Anna L. Schwartz, PhD, FNP-BC, FAAN

Exercise Guidelines and Certifications: What’s new?

Overview Overview Review of Research Evidence

ACSM Cancer Survivor Exercise Guidelines

ACSM/ACS Certification

CollaboratorsCollaborators

Current StateCurrent StateOver 1.5 million new cases cancer in 2009

Over 12 million survivors alive in U.S.

Burden of cancerMorbidity, mortality,

Economic cost

Lost work days,

Reduced quality of life,

Family burden

Need for cancer rehabilitation

Need for exercise guidelines

ACSM RoundtableACSM RoundtableRound table and Consensus meeting

June 2009 Siteman Cancer Center, Washington University, St. Louis, MOOncology Nursing Foundation

International multidisciplinary teamNursingMedicineEpidemiologyExercise physiology

Representation fromNational Cancer Institute (divisions Survivorship & Epidemiology)Lance Armstrong FoundationYMCAAmerican Cancer Society

Review of EvidenceReview of EvidenceNational Health, Lung, & Blood Institute (1998)

Category A: Overwhelming RCT data

Category B: Few RCTs, small in size and results inconsistent

Category C: Uncontrolled/nonRCTs and/or observational studies

Category D: Panel experts opinion when evidence is insufficient Category

ConsensusConsensusRecommendations the same as for age appropriate guidelines from the US DHHS Physical Activity Guidelines for Americans

150 minutes/week moderate-intense aerobic exercise or 75 minutes/week of vigorous exercise

Strength training 2-3 time/week, 8-10 exercises of 10-15 repetitions/set, with at least one set per session

Avoid Inactivity!!!

Return to normal daily activities as quickly as possible

Continue normal daily activities and exercise as much as possible during and after non-surgical treatments

What to do?What to do?

Avoid InactivityAvoid Inactivity!!!!!!

Goals of Exercise Goals of Exercise PrescriptionPrescription

Regain and improve physical function, aerobic capacity, strengthand flexibility

Improve quality of life

Improve body composition and body image

Improve cardiorespiratory, endocrine, neurological, muscular, cognitive and psychological outcomes

Potentially reduce or delay recurrence or secondary primary cancer

Reduce, attenuate and prevent long term and late effects of cancer treatment.

General ContraindicationsGeneral ContraindicationsExtreme anemia or ataxia

Follow ACSM Guidelines for exercise prescription regarding cardiovascular and pulmonary contraindicationsto exercise

Potential for adverse cardiopulmonary event may be higher in cancer survivors than age matched comparisons given toxicity of treatments and long term/late effects of cancer.

General Injury RisksGeneral Injury RisksOsteoporosis from bone metastasis and bone-wasting drugs

Peripheral neuropathy

Immune function

Weighty issuesWeighty issues……

Special ConsiderationsSpecial ConsiderationsBreast Cancer

LymphedemaFracture risk

Prostate CancerFracture riskPelvic floor exercises

Colorectal CancerPhysician recommendation after ostomy if contact sportsStoma herniation riskAvoid excess intra-abdominal pressure

Adult Hematologic CancersOsteoporosis risk (especially with multiple myeloma)

Special ConsiderationsSpecial Considerations

Gynecologic CancersMorbid obesityLower limb lymphedema

After Bone Marrow TransplantDaily exercise as toleratedImmune statusResistance training may be most important immediately following transplant

Childhood Hematologic CancersPhysician permissionImmune function

What do we need to do???What do we need to do???

How to Apply to PracticeHow to Apply to PracticeProvide clear instructions to exercise and avoid inactivity

Reassure patient that exercise is safe

Instruct patient to exercise:At least every other day

Build up to 30 minutes

Start slowly and Progress slowly

Moderate intensity

Choose an activity they enjoy

Aerobic and resistance exercises

ACSM/ACS CertifiedACSM/ACS Certified Cancer Exercise TrainerCancer Exercise Trainer

ACSM/ACS Certification:ACSM/ACS Certification: Cancer Exercise Trainer Cancer Exercise Trainer

Train cancer survivors

Provides fitness assessment

Makes exercise recommendations

Has understanding of cancer:Diagnosis

Surgeries

Treatments

Symptoms

Side effects

Recommended CompetenciesRecommended Competencies

Knowledge and ability to:Discuss cancer diagnosis, treatment and side effects

Discuss effects of exercise

Discuss cancer specific benefits and risks of exercise

Select appropriate exercise program

Understand impact of cancer treatments, risks of injury, complications such as lymphedema

Evaluate adverse responses to exercise training and how to modify exercise program,

Seek clinical consultation for client during or following treatment.

Resources for CETResources for CETACSM Certification department

acsm.org/CET

certification@acsm.org

Training information

Knowledge Skills & Abilities (KSA’s)

Live Webinar August 12-September 23$240 registration

6 90-minute sessions

CET ExamCET ExamOnline

Cost:$150 ACSM Certified Professions

Summary PointsSummary PointsAerobic exercise

150 minutes/wk moderate intensity

75 minutes vigorous exercise/week

Resistance Exercise2-3 days/week

Avoid Inactivity

ACSM/ACS Cancer Exercise TrainerAcsm.org/CET

Study resources and information