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Cancer and exercise
Published in Adam P. Sharples, James P. Morton, Henning Wackerhage, Molecular Exercise Physiology, 2022
Tormod S. Nilsen, Pernille Hojman, Henning Wackerhage
Exercise may reduce the risk of developing several cancers. Emerging evidence from preclinical studies have improved our understanding of the potential role of exercise in risk of cancer incidence. These mechanisms include improved genomic control and increased cancer cell apoptosis, improved tumour vascularisation and reduced tumour hypoxia, altered cancer cell metabolism, and improved immune detection. Exercise may also improve the circulatory environment, in terms of lower levels of stimulating hormones and growth factors. Furthermore, exercise is a valuable strategy during cancer treatment, as it may help relieve the symptom burden (i.e. less cancer-related fatigue and improved QoL) and help patients maintain their physical function. In addition, exercise prior to cancer treatment (i.e. prehabilitation) may help prepare patients for major cancer surgery. Thus, exercise plays an important role in all phases of the cancer continuum.
Peri-operative medicine
Published in Henry J. Woodford, Essential Geriatrics, 2022
Prehabilitation aims to improve health status in advance of the stress of surgery. Smoking cessation four to six weeks prior to surgery has been shown to reduce post-operative complications, including pneumonia, myocardial ischaemia and impaired wound healing.14 Reducing alcohol intake, when relevant, to within recommended levels (i.e. 14 units per week or less) also reduces the incidence of post-operative complications. Exercise training for periods of four to six weeks can meaningfully improve physical fitness. Ideally, this would include resistance training to increase muscle mass. Screening for nutritional status before surgery is appropriate. A protein intake of 1.5 to 2 g/kg is recommended to address pre-operative malnutrition, especially when aiming to improve muscle mass. Inspiratory muscle training can improve respiratory muscle strength and reduce the risk of post-operative pneumonia.
Malignant Neoplasms
Published in Amy J. Litterini, Christopher M. Wilson, Physical Activity and Rehabilitation in Life-threatening Illness, 2021
Amy J. Litterini, Christopher M. Wilson
The continuum of cancer survivorship extends from prevention and pre-treatment to palliation (see Figure 9.4).13 As with many health conditions, early intervention is key to reducing the risk of future complications after the initial diagnosis of cancer. The pretreatment phase, sometimes referred to as pre-rehabilitation (or prehabilitation), can be effective for patients of all stages of disease undergoing aggressive surgical interventions. A systematic review of prehabilitation interventions for cancer survivors found improvements in function and physical capacity within 18 studies of 966 patients.14 For individuals with early stage cancers, lifestyle modification to reduce the risk for metastasis, secondary cancers, or new primary cancers is appropriate. For individuals in active cancer treatment, oncology rehabilitation and physical activity to address cancer treatment-related side effects are key. Nutrition consultations for weight management are also key in cancer risk reduction in long-term survivorship. Comprehensive survivorship programming for all stages of disease is the ideal format for monitoring cancer survivors for treatment-related sequela including cardiomyopathy from cardiotoxic chemotherapy or immunotherapy, late effects from radiation such as plexopathies and radiation fibrosis, and signs and symptoms of disease progression (Figure 9.4).
Presurgical rehabilitation program for patients with symptomatic lumbar spinal stenosis: A pilot randomized controlled trial protocol
Published in Canadian Journal of Pain, 2022
Nora Bakaa, Douglas P. Gross, Lisa C. Carlesso, Joy MacDermid, Kenneth Thomas, Florence Slomp, Alison Rushton, Maxi Miciak, Rob Smeets, Raja Rampersaud, Andrew Nataraj, Brian Drew, Pahuta Markian, Daipayan Guha, Aleks Cenic, Luciana Macedo
The proposed program was developed using best available evidence, results from our preliminary work (manuscripts under review), and in collaboration with patients and our multidisciplinary team (Table 1). The intervention will be reported using the Consensus on Exercise Reporting Guidelines.30 All participants will be prescribed exercises (by either a chiropractor or physiotherapist) over a period of 8 weeks using the commercially available web-based Physitrack exercise programming application (https://www.physitrack.ca). Physitrack is a commercially available cloud-based digital platform that allows health professionals to assign exercise programs and education to individuals remotely and allows for videoconferencing. All data sent to and from the Physitrack platform are encrypted. Access to patient data is severely restricted and any person or party that has access to Physitrack patient data is bound by confidentiality agreements. Physitrack provides network security through a virtual private cloud, a bastion host, a firewall, and IP address filtering. The prehabilitation program will consist of synchronous (five one-on-one exercise sessions at 1, 3, 5, and 7 weeks, 6 weeks postoperatively with a clinician) and asynchronous (independent) home exercise sessions (minimum three times a week). The initial synchronous (one-on-one) session with the clinician will include a structured baseline assessment of mobility and balance.
Effect of Whey Protein Supplementation on Perioperative Outcomes in Patients with Cancer—A Systematic Review and Meta-Analysis (PROSPERO 2020: CRD42020188666)
Published in Nutrition and Cancer, 2022
Nivedhyaa Srinivasaraghavan, Nairita Das, Kalpana Balakrishnan, Swaminathan Rajaram
Enhanced recovery after surgery (ERAS) has now become standard of care in most major surgeries including oncological surgeries with benefits ranging from decreased length of stay (LOS) to decreased costs without increasing complication or readmission rates (19). Supplementing whey as a part of the ERAS program to improve postoperative outcomes has garnered recent attention (20). A more proactive approach to the problem is better preoperative preparation of the patient to withstand the surgery and this has been termed as “Prehabilitation.” Thus nutritional prehabilitation before cancer surgery is vital to improving outcomes as suggested by the “the better in, the better out” principle (21). A multimodal form of prehabilitation including exercise, nutritional enhancement, and psychological counseling has been advocated to improve surgical outcomes (22, 23). Furthermore, when the prehabilitation becomes personalized, especially in the elderly, it is associated with reduced postoperative complications and paralytic ileus (24).
Exercise oncology: an emerging discipline in the cancer care continuum
Published in Postgraduate Medicine, 2022
Ga Watson, Zl Coyne, E Houlihan, Gd Leonard
More recently, there has been accumulating evidence supporting the benefits of exercise in the cancer prehabilitation setting [69–73]. Cancer prehabilitation is a modern concept describing the implementation of exercise programs in the pre-treatment time period to optimize functional status and prevent treatment-related functional decline. The aim of this earlier intervention is to augment the ability of cancer patients to tolerate their cancer treatment, but also to enhance motivation and confidence in patients’ ability to comply and adhere to multimodal rehabilitation efforts both during and after their medical treatment. This early intervention has been shown to improve functional status, physical and psychological health outcomes and decrease overall health-care costs [69]. Prehabilitation regimens may focus on one specific modality such as exercise, or incorporate a wider variety of interventions such as patient information and education, nutrition, psychological counseling such as psycho-oncology, smoking cessation, and reduction of alcohol consumption. A recent randomized clinical trial by Minella et al. involving 68 patients with esophageal cancer undergoing preoperative exercise prior to elective surgery demonstrated improved functional status both before and after surgery compared to the control group [73].