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EXSC 637: Cancer Part IV (Special Considerations)
Terms in this set (31)
What are some special considerations in ExRx?
- Advanced cancer (i.e. stage IV)
- Cancer related fatigue
- Peripheral neuropathies
- Bone metastases (bone pain/weakness)
Advanced cancer: what do we need to note?
- Tumour burden
- Side effects of tx and tumour
Advanced cancer: what are some precautions?
- Bone metastases
- Cognition changes (brain mets)
- Changes in organ function
- Medications to treat side effects (e.g. corticosteroids)
Advanced cancer (bone mets): what are the precautions for an individual with bone disease?
- Use extreme caution & work with clinicians
- Avoid contact sports
- Avoid activities with risk risk of falls/injury
- Avoid high impact, heavy lifting, twisting and turning
Advanced cancer (bone mets): what are some good modes of ex?
- Resistance (not heavy)
- Stationary bike/recumbent (low resistance)
Advanced cancer: specific goals?
- QOL focus
- Maintain function
- Spending time with family/friends
- Avoiding inactivity
NB: liaise with other care providers
1. Severe and distressing
3. Not consistently relieved by sleep/rest
4. Not in proportion to recent activity
5. Interferes with daily activities and social functioning
Symptoms of CRF can be...?
1. Present at dx as a symptom of cancer
2. Develop during tx
3. Develop following tx (late effect)
What does the research show about CRF & Exercise?
- Resistance training reduces fatigue
- Aerobic training reduces fatigue
- Rest does not alleviate CRF
- Deconditioning only makes fatigue worse
What are some general screening considerations for cancer?
1. Type of cancer
2. Timing of exercise program in relation the tx
3. Fatigue level +++
4. Current fitness level
5. Medical hx
Give examples of four tools used to measure fatigue
- FACIT fatigue
- Piper fatigue scale
- Visual analog scale
- Fatigue severity scale
What are the key characteristics for ExRx for clients with mild (<3/10) fatigue?
- Start with appropriate ACSM recommendations
- Couple with a RT program as standard
What are the key characteristics for ExRx for clients with moderate (4-6/10) fatigue?
- Start with repeated short (5-10 mins) bouts of aerobic activity, progressing t0 60-80% of HRM
- Increase frequency and duration before increasing intensity
- RT should be 30-50% 1RM, high rep (10-15), for 1-2 sets. Progress as normal.
What are the key characteristics for ExRx for clients with severe (7+/10) fatigue?
- Begin with low intensity bout of aerobic activity (5-10min), spaced out over the day
- Duration progressed gradually as tolerated
- Refer to physio for AROM, gravity only resistance, and light weight (or EP)
What are some program considerations with regards to CRF?
- Ex when fatigue is lowest
- Use interval training (split up over day)
- Be flexible
- Start slow, build gradually
- Decrease intensity is fatigue gets worse
- Increase recovery between RT sets
- RT alone might be preferable for first 6-12/52
What is lymphedema caused by?
- Secondary to surgery, radiation
- Melanoma or breast
- Head, neck, prostate
What is lymphedema?
- An abnormality in the lymphatic system
- Leads to build up of protein rich fluids and cell debris
- Causes swelling
What are the consequences of untreated lymphedema?
- Chronic inflammation
- Hardening of skin
- Could cause further lymph vessel damage
What lifestyle factor increases the risk of lymphedema occurring?
What are the general risk factors for developing lymphedema?
- Sustained damage to lymphatic system due to surgery of radiation therapy
- Surgical incision in vicinity of lymph transport
What are the symptoms of lymphedema?
- Feelings of heaviness/tightness
- Swelling/puffiness in affected area
- Arm/chest becomes hot/red
- Full sensation (?)
- Tightness of skin
- Decreased flexibility in hand & wrist
- Difficulty fitting into clothing in one specific area of body
What are some key precautions with lymphedema?
- Risk of infection is high (be careful with cuts, and avoid trauma)
- Avoid taking BP on affected arm
- Be cautious with hot/cold therapies
What does the research say about lymphedema and exercise?
- It is an important part of tx
- Active non-resistive motion is good
- Flexibility exercises should be prescribed
What does the NLN position stand say with regards to lymphedema and exercise?
- GP clearance necessary
- Be extra safe during aerobic & resistance training
- Allow adequate rest between sets
- Avoid weights that wrap tightly around body
- Wear compression garment where recommended
- Maintain hydration
- Avoid extreme heat
- Avoid repetitive use of affected limb
- Progress slowly
What are the ExRx recommendations for clients with lymphedema?
- 40% 1RM to start
- No weight (or very low)
- Very gradual progression
NB: exercise should be stopped for pain, swelling or discomfort
What are the Ex Testing recommendations for clients with lymphedema?
- Avoid high stress/inappropriate tests (e.g. push up test)
- Use caution with 1RM testing
What is peripheral neuropathy?
- Impaired sensation (numbness, tingling) in the extremities as a result of cancer tx
- May pose specific risks when exercising
What can be done in order to decrease risk in clients with peripheral neuropathy during exercise?
- Good footwear
- Walk on even surfaces
- Protect extremities from hot/cold when exercising
- Use caution with balance exercises
- Use caution with treadmills, free weight, etc
- Monitor BP alterations
What are the common causes of disproportionate SOB?
- Muscle weakness
- Loss of CV capacity
- Being generally inactive
What must be remembered when working with clients with disproportionate SOB?
- Take breaks
- Avoid supine exercises
- Utilise resistance training
- Utilise relaxation techniques
What are some overarching symptoms that might rouse suspicion in cancer clients?
- Unexplained weight loss (>4.5kg)
- Skin changes
- Other (bowel/bladder dysfunction, sores the don't heal, nagging cough)
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