CLINICAL EXERCISE PHYSIOLOGY FOR CANCER, CARDIOVASCULAR, AND PULMONARY REHABILITATION CLINICAL EXERCISE PHYSIOLOGY
The Clinical Exercise Physiology in the clinical setting—has an important place in health care. An Exercise Physiologist focuses on restoring the patient’s mobility and functional capacity; these efforts are in conjunction with physical therapists, occupational therapists and the patient’s physician (s).
The roles and responsibilities for health care professionals in regards to rehabilitation, is to work in conjunction with each other to improve the patient’s functional capacity. Their roles and responsibilities are:
1. Physician / Nurses help the patient to attain and maintain good health so functional capacity can be improved.
2. Occupational Therapists help the patient with the ability to function in daily life and safely perform occupational tasks.
3. Social Workers help the patient to function within their social system.
4. Clinical Exercise Physiologist and Physical Therapist help the patient to improve their functional capacity and overall mobility.
5. An Exercise Physiologist has an extended role in the clinical practice due to the fundamental relationships between measures of functional capacity, physical fitness and over all optimum health.
The World Health Organization defines health as “a state of complete physical, mental and social well-being, not merely the absence of disease and infirmity.” Good health is the ability to complete physical tasks successfully and maintain functional independence.
Functional capacity measurement provides an objective assessment of a patient’s health status and quantifies changes from diverse strategies to improve health and well being.
The hierarchy of possible outcomes from disease progression is as follows: Pathophysiology (disease) Impairment (alterations in structure and function) Functional Limitations (difficulties performing tasks) Disability (significant functional limitations can’t perform certain tasks) Handicap (socially disadvantaged because of disability).
Disability of a patient, within this text refers to diminished functional capacity due in part to an inactive life style. Handicap is best characterized by physical performance views as defined by society. These patients aren’t able to perform tasks expected by society.
PREVALENCE AND TYPES OF DISABILITIES
There are numerous medical conditions that consequently impact functional capacity and physical performance. Disabilities onset occurs at different stages of life. Disabilities that have onset at or during birth may include blindness, brain injuries, deafness, deformed limbs, mental retardation and acquired diseases. Disabilities that have onset during youth and young adulthood may include injury related disabilities, sport related injuries, diabetes and general disease. Other disabilities that may occur later in life include but are not limited to cardiovascular, cancer and pulmonary pathologies.
Men usually lead women in regard to disabilities with progression in aging except pre and post menopausal women during the age range of forty five to sixty four and seventy five years of age and older.
Furthermore, Clinical Exercise Physiologists play a large role in sport medicine, physiologist evaluations and reconditioning of patients with disease and physical disabilities.
CLINICAL EXERCISE PHYSIOLOGY FOR ONCOLOGY
Our focus will primarily be placed on the disability in the patient’s greatest area of involvement.
ONCOLOGY
Cancer is a group of diseases characterized by “uncontrolled growth and unchecked spread of abnormal cells that form larger than normal cell clusters that become tumors. Currently there are more than 100 types of cancers, which most often but not always occur in adults.
CANCER STATISTICS
Cancer is the second leading cause of death in the United States, it is estimated that one third of this population is diagnosed with some type of cancer (www.cancernet.nci.nih.gov/). Nearly 600,000 people in the United States die from cancer each year, it is estimated that 1.3 million new cases are diagnosed each year. These estimates exclude noninvasive cancers (except non invasive urinary bladder cancer) and include basal cell and squamous cell cancers.
Skin cancer is more prevalent than any other types of cancer; it estimated that nearly 1.35 million basal and squamous cell skin cancers are diagnosed each year (www.skincancer.org).
In regards to mortality, lung cancer represents the most prevalent cancer killer of all Americans, followed by, colon, rectal, breast and prostate. Mortality rates for men are higher than for women who are diagnosed and treated for lung cancer. With men, prostate cancer is more frequent and prevalent, and lung cancer moves into second place then colorectal and bladder cancer. In young women, breast cancer is the # 1 killer for women between the ages of twenty five and forty four. Breast cancer exceeds lung cancer, colorectal and uterine cancers. Minorities have reported higher rates of cancer.
Cancer rates declined by 0.8 percent during 1990 and 1997 this result may be attributed to early detection, aggressive treatment modalities and patient compliance. The largest decline was represented by men, due to public awareness and education programs aimed at early prostate screening, breast cancer Mammography and breast exams for women and colorectal examination for both genders has resulted in a positive impact on early detection and treatment options. Of the 8 million cancer survivors from the 1970’s – 1880’s emphasizes the ongoing need for rehabilitation and maintenance options in this important area of medicine.
