exercise modification to maintain safety. Any abnormal changes in pain or swelling during an exercise program should be considered warning signs that require caution and follow up with the physician. (American College of Sports Medicine, 2019). Table 8: ACSM Guidelines for Resistance Exercise Intensity (% of 1-RM estimation) 20-50%: Older adults to improve power. < 50%: To improve muscle endurance. 40-50%: To improve strength in sedentary individuals beginning a problem. 40-50%: To improve muscular strength in older adults. 60-70%: To improve strength in novice to intermediate exercisers. > 80%: Experienced strength trainers to improve strength.
Table 9: ACSM Guidelines for Flexibility Frequency
>2-3 days / week; greatest gains with daily stretching. Stretch to the point of feeling tightness. Hold a stretch for 10-30 sec; older people holding for 30-60 seconds may be better. Each of the major muscle-tendon units. Perform 60 sec of total stretching time for each exercise.
Intensity
Time
Type
Volume
Pattern 2-4 reps. Progression Unknown.
The Clinical Oncology Society of Australia recommendations The Clinical Oncology Society of Australia (COSA), published a position paper with three core recommendations (Cormie et al., 2018). They name exercise as a key component of cancer care that should be viewed as an adjunct treatment embedded in standard practice to reduce the adverse effects of cancer and its treatments. The second recommendation is that all members of the multidisciplinary care team promote physical activity and patient compliance with exercise guidelines. Lastly, COSA states that best practice cancer care should include referral to an accredited physical therapist and/or exercise physiologist with training and experience in cancer care.
The COSA position statement also includes guidelines for changes in case management. They encourage all health professionals working with cancer patients to discuss the role of exercise in cancer recovery early in the plan of care. The plan should ensure that patients are compliant with exercises guidelines and avoid inactivity. Patients should progress toward at least 150 minutes of moderate intensity aerobic exercise and two to three moderate intensity resistance exercise sessions per week. Healthcare providers should also refer patients to other health professionals who specialize in exercise prescription and deliver exercise-based treatments such as physical therapists.
ASSESSMENT TOOLS
Oncology rehabilitation programs are designed to address impairments and functional limitations of patients diagnosed with cancer. The ultimate goals of oncology rehabilitation programs are to reduce disability and restore patients’ ability to resume their usual daily activities. Monitoring their physical responses and exercise progression, quality of life, self-reported health status, and general wellbeing is important. The following are a sampling of the many tools that can be used to assess function and patient outcomes over time. General health assessment The 36-Item Short Form Health Survey (SF-36) was developed by the RAND Corporation as part of a multi-site, multi-year Medical Outcomes Study (MOS) that examined variations in patient outcomes. It assesses eight health areas including physical functioning, pain, role limitations due to physical health problems, role limitations due to personal/emotional problems, emotional well-being, social functioning, fatigue, and general health perceptions. The details of the scoring rules for the SF-36 are beyond the scope of this course; however, it includes a two- step process. The first step scores the items using pre-coded numeric values, and the second step converts each item into a percentage of the total possible score achieved. The SF-36 can be used in cancer rehabilitation as a self-reported tool to monitor patient outcomes. Each patient completes the survey at the start of the program, then again at different intervals during the program. In a study published by Samuel et al. (2019), the researchers examined the effectiveness of exercise-based cancer rehabilitation on functional capacity and quality of life. They evaluated patient-reported quality of life using the SF-36, primarily focusing on the Physical Component Score (PCS), the Mental Component Score (MCS), and the fatigue score. The researchers found that not only were exercise- based interventions effective in improving functional capacity,
but they were also related to improvements in self-reported quality of life scores using the SF-36. The tool can be found in Appendix A. Pain Pain is a common complaint in cancer survivors, particularly after surgery, and can be one of the complaints that physical therapists address with their patients. Therefore, it is important to be able to reliably track changes in pain over time. The American Physical Therapy Associations (APTA)’s Oncology Section EDGE Task Force performed a systematic review on clinical measures for pain and their relevance for use with patients with cancer. Based on psychometric properties, clinical utility, and relevance to adults with cancer, they highly recommend the McGill Pain Questionnaire-Short Form, the Numeric Rating Scale, and the Visual Analog Scale (Harrington, et al., 2018). See the Resources section for more information. Cancer-related fatigue As stated above, cancer-related fatigue (CRF) is one of the common side effects of cancer treatment. In order to effectively screen for its presence and thoroughly assess factors related to CRF, sound measurement tools must be used. Another APTA Oncology Section EDGE Task Force performed a systematic review of tools to measure fatigue in people with cancer. They found that the 10-point Numeric Rating Scale for Fatigue is the best for screening for CRF, while the Multidimensional Fatigue Symptom Inventory is the most comprehensive, multidimensional tool for assessment of CRF (Fisher et al., 2018). Physical therapists working with individuals with cancer should familiarize themselves with these tools. See the Resources section for more information.
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