A Replicable and Sustainable Whole Person Care Model for Chronic Pain.

BACKGROUND: Integrative health is an expanding field that is increasingly called upon by conventional medicine to provide care for patients with chronic pain and disease. Although evidence has mounted for delivering integrative therapies individually, there is little consensus on how best to deliver these therapies in tandem as part of whole person care. While many models exist, few are financially sustainable. METHODS AND RESULTS: This article describes a conceptual and logistical model for providing integrative outpatient health care within an academic medical center or hospital system to patients with chronic pain and disease. In hopes that the model will be replicated, administrative details are provided to explain how the model operates and has been maintained over nine years. The details include the intentional building of a particular work culture. CONCLUSION: This whole person care model that addresses chronic pain and disease in an outpatient integrative clinic has been successful, sustainable and can be replicated in other academic medical centers or hospital clinics.

A Feasibility Study Related To Inactive Cancer Survivors Compared with Non-Cancer Controls during Aerobic Exercise Training.

Cancer survivors (CA) tend to demonstrate metabolic, cardiac, and ventilatory alterations due to previous chemotherapy and radiation that may impair adaptability following aerobic exercise training. Exercise training adaptations of CA finished with primary treatment compared to non-cancer participants (NC) have not yet been extensively elucidated. Thus, the present study compared physiologic responses of CA versus NC following a low-to-moderate intensity, 8-wk aerobic training program. Thirty-seven previously sedentary participants (CA: n = 14, 12 females; NC: n = 23, 19 females) with no heart or metabolic disease did not differ in age, height, weight, and body mass index (51 ± 2 y, 1.66 ± 0.02 m, 83.8 ± 3.2 kg, and 30.5 ± 1 kg·m-2). Each participant underwent baseline, 3-, 6-, and 8-wk VO2peak treadmill testing using the USAFSAM protocol and walked on a treadmill three times per week at 80-90% of ventilatory threshold (VT) for approximately 40-min·session-1. Variables obtained on the VO2peak tests included: HR at stage 2 (HR@stage2), rating of perceived exertion at stage 2 (RPE@stage2), lactate threshold (LT), ventilatory threshold (VT), salivary cortisol at 30-min post VO2peak test (SC@30-minPost),VO2peak level, time of fatigue (TOF), and maximal heart rate (HRmax). NC had significantly (p < 0.05) higher VO2peak, TOF, and HRmax at baseline, 3- and 6-wks of training but not at 8-wks. There were no differences between groups on RPE@stage2 except at baseline (p < 0.05). A significant (p < 0.05) interaction was observed only for RPE@stage2 with CA rating their initial RPE significantly greater at baseline versus NC. CA notably improved submaximal and maximal exercise capacity during 8 weeks of aerobic training and did not show altered adaptability compared to NC. We suggest prescribing aerobic exercise training at low/moderate intensity and duration initially, with progressive increases in duration and intensity after approximately 8-weeks. If available and supported, we advise clinicians to utilize submaximal threshold concepts obtained from cardiopulmonary exercise testing to prescribe more precise aerobic exercise training parameters.

Effects of a supervised exercise intervention on recovery from treatment regimens in breast cancer survivors.

