Exercise as it relates to Disease/Exercise prescription for breast cancer survivors

Breast cancer is one of the most important diseases worldwide in terms of incidence and mortality. In recent years the improvement of treatments for this disease has increased the survival rate. Physical exercise has consistently been identified as a central element of rehabilitation for many chronic diseases including several types of cancer. The main benefit of exercise when applied to breast cancer survivors is to improve quality of life and rehabilitation from the negative side effects of cancer diagnosis and treatment.

Background

Breast cancer

Age-standardized death from breast cancer per 100,000 inhabitants in 2004.

no data      <2      2–4      4–6      6–8      8–10      10–12

12–14      14–16      16–18      18–20      20–22      >22

Breast cancer is usually characterised into ductal or lobular carcinomas which occur in the tissue of the breast. The treatment for this type of cancer is usually determined by the size, stage, rate of growth and other characteristics of the cancer. Treatment for this particular cancer may include a combination of the following; surgery, hormonal drug therapy, chemotherapy, radiation and/or immunotherapy. The most effective method currently used is the surgical removal of any growths, which is usually combined with several chemotherapy regimens to increase the likelihood of cure. Breast cancer accounts for 22.9% of all cancers in women worldwide .It has been shown to be less prevalent in developing countries and greatest in developed countries. The primary risk factors that are associated with an increase of morbidity are female sex and older age. Other associated risk factors are lack of childbearing or breastfeeding, higher hormone levels, diet and obesity. There are also risk factors associated with certain lifestyle choices, genetics and particular medical conditions. The impact of cancer therapy is not limited to cancer cells but also causes deleterious effects on healthy tissues that result in acute and chronic physiological and psychological negative side effects in cancer survivors. Research has shown that these negative side effects can lead to deterioration of lean body tissue, lowered functional capacity, weight gain, difficulty in sleeping, fatigue, nausea, pain, depression, poor body image, and lowered self-concept.

Breast cancer and exercise

The prolonged and repeated nature of breast cancer treatment has many negative side effects post treatment. Exercise for these survivors can be of great benefit in helping to increase the quality of life in many aspects. The quality of life outcomes that exercise has been found to help in include physical, functional, emotional, and social aspects. Some of the benefits that exercise has been shown to give are as an effective intervention to improve quality of life, cardio respiratory fitness, physical functioning and symptoms of fatigue in breast cancer patients and survivors. Exercise can benefit cancer survivors in a number of ways. Mood management is a benefit that is associated with exercise. From the research that has been done it has been shown that with the adoption of regular exercise regimens, significant improvements in anxiety, depression and self-esteem have been found. Weight gain is a troubling and common consequence following treatment for breast cancer particularly among women receiving adjuvant therapy. Fatigue from the treatment is another negative side effect of cancer treatment. It usually begins during radiation treatment and chemotherapy, increases over the course of treatment and may persist for months afterwards. Fatigue decreases patients’ activity levels, interferes with their ability to care for themselves, and with role functioning at home and work . Cross-sectional studies have shown that patients report that exercise is a very useful strategy to overcome fatigue . Another positive effect that exercise has been associated with in breast cancer survivors is improved sleeping patterns. Exercise or increased physical activity has long been an integral part of good sleep.

Recommendations

In regard to recommendations a roundtable statement was presented at the American College of Sports Medicine (ACSM) 57th Annual Meeting in June of 2010. The statement suggests that, unlike previous clinical recommendations, it is believed beneficial and is in fact recommended cancer survivors engage in some form of exercise modality post treatment. As for mentioned breast cancer survivors who exercise post treatment have demonstrated better overall quality of life and functional capacity. Although one of the conclusions of the statement was cancer survivors for the most part should adhere to the 2008 Federal Physical Activity Guidelines for Americans (150 mins/wk of moderate intensity aerobic activity), it is recommended that breast cancer exercise prescription should undergo alteration to these guidelines given the specific nature of this form of cancer. Current literature supports the implementation of both aerobic and strength training programs to improve the health related outcomes for breast cancer survivors . Exercise prescription should be tailored to the specific needs of the breast cancer survivor and should take into account severity of treatment and previous training history. A general guide to exercise prescription in regard to both aerobic and strength training programs are as follows:

Parameter	Recommendation
Mode	Large muscle groups walking or cycling
Frequency	3-5 times per week
Intensity	50-80% of Vo2 max / RPE between 11-14
Duration	20-30 minutes of continuous exercise
Progression	Via frequency and duration initially then intensity

General Aerobic Recommendations For Breast cancer survivors

Parameter	Recommendation
Mode	Free weights, body weight or machines
Frequency	3 times per week
Intensity	Light weights <10% increments
Duration	2 sets of 10 repetitions first 2 weeks, increase to 15 reps
Progression	Initially increase reps then sets, increases in resistance then return to 2 set model

General Resistance Training Recommendations For Breast Cancer Survivors

Further readings

2008 Physical Activity Guidelines for Americans http://www.health.gov/paguidelines/pdf/paguide.pdf

References

3..^ "WHO Disease and injury country estimates". World Health Organization. 2009.

4. "World Cancer Report". International Agency for Research on Cancer. 2008. Retrieved 15-10-2012. (cancer statistics often exclude non-melanoma skin cancers such as basal cell carcinoma, which are common but rarely fatal)

5. Lee, I-Min; Shiroma, Eric J; Lobelo, Felipe; Puska, Pekka; Blair, Steven N; Katzmarzyk, Peter T (1 July 2012). "Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy". The Lancet.

6.^ Milne, H. M., Wallman, K. E., Gordon, S., & Courneya, K. S. (2008). Effects of a combined aerobic and resistance exercise program in breast cancer survivors: a randomized controlled trial. Breast Cancer Research and Treatment, 108(2), 279-288.

7.^ Mcneely, M. L., Campbell, K. L., Rowe, B. H., Klassen, T. P., & Mackey, K. S. (2006). Effects of exercise on breast cancer patients and survivors: a systematic review and meta-analysis. Canadian Medical Journal, 175(1), 34-41.

8.^ Pinto, B. M., & Maruyama, N. C. (1999). Exercise in the rehabilitation of breast cancer survivors. Psycho-Oncology, 8, 191-206.

9.^ King, A.C., Haskell, W.L., Taylor, C.B., Kraemer, H. C. and DeBusk, R.F. (1991) Group- vs. homebased exercise training in healthy older men and women. Journal of the American Medical Association, 266, 1535–1542.

10.^ Rhodes, V.A., Watson, P.M. and Hanson, B.M. (1988) Patients’ descriptions of the influence of tiredness and weakness on self-care abilities. Cancer Nursing, 11(3), 186–194.

11.^ Graydon, J.E., Bubela, N., Irvine, D. and Vincent, L. (1995) Fatigue-reducing strategies used by patients receiving treatment for cancer. Cancer Nursing, 18, 23–28.

12.^ Schneider, C. M., Hseih, C. C., Sprod, L. K., Carter, S. D., & Hayward, R. (2007) Effects of supervised exercise training on cardiopulmonary function and fatigue in breast cancer survivors during and after treatment. Cancer, 110(4), 918-925.

13. Stewart B. W. and Kleihues P. (Eds): World Cancer Report. IARCPress. Lyon 2003