LUNG CANCER & EXERCISE

1. LUNG CANCER & EXERCISE Cindy Maruna PT

2. Goals of Today’s Discussion • Benefits of Exercise • General Exercise Recommendations • Contraindications/Precautions • Breathing Techniques

3. Benefits of Exercise • Decreases emotional stress, BP, duration of neutropenia & thrombocytopenia, and pain • Increases/improves quality of life (QOL), max O2 uptake during exertion, sleep patterns & cognition • QOL issues – weight gain, muscle atrophy & cancer related fatigue

4. Stricker, et al 2004 • Exercise training at moderate levels were reported to improve cardiorespiratory response, increase cardiac output, improve mood state & sleep quality; decrease HR & fatigue

5. Cancer Related Fatigue • Definition: “a persistent, subjective sense of tiredness related to cancer or cancer treatment that interferes with usual functioning” (National Comprehensive Cancer Network) • Described as intense, chronic & disruptive symptom unrelieved by rest

6. Causes of CRF • Partially by decreased neuromuscular efficiency • Further exacerbated by physical inactivity • Inactivity & deconditioning clearly NOT sole primary cause of CRF

7. Treatment of CRF • Passive approaches used most frequently • Exercise to break the cycle • Drugs

8. General Exercise Recommendations • Recommends individual program adapted for individual safety • Interventions tailored to individual’s specific disease & treatment characteristics & health status • Obtain permission of Oncologist

9. General Exercise cont. • Substantial ambiguity in type, duration & intensity of recommended exercise interventions • Aerobic interval training & low to moderate intensity aerobic exercise programs best supported by evidence for application to diverse oncology populations

10. Exercise cont. • Stricker, et al 2004 – at least 15 min of exercise 3-5x/wk to reduce or stabilize fatigue levels • Walk at mod intensity 15-45 min for 4-5x/wk with 5 min warm-up & cool down; increase duration by 2-3 min every 1-2 wks • If deconditioned at baseline, start at 5 min brisk walking 2x/day

11. Duke Energizing Exercise Program • Periods of exercise several times/day • Intensity & duration equal to half of what can comfortably be performed

12. Karvonen Formula • 220 – age – resting heartrate (RHR) x ___% work + RHR = Target HR • Example: age of 60 RHR 60 • 220 – 60 = 160 160 – 60 = 100 100 x 50% = 50 + RHR of 60 = 110 Target exercise HR • Low intensity = 20-40% • Mod intensity = 40-60% • High intensity = 70-80%

13. Exercise cont. • Exercise > 60 min per session, more likely to report increased level of fatigue • ACSM had no guidelines for patients with cancer • Walking & biking were used for most exercise programs

14. Contraindications to Exercise • In one study: platelets < 20,000, fever, uncontrolled infection or multiple complications • Exercise that needs significant oxygen transport if Hgb < 8 g/dl, temp > 38, dyspnea, severe nausea, ataxia, dizziness or peripheral sensory neuropathy

15. Contraindications cont. • Course: acute infection, fever, Hgb < 7, platelets < 10,000, bony mets > 50% cortex involved, increased RHR, cachexia • Exclusion to one study: symptomatic bone mets, Hbg < 10, resting pain > 2

16. Other • Precaution – loss of sensation in lower extremities (peripheral neuropathy) • High Risk: acetabular mets, intertrochanteric mets, 2-3 column spinal mets • Avoid bone stress with metastatic bone disease – avoid therabands, weights, lifting BUT weightbearing is good

17. Specific Info on Lung Cancer • Study by Nagamatsu 2007 on long-term recovery of exercise capacity & pulmonary function after lobectomy • Ongoing studies for seated exercise programs on fatigue & QOL while receiving chemo • Fatigue complaints

18. Breathing Techniques/Strategies • Strategy to decrease dyspnea in lung cancer pts – relaxation techniques, breathing exercise & self-management techniques • Diaphragmatic breathing • Pursed lip breathing • PNF pattern to open chest • Posture

23. Breathing cont. • Increase oxygen for exercise? • Appropriate intensity of exercise

24. Questions??

25. REFERENCES Benzo, R. (2007). Pulmonary Rehabilitation in Lung Cancer: A Scientific Opportunity. Journal of Cardiopulmonary Rehabilitation and Prevention. 27(2), 61-64. Kirschbaum, M. (2006). A review of the benefits of whole body exercise during and after treatment for breast cancer. Journal of Clinical Nursing. 16, 104-121. Losito, JM., Murphy, SO. & Thomas, ML. (2006). The Effects of Group Exercise on Fatigue and Quality of Life During Cancer Treatment. Oncology Nursing Forum. 33(4), 821-825. Mutrie, N., Campbell, AM., Whyte, F., McConnachie, A., Emslie, C., Lee, L., Kearney, N., Walker, A. & Ritchie, D. (2007). Benefits of supervised group exercise programme for women being treated for early stage breast cancer: pragmatic randomized controlled trial. BMJ. 334:517. Nagamatsu, Y., Maeshiro, K., Kimura, NY, Nishi, T, Shima, I, Yamana, H., Shirouzu, K. (2007). Long-term recovery of exercise capacity and pulmonary function after lobectomy. J Thorac Cardiovasc Surg. Nov; 134(5), 1273-8. Tompkins Stricker, C., Drake, D., Hoyer, KA, & Mock, V. (2004). Evidence-Based Practice for Fatigue Management in Adults with Cancer: Exercise as an Intervention. Oncology Nursing Forum. 31(5), 963-974. Visovsky, C., Schneider, SM. (2003). Cancer-related Fatigue. Online Journal of Issues in Nursing. 8(3). Visovsky, C. & Dvorak, C. (2005). Exercise and Cancer Recovery. Online Journal of Issues in Nursing. 10(2), 148-170. Treatment of Cancer Related Weakness and Fatigue presented by Sharon Konecne, MHS, PT.