Intervention 2641 Physical Activity

The most researched, efficacious, and efficient intervention to address physical impairments, activity limitations, participation restrictions, and reduced quality of life in people receiving treatment for cancer is physical exercise. Studies of various exercise interventions on adult populations have contributed most of the data that support the current understanding of the effects of exercise in AYA with cancer. Reviews of these studies have shown consistently that physical exercise following diagnosis has a clinically and statistically positive effect on many of the negative consequences of cancer and its treatment [19]. Exercise benefited physiological functions including aerobic capacity, muscle strength, flexibility, body composition and weight, hematological indexes, nausea, fatigue, pain, and diarrhea, and also had positive effects on many facets of psychological and emotional well-being including personality functioning, anxiety, depression, feeling of control, perceived physical competence, self-esteem, self-confidence, and satisfaction with life [3, 19, 20]. There is some evidence that physical activity can have an effect on the immune system, to reduce the risk of cancer recurrence and/or secondary malignancies and increase survival time. However, these data must be considered in the context of several methodological limitations inherent in the studies with respect to sampling, design, and outcome measures [3, 21].

Some studies of fatigue have included AYA. In a qualitative investigation of adolescents with cancer, clinical interventions identified as alleviating fatigue included maintenance of optimal fitness levels through an appropriate balance of rest and exercise, in addition to distraction and entertainment and relief from disease or treatment-related symptoms [4, 22]. A survey of cancer survivors who considered themselves athletes prior to diagnosis included young adults. Those who continued to exercise with modifications during treatment believed exercise made them less likely to develop health problems, and physical activity balanced with rest was an effective intervention for fatigue [23]. These studies have been complemented by the more rigorous research investigating the role of exercise in preventing and/or alleviating cancer-related fatigue in adults. This has demonstrated that increased physical exercise is associated with less fatigue during and after treatment [3, 19]. These findings are particularly important as the past recommendations of resting and avoiding physical effort can have a paradoxical effect. Inactivity induces further muscular wasting and loss of cardiorespiratory fitness and endurance, creating a self-perpetuating condition of further diminished activity, leading to easy fatigue and vice versa, which can be long lasting [3].

Sharkey et al. [7] found that an exercise program in AYA who had received anthracyclines resulted in increased exercise ability and a trend toward improved peak oxygen uptake and ventilatory anaerobic threshold. Children and adolescents who were encouraged to be physically active during treatment for ALL had less loss of passive range of motion compared to a group who did not receive activity intervention. Surgical procedures had been necessary in some of the patients in the nonintervention group [25].

To promote exercise in AYA receiving treatment for cancer, it is necessary to be aware of the determinants of physical activity. In addition to the many potential impairments, prediagnostic levels of activity influence participation during and following treatment [17]. Other predictors include individual factors such as physical and cognitive status, communication and psychosocial abilities, gender, body mass index, feelings of competence, and perceived benefits. Environmental and personal factors such as available facilities, season, economics, alternative sedentary activities, social influences, cultural perspectives, preferences, and activity levels of family and peers; the educational influences of health professionals and educators, and the media are also influential [1]. These factors must be taken into consideration when working with AYA. Therapists must provide ongoing encouragement and reinforce the importance of regular activity. Ideally, participation in physical activity should take place throughout and following treatment. Efforts should be focused particularly on those individuals identified with low incentive, as they are most at risk for inactivity and its associated problems.

In addition to physical activity promoting health and well-being during treatment, there may be implications for long-term health, as adolescence is an important time for adopting healthy practices including preferences for activity or inactivity [25], which may impact on future fitness, obesity, bone density, and cardiovascular disease. This is particularly important for adult survivors of cancer who are at risk for multiple health problems.

The intensity, frequency, type, location, and progression of programs are based on medical condition, assessment, preferences, and goals. Exercise prescription in adult cancer studies is typically moderate-intensity exercise, 3-5 days per week, 20-30 min per session. However, low exercise intensities may achieve similar health benefits [19, 20]. Daily exercise with shorter, lighter-intensity bouts with rest intervals and slower progressions may be preferable for decondi-tioned patients [19]. These recommendations can be used for adolescents, but a consensus process developed recommendations for children and adolescents in the general population of participation in at least 1 h of moderately intensive physical activity daily, either continuous or spread throughout the day. Moderate intensity is activity equivalent to a brisk walk, such as that when the participant might feel warm or slightly out of breath. Those who do very little activity per day should start with 30 min per day. Activities that enhance muscle strength, flexibility, and bone health should be done twice weekly [26]. Exercise pre scription should include warm-up and cool-down activities.

Types of exercise used most frequently in adult cancer patients were aerobic or cardiovascular endurance and occasionally strength training programs [19]. Activities included regular walking, treadmill walking, bicycle ergometry, or bed ergometry for hospitalized patients. Walking is the most common exercise for cancer patients [19, 27]. It is a natural, safe, and tolerable choice that relates directly to daily living and is conducive to AYA lifestyle, particularly if complemented with music or participation with peers. It is important for AYA to participate in activities in which they will experience personal accomplishment. Recreational pursuits are often the most preferred form of activity. Popular options include martial arts, dance, aerobics, swimming, walking, biking, and activities at fitness clubs. Some AYA are able to resume competitive sports, although adaptations may be necessary.

Individual lifestyle may influence the preference for type of program, varying from self-directed home programs to group exercise classes [27]. Alternatives should be offered, particularly for those who have a busy school or work life. The concept of "lifestyle physical activity interventions" has been an efficacious approach for youth treated for cancer. This approach focuses on increasing moderate-intensity activity through individualized programs that take into account individual, cultural, and environmental differences [28].

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