Category Archives: Physical Activity

Guest Post: Physical Activity in Childhood Cancer

Amanda Wurz & Dr. S. Nicole Culos-Reed

As it is now nearing the end of August, you should be convinced of the importance of physical activity during childhood, a key factor in the development of healthy children and eventually healthy adults. As Andrew mentioned in “How Much Physical Activity do Children Need?”, physical inactivity in our children and youth is alarming. We know that less than half of children are meeting the Canadian Society for Exercise Physiology (CSEP) Physical Activity Guidelines. And research suggests that childhood cancer patients and survivors are more sedentary than their healthy peers1,2,3. It may seem counterintuitive to focus on physical activity levels while a child is battling cancer, as we typically think children should be resting and recovering from their treatment. However, the research consistently stresses the importance of exercise throughout the childhood cancer trajectory4,5,6,7.

Tremendous advances in research and technology over the past 30 years have resulted in improved treatment and survival rates, with over 80% of childhood cancer patients becoming long-term survivors8,9. Unfortunately, survivorship is often accompanied by negative side-effects that develop both during and after treatments10. Physical early side-effects impact a range of body tissues and functions during or shortly after treatment (i.e., increased risk of infections, bleeding and clotting complications, nausea, vomiting, allergic reactions, skin changes, temporary hair loss, fatigue). Physical late side-effects occur months or years after treatment ends and include, reduced muscular strength, damage to nerves in the extremities, reduced cardiovascular functioning due to damage to the lungs and heart, persistent fatigue. Psychosocial early side-effects include a range of negative social and emotional states that would be expected to occur during or shortly after treatment (i.e., anxiety, fear, depression, social isolation) with many of the late side-effects occurring months or years after treatment ends (i.e., poor social functioning, withdrawal, decreased health related quality of life). Several resources outlining the array and degree of side-effects experienced can be accessed online11,12. Unfortunately, adding physical inactivity into this mix not only worsens the side-effects experienced, but it also increases the likelihood of childhood survivors developing diseases such as hypertension, diabetes, osteoporosis and cancer recurrence4,13,14.

Across childhood cancers, patients report lower amounts and intensity levels of physical activity than healthy children. Pain, fear, anxiety, fatigue, difficulty accessing programs, and the overprotective attitudes of parents and educators have been commonly cited in the literature as barriers to physical activity in this population15,16. Additionally, it is suggested that the low levels of physical activity typically seen in this population may be due to the fact that pediatric cancers peak in incidence between the ages of 2-5 years, a time when many children are introduced to leisure time physical activity4,17. Thus, their disease may impede their ability to play with their peers and establish healthy physical activity habits. Likely it is a culmination of disease timing, fatigue, limited programming, parental attitudes, and an array of personal and familial characteristics that result in lower than average physical activity levels.

Fortunately, researchers and clinicians are aware of the importance of early intervention in this population. The last 15 years have shown physical activity’s beneficial impact on many of the negative physical and psychosocial side-effects of treatment2,4,5,18.

Although the field is still young and the majority of findings are preliminary, the existing evidence consistently suggests that mild to moderate exercise is safe, beneficial and feasible for both childhood cancer patients and survivors. As the field grows it will be important to:

(i) Share the research information we have;

(ii) Create tailored guidelines. Our lab is currently working with an international team to put out the first Pediatric Oncology Exercise Manual – POEM – which will be distributed to physicians and parents at the Alberta Children’s Hospital, as well as across Canada, and through our colleagues worldwide); and,

(iii) Create safe, evidence-informed programs to offer patients and survivors a safe space to exercise (that takes into account their compromised immune systems, lower level of physical functioning etc.). We have developed Pediatric Survivors Engaging in Exercise for Recovery (PEER), and will be launching Yoga Thrive for Youth (YTY) an innovative yoga program for childhood and adolescent cancer patients and survivors in Fall 2013. These programs have a central goal: Provide childhood cancer patients and survivors safe, accessible, evidence-informed activity programming that will enhance and restore their levels of physical and psychosocial functioning. We need to continue reaching out to childhood cancer patients and survivors to ensure they are meeting physical activity guidelines.