CANCER REHABILITAION THROUGH EXERCISE
It is noted that varying levels of physical exercise helps the cancer patient to recuperate and return to their normal lifestyles with greater independence and functional capacity as compared to those that received little to no physical activity. Cancer patients and survivors experience loss of body mass and decreased energy levels and functional status that is most noted post surgically, during chemotherapy, and/or radiation therapy.
There are numerous reasons why surgery, chemotherapy and radiation therapy has this affect on the patient’s condition post treatment. In regards to function capacity, the patient is affected by chronic fatigue that limits completion of routine household chores or even walking more than a block. Studies indicate that seventy five percent of the cancer survivors report extreme fatigue during radiation therapy or chemotherapy may be due to weight loss, dehydration, stress, decreased muscular strength, decrease lung and oxygen carrying capacity, depression, and decreased cardiovascular endurance.
A home based exercise regimen that follows exercise treatment protocol has reduced symptoms of fatigue while enhancing the quality of life following cancer diagnoses/treatment. Maintaining and restoring function presents challenges to the cancer survivor and their families. Evidence collected from research justifies exercise intervention for breast cancer survivors along with nutritional intervention reduce the risk of contracting several forms of cancer.
PROTECTIVE EFFECTS OF EXERCISE ON CANCER
Epidemiologic evidence reveals a significant inverse relationship between amounts of occupational or leisure time physical activity and reduction in all causes cancer risk (i.e., magnitude of the protective effect of physical activity on estrogen – dependent cancer warrants low to moderate exercise as a prudent preventive strategy). Community based studies of colorectal and prostatic hyperplasia reveals that increased activity significantly reduces cancer risk and mortality; women may reduce their risk factor for breast cancer by twenty percent or more.
Men that are at a higher risk for colorectal cancer may decrease their risk by increasing physical activity, limiting red meat consumption, staying within a healthy BMI range, moderate alcohol consumption, not or stop smoking and keeping a low folic acid intake. Experts and researchers present many hypotheses as to how exercise reduces the risk and prevent of cancer.
Breast Cancer:
1. Lowering effect of exercise on estrogen, a hormone that stimulates breast cell growth.
2. Regular physical activity also lowers circulating levels of blood glucose and insulin and increases corticosteroid hormones.
3. Exercise increase anti- inflammatory cytokine levels and augments insulin-receptor express in cancer fighting T cells.
4. Physical activity promotes interferon production.
5. Stimulates glycogen synthetase.
6. Enhances leukocyte function.
7. Improves ascorbic acid metabolism.
8. Exerts beneficial effect on provirus or oncogene activation.
NINE GENERAL TREATMENT GOALS OF THE CLINICAL EXERCISE PHYSIOLOGIST FOR PATIENTS WITH DECONDITIONING, IMMOBILITY OR DISUSE SYNDROMES
1. Improve the patient’s overall functional status.
2. Improve active motion for nonrestrictive segments and joints.
3. Prevent loss of flexibility by active and passive movements.
4. Prevent thrombosis through physical activities.
5. Prevent loss of motor control, muscle strength, and endurance with resistance exercises.
6. Reduce bone loss through weight-bearing aerobic and anaerobic exercises.
7. Increase or prevent gentility function with systematic breathing exercises.
8. Prevent loss of fat free mass.
9. Increase circulation and blood flow.
EXERCISE PERSCRIPTION AND CANCER
In regards to exercise prescription concerning cancer patients, the time of exercise during the recovery process is problematic. The result obtained for exercise prescription with cancer patient is promising. However, exercise intervention significantly increases natural killer cell cytotoxic activity.
Furthermore, there isn’t a protocol measurement of exercise prescription and rehabilitation designated for the varying types of cancer with different age ranges and gender. Exercise prescription is symptoms limited and case specific. Generally any type of monitored physical mobility as soon as practical is important for the deconditioned and sedentary patient.
The mode of the exercise may vary case dependent; however the intensity and the duration of the rehabilitation may be critical. The intensity should begin at low to moderate level; the duration may vary from several minutes a session to several times a day. Clinical Exercise Physiologist should avoid long period in duration with regards to rehabilitation of cancer patients.
The prescription is intended to increase or improve ambulation if the patient has no specific contraindications. The prescription must include range of motion movements as well as exercise to improve muscular strength, retain and build fat free mass while improving overall mobility.
With the ever increasing age groups of Baby Boomers and Senior Citizens living longer with the advancement of modern, ancient, allied medicine. The increase need for Gerontologist is at even higher demands, professional Gerontologist are highly trained and skilled in assisting these age groups with disease and the disease process.
Our services help individual understand what is happening to their body and mind during this process while assisting with other dynamics that affects the person disease and illness.
