Traditional approach to oncology group exercise
In the cancer population, many adverse health problems are experienced as side effects of cancer and its associated treatments. These negative effects can be seen in both the physical and mental domains and have been associated with a decreased quality of life for these individuals. More specifically, these side effects can include fatigue, cognitive dysfunction and depression [1]. Recently, research has shown the potential of exercise to alleviate or aid in the management of these side effects and symptoms. Traditionally, the benefits of exercise in this population have been determined through studies involving one-on-one exercise training. Benefits from conventional exercise have demonstrated improvements in a patient’s physical health in areas such as muscular and cardiovascular strength and an improved quality of life [2,3]. Little emphasis, however, has been placed on the effectiveness of group exercise classes on cancer rehabilitation in these same domains. Nearly 85% of the cancer patients we work with at Maple Tree Cancer Alliance were sedentary prior to their cancer diagnosis. Therefore, the concept of exercise can be daunting to someone, especially in light of fatigue and treatment side effects they may experience. Group exercise classes offer a less intimidating approach to fitness. Not only can it be a place where participants learn helpful ways to increase their daily activity, but they also have the opportunity to fellowship with other patients who are in a similar stage of treatment.
Structured group exercise has the potential to produce even greater improvements in overall health than individualized exercise alone. Our lab observed that structured, progressive group exercise decreases depression and improves quality of life by allowing patients to exercise in a social environment with people that can motivate them [3]. Along with that, group exercise allows patients to maintain a consistent exercise schedule and follow a safely designed, effective workout plan [4].
Wellsprings of hope exercise class curriculum & fitness parameters
Maple Tree Cancer Alliance’s Wellsprings of Hope group exercise class is a structured and progressive 8 weeks class that involves pre- and post-fitness testing. A large percentage of the individuals that attend the Wellsprings of Hope class are women, typically over the age of 40, that have, or are currently going through treatments for breast cancer. Class sizes range from about 5-12 participants per group. The class operates during regular business hours.
Prior to the start of each 8-week session, fitness assessments are completed to determine baseline measurements. The testing covers abilities in cardiovascular fitness, muscular strength and endurance, flexibility, and body composition. Body composition (including body fat percent and body mass index) scores are taken via skinfold measurement. The skinfold assessment is a well-validated, reliable method of obtaining body composition scores that is easy and non-invasive for the patient [5]. Cardiovascular health is assessed as a measure of VO2 as determined by the Rocky Mountain Cancer Institute endurance test performed on the treadmill. Flexibility is measured using the modified sit-and-reach box test while muscle strength and endurance are assessed using a handgrip dynamometer and curl up test, respectively. These scores are compared to norms laid out by the American College of Sports Medicine.
The Wellsprings of Hope class meets once a week and follows a curriculum that utilizes mostly Thera band exercises. Thera band exercises have been used in many populations including breast cancer patients and the elderly [2]. The exercises are designed to provide the patient with resistance exercises that utilizes a wide variety of resistance weight starting at 2.5 pounds (light resistance). Classes are typically held in an open area (gym, yoga room, etc.) and Thera bands and a chair for modifications are the only equipment needed. The beginning portion of the class starts with a general warm up and a few aerobic exercises to get the blood flowing, followed by about 20 minutes of Thera band exercises that target the entire body. Each class is intended to hit all fitness parameters tested prior to the start of the 8-week session to ensure that improvements are seen. The end of each class consists of general stretching and modifications as well as further instruction on proper technique of exercises. Class concludes with a brief lecture on various nutrition topics, including “How to Read a Label”, “Portion Control”, and “How to Navigate a Grocery Store”. These offer some helpful tips that will help the patients make healthy lifestyle choices in their daily lives. Each patient is given a Thera band to take home, as well as exercise and nutrition handouts at each class. Patients are encouraged to exercise on their own at least two additional days each week.
Upon completion of the 8-week session, fitness parameters are reassessed using the same testing protocol and equipment. These values are compared to those found prior to the start of the session to determine efficiency of the program. The differences in fitness parameters found through the 8 weeks are then further compared to previous 8-week sessions to provide more information regarding consistency of the program and times of greatest attendance, greatest improvements, etc. In general, we have observed improvements in fitness parameters as a result of these classes.
Conclusion
In conclusion, our Wellsprings of Hope class has been fundamentally developed in order to improve the fitness parameters of our patients, as well as educate our patients to make healthy lifestyle choices. The exercises performed in each class are well-validated, based on extensive research, and designed to improve the quality of life of each participant. Previous data has confirmed the multitude of benefits associated with exercise as well as attending group-based classes. Thus, continued utilization of the 8-week group program could only bring more benefits as well as a different mode of exercising that patients can enjoy.
References
- Haas BK, Kimmel G (2011) Model for a community-based exercise program for cancer survivors: taking patient care to the next level. J Oncol Pract 7: 252-256. [Crossref]
- Lin S, Sung H (2012) The effectiveness of resistance training with thera band on physiological functions for older adults: A systematic review. JBI Library of Systematic Reviews 10.
- Timonen L, Rantanen T, Timonen T, Sulkava R (2002) Effects of a group-based exercise program on the mood state of frail older women after discharge from hospital. Int J Geriatr Psychiatry 17: 1106-1111. [Crossref]
- Dolan S (2012) Benefits of group exercise. Retrieved from https://www.acsm.org/public-information/articles/2012/01/20/benefits-of-group-exercise
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- Heydari S, Ayatollahi S, Zare N (2011) Diagnostic value of bioelectrical impedance analysis versus body mass index for detection of obesity among students. Asian J Sports Med 2: 68-74. [Crossref]