A more in depth article expressing our teams vision for the future of physical activity and pediatric oncology can be found here: Chamorro-Vina, C, Wurz, AJ, & Culos-Reed, SN (2013). Promoting physical activity in pediatric oncology. Where do we go from here? Frontiers in Oncology, 3(173), 1-4. doi: 10.3389/fonc.2013.00173 

References:

  1. Ness, K.K., Leisenring, W.M., Huang, S., Hudson, M.M., Gurney, J.G., Whelan, K. et al. (2009). Predictors of inactive lifestyle among adult survivors of childhood cancer: A report from the Childhood Cancer Survivor Study. Cancer, 115(9), 1984-1994.
  2. Kelly, A.K. (2011). Physical activity prescription for childhood cancer survivors. Current Sports Medicine Reports, 10(6), 352-359.
  3. Ness, K.K., Hudson, M.M., Ginsberg, J.P., Nagarajan, R., Kaste, S.C., Marina, M. et al. (2009). Physical performance limitations in the Childhood Cancer Survivor Study cohort. Journal of Clinical Oncology, 24(14), 2382-2389.
  4. San Juan, A.F., Wolin, K., & Lucia, A. (2011). Physical activity and pediatric cancer survivorship. In: Courneya K.S., & Friedenreich, C.M. (eds) Physical activity and cancer: Recent results in cancer research (pp.319-347). New York: Springer – Berlin Heidelberg.
  5. Huang, T-T., & Ness, K.K. (2011). Exercise interventions in children with cancer: A review. International Journal of Pediatrics, 1-11.
  6. Soares-Miranda, L., Fiuza-Luces, C., Lassaletta, A et al. (2013). Physical activity in pediatric cancer patients with solid tumors (PAPEC): Trial rationale and design. Contemporary Clinicial Trials, 5(1), 106-115.
  7. Winter, C., Muller, C., Brandes, M., Brinkmann, A., Hoffman, C., Hardes, J. et al. (2009). Level of activity in children undergoing cancer treatment. Pediatric Blood and Cancer, 53(3), 438-443.
  8. Jemal, A., Siegel, R., Ward, E., Hao, T., Xu, J., & Thun, M.J. (2009). Cancer statistics, 2009. CA – A Cancer Journal for Clinicians, 59(4), 225-229.
  9. Ellison, L.F., Prithwish, D., Mery, L.S., & Grundy, P.E. (2009). Canadian cancer statistics at a glance: Cancer in Children. Canadian Medical Association Journal, 180(4), 422-424.
  10. Oeffinger, K.C., Mertens, A.C., Sklar, C.A., Kawashima, T., Hudson, M.M., Meadows, A.T. et al. (2006). Chronic Health Conditions in Adult Survivors of Childhood Cancer. New England Journal of Medicine, 355, 1572-1582.
  11. Shad, A.T., Late Effects of Childhood Cancer and Treatment. (2010). http://emedicine.medscape.com/article/990815-overview.Retrieved August 28, 2013.
  12. American Cancer Society. (2012). Children diagnosed with cancer: Late effects of cancer treatment. http://www.cancer.org/treatment/childrenandcancer/whenyourchildhascancer/children-diagnosed-with-cancer-late-effects-of-cancer-treatment. Retrieved August 28, 2013.
  13. Finnegan, L., Wilkie, D.J., Wilbur, J., Campbell, R.T., Zong, S., & Katula, S. (2007). Correlates of physical activity in young adult survivors of childhood cancers. Oncology Nursing Forum, 34(5), E60-E69.
  14. Wolin, K.Y., Ruiz, J.R., Tuchman, H., & Lucia, A. (2010). Exercise in adult and pediatric hematological cancer survivors: An intervention review. Leukemia, 24(6), 1113-1120.
  15. Arroyave, W.D., Clipp, E.C., Miller, P.E., Jones, L.W., Ward, D.S., Bonner, M.J. et al. (2008). Childhood cancer survivors’ perceived barriers to improving exercise and dietary behavior. Oncology Nursing Forum, 35, 121-130.
  16. Aznar, S., Webster, A.L., San Juan, A.F., Chamorro-Vina, C., Mate-Munoz, J.L., Moral, S. et al. (2006). Physical activity during treatment in children with leukemia: A pilot study. Applied Physiology, Nutrition and Metabolism, 31, 407-413.
  17. Oeffinger, K.C., Buchanan, G.R., Eshelman, D.A., Denke, M.A., Andrews, T.C., Germak, J.A. et al. (2001). Cardiovascular risk factors in young adult survivors of childhood acute lymphoblastic leukemia. Journal of Pediatric Hematology/Oncology, 23(7), 424-430.
  18. Keats, M.R., & Culos-Reed, S.N. (2008). A community-based physical activity program for adolescents with cancer (project trek): Program feasibility and preliminary findings, Journal of Pediatric Hematology and Oncology, 30, 272-280.