We are trained at the least to process information in the areas of sociological factors, finance, family issues, depression, the disease process, autonomacy, independence, insurance, medical issue and complications, communication, gender and cultural specific issues.
The Clinical Exercise Physiology in the clinical setting—has an important place in health care. An Exercise Physiologist focuses on restoring the patient’s mobility and functional capacity; these efforts are in conjunction with physical therapists, occupational therapists and the patient’s physician (s).
The roles and responsibilities for health care professionals in regards to rehabilitation, is to work in conjunction with each other to improve the patient’s functional capacity. Their roles and responsibilities are:
1. Physician / Nurses help the patient to attain and maintain good health so functional capacity can be improved.
2. Occupational Therapists help the patient with the ability to function in daily life and safely perform occupational tasks.
3. Social Workers help the patient to function within their social system.
4. Clinical Exercise Physiologist and Physical Therapist help the patient to improve their functional capacity and overall mobility.
5. An Exercise Physiologist has an extended role in the clinical practice due to the fundamental relationships between measures of functional capacity, physical fitness and over all optimum health.
The World Health Organization defines health as “a state of complete physical, mental and social well-being, not merely the absence of disease and infirmity.” Good health is the ability to complete physical tasks successfully and maintain functional independence.
Functional capacity measurement provides an objective assessment of a patient’s health status and quantifies changes from diverse strategies to improve health and well being.
The hierarchy of possible outcomes from disease progression is as follows: Pathophysiology (disease) Impairment (alterations in structure and function) Functional Limitations (difficulties performing tasks) Disability (significant functional limitations can’t perform certain tasks) Handicap (socially disadvantaged because of disability).
Disability of a patient, within this text refers to diminished functional capacity due in part to an inactive life style. Handicap is best characterized by physical performance views as defined by society. These patients aren’t able to perform tasks expected by society.
PREVALENCE AND TYPES OF DISABILITIES
There are numerous medical conditions that consequently impact functional capacity and physical performance. Disabilities onset occurs at different stages of life. Disabilities that have onset at or during birth may include blindness, brain injuries, deafness, deformed limbs, mental retardation and acquired diseases. Disabilities that have onset during youth and young adulthood may include injury related disabilities, sport related injuries, diabetes and general disease. Other disabilities that may occur later in life include but are not limited to cardiovascular, cancer and pulmonary pathologies.
Men usually lead women in regard to disabilities with progression in aging except pre and post menopausal women during the age range of forty five to sixty four and seventy five years of age and older.
Furthermore, Clinical Exercise Physiologists play a large role in sport medicine, physiologist evaluations and reconditioning of patients with disease and physical disabilities.
CLINICAL EXERCISE PHYSIOLOGY FOR ONCOLOGY
Our focus will primarily be placed on the disability in the patient’s greatest area of involvement.
ONCOLOGY
Cancer is a group of diseases characterized by “uncontrolled growth and unchecked spread of abnormal cells that form larger than normal cell clusters that become tumors. Currently there are more than 100 types of cancers, which most often but not always occur in adults.
CANCER STATISTICS
Cancer is the second leading cause of death in the United States, it is estimated that one third of this population is diagnosed with some type of cancer (www.cancernet.nci.nih.gov/). Nearly 600,000 people in the United States die from cancer each year, it is estimated that 1.3 million new cases are diagnosed each year. These estimates exclude noninvasive cancers (except non invasive urinary bladder cancer) and include basal cell and squamous cell cancers.
Skin cancer is more prevalent than any other types of cancer; it estimated that nearly 1.35 million basal and squamous cell skin cancers are diagnosed each year (www.skincancer.org).
In regards to mortality, lung cancer represents the most prevalent cancer killer of all Americans, followed by, colon, rectal, breast and prostate. Mortality rates for men are higher than for women who are diagnosed and treated for lung cancer. With men, prostate cancer is more frequent and prevalent, and lung cancer moves into second place then colorectal and bladder cancer. In young women, breast cancer is the # 1 killer for women between the ages of twenty five and forty four. Breast cancer exceeds lung cancer, colorectal and uterine cancers. Minorities have reported higher rates of cancer.
Cancer rates declined by 0.8 percent during 1990 and 1997 this result may be attributed to early detection, aggressive treatment modalities and patient compliance. The largest decline was represented by men, due to public awareness and education programs aimed at early prostate screening, breast cancer Mammography and breast exams for women and colorectal examination for both genders has resulted in a positive impact on early detection and treatment options. Of the 8 million cancer survivors from the 1970’s – 1880’s emphasizes the ongoing need for rehabilitation and maintenance options in this important area of medicine.
