18th December 2024
Ruth Calder, Chartered Physiotherapist, Mount Alvernia Hospital Guildford, Circle Health Group
There are an estimated 2.5 million people living with cancer in the UK and this is estimated to rise to over 4 million by 2030. Thanks to advances in treatment, people are now living longer, and this is expected to rise.
Cancer survivors face unique health challenges as a result of their cancer diagnosis and the impact of treatments on their physical and mental well-being 1. There is strong evidence that both aerobic and resistance training help.
- Cancer-related fatigue
- Health related quality of life
- Physical function
- Anxiety and depression
- Lymphoedema
Public Health Physical Activity Recommendations
Cancer Care at Mount Alvernia
At Mount Alvernia Hospital Guildford, part of Circle Health Group, they have an outpatient and day case unit and a multidisciplinary approach to care and treatment.
- Cancer-related fatigue
- Health related quality of life
- Physical function
- Anxiety and depression
- Lymphoedema
Case Study One
- Age & Gender: 77-year-old Male.
- Diagnosis : Glioblastoma left temporal lobe. No metastases
- Medical management: No surgery, Radiotherapy with Temozolomide and then Chemotherapy -Avastin, Lomustine, Bevacizumab, Dexamethasone
- Past medical history: Bilateral hip replacements
- Social History: Non-smoker, Retired, owed mental health software company lives with wife and grown-up daughter.
- Exercise history: Used to use the gym 3 x week and a keen tennis player
- Presented: Had been bed bound for 3 months and now shuffling gait. Anxious and Depressed.
- Treatment: progressive strength and conditioning home exercise programme with balance, gait and strength training programme using the AlterG
AlterG Training
| Walking | % Weight | Incline | Speed | Time |
|---|---|---|---|---|
| Week 1- 4 | 20% - 30% | 15% | 1 – 1.5 km/hr | 30 secs x 10 – 5min x 3 |
| Week 5 - 8 | 30% - 40% | 15% | 1.5 – 2. 5 km/hr | 5 mins x 3 – 20 mins |
| Week 9 - 12 | 40% - 80% | 10% - 5% | 2.5 – 3 km/hr | 20 mins |
Balance and strength training in the AlterG included
- SLS, SLdips, Heel raises
- Squats and Lunges
- Upper limb activities while supported including use of tennis racquet
Patient moved on to gym sessions with Personal Trainer and returned to hitting balls on tennis court with trainer.
- Quality of life EQ-5D-3L state of health 5/100 to 65/100
- FACIT fatigue scale with 56% improvement
Case Study Two
- Age & Gender: 62-year-old Male.
- Diagnosis : Gastro- oesophageal junction cancer stage 4 now spread to liver and lungs.
- Medical management: No surgery, Radiotherapy, Immunotherapy Nivolumab and Chemotherapy – Ramucirumab and Paclitaxel. Dexamethazone
- Past medical history: Nil
- Social History: Non-smoker, Retired financial director, involved in charity work
- Exercise history: Keen runner used to do park run every weekend
- Presented: Suffering with neuropathies and feeling whole body weak and deconditioned with sickness and nausea, 4 months into treatment.
- Treatment: Acupuncture for CIPN, return to running programme with AlterG offloading and strength exercises.
AlterG Training
| Walking | % Weight | Incline | Speed | Time |
|---|---|---|---|---|
| Week 1- 4 | 30% - 40% | 15% | 3 - 8 km/hr | Walk 3 mins, run 5 mins x 4 |
| Week 5 - 8 | 40% | 10% | 8 - 10 km/hr | Built up to 30 mins run |
| Week 9 - 12 | 40% - 100% | 5% - 0% | 10 km/hr | Built up to 5km |
Strength training alongside
- Dead bugs, plank, sideplank, gym ball – stability and
- Bridge, squat/sit to stand, deadlift, heel raises – double to single
- Quality of life EQ-5D-3L state of health 20/100 to 90/100
Returned to park runs within 3 months.
Case Study Three
- Age & Gender: 52-year-old Male.
- Diagnosis : Oesophageal cancer stage 4
- Medical management: No surgery, Radiotherapy and Chemotherapy – palliative for comfort.
- Past medical history: Nil
- Social History: Non-smoker, working Graphic designer, 2 young children
- Exercise history: Keen runner
- Presented: 3 months into treatment, huge weight loss and tumour pressing on other organs in chest cavity.
- Treatment: return to running for wellbeing on AlterG
AlterG Training
| Walking | % Weight | Incline | Speed | Time |
|---|---|---|---|---|
| Week 1- 2 | 20% | 15% | 1 - 6 km/hr | Walk 3 mins, run 30 secs x 3 |
| Week 5 - 10 | 20% | 15% | 2 - 11 km/hr | Walk 1 min, run 1 min x 10 build up to run 5 mins x 3 |
| Week 11 - 20 | 20% | 15% | 2 - 11 km/hr | Warm up , run 15 mins |
2 x Week maintenance
Quality of Life – happy place with not too much pressure discomfort on his organs
Conclusions
- Exercise can make a huge difference to the quality of life of patients with cancer.
- AlterG can be an effective modality to aid rehabilitation or maintain as much function as possible in palliative care.
- Patient has control of this aspect of their life
- CAMPBELL, KRISTIN L.; WINTERS-STONE, KERRI M.; WISKEMANN, JOACHIM; MAY, ANNE M.; SCHWARTZ, ANNA L.; COURNEYA, KERRY S.; ZUCKER, DAVID S.; MATTHEWS, CHARLES E.; LIGIBEL, JENNIFER A.; GERBER, LYNN H.; MORRIS, G. STEPHEN; PATEL, ALPA V.; HUE, TRISHA F.; PERNA, FRANK M.; SCHMITZ, KATHRYN H.. (2019, November). Exercise Guidelines for Cancer Survivors: Consensus Statement from International Multidisciplinary Roundtable. journals.lww.com. https://journals.lww.com/acsm-msse/Fulltext/2019/11000/Exercise_Guidelines_for_Cancer_Survivors_.23.aspx