A word from the DBL:

Many thanks to our guest contributors, Amanda Wurz and Dr. S. Nicole Culos-Reed. Dr. Culos-Reed is the director of the Health & Wellness Lab, University of Calgary, Faculty of Kinesiology. She is an Associate Professor in Health and Exercise Psychology in the Faculty of Kinesiology and Adjunct Associate Professor in the Department of Oncology in the Faculty of Medicine at the University of Calgary. She also holds a Research Associate appointment with the Department of Psychosocial Resources in the Tom Baker Cancer Centre. Her research is focused on the benefits of physical activity throughout the cancer trajectory. Amanda Wurz holds a BA in Psychology and is currently a MSc student at the University of Calgary, in the Health & Wellness Lab. Her research is exploring the effects of a 12-week yoga intervention in childhood cancer out-patients. Additionally, she assists with both the PEER and YTY programs.

Physical Activity and Older Adults: A Rapid Guide

By: Lisa Campkin                                                                                                         Published August 28, 2013

The notion of physical activity and exercise can be daunting for adults over the age of 65, especially for those living with a chronic condition or those who have never felt comfortable with being physically active previously. Fear not, older adults! There is plenty of evidence to show that becoming more active is within your reach and well worth the effort.

This article outlines why it is important to get active and how you can do so. Not only will a daily dose of activity improve your health today, it can contribute to your increased quality and life over time as well as decrease the risk of premature death [2].

Let’s outline the ways you can get active. There are a few broad categories to understand regarding fitness and physical activity:

  1. ImageAerobic Activity to get the heart beating faster and increase overall cardiovascular fitness [1]
  2. Flexibility and Balance to keep motion in the joints and help to prevent falls [1]
  3. Strengthening Activity to keep bones strong, maintain muscle mass and strength for daily activities [2]

By maintaining a mixture of these three activities, the preventative and therapeutic effects of physical activity can also improve your health in the following ways:

Image

  • Improve balance [2]
  • Maintain independence further into life [2]
  • Prevent a number of diseases such as heart disease, type II diabetes, osteoporosis & some forms of cancer [2]
  • Improvements in cognition [6]
  • Reduce the incidence of dementia [6]

 

 

Specifically, how should you go about creating this lifestyle-based physical activity plan? Generally, it is best to look to Canadian Physical Activity Guidelines [2] for suggestions on how much activity is needed for health benefits as well as useful tips on how to incorporate activity into your life. Take these suggestions for example:

Aerobic Activity…

Strengthening Activity…

Mow the lawn Gardening & yard work (digging, lifting etc.)
Dance Yoga
Walk to the store Carrying groceries
Cross-country skiing Climbing stairs

Overall, the activity should make you…

BE IN CONTINUOUS MOVEMENT – INCREASE HEART RATE – BREATHE HARDER PUSH OR PULL AGAINST A WEIGHTED OBJECT (could be your own body weight)

Finally, how much and how often should you be enjoying activities such as the ones described above?

Take part in at least 2.5 hours of moderate- to vigorous-intensity aerobic activity each week. This time can be spread into sessions as low as 10 minutes each, and you will still obtain health benefits [2]. Moderate intensity can be best described as a brisk walk while vigorous activity causes further heart rate and breathing rate increases over a moderate level; this intensity would closely resemble jogging for most people [3]. Muscular strength activities should be performed at least two days per week [3]. Inspire others to get off the couch – include friends and family in your efforts to become active and look into joining a community fitness class [2] Make the activity social and fun and you’re more likely to stay engaged longer. These are the minimum current standards to maintain health and prevent illness, so to exceed these amounts could result in further risk reduction of disease and disability [3]. Talk to your health professional if you have any activity-based questions or health concerns regarding these recommendations [2].