CANCER REHABILITAION THROUGH EXERCISE
It is noted that varying levels of physical exercise helps the cancer patient to recuperate and return to their normal lifestyles with greater independence and functional capacity as compared to those that received little to no physical activity. Cancer patients and survivors experience loss of body mass and decreased energy levels and functional status that is most noted post surgically, during chemotherapy, and/or radiation therapy.
There are numerous reasons why surgery, chemotherapy and radiation therapy has this affect on the patient’s condition post treatment. In regards to function capacity, the patient is affected by chronic fatigue that limits completion of routine household chores or even walking more than a block. Studies indicate that seventy five percent of the cancer survivors report extreme fatigue during radiation therapy or chemotherapy may be due to weight loss, dehydration, stress, decreased muscular strength, decrease lung and oxygen carrying capacity, depression, and decreased cardiovascular endurance.
A home based exercise regimen that follows exercise treatment protocol has reduced symptoms of fatigue while enhancing the quality of life following cancer diagnoses/treatment. Maintaining and restoring function presents challenges to the cancer survivor and their families. Evidence collected from research justifies exercise intervention for breast cancer survivors along with nutritional intervention reduce the risk of contracting several forms of cancer.
PROTECTIVE EFFECTS OF EXERCISE ON CANCER
Epidemiologic evidence reveals a significant inverse relationship between amounts of occupational or leisure time physical activity and reduction in all causes cancer risk (i.e., magnitude of the protective effect of physical activity on estrogen – dependent cancer warrants low to moderate exercise as a prudent preventive strategy). Community based studies of colorectal and prostatic hyperplasia reveals that increased activity significantly reduces cancer risk and mortality; women may reduce their risk factor for breast cancer by twenty percent or more.
Men that are at a higher risk for colorectal cancer may decrease their risk by increasing physical activity, limiting red meat consumption, staying within a healthy BMI range, moderate alcohol consumption, not or stop smoking and keeping a low folic acid intake. Experts and researchers present many hypotheses as to how exercise reduces the risk and prevent of cancer.
Breast Cancer:
1. Lowering effect of exercise on estrogen, a hormone that stimulates breast cell growth.
2. Regular physical activity also lowers circulating levels of blood glucose and insulin and increases corticosteroid hormones.
3. Exercise increase anti- inflammatory cytokine levels and augments insulin-receptor express in cancer fighting T cells.
4. Physical activity promotes interferon production.
5. Stimulates glycogen synthetase.
6. Enhances leukocyte function.
7. Improves ascorbic acid metabolism.
8. Exerts beneficial effect on provirus or oncogene activation.
NINE GENERAL TREATMENT GOALS OF THE CLINICAL EXERCISE PHYSIOLOGIST FOR PATIENTS WITH DECONDITIONING, IMMOBILITY OR DISUSE SYNDROMES
1. Improve the patient’s overall functional status.
2. Improve active motion for nonrestrictive segments and joints.
3. Prevent loss of flexibility by active and passive movements.
4. Prevent thrombosis through physical activities.
5. Prevent loss of motor control, muscle strength, and endurance with resistance exercises.
6. Reduce bone loss through weight-bearing aerobic and anaerobic exercises.
7. Increase or prevent gentility function with systematic breathing exercises.
8. Prevent loss of fat free mass.
9. Increase circulation and blood flow.
EXERCISE PERSCRIPTION AND CANCER
In regards to exercise prescription concerning cancer patients, the time of exercise during the recovery process is problematic. The result obtained for exercise prescription with cancer patient is promising. However, exercise intervention significantly increases natural killer cell cytotoxic activity.
Furthermore, there isn’t a protocol measurement of exercise prescription and rehabilitation designated for the varying types of cancer with different age ranges and gender. Exercise prescription is symptoms limited and case specific. Generally any type of monitored physical mobility as soon as practical is important for the deconditioned and sedentary patient.
The mode of the exercise may vary case dependent; however the intensity and the duration of the rehabilitation may be critical. The intensity should begin at low to moderate level; the duration may vary from several minutes a session to several times a day. Clinical Exercise Physiologist should avoid long period in duration with regards to rehabilitation of cancer patients.
The prescription is intended to increase or improve ambulation if the patient has no specific contraindications. The prescription must include range of motion movements as well as exercise to improve muscular strength, retain and build fat free mass while improving overall mobility.
With the ever increasing age groups of Baby Boomers and Senior Citizens living longer with the advancement of modern, ancient, allied medicine. The increase need for Gerontologist is at even higher demands, professional Gerontologist are highly trained and skilled in assisting these age groups with disease and the disease process.
Our services help individual understand what is happening to their body and mind during this process while assisting with other dynamics that affects the person disease and illness.
We are trained at the least to process information in the areas of sociological factors, finance, family issues, depression, the disease process, autonomacy, independence, insurance, medical issue and complications, communication, gender and cultural specific issues.
