Gary Kimmel

Community-Based FitSTEPS for Life Exercise Program for Persons With Cancer: 5-Year Evaluation

PURPOSE To determine the effects of a community-based program of exercise on quality of life (QOL) of persons with cancer over time. METHODS Participants were referred by their physician to participate in an individualized program of exercise at one of 14 community centers. The Medical Outcomes Survey, Short Form, version 2.0 (SF-36) was used to assess QOL. Individual participants were monitored for 2 years. Data collection took place at baseline, every 3 months months during year 1, and every 6 months during year 2. RESULTS Enrolled participants (n = 701) had been diagnosed with different cancers and were at all stages; 177 completed data collection for 2 years. One-way analysis of variance (n = 177) supported the positive impact of exercise on QOL over time. Significant subscale scores of the SF-36, including Physical Function (F = 2.13, P ≤ .047), Role Physical (F = 3.78, P ≤ .001), Vitality (F = 5.97, P ≤ .001), Social Function (F = 4.46, P ≤ .001), Role Emotional (F = 2.56, P ≤ .01), Mental Health (F = 2.16, P ≤ .05), and General Health (F = 3.42, P ≤ .01), were sustainable over time. CONCLUSION This research introduces the concept of a long-term community-based program of individualized exercise as a feasible and effective intervention to improve QOL for persons with all stages of cancer. Improvements, noted at the 3-month time point, appear to be sustainable for extended time (24 months). Attrition is problematic and needs to be addressed. Results from this study have significance for practice recommendations and health policy reimbursement issues.

Model for a Community-Based Exercise Program for Cancer Survivors: Taking Patient Care to the Next Level

This article describes the development and refinement of a not-for-profit, community-based exercise program, the Cancer Foundation For Life (CFFL), designed to improve quality of life (QOL) for persons with cancer, regardless of type or stage of disease. Beginning in 2001, policies and procedures were developed, and personnel were hired and trained. Program evaluation measured safety, exercise adherence, demographic variables, and QOL. CFFL had nearly 3,000 referrals and handled more than 66,000 patient encounters in 2010. Financial and social resources for the program have been established through collaboration with existing institutions (churches, cancer centers, hospitals, and community centers), in conjunction with community support. American College of Sports Medicine guidelines presented at the ASCO 2010 meeting recommend exercise for persons with cancer. The CFFL program provides a cost-effective and safe exercise program for persons with all types and stages of cancer that meets these recommended guidelines.

The Role of Exercise in Cancer Treatment: Bridging the Gap

In recent years, there has been a burgeoning amount of evidence-based scientific data demonstrating the benefit of exercise during and following cancer treatment. This compelling evidence has resulted in major stakeholders in cancer management, including the American College of Sports Medicine, American Society of Clinical Oncology, National Comprehensive Cancer Network, American Cancer Society, Oncology Nursing Society, and the Commission on Cancer, advocating exercise as an integral component of cancer care. Despite the acknowledgment of exercise as an essential component, it remains virtually absent in routine cancer treatment. This article discusses the role of exercise in cancer treatment utilizing a community-based program. The rationale presented is that a scalable and replicable standard of care model is a plausible avenue to assimilate exercise into routine oncology practice.

Tai Chi Exercise on Muscle Strength and Physical Function in Peripheral Neuropathy Patients: 2578 Board #101 June 3, 9: 30 AM - 11: 00 AM.

Tai Chi Exercise on Muscle Strength and Physical Function in Peripheral Neuropathy Patients Joyce E. Ballard1, Arturo A. Arce-Esquivel1, Barbara K. Haas2, Melinda L. Hermanns2, Carol Rizer2, Gary T. Kimmel3, and Yong T. Wang2 1Department of Health and Kinesiology and 2School of Nursing, The University of Texas at Tyler. 3Cancer Foundation for Life, Tyler, Texas An estimated 20 million people in the U.S. suffer from peripheral neuropathy (PN). Patients with PN develop gait abnormalities. Foot pain is one of the factors affecting walking ability. As a result, a large number of individuals with PN suffer from a reduction in daily physical activity and reduced quality of life. Tai Chi appears to be safe and effective in promoting strength and functional capacity in older patients with other chronic disabilities. Purpose: This study aimed to assess the effects of Tai Chi on muscle strength and physical function in patients with PN. Methods: Thirty seven participants (men=21, women=16) were randomly assigned to either Tai Chi exercise (Ex, n=20, age: 71 ± 9.50 years) or control group (Con, n=17, age: 75 ± 9.02 years). Exercise training consisted of 12-week progressive Tai Chi (i.e., Yang Style), offered 3 times per week, 60 minutes each time. Before and after training, muscle strength [One repetition maximum (1RM) for leg extension and leg curl] and physical function [time of 8-foot up-and-go; TUG] were evaluated. Results: Muscle strength increased significantly in the Ex group [leg extension: pre = 26.76 ±16.05; post = 46.12±25.55 kg; leg curl: pre = 28.69±13.51; post = 44.22±13.97 kg; (p<0.05)]. In addition, the TUG decreased significantly in the Ex group [pre = 12.34±5.73; post = 7.43±2.87 sec, (p<0.05)]. No significant changes were observed in the Con group. Conclusions: Clearly, these findings demonstrated that Tai Chi was capable of increasing lower extremity muscle strength and physical function among PN patients. Interestingly, the exercise training program was able to reduce the risk for loss of functional mobility (i.e., decreased 8-foot up-and-go time) among the participants.

