The Central Role of Abdominal Adiposity in the development of ObesityRelated Disorders - PowerPoint PPT Presentation

Loading...

PPT – The Central Role of Abdominal Adiposity in the development of ObesityRelated Disorders PowerPoint presentation | free to download - id: 20905-YmFkY



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

The Central Role of Abdominal Adiposity in the development of ObesityRelated Disorders

Description:

... dl Avoid high intensity exercise ... Fever 38oC Avoid exercise ... Severe cachexia Loss of muscle mass limits exercise intensity - modify program accordingly ... – PowerPoint PPT presentation

Number of Views:78
Avg rating:3.0/5.0
Slides: 48
Provided by: RehabMe1
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: The Central Role of Abdominal Adiposity in the development of ObesityRelated Disorders


1
Exercise Cancer Rehabilitation
Lee W. Jones, Ph.D.
Behavioral Medicine Laboratory, Faculty of
Physical Education, University of Alberta
HE ED 221 (E-121) November 24, 1.00-2.00pm, 2003
2
Framework PEACE
DIAGNOSIS
3. Rehabilitation
Prevention
1. Pre-Treatment
2. Treatment
5. Survival
4. Palliation
PRE-DIAGNOSIS
POST-DIAGNOSIS
Adapted from Courneya Friedenreich, Ann Behav
Med 2001
3
Why Exercise?
4
Cancer Therapies
Surgery Tx for localized tumors 60 pts, 30 cure
rate
Radiation Local regional tx 50 patients
Systemic Therapy Advanced solid
tumors Chemotherapyhormonal therapy biological
therapy
5
Cancer Quality of Life
- Psychological/physical functional side-effects
Surgery - infection, loss of function, dyspnea,
pain, diarrhea, lymphedema
Radiation - nausea, fatigue, vascular damage
(cardiac lung tissue)
Chemotherapy - myelosuppression, nausea, weight
gain, cardiac toxicity, fatigue
Shapiro NEJM 2001 3441997-2008
6
Current Quality of Life Interventions
- Cognitive-behavioral therapies, educational
strategies, grp psychotherapy - Largely
psychological in nature - Unlikely to address
physical/functional aspects - Exercise not
important or appropriate
Courneya, Mackey Jones Phys SportsMed 2000
7
Cancer, Quality of Life, Exercise
Clinical Concerns -Immunosuppressive
effects -Pathological bone fractures - ?
Cardiotoxicity (RT CT) - Unwillingness of
cancer pts - Recent research dispelling myths
Courneya, Mackey Jones Phys SportsMed 2000
8
Current Status Exercise Cancer Research
9
Review of Literature
Cancer Site
Study Design
Exercise Modality
Adjuvant Tx
10
Review of Literature
Outcomes/Results
All reported significant benefits No Adverse
events Multiple Outcomes…..
Physiologic Outcomes - VO2peak, body comp, NK
activity, flexibility
Tx-Related Symptoms fatigue, pain, nausea,
diarrhea, platelet transfusion, hospital stay
QOL Outcomes overall, PWB, FWB, SWB, SWL,
anx/dep
Courneya et al. Phys SportsMed 20002849
Courneya ACSM 2003
11
Review of Literature
Limitations
Small number of studies (n47 only 14
RCTs) Small sample sizes (heterogeneous) Self-r
eport measures of exercise Methodology not well
described
Courneya et al. Phys SportsMed 20002849
Courneya ACSM 2003
12
V. Clinical Exercise Prescription Guidelines
13
General Guidelines
Cancer dx affects all aspects of physical
functioning Unique manifestations - Tumor -
Treatment - Side effects - Demographic
profile ACSM guidelines (3-5d/wk, 30-60mins,
moderate intensity) Optimal guidelines not yet
established
14
Prescription Guidelines
Mode
Walking / cycle ergometry natural choice Account
for specific impairments (e.g., colorectal,
breast cancer) Resistance/upper body lymphedema
concerns - unfounded Combined program optimal
15
Prescription Guidelines
Frequency Intensity
At least 3-5d/wk Daily for deconditioned
patients Moderate Intensity 50-70 VO2max
60-80 HRmax RPE 11-14
16
Prescription Guidelines
Duration Progression
  • 20-30mins (continuous)
  • Intermittment bouts (5-10 mins)
  • Initially in frequency duration - then
    intensity
  • Progression slower for deconditioned pts those
    suffering severe side effects