PURPOSE/OBJECTIVES: To investigate the effects of supervised exercise training on cardiopulmonary function and fatigue in cancer survivors undergoing various clinical treatments. DESIGN: Pretest and post-test quasiexperimental. SETTING: Outpatient oncology rehabilitation center. SAMPLE: 96 breast cancer survivors undergoing various clinical treatments. METHODS: Subjects were divided into four groups based on the specific type of clinical treatment: surgery alone (n = 22); surgery and chemotherapy (n = 30); surgery and radiation (n = 17); and surgery, chemotherapy, and radiation (n = 27). Following a comprehensive screening and medical examination, cardiovascular endurance, pulmonary function, and fatigue were assessed, leading to the development of an individualized exercise prescription and a six-month exercise intervention. Repeated-measures analysis of variance and covariance were used to compare the effectiveness of the intervention and differences among treatment groups. MAIN RESEARCH VARIABLES: Systolic and diastolic blood pressure, resting heart rate, forced vital capacity, forced expiratory volume, predicted oxygen consumption, time on treadmill, and fatigue. FINDINGS: Cardiopulmonary function (predicted maximal oxygen consumption and time on treadmill) significantly increased in all groups after exercise training. In addition, resting heart rate and forced vital capacity significantly improved in those receiving surgery, chemotherapy, and radiation. Psychologically, the exercise intervention resulted in significant reductions in behavioral, affective, sensory, cognitive and mood, and total fatigue scale scores in all three groups who received treatment with surgery. The breast cancer survivors in the surgery-alone group showed significant reductions in behavioral, affective, and total fatigue scale scores but not in sensory and cognitive and mood fatigue scale scores. CONCLUSIONS: The results suggest that moderate intensity, individualized, prescriptive exercise maintains or improves cardiopulmonary function with concomitant reductions in fatigue regardless of treatment type. Moreover, cancer survivors receiving combination chemotherapy and radiotherapy following surgery appear to benefit to a greater extent as a result of an individualized exercise intervention. IMPLICATIONS FOR NURSING: Clinicians need to be aware of adjuvant therapies such as moderate exercise that attenuate negative side effects of cancer treatments. Symptom management recommendations should be given to cancer survivors concerning the effectiveness of exercise throughout the cancer continuum and the importance of participating in a cancer rehabilitation exercise program.

Exercise training manages cardiopulmonary function and fatigue during and following cancer treatment in male cancer survivors.

This investigation determined the cardiopulmonary function and fatigue alterations in male cancer survivors during treatment as well as following treatment utilizing similar exercise assessment protocols and individualized, prescriptive exercise interventions. The study included 45 male cancer survivors that were referred by local oncologists. Following a comprehensive screening and physical examination, cardiovascular endurance, pulmonary function, and fatigue were assessed leading to the development of 12-week individualized exercise prescriptions and exercise interventions. The cancer survivors were divided into during treatment (DTm) and following treatment (FTm) groups. Repeated-measures analysis of variance and analyses of covariance were used to compare pre- versus postintervention and between groups. Cardiopulmonary function was maintained in the DTm, whereas the FTm showed significant reductions in resting heart rate (P < .05) with concurrent increases in predicted VO2max and time on treadmill ( P < .05) postexercise intervention. Fatigue levels did not increase in the DTm group, whereas the FTm group showed significant reductions in behavioral fatigue, affective fatigue, sensory fatigue, cognitive/mood fatigue, and total fatigue (P < .05) after the exercise intervention. The results of the current study suggest that moderate intensity, individualized, prescriptive exercise intervention maintains or improves cardiovascular and pulmonary function with concomitant reductions in fatigue in cancer survivors during and following cancer treatment. Exercise appears to be a safe, efficacious strategy for improving physical fitness in cancer survivors during and following treatment.

Effects of supervised exercise training on cardiopulmonary function and fatigue in breast cancer survivors during and after treatment.

BACKGROUND: Cancer treatments have serious physiological and psychological side effects in cancer survivors. This investigation examined cardiopulmonary function and fatigue in breast cancer survivors during and after treatment by using similar exercise assessments, prescriptions, individualized interventions, and reassessments. METHODS: The study included 113 women diagnosed with breast cancer. Participants were grouped according to whether they participated in an individualized prescriptive exercise program during cancer treatment (DTm) or after cancer treatment (FTm). After a comprehensive screening and medical examination, cardiovascular endurance, pulmonary function, and fatigue were assessed, which led to the development of an individualized 6-month exercise prescription and exercise intervention. Repeated-measures analysis of variance (ANOVA) and analyses of covariance (ANCOVA) were used to compare the effectiveness of the intervention and differences between groups. RESULTS: Cardiopulmonary function (systolic blood pressure, time on treadmill) improved in the DTm group (P < .05), whereas the FTm group showed reductions in systolic and diastolic blood pressure and resting heart rate (P < .05) with concurrent increases in percentage of predicted FVC, % of predicted FEV(1), predicted VO(2)max, and time on treadmill (P < .05). Psychologically, the DTm group showed reductions in behavioral, sensory, and total fatigue (P < .05), whereas the FTm group showed reductions in behavioral, affective, sensory, cognitive/mood, and total fatigue (P < .05). CONCLUSIONS: The current study suggested that moderate intensity, individualized, prescriptive exercise maintains or improves cardiovascular and pulmonary function with concomitant reductions in fatigue during and after cancer treatment. However, it is critical that exercise be individualized to specific needs of the cancer survivor to prevent exacerbation of cancer treatment toxicities.

