Undergraduate Curriculum Designed to Facilitate a Cancer Exercise Rehabilitation Program.

In 2030, more than 22.1 million cancer survivors are expected to reside in the USA. A workforce knowledgeable in the unique issues of oncologic exercise design and delivery will help to fulfill the need for services that improve survivor health, prognosis, and quality of life (QOL). The purpose of this project was to describe the application of a cancer exercise rehabilitation training program on student performance benchmarks and patient outcomes. Thirty-seven kinesiology students were taught how to design an exercise program for cancer patients through face-to-face instruction (10 h) and online material. Students created and delivered exercise prescriptions to cancer patients (n = 111) over 12 weeks. Surveys evaluating student performance, patient fitness, and patient psychosocial outcomes were used to assess students' skill proficiency, ability to apply newly acquired knowledge, and academic/professional growth. A 2-way ANOVA evaluating student performance scores revealed a significant main effect of time (F(1, 165) = 22.92, p < 0.001), indicating that student performance was improved. Post hoc tests showed the "skill proficiency, knowledge and exercise leadership" dimension was significantly improved (p < 0.0001). Cancer patients had significant improvements in body composition, muscular function, flexibility, and balance (p < 0.05). Students succeeded in tasks directly related to content learned in prerequisite kinesiology courses, while 3 weeks was required for students to become proficient in clinic-related duties. Ninety percent of the students reported that the internship was an excellent learning experience. The curriculum was successful in teaching students how to design and implement exercise programs that improve cancer patient fitness and QOL.

Exercise-Based Cancer Rehabilitation Program Improves Phase Angle in Breast Cancer Survivors.

Phase angle (PhA) is an index of cell membrane integrity and prognostic indicator of survival and quality of life in cancer survivors. The efficacy of exercise-based cancer rehabilitation programs (ExCR) on PhA is unknown. To assess the effect of ExCR on PhA in breast cancer survivors. Fifty-nine female breast cancer survivors (61 ± 9 years) were referred to the ExCR by their oncologist and participated in one-on-one exercise-based training for 90 minutes, 3 times a week, for 12 weeks. Training sessions included 45 minutes of resistance training at intensities between 40-85% of 1-repetition maximum with a rate of perceived exertion (RPE) between 3-8, 30 minutes of cardiorespiratory training at intensities between 40-85% of heart rate reserve with an RPE between 3-8, and 15 minutes of flexibility training. Participants completed pre- and post-measurements of body composition, cardiorespiratory endurance, flexibility, muscular endurance, muscular strength, and PhA (Inbody 770). PhA significantly increased (p < 0.05) after ExCR (PhApre = 4.56; PhApost = 4.64; Δ = 1.8%). Changes in measures of muscular strength have a weak but significant positive relationship (r = 0.20-0.39; p < 0.05) with changes in PhA. There was no relationship between changes in PhA and changes in cardiorespiratory endurance or muscular endurance. A 12-week ExCR significantly improves PhA in breast cancer survivors. Training muscular strength may be an integral component of ExCR with the objective of improving PhA.

Group-based Exercise Therapy Improves Psychosocial Health and Physical Fitness in Breast Cancer Patients in Hawai'i.

Cancer diagnosis and treatment often negatively impact quality of life, worsening prognosis, and long-term survival in cancer patients. Rehabilitation is effective at reversing cancer-related effects, but these services are not standardized. An implementation study was conducted to determine the usability and efficacy of group-based exercise therapy delivered from an outpatient therapy clinic. Thirty breast cancer patients (mean age ± standard deviation [SD],= 55 ± 10 years) completed 36 90-minute group-based exercise sessions in small groups. Team-based exercises were used to foster peer interaction and social support. Usability was evaluated with participant feedback, adherence, and occurrence of adverse events. Effectiveness was measured with the Revised Piper Fatigue, the City of Hope Quality of Life (QOL), and the Beck Depression Inventories. Paired t-tests and 2-way ANOVAs were used to detect significance (P<.05); Cohen's d was used to measure effect size. Twenty-five patients completed the program; they reported that they liked the program design. One anticipated, moderate adverse event occurred. The intervention improved fatigue and QOL, where significant main effects of time were detected [Fatigue: (F(1,76)=29.78, P <.001); QOL: (F(1,80)=24.42, P<.0001)]. Improvements in the fatigue inventory's behavioral/security and sensory dimensions (Cohen's d=-0.43 and È¡0.68, respectively) and the physical dimension of the QOL inventory were detected (Cohen's d=0.92). There were no significant changes in depression (P=.0735). Seven patients continued to participate in exercise classes for 2.5-years post-intervention, demonstrating achievability of program maintenance. Providing group-based exercise therapy services at an outpatient clinic is an effective and practical approach to improve cancer patients' QOL.

Paired exercise has superior effects on psychosocial health compared to individual exercise in female cancer patients.

PURPOSE: Exercise improves the quality of life (QOL) in cancer patients recovering from treatment. Since group exercise fosters cohesion, we sought to determine if paired exercise would have similar, positive effects. An experiential study design was used to compare the effect of exercise (12 weeks) on psychosocial health in paired versus individually trained cancer patients. METHODS: Female cancer patients (n = 28) who completed cancer treatment were placed into either the singly trained or paired group. Groups were matched for cardiorespiratory fitness (peak oxygen consumption, single: 24.1 ± 7.4, pair: 24.8 ± 6.3 ml/kg/min) and age (single: 58 ± 12, pair: 58 ± 9 years). Patients participated in 36, 90-min exercise sessions in accordance with exercise recommendations. QOL (Functional Assessment of Cancer Therapy-General, FACT-G), depressive, fatigue, and insomnia symptoms were measured before, midway, and after the intervention. Fitness was measured pre- and post-intervention. Participants did not meet prior to the intervention. Two-way ANOVAs and multiple comparisons tests were used to detect differences (p < 0.05). RESULTS: Emotional well-being and total FACT-G scores were significantly improved in the paired but not individually trained patients. Depressive symptoms were significantly improved at mid- and final time points in the paired group. Paired patients reported significant improvements in insomnia symptoms from pre- to mid-intervention. Depressive and insomnia symptoms in the individually trained group were unchanged. A significant main effect of group was detected in fatigue scores in patients who were not chronically tired at baseline (F(1, 12) = 6.318, p = 0.0272). Both groups exhibited similar improvements in fitness. CONCLUSION: Paired exercisers had greater benefits in QOL, emotional well-being, and insomnia and depressive symptoms compared to individual exercisers.