17
General Guidelines
No evidence that one type of exercise is
superior Safety is the primary concern Optimal
program may combine resistance aerobic training
Key point is to be flexible - modify
prescription based on response to treatment(s)
18
Special Precautions
  • Complication Precaution
  • Hemoglobin exercise
  • Absolute neutrophil count Avoid exercises that
    may increase chance of infection (swimming)
  • Fever 38oC Avoid exercise
  • Ataxia/dizziness Avoid exercises that require
    significant balance coordination
    (treadmill)
  • Severe cachexia Loss of muscle mass limits
    exercise intensity - modify program
    accordingly
  • Bone pain Avoid high impact exercises
  • Extreme fatigue Exercise at lower power output,
    avoid maximal tests

19
VI. Current Clinical Trials Forthcoming Studies
20
Breast Cancer
21
REHAB Trial
REHAB (Rehabilitation Exercise for Health After
Breast Cancer) Trial
Purpose Determine the effects of exercise
training on cardiopulmonary, QOL, and biologic
outcomes in postmenopausal b/c survivors
Outcomes QOL, VO2peak, metabolic hormones
(insulin, IGF-1), sex steroid hormones
(estradiol, estrogen), biomarkers of CVD (CRP,
lipids, etc.)
22
REHAB Trial
REHAB Trial
Method
53 participants EG (n25) or CG (n28) Cycle
ergometry 3x/wk, 15-35mins, 15wks, 70-75
VO2peak Results 52 participants completed
trial 98.4 adherence (44.3/45 sessions)
23
Results
VO2peak
QOL
Courneya et al. JCO 2003
24
Breast Cancer
START (Supervised Trial of Aerobic vs Resistance
Training)
Purpose Determine the effects of aerobic vs.
resistance training on QOL in early stage b/c
patients on chemotherapy
  • Objectives
  • Compare AET Vs RET on fitness QOL
  • Explore individual characteristics of these
    effects
  • Compare adherence rates
  • Investigate psychosocial determinants

Courneya, et al. Funded by CBCRA
25
START Trial
Study Design
210 Early Stage B/C Patients
Vancouver N70
Ottawa N70
Edmonton N70
Tax/Non-Tax
Tax/Non-Tax
Tax/Non-Tax
LM
RT
AE
LM
RT
AE
LM
RT
AE
Procedure
Eligible Pts Approached by Oncologist
Baseline Assessment 1st CT
Intervention Concurrent with CT
Post-Test 3wk Last CT
Courneya, et al. Funded by CBCRA
26
START Trial
Outcomes Primary QOL Secondary Fatigue
VO2peak Muscular Strength Body Composition
Lymphedema Bio-markers (Cancer Recurrence CV
Risk Factors)
Progress Edmonton (n21 83) Ottawa
(n18) Vancouver (n3)
Courneya, et al. Funded by CBCRA
27
Prostate Cancer
28
Prostate Trial
Prostate and Resistance Exercise Training Trial
Purpose Determine the effects of resistance
exercise on fatigue HRQOL in prostate cancer
patients receiving ADT. Outcomes HRQOL, fatigue,
body composition, muscular fitness (strength,
cardiopulmonary fitness)
Segal et al. JCO 2003
29
REHAB Trial
Prostate Trial
Method 155 RET (n83) or CG (n73) Resistance
Training 3x/wk, 12wks, 9 exercises, 2 sets of
8-12 reps _at_ 60-70 1 RM Results 135 participants
completed 76.2 adherence (27/36 sessions)
30
Prostate Results
Leg Press
Chest Press
Fatigue
QOL
31
Colorectal Cancer
32
CAN-HOPE RCT
  • Colorectal RCT (CAN-HOPE)
  • To determine if exercise can improve QOL in
    colorectal cancer survivors
  • Submaximal fitness test/QOL at baseline 16
    weeks
  • Moderate intensity, home-based exercise program
    (F3-5/wk D20-30)
  • Randomized 102 patients (33 Control /69 EX)