ImageThe key to becoming more active lies in your motivation to do so and enjoyment in the journey. Start by finding an activity you truly enjoy, and do it often enough to reap the health benefits associated with it. Only a few older adults are currently meeting basic physical activity guidelines [4]. Be a positive role model for others and get out there!

References

  1. Nelson, M.E., Rejeski, W.J., Blair, S.N., Duncan, P.W., Judge, J.O., King, A.C., Macera, C.A. & Castaneda-Sceppa, C. (2007). Physical activity and public health in older adults: recommendation from the American College of Sports Medicine and the American Heart Association. Medicine and Science in Sports and Exercise, 39(8), 1435-45.
  2. Public Health Agency of Canada (2012, April 25). Physical activity tips for older adults (65 years and older). Retrieved August 21, 2013, from http://www.phac-aspc.gc.ca/hp-ps/hl-mvs/pa-ap/08paap-eng.php
  3. Haskell, W.L., Lee, I.M., Pate, R.R., Powell, K.E., Blair, S.N., Franklin, B.A., Macera, C.A., Heath, G.W., Thompson, P.D. & Bauman, A. (2007). Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Medicine and Science in Sports and Exercise, 39(8), 1423-34.
  4. King, A.C. (2001). Interventions to promote physical activity by older adults. The Journals of Gerontology: Series A: Biological Sciences and Medical Sciences, 56 (2), 36-46.
  5. Lautenschlager, N.T. Cox, K.L., Flicker, L., Foster, J.K., van Bockxmeer, F.M., Xiao, J., Greenop, K.R. & Almeida, O.P. (2008). Effect of physical activity on cognitive function in older adults at risk for Alzheimer disease: a randomized trial. The Journal of the American Medical Association, 300(9), 1027-1037.

Image: “Balance” by applecorekevin (©2006-2013)

Image: “Cogs” by suedollin (©2007-2013)

Image: “walking” by Ciaran-Brennan (©2004-2013)

by Jodi Nettleton

Published August 14, 2013

Exercise Intensity?

The previous blog indicated the amount of physical activity that is recommended for adults between the ages of 18-64 years according to the Centres for Disease Control and Prevention (CDC). The amount of spent in physical activity was based on the exercise intensity that is being performed.

Well, what is exercise intensity?

The World Health Organization (WHO) describes intensity as “the rate at which the activity is being performed or the magnitude of effort required to perform an activity or exercise”. In other words, how hard a person has to work to perform an activity or a specific exercise.

There are many ways to measure intensity, however we will only focus on two that we believe is easiest to measure for the general population. Other methods are generally performed in a laboratory with trained professionals. The two I will focus on may be done on your own with little to no extra gadgets required.

1. Heart Rate:

Heart rate is the number of heartbeats per unit of time – in this case, per minute.

To monitor intensity, one must first determine the maximum amount of heartbeats they can sustain per minute. Sounds intimidating, right?

Well, there is a simple and validated equation that requires nothing else than simple math to determine this value. No exercise required figuring this out.

The equation:

220 – age = Maximum heart rate (HRmax)

For example: if you are 35 years old, your HRmax would be (220 – 35) = 185

According to the CDC, moderate physical activity is within the range of 50% to 70% of your HRmax.

To calculate the lower end of this range:

50% of HRmax = HRmax (which is 220 – age) x 0.5

The upper end of this range:

70% of HRmax = HRmax x 0.7

Therefore, a 35 year old individual have moderate exercise intensity between 93 – 130 beats per minute.

Vigorous intensity is considered to be within the range of 70% to 85% of HRmax.

To calculate the lower end of this range:

70% of HRmax = HRmax x 0.7

The upper end of this range:

85% of HRmax = HRmax x 0.85

Monitoring your heart rate does not require you to personally count your heartbeats while exercising – that would be too much work!! There are wonderful gadgets called heart rate monitors that will do the job for you. Generally they include a belt consisting of the monitor that wraps around your chest and a watch that will show you how hard your heart is working by recording the amount of beats per minute.

