Exercise%20Based%20Rehabilitation

1
Exercise Based Rehabilitation

• Mike Grisenthwaite
• Director and Founder

2
About me..

• Diagnosed 2000 Lymphatic Cancer NHL
• Ironman Triathlon 2001
• Numerous other endurance events
• Relapse 2005
• Donor stem cell transplant or BMT.
• 2007 Tour de France 2200 miles in 19 days
• Personal Trainer and Certified Cancer Exercise
  Specialist Northern Colorado University

3
Overall Cancer Risk

• Involvement in occupational or leisure-time
  activity or being physically fit is associated
  with a reduced risk of cancer
• Typical risk reduction of 20-30
• Independent of other lifestyle
• factors
• Risk reduction is dose-related

4
Physical Activity and Cancer PreventionPossible
Mechanisms

• Sex steroid hormones oestrogen, testosterone
• Energy balance fat distribution
• Growth factors Insulin/ IGF-1/IGF-BP3
• Anti-inflammatory system C reactive Protein,
  interleukins
• Immune defence system NK cells
• Antioxidant defence system/DNA damage/ apoptosis

5
Cancer SurvivorshipCancer Statistics - 2002

• Cancer incidence
• One in three people in UK will develop some form
  of cancer in their lifetime.
• Cancer survival rates have increased
• 43 of men and 54 of women survived to five
  years after diagnosis (prostate has improved to
  60 and breast to 77)
• Number of survivors
• 2 of men and 2.7 of women in Scotland are
  living with cancer (1.2 of women in Scotland are
  living with breast cancer).

6
Exercise and Activity for Children and TYAs -
Evidence

• The few childhood studies are far more neutral.
• Restricted by numbers of participants
• Access to facilities
• Measurement comparisons - age
• Activity motivation

7
Research evidenceBeneficial effects of exercise
interventions
Exercise during treatment
Exercise after treatment
Functional capacity Body weight
composition Fatigue Nausea Flexibility Physical
well-being Satisfaction with life Quality of life
Exercise capacity Natural killer (NK) cell
activity Mood Self-esteem Lean body mass body
fat Decreased levels of depression
anxiety Quality of life No adverse effect on
Lymphoedema
8
Exercise After Diagnosis Association with
Recurrence Mortality Data from Cohort of
2987 Breast Cancer Survivors in Nurses Health
Study
Relative Risk
Level of Exercise (MET hrs/week)
Holmes et al. JCO 202479-86, 2005
9
The Rehabilitation Exercise for Health After
Breast Cancer (REHAB) Trial

• RCT comparing aerobic
• exercise to control in 53
• postmenopausal BC
• survivors post therapy.
• Primary endpoints were
• QOL, fitness, biomarkers.

10
Baseline (p.807) Change (plt.001) 3.3 (18)
(Courneya et al. JCO 2003211660-8)
11
Baseline (p.286) Change (p.001) 8.8 (3.6 to
14.0)
(Courneya et al. JCO 2003211660-8)
12
Baseline (p.518) Change (p.017) -0.006 (-0.01
to -0.001)
(Fairey et al. CEBP 200312721-7)
13
Baseline (p.307) Change (plt.001) 6.0 (2.8 to
9.1)
(Fairey et al., submitted)
14
Activity Levels for Patients and Survivors What
is recommended?

• 30 minutes
• 5 days a week
• To a moderate intensity i.e.
• 60 70 of Maximum Heart
• Can be accumulative.
• This applies to everyone here!
• VERY IMPORTANT Practical note
• Carers need to buy in to this

15
Nacer Wish list

• To get exercise based rehabilitation results into
  practice via
• Integrating physical activity with other
  supportive care interventions
• Physiotherapy.
• Psychosocial interventions.
• Complementary Therapies etc.
• Training of primary, secondary and tertiary
  health professionals and community based exercise
  instructors.
• Provision of information through various existing
  media channels

16
Future Projects - Nacer

• Participation in TYA Cancer Survivorship
  programme at the Christie Hospital.
• More user friendly Website Focused on Patients
  and Support Networks
• Supplying information on
• local initiatives
• Cancer Exercise Specialists
• One to one consultation
• Latest proven research, downloads etc.

17
Cyclists Fighting Cancer

• in 2CFC award new bikes, tandems and specially
  adapted trikes to children and young people who
  have been affected by cancer throughout the UK
  and Northern Ireland.
• We encourage cycling as the best form of exercise
  based rehabilitation for those children
  undergoing and recovering from cancer treatments.
  
• To encourage them further CFC also give bikes to
  their siblings and in many cases their parents in
  order that they can take part in an activity as a
  family once again after what can be years of
  hospitalisation and disruption.
• Awarded over 300 bikes so far.

18
Bike Awards

• Referrals via Clic Sargent and other social
  workers, Physios, Consultants, Support groups
  etc.
• 0-18 years
• Siblings Included
• Can include parents
• No Cost whatsoever
• UK and Northern Ireland

19
The Benefits

• Moment of delight
• Assists mobility
• Gives back choice
• Family Activity
• Reintegration/normality
• Reconditioning of Muscles
• Help with side affects of treatment

20
Future Projects - CFC

• Pilot Scheme at the John Radcliffe Hospital
  Oxford.
• CFC has provided 2 static exercise bikes in
  junior and Adult size. 5 2 upwards
• Currently undergoing evaluation by physios on
  site.
• We hope to identify 2 further hospitals in 2009.

21
Get Set, Ready, Go!

• Contact details
• email mike_at_cyclistsfc.org.uk
• Web
• www.cyclistsfc.org.uk
• www.nacer.org.uk
• Thank you.