Courneya et al. EJCC, in press
33
CAN-HOPE RCT
Participant Characteristics
Participant Characteristics Demographic Age 60
59 male 74 married 40 university 60 40k
Medical Mths Sx 2 80 III/IV 100 Sx 20 RT
65 CT
34
CAN-HOPE Results
QOL
TOI
Anxiety
? Fitness
? Fitness
Courneya et al. EJCC, in press
35
Lung Cancer
36
Exercise Capacity NSCLC
Purpose Determine the Prognostic Value of
Symptom-Limited Exercise Testing on Survival in
Inoperable NSCLC Patients
Method New Patient Rounds via Medical Record
Review Blood draw/PFT/GXT
Jones et al. In Process
37
Exercise Capacity NSCLC
  • Outcomes
  • Primary Survival
  • Secondary
  • Association with traditional predictors
  • VO2peak Tx response/tolerability

Jones et al. In Process
38
Exercise Capacity NSCLC
Progress
Total Number of Patients Screened N49
Reasons for Non-Eligibility (n29) Recent CHD
(n4) Physically Disabled (n7) TB (n1) Age
(n2) O2 Dependent (n5) Extensive Met Disease
(n4) Psychological Distress (n2) Co-morbidities
(n4) Non Lung Cancer (n1) No Treatment (n1)
Total Number of Patients Eligible N20 (20/49
41)
Reasons for Non-recruitment (n8) Does Not
Believe in Exercise (n1) Exercise Test Too
Risky (n1) Too Sick (n3) Too Much On (n3)
Total Number of Patients Interested N12 (12/20
65)
Total Number of Patients Tested N10 (10/12
83)
Jones et al. In Process
39
Exercise Capacity NSCLC
Results Age 71 Range 64 - 83 VO2peak
16.2 Range 9.4 24.3 RER 1.2 BMI 27 Range
21 35
Aims Accurate prognostic information Optimal
therapeutic approach Feasibility safety - RCT
40
Pre Surgery Exercise RCT
Method Surgeon Referral Two-armed RCT Exercise
Training (n25) vs. Usual Care (n25) AET
4/5x/wk, 10-45mins, 50-75 VO2peak for 6 wks
Outcomes Primary Perioperative Complications
(infection, O2 utilization, etc.) Secondary
VO2peak, QOL, length of hospital stay
Timing of Assessments baseline, pre-sx, 5-7d
post sx
Jones et al. In Progress
41
Other Cancers
42
Exercise Anemia Trial
EXTRA (EXercise TRaining Anemia) Trial
Purpose Determine if a 12-wk exercise program can
improve QOL in anemic patients receiving Aranesp
Method Two-armed RCT Aranesp Alone (n50) vs.
Aranesp Exercise (n50) Periodized Cycle
Ergometry 3x/wk, 30-45mins, 60-75 VO2peak for 12
wks
Outcomes Primary QOL (FACT-An) Secondary
VO2peak, Hb Response, Blood Markers
Mackey, Courneya, Jones et al. Funded by Amgen Inc
43
EXTRA Trial
Results Age 51 Range 25 - 71 VO2peak
16.5 Range 11 25.3 RER 1.23 Hb 100 Range
91 - 107
44
Multiple Myeloma
Purpose Examine the Potential Role of Exercise in
Multiple Myeloma Cancer Patients
  • Objectives
  • Exercise preferences/level of interest
  • Exercise Rates
  • Determinants of exercise (attitudes, perceived
    capability)
  • Association with QOL fatigue

Jones et al. In Process
45
Exercise Multiple Myeloma
Method Cross-sectional provincial survey ACB
registry Oncologist-approval 162 sent
questionnaire
Results 11 returned (6 deceased, 5 moved) 87
(87/151 58) completed questionnaire
Jones et al. In Process
46
Exercise Glioma RCT
Purpose To determine the effect of exercise
training on QOL in newly diagnosed primary glioma
cancer patients during RT
Method Two-armed RCT usual care (n12) vs.
exercise training (n12)
Intervention 3x/wk 60-90 minutes, 8wks AET
50-70 VO2peak RET 8-12 repetitions _at_ 70-80
1-RM of 8 upper/lower body exercises
Jones et al. Submitted for Funding CIHR/ACB
47
Summary
ACSM Guidelines Early Stage Patients
Advanced Cancer Pts More Care
Safety primary concern
Integral component of comprehensive care for
cancer patients
About PowerShow.com