Plan of Treatment or Exercise Prescription and Progression
Plan of Treatment or Exercise Prescription and Progression
Principle
In patients with Cancer, disability is primarily a result of anti-cancer treatment with progressive deconditioning. As the disease progresses, limited functional capacity makes exertion unpleasant and leads to an increasingly sedentary lifestyle. Shortness of breath (breathlessness) and exercise intolerance are the most incapacitating symptoms patients develop. A counter-measure to progressive functional decline in patients with cancer is exercise training.
For cancer patients, low to moderate-intensity aerobic exercise training should be performed to maintain endurance, strength, and function. The goal of exercise at this time is to maintain function and prevent the loss of endurance and strength. Anti-cancer treatments exhaust physical and emotional reserves, so the goal of low to moderate-intensity aerobic exercise training is to maintain these resources. Cancer patients are easily fatigued, but benefit from low to moderate-intensity aerobic activities. Aerobic exercise during and after anti-cancer treatment maintains or significantly retards the loss of strength and endurance and assists in countering signs and symptoms associated with psychosocial ills. Additionally, special modifications in the type of exercise performed may be required if orthopedic limitations, such as range of motion deficits, occur as a result of surgery.
For ―lung cancer‖ patients, irreversible destruction of the lung is a hallmark which must be worked around by accessing compensatory systems to achieve functional independence. Significant ventilation-perfusion mismatch impairing maximal gas exchange. Additionally, the work of breathing is increased secondary to increased airway resistance and hyperinflation. Increased muscle mass and a better vascular system will help improve peripheral extraction of oxygen, which will lead to better physical activity. Evaluate the patients need for bronchodilator therapy, mucolytics or supplemental oxygen during exercise. Therapists will find that frequent follow-up, encouragement and reassurance are integral to the success of the rehabilitation process. Progress in exercise tolerance may be minimal in this population, however diligent participation can reduce symptoms, reverse anxiety and depression, and increase the ability to perform activities of daily living.
Purpose
It has clearly been demonstrated that exercise is beneficial for cancer patients. Structured exercise protocols and less demanding protocols for very low level cancer patients alike produced significant improvement in exercise tolerance. Exercise has been shown to improve the quality of life and therefore should be an integral adjunctive treatment for all cancer patients.
Components of a Plan of Treatment or Exercise Prescription
A Plan of Treatment or exercise prescription generally includes the following specific recommendations:
Type of exercise or activity (i.e. strength training, walking, cycling, swimming, chopping wood, fishing, cleaning house, washing the car…)
Specific workloads (i.e. MPH, MET, FPM-walking speed, Kcal/min, )
Duration-(variable) and frequency-(fixed:3 X Wk) of the activity or exercise session
Intensity guidelines – Target heart rate (THR) range and estimated rate of (RPE), (SOBr), (Fatigue).
Precautions or contraindications regarding ratings of perceived exertion, ratings of fatigue, shortness of breath and oxygen saturation should be kept in focus in order to prevent overtraining. Remember to keep oxygen saturation > 88% Sp02 at all times during the therapeutic exercise session, additionally an orthopedic, cardiac or co-morbidity concern may require close supervision.
