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CANCER, Exercise Training, PATHOPHYSIOLOGY, Exercise Testing, Exercise…
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Exercise Training
Keep in mind :star:
Mood disturbances (anxiety & depression)
•May have little interest in exercise
•Increase exercise dose progressively in individualized manner
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When in doubt, ask patient’s supervising physician
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Resistance Exercise
Start with resistance bands, light hand weights, or machines.
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PATHOPHYSIOLOGY
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Stem Cell Theory
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The process by which the pluripotent stem cell is able to develop special functions and structures within an organ system is called differentiation
Stem cells are triggered to differentiate and commit to a specific cell line
Pluripotent stem cell has self-renewal capacity
Once a stem cell becomes committed, it no longer has Pluripotent and self-renewal properties
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Immune System
The immune system is reponsible for mediating the interaction between an individual's internal and external environment
Innate Repsonses
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Components
Neutrophils
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Effect of acute exercise
Moderate exercise 
- Large and sustained
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Macrophages
Effect of acute exercise
Immediate in monocyte and macrophage count
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Moderate exercise - Phagocytosis
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Natural killer cells
Effect of acute exercise
Immediate in cell count and cytolytic activity
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Acquired responses
The acquired or adaptive immune system
= characterised by antigen-specific response to a foreign antigen or pathogen and generally takes several days or longer to activate
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Components
Cytotoxic T lymphocytes
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Effect on acute exercise
Moderate exercise proliferation, with depressed levels 30min post exercise
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Overall function
Rid the body of foreign agents (bacteria, viruses and malignant cells)
The immune system recognizes infectious agents and malignant cells because those agents and cells contain abnormal antigens in their cell membranes
The immune system can also inhibit subsequent formation of a tumor by countering factors responsible for its growth
Recognises infectious agents and malignant cells because those agents and cells contain abnormal antigens in their membranes
A cellular genetic mutation that converts a behaved cellular citizen of the body into a destructive renegade that is unresponsive to the ordinary checks and imbalances of the normal community of cells
In cancer, the cellular DNA of normal stem cells is damaged, leading to disordered cell growth and specialisation
A cancerous insult may produce a defect in the control of normal stem function, resulting in abnormalities in self-renewal, differentiation, and proliferation; the normal control of cell function and growth is lost. In other words,
Exercise Testing
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Cardiorespiratory
Clinical Measures
Oxygen consumption, METS, Workload, HR, RER, Treadmill time, RPE
Endpoints
Provides basis for determining starting point of exercise training. Used to evaluate response to training program
Protocol specifics
Individualised protocols, based on physical activity history and cormorbdilties
Special Considerations
Cancer treatment may result in cardiomyopathy, pulmonary fibrosis, or neuropathy Sensitivity to detect changes may be reduced in more fit individuals
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Resistance
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Endpoints
Provides basis for determining starting point of exercise training. Used to evaluate response to training program
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Take note:
Women who recently undergone lymph node biopsy or breast surgery may not be able to participate in upper body exercises for several weeks after surgery
Bone tenderness may be indicative of metastatic lesions to bones of the pelvic, back, or legs
The physical examination should attempt to identify acute signs or symptoms that are cancer specific and would prevent participation in exercise.
Other findings:
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Complications such as nausea, vomitng, fatigue and weakness may require modification of the exercise plan
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Exercise testing are relatively safe in cancer patients. However, the risk varies according to the type of cancer, the therapeutic management and the stage of disease.
Exercise prescription
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Cancer & Fatigue
Most common side effect of this disease.
Sustained physical, emotional, or cognitive exhaustion experienced during and after adjuvant cancer treatments that is not proportional to recent activities and interferes with usual functioning
Cancer-related fatigue is experienced in > 70% of patients undergoing chemotherapy
Cancer-related fatigue
Emotional stress, Sleep disturbance, Anemia, Nutrition, Decreased level of Physical activity, Cormorbidities
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Regular exercise, which counteracts many of the potential causes of fatigue, has shown to mitigating this common condition both during and following treatment.
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The timing of exercise in relation to when cancer treatments occur can also affect how a patient perceives fatigue.
Under the backdrop of dramatic changes that can occur with some treatments (e.g., hair loss, anaemia, anxiety), the impact of exercise on fatigue may at times be masked
Stronger effect size conducted after patients have completed cancer treatments
Patients with cancer exhibit higher than average inflammatory markers due to local immune response of the neoplasm, tissue injury from adjuvant treatments (i.e., surgery, chemotherapy, radiotherapy and the neoplasm itself). Inverse relationship between exercise and proinflammatory cytokines.
Type
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Range of Motion
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Intensity
Stretch maximally but avoid pain, especially in joints
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Aerobic
Duration
= 150 min/week of moderate intensity or >=75 min/week of vigorous intensity
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Goals
Increase Peak VO2, total work and endurance
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The 50% Rule
Ask the patient how far he can walk before becoming too tired, and start at half that distance of time.
There is no evidence supporting a different training response to exercise in the patient with cancer (vs. healthy adult).
Progression of the duration and frequency should precede increases in intensity.
Because cancer is a constellation of diseases, when working with a new patient it is important to learn about the specific cancer type, as well as common treatment regimens and their associated side effects
Definition
2 Discrepancies
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Benign Neoplasm/Tumor
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Slow growing, well organised, well differentiated cells and not fatal
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Tissue grows through unregulated cellular proliferation, shows partial or complete lack of structural organisation, lacks functional coordination with the normal tissue, and usually forms a distinct mass that may be either benign or malignant.
Cancer is a unique disease as it originate in any organ system, can spread to multiple organ systems and has multiple etiologies
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Treatment
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Hormone therapy
Either block hormone production or limits effects of these hormones, which can proliferate the malignant tumor
Side effects - Hot flashes, weight gain, bone and muscle loss, increased CV risk
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Diagnostic Testing
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Each cancer has a staging system unique to itself, one that takes into consideration pathogenic features, the modes of spread, and the curability of the disease
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