Heart rate monitors range in price, from around $30 to $300. They may be found at most running and sport stores.

2. Rating of Perceived Exertion (RPE) Scale:

 The RPE scale is a subjective measure of exercise intensity. Originally created by Gunnar Borg in the 1980’s, intensity was measure on a scale of 6 – 20, based on inferred heart rates that would correspond. For example, a rating of 12 on the scale would represent a heart rate of 120. It has been modified to a scale of 1 – 10, that many people may find conceptually easier, with 0 = when the body is at rest and 10 = maximum heart rate.

However, I have posted the Borg scale from values 6 – 20 because this scale has had more research determining its validity, and is used primarily in the exercise physiology labs for undergraduate kinesiologystudents when performing exercise testing.

The rating of 6 corresponds to “no exertion at all” where 20 correspond to “maximal exertion”.

Rating between 11 – 12 are considered moderate intensity, where 13 and higher is considered vigorous.

The Borg Scale:

Picture 1

References:

Centres for Disease Control and Prevention. (2011, December 1). How much physical activity do adults need? Retrieved August 10, 2013, from http://www.cdc.gov/physicalactivity/everyone/guidelines/adults.html

Mayo Clinic. (2011, March 5). Exercise intensity: why it matters, how it’s measured. Retrieved August 12, 2013, from http://www.mayoclinic.com/health/exercise-intensity/SM00113

McArdle, W. D., Katch, F. I. & Katch, V. L. (2010). Exercise physiology: nutrition, energy, and human performance, 7th. ed. Baltimore, MD: Lippincott Williams & Wilkins.

Public Health Agency of Canada. (2012, April 25). Physical activity tips for adults (18-64 years). Retrieved August 10, 2013, from http://www.phac-aspc.gc.ca/hp-ps/hl-mvs/pa-ap/07paap-eng.php

Scherr, J., Wolfarth, B., Christle, J. W., Pressler, A., Wagenpfeil, S. & Halle, M. (2013). Associations between Borg’s rating of perceived exertion and physiological measure of exercise intensity. European Journal of Applied Physiology, 113, 147-155.

World Health Organization. (2013). What is moderate-intensity and vigorous-intensity physical activity? Retrieved August 13, 2013 from http://www.who.int/dietphysicalactivity/physical_activity_intensity/en/

Teaching Kids (and Youth) to Play

by: Andrew Stewart                                                                                                   Published 08/08/13

street_hockey_by_a_puffsSince I have already touched on the amount of physical activity experts have recommended for kids and the youth it only makes sense in this following post we explore ways of encouraging this behavior. Unfortunately, finding resources on this subject are difficult; verifying their credibility even more so. As a result the majority of this post will focus on theories which may or may not apply in all cases.

As children are developing they are constant learning. While this fact may not come as much of a surprise, one aspect of this that isn’t often considered is the fact this also applies to the way kids play. The act of playing is a complex physical and social action, when we are young the activities we are exposed to by our parents shape the way we engage in physical activity and how we incorporate it into our lives.

In our current society it appears that a large amount of emphasis is put on “organized sport” as a way of getting, and keeping kids active. In general, organized sports programs are highly specialized and regulated. Adults set practice times, buy the necessary equipment, pay fees, and enforce the rules.

play_by_iosa-d4d4uerThere is nothing directly wrong with organized sport but in many circumstances it limits input from the child. We must remember that children do things that are presently fun, training specifically for future athletic endeavors is often the opposite. In fact, a large proportion of successful professional athletes don’t choose to specialize in a sport at a young age ( Baker 2003).

How do we give children more freedom while keeping them active? We must consider the lost art of the “pick up” game. In an article by Peter Gray (a professor at Boston College) it is proposed there are a few key elements present in informal sports that children need to be exposed to.

Here they are:

“There is no real difference between your team and the opposing team”

“To keep the game going, you have to keep everyone happy, including the players on the other team”

“Rules are modifiable and are generated by the players themselves”

“Conflicts are settled by argument, negotiation, and compromise”

“Playing well and having fun really ARE more important than winning”

–        Peter Gray 2009

While Dr. Gray does appear to be using the article I used to promote his book, after considering the points he raises it does appear that each of these elements have the potential to increase the levels of fun inherent in sport. They also create the potential for a child/youth to take ownership of the activity.

