10. Physical activity and exercise
• Physical activity
– Human movement that results in a substantial
increase in energy expenditure over resting
levels
• Exercise
– A form of physical activity that is performed on
a repeated basis over an extended period of
time with the intention of improving fitness,
performance, or health
10
15. 恢復/復健期之身體活動
Physical activity and recovery/rehabilitation
• 10 研究探討在完成治療後3-6 個月（復健
期）運動的效果
• Outcomes
– 身體功能
– 疲倦與生活品質
– 免疫功能
Feasible and may provide
– 身體組成 physiological and psychological
benefits for cancer survivors
15
24. 美國癌症協會防癌指引
對個人
• Achieve and maintain a healthy weight throughout life
• Adopt a physically active lifestyle
– 成人:每周至少150分鐘中等程度運動或75分鐘劇烈運動，或是相當的
運動量，最好平均分配到每一天
– 兒童及青少年：每天至少60分鐘中至強度運動，每週至少3天以上為
劇烈運動量。
– 減少靜態生活，例如坐、躺著、看電視或其它對著螢幕(screen-
based )形式的娛樂。
– 除了日常生活外，多增加身體活動，對健康有很多益處。
• Consume a healthy diet, with emphasis on plant food
• If you drink alcoholic beverage, limit consumption
ACS guidelines on nutrition and physical activity for cancer prevention, 2012
24
27. Medical and pre-exercise evaluation
• Comprehensive medical evaluation:
medical history, physical exam and
physician clearance
• Testing to exercise tolerance
• Follow-up and re-evaluation at regular
interval
27
30. ECOG performance status
Grade ECOG
0
Fully active, able to carry on all pre-disease performance without restriction
1
Restricted in physically strenuous activity but ambulatory and able to carry out
work of a light or sedentary nature, e.g., light house work, office work
2 Ambulatory and capable of all selfcare but unable to carry out any work
activities. Up and about more than 50% of waking hours
3 Capable of only limited selfcare, confined to bed or chair more than 50% of
waking hours
4 Completely disabled. Cannot carry on any selfcare. Totally confined to bed or
chair
5 Dead
Oken, M.M., Creech, R.H., Tormey, D.C., Horton, J., Davis, T.E., McFadden, E.T., Carbone, P.P.:
Toxicity And Response Criteria Of The Eastern Cooperative Oncology Group. Am J Clin Oncol 5:649-
655, 1982. 30
31. KARNOFSKY PERFORMANCE STATUS SCALE
KPS scale
Able to carry on normal 100 Normal no complaints; no evidence of disease.
activity and to work; no
special care needed. 90 Able to carry on normal activity; minor signs or symptoms of disease.
80 Normal activity with effort; some signs or symptoms of disease.
Unable to work; able to live at 70 Cares for self; unable to carry on normal activity or to do active work.
home and care for most
personal needs; varying 60 Requires occasional assistance, but is able to care for most of his
amount of assistance needed. personal needs.
50 Requires considerable assistance and frequent medical care.
Unable to care for self; 40 Disabled; requires special care and assistance.
requires equivalent of
institutional or hospital care; 30 Severely disabled; hospital admission is indicated although death not
disease may be progressing imminent.
rapidly.
20 Very sick; hospital admission necessary; active supportive treatment
necessary.
10 Moribund; fatal processes progressing rapidly.
0 Dead
31
32. Red flags or yellow flags
• Neural impairments
• Skeletal impairments
• Complete blood count
• Cardiovascular or pulmonary system
32
35. 骨骼轉移
• 60%的癌症復發會轉移到骨骼，其中一半轉移到脊椎骨
• 癌症對骨骼的影響
– Loss of bone material (lytic tumor)
– Invasion of bone (sclerotic tumor)
– Osteonecrosis
– Reduced bone mineral density
• 主要症狀
– 疼痛
– 脊髓神經症狀
– 病理性骨折
35
48. Exercise prescriptions for oncology patients: aerobic
component Aerobic
Frequency 3-7 x/week
40%-60% of HR reserve or Oxygen uptake reserve, or
Intensity 60%-80% of max HR, or
RPE of 12-15
Mode Start with walking or recumbent bike
Start with 5-20 minutes depending on exercise tolerance,
Duration including warm-up and cool-down.
Goal is 20-60 minutes of continuous exercise
Progression Duration > frequency> intensity > mode
HR, BP, O2 sat, RPE, and pain
Patient
Avoid group exercise during periods of neutropenia
monitor
Avoid training with presence of a new migrating central line
consideration
Avoid aquatics if neutropenic or with central line 50
49. Exercise prescriptions for oncology patients:
strength training
component Strength training
Frequency 2-3 x/week, 48 hour recovery between sessions
Intensity 40%-60% of 1 RM or 6-12 reps
8-10 dynamic exercises involving, functional task training, using
weight machines or free weights. Recommend caution with
Mode TheraBand resistance.
Target large, major muscle groups, performing concentric, and
eccentric contractions, in supine, sitting or standing positions
Start with 1 set of 8-12 reps;.
Duration
Goal is 1-3 sets of 8-15 reps
Frequency > intensity:
2-3 x/week with 48 hr recovery
Progression
Add TheraBand only if no additional hematologic or orthopedic
precautions are present
HR, BP, O2 sat, RPE, DOE and pain
Patient monitor Avoid group exercise during periods of neutropenia
consideration Avoid training with presence of a new migrating central line
Avoid aquatics if neutropenic or with central line 51
50. Exercise prescriptions for oncology patients:
flexibility
component Flexibility training
Frequency 2-7 days/week
Intensity Slow static stretches only to the end range
Mode
Duration 4 reps of 10-60 seconds per stretch
Progression Duration > frequency > intensity >mode
Patient
HR, BP, O2 sat, RPE, DOE and pain
monitor
Avoid group exercise during periods of neutropenia
consideration
52