Effect of Tai Chi on Vascular Function Among Patients with Peripheral Neuropathy

Foot pain due to Peripheral Neuropathy (PN) is one of the factors affecting walking ability. It has been reported that diminished vascular function contributes to a decrease in physical function in individuals with PN. Microvascular disturbances have been reported in humans with neuropathic pain. Tai Chi, a Chinese conditioning exercise, has been associated with enhanced endothelial function. However, the effect of Tai Chi training on microvascular function in patients with PN has not been studied. This study aimed to assess the effects of Tai Chi on vascular function (i.e., vascular reactivity) and functional exercise capacity among patients with PN. Thirty-seven participants (men = 21, women = 16) were randomly assigned to either Tai Chi exercise (Ex, n = 20, age: 71 ± 9.50 years) or control group (Con, n = 17, age: 75 ± 9.02 years). Exercise training consisted of 12-week progressive Tai Chi (i.e., Yang Style), offered 3 times per week, 60 minutes sessions. The Con group didn’t participate in any exercise activity. Before and after training, vascular function [fingertip Digital Thermal Monitoring (DTM) of vascular reactivity] and functional exercise capacity [Six-Minute Walk test (6MW)] were evaluated. The Ex group experienced a significant 25% increase in Vascular Reactivity Index (VRI) from baseline [1.93 ± 0.43 to 2.41 ± 0.47, (p < 0.05)]. In addition, the 6MW test increased significantly in the Ex group by 28% [pre = 392 ± 93; post = 503 ± 105 m, (p < 0.05)]. In the control group no significant changes were observed in either vascular function [1.83 ± 0.43 to 1.81 ± 0.37] or in the 6MW test [393 ± 142 to 398 ± 149 m]. Participants experienced no complications and/or falls as a result of the intervention. These findings demonstrated that in patients with PN, a 12-week progressive Tai Chi exercise program was capable of increasing not only vascular function, specifically vascular reactivity index, but also of increasing the distance covered during the 6MW test. Clearly, this study underlies the importance of Tai Chi as an effective and safe exercise intervention suitable for patients with PN. Received Date: August 03, 2016 Accepted Date: October 26 2016 Published Date: November 03, 2016 Citation: Arce-Esquivel, A.A., et al. Effect of Tai Chi on Vascular Function among Patients with Peripheral Neuropathy. (2016) J Heart Cardiol 2(4): 16.

Incorporating Exercise Into the Cancer Treatment Paradigm

BACKGROUND The benefits of exercise for patients with cancer are well documented. However, exercise is still not a standard of care for this population. Several factors contribute to the lack of exercise prescriptions for patients with cancer, including challenges posed by treatment-related side effects, lack of knowledge among healthcare providers and the laypeople, and inadequate resources. OBJECTIVES This article reviews the benefits of exercise in general and specifically to patients with cancer, discusses the specific challenges and considerations required in recommending exercise to this population, and provides specific recommendations for healthcare providers to incorporate exercise into treatment plans. METHODS Using a case study exemplar, this article discusses the benefits and challenges to exercise while undergoing treatment for cancer and proposes specific solutions and recommendations. FINDINGS Oncology practitioners can provide the opportunity for patients to safely engage in exercise with the appropriate resources and trained personnel using a successful model of delivering exercise to patients undergoing treatment for cancer. Exercise improves quality of life in all patients, including those with advanced-stage cancers and those actively receiving treatment.