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growing need to address functional changes following cancer treatments. 

27% decline in cancer death-- improve treatment and faster recognition

More long term related functional limitation and decline. 

	Surgery*	Chemotherapy	Radiation therapy	Hormone therapy	Immunotherapy
Cardiovascular 🧡		x**	x	x	x
Endocrine	x	x	x	x	x
Gastrointestinal	x	x	x		x
Neurological 🧠	x	x	x	x
Pulmonary	x	x	x
Fatigue🛏		x**		x***	x

*based on surgical involvement

** no increased RBC with Adjuvant CT, consider alternative to help moderate symptoms: plasma volume, increased Cardiac output, peripheral utilization (caution with over working heart, may limited intensity and had longer duration)

*** Muscle loss can be increased with 2 sets of 8-15 reps at 60% 1 rep max, helps with weight management

Common Reported Side affects and recommended exercises: 

All should be adjusted based type and stage of cancer, current cancer treatment, medical comorbidities 

Common Cancer stagine: 

TNM: Tumor size, Node involvement, Metastasis 

Anxiety	(3mod Aerobic + resistance )x12 weeks	Better with supervision
Altered bone metabolism	(3mod Resistance +  high 2-3 high impact)x52 weeks	Caution with osteoporosis Caution with metastasis Badk for joint health *** stay in normal ROM for form Limited usefulness
Chemotherapy-induced peripheral neuropathy	Aerobic + balance training	Mostly to limit impact on function and safety
Depression	(3mod Aerobic + resistance )x12 weeks	Dose Responsive up to 180 min/week
Altered cognition	--	No specific studies
Lymphedema	SLow progressive supervised resistive training	Exacerbation need MLD and compression
Falls	Endurance and strengthening	Multifactorial make difficult to define actual effective treatment
Nausea
Pain	Focused exercise to reestablish proper biomechanics
Altered sexual function	Limited general studies, Focused Pt has been shown with limited improvement (Pelvic floor) Improved mood or personal image has also been noted to improve.
Impaired sleep	(3mod Aerobic) 30 minutes x12 weeks	No specific studies, expect usual response with increased aerobic activity
Quality of life	(2-3mod Aerobic + 2-3 Mod resistance )x12 weeks	Combination is better Improved results with supervision
Fatigue	(3mod Aerobic + resistance ) 30 minx12 weeks	More results creatine increased intensity Linear response to 150 min/week
Physical Function	(3mod Aerobic +/- resistance )x12 weeks	Increased duration is key Focal changes need supervision

Types of Physical Exercises/expected functional changes:

Aerobic	Resistance	Flexibility
Activity Tolerance Improved sleep Mood management Perceived improved quality of life Appetite regulations	Weight management Increased bone density Joint protection Physical appearance	Range of motion Ligament and tendon protection Improved perception of function

Aquatherapy-- combo of aerobic and flexibility

Yoga - Resistance, aerobic and mental 

FITT guidelines

Main Article

Campbell KL, Winters-Stone KM, Wiskemann J, May AM, Schwartz AL, Courneya KS, Zucker DS, Matthews CE, Ligibel JA, Gerber LH, Morris GS, Patel AV, Hue TF, Perna FM, Schmitz KH. Exercise Guidelines for Cancer Survivors: Consensus Statement from International Multidisciplinary Roundtable. Med Sci Sports Exerc. 2019 Nov;51(11):2375-2390. doi: 10.1249/MSS.0000000000002116. PMID: 31626055.

Link

https://pubmed.ncbi.nlm.nih.gov/31626055/