objectives Learning Objectives • After completing this chapter you should have and understanding of: • increased use of mind-body therapies n cancer • breast cancer patients’ use of complementary therapies • the concept of mindfulness as well as the mindfulness-based stress reduction program • quality-of-life factors in cancer especially cancer-related fatigue • the benefits of exercise as a complementary therapy in cancer

3. Introduction • Breast Cancer • most common cancer among women, accounting for nearly 1 in 3 cancers diagnosed in the U.S. • Considered to elicit greater distress than any other diagnosis, regardless of the prognosis, including depression and anxiety • There is an increase in patients seeking complementary or mind- body therapies to help them cope • Patients must endure harsh treatment effects • Moderate physical activity is also suggested for therapy

4. Mind-Body Medicine, Integrated Care, and Mindfulness • Mind-body medicine should be part of an evidence based, cost-effective, quality health care • Psycho-physiological, psychosocial, educational interventions for patient distress • Mindfulness meditation • Involves including rather than excluding stimuli from the field of consciousness • Provides means of self-monitoring and self-regulating one's arousal with detached awareness.

5. The Concept of Mindfulness and the Program • Mindfulness-based stress reduction program (MBSR) • Once/week for 2 hours over 8 weeks • Mindful awareness, being in the present moment, or just paying attention to now

6. The Concept of Mindfulness and the Program Cont’ • Training in several basic practices of mindfulness meditations: • Body scan: journey through geography of he physical form • Hatha yoga: stretches and postures to strengthen and stretch the musculoskeletal system and develop mindful movement • Sitting meditation: attention to breath and other psychophysical perception • Walking meditation: cognitive-behavioral practice of paying attention to all physical sensations and fluctuations in a concentrative awareness during walking

7. Research on MBSR • Effective in reducing levels of stress and anxiety, chronic pain and fibromyalgia • Improvements pre-post quality of life, significant positive shifts in mood, coping, health locus of control, and mental adjustment to cancer • Significant positive shift in overall immune profile

8. Exercise Therapy for Cancer • 30 minutes of moderate activity 5 or more days per week can help prevent chronic diseases like cancer • Exercise is gaining acceptance as a major quality of life rehab intervention for cancer survivors

9. Exercise, Quality of Life, and Cancer • Cancer treatments and the process of cancer can destroy a persons quality of life • Exercise can increase the quality of life even during high dose cancer treatments

10. Exercise, Quality of Life, and Cancer • Exercises prescription for those with moderate-intensity exercise includes: • 3 to 5 time a week • 20 to 30 minutes per session • Walking most preferred • High-intensity exercise should be avoided during cancer treatment because of potential immunosuppressive effects

11. Cancer-Related Fatigue and Exercise: Definition and Rationale • Most common symptom of cancer patients is fatigue • which can be even more distressing and disruptive to a patient’s daily activities than the pain associated cancer • Fatigue may affect patient’s ability to tolerate treatments • Treatments may be delayed which impacts disease progression • Exercise training stops the loss and even increases functional capacity which reduced effort and decreased fatigue at any level

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

13. Mindfulness-Based Exercise Rehabilitation Program (MBER) • Format and Structure • Prior to program, women be cleared by physician • Baseline physical fitness assessment conducted

14. Mindfulness-Based Exercise Rehabilitation Program (MBER) • Format and Structure • First 8 weeks: • Same basic format and mindfulness practice of original program (modified program for cancer patients also) • Participants meet 2 hours, 1 night per week for 8 weeks, where exposed to: • Didactic, inductive, and experiential modes of learning mindfulness strategies • 6- week exercise program showed improvement • Expected to perform daily “homework” that emphasizes strategies learned in the sessions

15. Session Contents • Weeks 1 & 2 • At the first session: • Reasons for participating are shared and overview of the intervention is presented • To ease participants fear about unrealistic expectations • Let participants know that they will be at a different place with different abilities and limitations. • The body scan is introduced laying on mats

16. Session Contents • First Session cont’ • Meditation is used to get women reacquainted with their bodies, especially if treatment has changed the body landscape • The assigned homework for the first week: • to do the guided body scan on the first audiocassette tape (45 min) at least 5 days/week • 15 minutes of walking at a moderate pace at 50-70% of their maximum heart rate

17. Session Contents • Second Session • Participants discuss the previous week’s homework and share their experiences • The women participate in experimental exercise of mindfulness eating known as the raisin exercise • Two purposes: • Reinforce idea that meditation is a natural act of paying attention and that there is nothing mysterious about it • Initiate the topic of food and nutrition in the context of cancer and exercise

18. Session Contents • Second Session Cont’ • Sitting meditation is presented • Mindful walking is then presented where they pay close attention to all sensations involved during this daily, routine activity • The assigned homework for the second session • continue the body scan as per the previous week • increase daily walking to 25 minutes • add 15 minutes of sitting meditation daily at least 5 days/week

19. Session Contents • Weeks 3 & 4 • Week 3 • walking mediation is followed by Hatha yoga • then an increased period of sitting meditation • Homework assigned for week 3: • tape 1 of a 45 minute guided yoga routine as daily practice

20. Session Contents • Week 4 • the topic of stress and the physiological stress response is presented with a discussion of mindfully tuning in to the body’s language • Homework assigned for week 4: • continue tape 1 of yoga • brisk walking of now 40 minutes per day, at least 5 day/week • alternate 30 minutes of meditation daily with 30 minutes of mindfulness eating

21. Session Contents • Weeks 5 & 6 • Different yoga asanas introduced • Homework assigned for weeks 5 & 6 • tape 2 is of a new 45-minute guided yoga routine daily • Brisk walking is 45 minutes per day at least 5 days/week • alternate 30 minutes of sitting meditation daily with 30 minutes of mindfulness eating

22. Session Contents • Weeks 7 & 8 • Last 2 sessions involve discussing the primary mental attitudes of coping with cancer and exploring issues of internal versus external locus of control and irrational beliefs • Mindfulness-based strategies are reviewed and discussed in terms of being applied to stressful, real life situation and challenges • The purpose is say that “quality” of life takes work

23. Session Contents • Weeks 7 & 8 cont’ • Homework assigned for weeks 7 & 8: • alternating 45 minutes of daily brisk walking with 45 minutes of yoga • Alternating 45 minutes of daily sitting meditation with the body scan or with mindful eating as desired • Finally, the role of conscious awareness in exercise motivation and behavioral maintenance are discussed along with the needed commitment to healthy lifestyle choices