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Exercise Based Rehabilitation Mike Grisenthwaite Director and Founder
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
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
Physical Activity and Cancer Prevention: Possible Mechanisms Sex steroid hormones: oestrogen, testosterone Energy balance & fat distribution Growth factors: Insulin/ IGF-1/IGF-BP 3 Anti-inflammatory system – C reactive Protein, interleukins Immune defence system: NK cells Antioxidant defence system/DNA damage/ apoptosis
Cancer Survivorship Cancer 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).
Exercise and Activity for Children and TYA’s - Evidence The few childhood studies are far more neutral. Restricted by numbers of participants Access to facilities Measurement comparisons age Activity motivation
Research evidence Beneficial effects of exercise interventions Exercise during treatment Exercise after treatment Functional capacity Exercise capacity Body weight & composition Natural killer (NK) cell activity Fatigue Nausea Flexibility Mood Self-esteem Lean body mass & body fat % Physical well-being Decreased levels of depression & anxiety Satisfaction with life Quality of life No adverse effect on Lymphoedema
Exercise After Diagnosis & Association with Recurrence & Mortality Relative Risk Data from Cohort of 2987 Breast Cancer Survivors in Nurse’s Health Study Level of Exercise (MET hrs/week) Holmes et al. JCO 20: 2479 -86, 2005
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.
Baseline (p=. 807) Change (p<. 001) 3. 3 (18%) (Courneya et al. JCO 2003; 21: 1660 -8)
Baseline (p=. 286) Change (p=. 001) 8. 8 (3. 6 to 14. 0) (Courneya et al. JCO 2003; 21: 1660 -8)
Baseline (p=. 518) Change (p=. 017) -0. 006 (-0. 01 to -0. 001) (Fairey et al. CEBP 2003; 12: 721 -7)
Baseline (p=. 307) Change (p<. 001) 6. 0 (2. 8 to 9. 1) (Fairey et al. , submitted)
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
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
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.
Cyclists Fighting Cancer in 2 CFC 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.
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
The Benefits Moment of delight Assists mobility Gives back choice Family Activity Reintegration/normality Reconditioning of Muscles Help with side affects of treatment
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 physio’s on site. We hope to identify 2 further hospitals in 2009.
Get Set, Ready, Go! Contact details email: mike@cyclistsfc. org. uk Web: www. cyclistsfc. org. uk www. nacer. org. uk Thank you.