DPTD 873 - cancer and exercise

differences between CFR and other fatigue

• no relationship between the symptoms and the activities that led to it

• does not improve or only slightly improved with rest

• significantly impacts QoL and physical performance

risk factors for developing CRF

• pain

• depression and anxiety

• inactivity

• poor sleep hygiene

• poor nutrition

• medication side effects

CRF pathophysiology

• associated with increase in cytokines and decrease in carbohydrates in the body

• body has a hard time keeping up with ATP production demands from the body and the tumor

PT focus during and immediately after cancer treatment

education, energy conservation, addressing treatable contributing factors, developing an exercise program

CFR contributing factos

anemia, poor nutrition status, sleep disturbance, physical inactivity

CRF PT focus at end of life

help pt find meaningful interactions and optimizing their activity level in consideration of their specific situation

cancer-related cognitive impairment

• can last from months to years after treatment ends

• may present as - learning new things, remembering, multi-tasking, sequencing

• PT implications - limit HEP exercises, concise pt ed

myelosuppression ia a … and may manifest as …

myelosuppression is a known chemo-related deficit - may manifest as anemia, neutropenia, and/or thrombosytopenia due to damage of WBCs, RBCs, and platelets within the bine marrow

nadir

timeframe when patient is the highest risk for infection or other adverse events

neutropenia presentation

• fever, chills, sore throat

• SOB

• higher risk for infection

• risk for neutropenic fever

neutropenia side effect

joint pain

platelet range

norm = 150,000-400,000; critical value = <50,000 or >1 million

thrombocytopenia presentation

• easy bruising

• uncontrolled bleeding with injuries

• gum bleeding, nose bleeds

• small burst blood vessels

thrombocytopenia PT considerations

• education on reducing fall risk

• monitoring for fatigue - use borg RPE/dyspnea scale

thrombocytopenia exercise guidelines

• <10,000 = walk in room with assistance, focus on ADLs & safety

• 11,000-50,000 = walking, stationary bike, active exercise (no resistant) - can increase effort over time

• >50,000 = increase walking distance, add stairs - slowly introduce resistance

anemia presentation

fatigue, SOB, increased HR and RR

anemia exercise guidlines

• <8 = walking to tolerance, no biking, AROM - no resistance

• 8-12 = short distance walking, stationary bike in short intervals (5-10 mins)

• >12 = walking in room/hallway, stationary bike - add resistance as tolerated

osteolytic vs osteoblastic metastasis

• osteolytic = results in loss of bone material (punched out appearance on x-ray)

• osteoblastic = results in an increase of bone material, but is fragile and unstable (bright on x-ray)

bone met symptoms

• bone pain - often worse at night/with bed rest

• pathologic fracture - particularly spine, humerus, and femur

• s/sx associated with hypercalcemia

PT considerations for bone mets

• 0-25% invasion → FWB to PWB

  • low to no impact aerobic exercise

  • avoid lifting/straining activities

• 25-50% → PWB to TT or foot-down WB

  • no resistance exercise

  • minimize torque forces

  • stretching and strengthening of areas that do not have lesions

• 50-75% → TTWB to NWB

  • basic ADLs

  • passive movement or AAROM

  • no torque

vo2 max vs vo2 peak

• vo2 max

  • maximum volume of o2 consumption

  • best measure of overall heart function

• vo2 peak

  • highest vo2 achieved during a fitness test

  • doesn’t require gas analysis - more clinically accessible

  • can be used as a predictor of VO2 max

indications to stop treadmill test

• HR does not increase w intensity

• SBP does not increase with intensity

• DPB fluctuates >10 mmHg from baseline

• SpO2 below 80%

• HR exceeds HR max calculated by tanaka formula

normal BP response to exercise

systolic increases with intensity, diastolic stays about the same