Background:
The provision of broad spectrum, community based exercise programs for Cancer Survivors enhances accessibility and feasibility of these services. Assessing objective responses to same should serve to provide data to denote the effectiveness of such programs.
Objectives:
The objective of this study was to investigate changes in body composition and cardiovascular outcome measures as a result of a 10-week, self-referred, community-based, exercise group exercise program for Cancer Survivors.
Methods:
Cancer Survivors who self-referred for participation in a ten week, community based group exercise program were included in the study. Each individual completed one formal structured aerobic and strengthening exercise session, and one informal group walk per week. For the formal exercise session, individuals were categorized, by a chartered physiotherapist, to either a beginners or advanced group after their pre-assessment. Assignment was depended on their baseline health and fitness as discerned during pre-screening. Pre and post-testing involved subjective questioning, followed by measurement of waist circumference, body mass index, blood pressure, heart rate at rest, heart rate response to exercise during either the Chester or Tecumseh step test, and heart rate post exercise.
Results
A total of twenty three Cancer Survivors were recruited for the program and pre-assessed. After pre-assessment, three did not partake in the program (one secondary to complaints of exercise induced migraine, one secondary to Cancer relapse and one secondary to an acute bout of lower back pain). Of the twenty who started the program, one relapsed after 2 weeks and therefore ceased to participate and two were not available for post-assessments. Therefore, a total of seventeen (74%) completed the entire program. Adherence rates for the seventeen who completed the program ranged between 66% and 100%.
Cardiovascular complications of Cancer treatment are frequent and therefore, the screening and monitoring of cardiovascular health, in Cancer Survivors, has been given greater attention in recent times (Hermann et al, 2015). Therefore, we sought to measure changes in body composition, secondary to their direct link to cardiovascular health, by measuring (1) waist circumference and (2) Body Mass Index (BMI) pre and post programme. We also assessed changes in Aerobic Fitness measuring (1) heart rate at rest and (2) rate of perceived Exertion (RPE) on the Tecumseh Step Test.
In terms of changes in body composition, of the seventeen who completed the program, 65% had a reduced waist circumference. However, using Paired sample T tests it was found that this difference was not statistically significant (P .387). Overall, there was no significant reduction in Body Mass Index (P>.05).
In terms of changes in aerobic condition and exercise tolerance, there was no significant improvement in resting HR pre and post programme. However, there were statistically significant improvements on the Tecumseh Step Test (P<.05) as measured by Rate of Perceived Exertion during the test
Conclusion
Broad Spectrum Community Based Exercise Programs for Cancer Survivors, directed by a Chartered Physiotherapist, lead to significant gains in aerobic fitness.
There is a need to standardise outcome measures used for assessing the impact of exercise programmes for cancer survivors
Implication for Practice
Significant fitness gains can be made by Cancer Survivors on Community Based Group Exercise Programs, screened and directed by a Chartered Physiotherapist, whereby individuals are stratified based on baseline assessment of health and fitness, as opposed to Cancer Type or Stage of Treatment.
References
Herrmann J, Lerman A, Sandhu N, Villarraga HR, Mulvagh S, Kohli M (2015) Evaluation and Management of Patients with Heart Disease and Cancer: Cardio-Oncology. Mayo Clinic Proceedings 2014 Sep; 89 (9) : 1287-1306
SchmitzKH, Courneya KS, Matthews C, Demark-Wahnefried W, Galvao DA, Pinto BM, Irwin ML, Wolin KY, Segal RJ, Lucia A, Schneider CM, Von Gruenigen VE, Schwartz AL(2010) American College of Sports Medicine roundtable on exercise guidelines for cancer survivors. Medicine and Science in Sports and Exercise,42; 7: 1409-26
Velthuis MJ, May AM, Koppejan-Rensenbrink RA, Gijsen BC, Van Breda E, de Wit GA, Schroder CD, Monninkhof EM, Lindeman E, Can der Wall E, Peeters PH (2010) Physical Activity during Cancer Treatment (PACT) Study: design of a randomised clinical trial. BMC Cancer, Volume 10, Issue 272
Ethical Approval
Ethical Approval has not been sought as those who partook in the study did so of their own voluntary will via self-referral and they each signed a waiver,at the Cancer Center, confirming that they agreed for any data collated to be used for research purposes.