The effects of walking poles on shoulder function in breast cancer survivors.

Breast cancer treatment often results in impaired shoulder function, in particular, decrements in muscular endurance and range of motion, which may lead to decreased quality of life. The purpose of this investigation was to determine the effects of walking pole use on shoulder function in female breast cancer survivors. Participants had previously been treated with 1 or a combination of the following: mastectomy, breast conservation therapy, axillary lymph node dissection, chemotherapy, or radiation. Participants were randomly placed in experimental (n = 6) and control (n = 6) groups and met with a cancer exercise specialist 2 times each week for 8 weeks. The experimental group used walking poles during the 20-minute aerobic portion of their workout, whereas the control group did not use walking poles but performed 20 minutes of aerobic exercise per workout session. Both groups participated in similar resistance training programs. Testing was done pre- and postexercise intervention to determine upper body muscular endurance and active range of motion at the glenohumeral joint. Repeated-measures analysis of variance (ANOVA) revealed significant improvements in muscular endurance as measured by the bench press (P = .046) and lat pull down (P = .013) in the walking pole group. No within-group improvements were found in the group that did not use walking poles. The data suggest that using a walking pole exercise routine for 8 weeks significantly improved muscular endurance of the upper body, which would clearly be beneficial in helping breast cancer survivors perform activities of daily living and regain an independent lifestyle.

A case study: prescriptive exercise intervention after bilateral mastectomies.

Exercise for cancer patients is gaining support. In the current case study, a female breast cancer patient was diagnosed with breast cancer at the age of 29 years; she underwent a left modified radical mastectomy. She developed cancer again in the opposite breast at the age of 57 years and had a right modified radical mastectomy. After the second mastectomy (the right breast), the patient received chemotherapy and radiation. Following her cancer treatments, she participated in an exercise intervention for 6 months at the University of Northern Colorado's Rocky Mountain Cancer Rehabilitation Institute. A 6-month reassessment showed that she increased her muscular strength and cardiovascular function in addition to attenuating her cancer-related fatigue and depression. It is recommended that health professionals work together to ensure that a collaborative effort is undertaken to increase functional work capacity that will significantly improve patients' quality of life.

A model program: exercise intervention for cancer rehabilitation.

Recent advances in cancer detection and treatment have resulted in an increase in the survival rate of individuals diagnosed with cancer. The increased survival rate brings new challenges for increasing the quality of life for cancer survivors. Debilitating side effects can result from the cancer itself and the cancer treatment. The negative effects lead to decreased functional (work) capacity, increased fatigue, and debilitating muscular weakness. There have been very positive benefits seen from the use of individualized prescriptive exercise intervention in alleviating these cancer treatment related symptoms. The role of exercise intervention as a complementary therapy is just emerging. Studies have shown that exercise decreases the amount of fatigue, improves functional capacity, increases immune function, and leads to improved quality of life. The effects of cancer and cancer treatments require that an exercise intervention program be well based in sound scientific principles. The exercise intervention needs to be carefully structured and controlled. All patients should be assessed and reassessed to evaluate progress. A cancer exercise specialist should closely monitor the exercise regime. Exercise should involve a whole-body approach that emphasizes all areas of fitness. Exercise therapy for cancer patients is a new and exciting area that will continue to grow as medical professionals realize the necessity for post-cancer treatment intervention to improve quality of life.