Multiple studies have proven that children engage in more physical activity if they feel that they have personal control over it (Welk 1999).

In conclusion I would like to say that while the article I have ended up writing is far different than the one I set out to write I think the topic of informal play/ physical activity is important to consider. To wrap up this post I just want to emphasize that children aren’t born knowing how to organize leisure activities with their friends. Initially it is something they will need help doing it but at some point, for kids to get the full effect the training wheels need to come off.

References:

Baker, J. (2003). Early Specialization in Youth Sport: a requirement for adult expertise? High Ability Studies, 14(1), 85-94.

Gray, P. (2009). The Roles of Play and Curiosity as Foundations for Learning.  Retrieved from http://www.psychologytoday.com/blog/freedom-learn/200911/some-lessons-taught-informal-sports-not-formal-sports

Welk, G. J. (1999). The Youth Physical Activity Promotion Model: A Conceptual Bridge Between Theory and Practice. Quest, 51(1), 5-23. doi: 10.1080/00336297.1999.10484297

Image: “Play” by Iosa (©2011-2013)

Image: “Street Hockey” by a-puffs (©2008-2013)

How Much Physical Activity Do Children Need?

by: Andrew Stewart                                                                                                   Published 08/06/13

the_athlete_by_komodoempire-d2yxgbi

To Kick off August, and our Physical Activity Theme I figured it would be a good idea to start by focusing on children and youth.

Unbeknownst to the majority of the population a disease epidemic of massive proportions is occurring in most first world countries and it is going almost unnoticed – it is an epidemic of obesity in the young.

Results from the 2004 Canadian Community Health Survey indicate that ~18% of children ages 2 to 17 in Canada are overweight with an additional 8% of these individuals being obese. This is not normal and is a fairly recent and startling development.

While to some “weight” is a controversial subject, from medical standpoint obesity is clearly a disease that threatens the long term survival of an individual. It is good idea to try to nip it in the bud. With a few rare exceptions an overweight child is the result of the environment they are raised in. There are some genetic predispositions but through physical activity and a balanced diet they can be suppressed for a lifetime.

To get this week started I would like to introduce you to the currently accepted physical activity guidelines for children (As recommended by The Canadian Society of Exercise Physiologists). As the week progresses I will then provide you with information on why they are important and some good ways of getting kids moving.

The following recommendations are taken from the Canadian Society of Exercise Physiologists (CSEP) for levels of both sedentary and non-sedentary activities in children which we at the lab (generally) trust to be accurate.

CSEP recommends that children (ages 5-11) and youth (ages 12-17) should limit recreational screen time to no more than two hours per day. On top of this in an official press release they stated that “children and youth should also limit sedentary transport, prolonged sitting and time spent indoors throughout the day”.

Secondly, CSEP also indicates that for health benefits children and youth should partake in at least 60 minutes of moderate to vigorous intensity physical activity daily (moderate to vigorous activity means that Kids need to be getting their hearts and lungs working hard).

dandelion_____by_mechtaniyaHow often have you driven by a children’s soccer game to see half of the team sitting on the field picking the dandelions instead of chasing the ball? While there is nothing wrong with this widely practiced form of amateur horticulture; to get that 60 minutes a day we need to make sure that every once in a while they engage with the game and run as hard as they can after that ball!

It is also important to take into account that the recommendation is for 60 minutes of moderate to vigorous activity – not 60 minutes total of physical activity. With a maximum of 2 hours of sedentary activity, even with time spent at school and completing ever growing piles of homework children and youth need to be filling up their free time with as many active pursuits as possible.

Now that you know how much physical activity a child needs, how can we make sure they get it? Look for my next posts as I attempt to find some answers for this question. In the following weeks look forward to articles by my colleagues who will try to figure out how you can fit in the physical activity you need as well as a guest post on the challenges which face cancer patients who are attempting to remain active while battling disease.

References:

Starky, S. (2005). The Obesity Epidemic In Canada. Library of Parliament.

Teed, L. (2011). New Canadian Physical Activity Guidelines Released: Canadian Society of Exercise Physiologists.

Teed, L., & Pacheco, M. (2011). