Components of oncology rehabilitation programs Oncology rehabilitation programs can follow different models depending on the complexity and severity of the condition; however, they should generally follow a stroke rehab model. This is an interdisciplinary model that combines physical therapists, occupational therapists, speech/language therapists, and nurses with physicians. It allows patients to receive care from skilled and highly educated rehabilitation professionals instead of extenders. Even complex rehabilitation issues, such as cognitive dysfunction, musculoskeletal diagnoses, and speech/swallowing, can be addressed appropriately. Physical therapy interventions focus on reducing pain, managing swelling/lymphedema, improving flexibility, increasing strength, improving endurance, and restoring function. Pain management can be accomplished with modalities including heat, cold, and electrical stimulation when indicated. Swelling and lymphedema management is best performed by specially trained therapists who have advanced knowledge of the anatomy and function of the lymphatic system. They may use manual lymph drainage techniques or mechanical devices (Aldrich et al., 2017), that provide sequential compression to the affected limb. Patients
who are treated for lymphedema can use compression garments to control swelling between treatment sessions. Some patients experience joint stiffness, muscle or soft tissue tightness, and overall decreased flexibility during and after cancer treatment. These symptoms can be caused by disuse and side effects from radiation therapy, surgery, or chemotherapy. Patients can benefit from manual therapy techniques, including manual stretching, myofascial release, and joint mobilizations to improve motion and increase soft tissue length. Fatigue related to cancer treatment can be challenging to overcome because there are so many factors that can potentially cause this symptom. It can be a side effect of chemotherapy, radiation treatment, or disuse. Physical therapists can educate patients about adjusting their schedules to include rest periods to allow recovery time. Medications may be indicated depending on the suspected cause of fatigue. Therapeutic exercise can help patients not only improve their strength, endurance, flexibility, but also improve sleep and reduce fatigue. Some patients are able to reduce depression and relieve stress through exercise.
EXERCISE AND CANCER
Research has shown the benefits of structured exercise training for a variety of physiological and psychosocial outcomes among patients diagnosed with cancer. Improvements have been shown in quality of life, aerobic capacity, muscular strength, fatigue, and function. Studies have shown patients achieving strength gains, as well as decreased resting heart rate, improved pulmonary function, and decreased lactate concentration (Kestling et al., 2020). Patients report over 21% improvement in self-reported quality of life. Other benefits from exercise training along the cancer continuum include improved immune system function, decreased hospitalization, increased joint range of motion, improved soft tissue extensibility, reduced episodes of nausea, decreased fatigue, and reduction in depression. Exercise training is safe for most medically stable patients, but they should be cleared by their oncologist before beginning any program. According to a study by Blanchard et al. (2003), 30% of patients diagnosed with cancer reduced their activity level immediately after diagnosis. They found that 15% actually increased their activity level without negative consequences; however, only 16% of patients remained active during their treatments. A study by Adamsen et al. (2009) found that a supervised multimodal exercise program including high- and low-intensity components was safe and appropriate for patients with various cancers. Their results showed that patients had reduced fatigue, improved aerobic capacity, increased muscular strength, improved Exercise prescription As the research shows, exercise can have a significant impact on the lives of patients before, during, and after cancer treatment. However, exercise prescription requires careful planning to ensure that the appropriate exercises are given and safe parameters are used. The FITT (frequency, intensity, time [duration], and type [mode]) Principle is a frequently used method to prescribe and monitor exercise programs. It is a threshold model that allows patients to achieve sufficient physiological challenge to create adaptive changes, training effects, and reconditioning. Frequency is the first component and it refers to the number of times per week that a patient participates in exercise. It can be informed by the intensity of the exercises performed – higher- intensity exercises would require longer recovery time, and, therefore, would be performed fewer times per week. Frequency is treatment-dependent and may be modified if fatigue is present. Patients can exercise more than once per day for short periods of time if they are deconditioned. Exercises may be combined with the performance of usual ADLs, as appropriate, and they should be consistent with the patient’s goals.
tolerance for physical activity, greater emotional wellbeing, and improved functional ability. Exercise can reduce cancer-related fatigue. Schwartz et al. (2017) found that the majority of patients who continued to exercise during their cancer treatments (with modifications) reported less fatigue. These subjects averaged 9 hours of exercise per week and only 52% reported fatigue that “affected the whole body.” Exercise and rest were the most commonly used strategies for managing their symptoms. Studies that examined the impact of exercise and the safety of patients’ participation in these programs concluded the following: ● Oncology patients can adapt to exercise. ● Oncology patients can exercise through the spectrum of oncology care. ● Exercise can prevent or reduce the negative effects from cancer treatments including fatigue, decreased cardiovascular function, muscle weakness, and function. ● Exercise during and following treatment has been associated with decreased recurrence and mortality. ● Mechanisms may exist that link inactivity with carcinogenic processes. (Schwartz et al., 2017) Progressing an exercise program should start with duration first, then frequency as patients become more conditioned. Intensity can be described as a percentage of VO2 Max, estimated VO2 Max, estimated maximum heart rate, estimated maximum heart rate reserve, the six-minute walk test, or a 1-RM (rep maximum). Considerations when setting exercise intensity include a patient’s safety issues, treatment status, and functional status. Therapists should use caution when determining intensity. The American College of Sports Medicine recommends an intensity of 40-60% of heart rate reserve (HRR); however, some studies recommend 30-75% of HRR (Mayo Clinic, 2019). The heart rate maximum (HRmax) is generally calculated using the formula HRmax = 220 - age. See Table 5 below for the American College of Sports Medicine’s intensity recommendations.
Page 24
EliteLearning.com/Physical-Therapy
Powered by FlippingBook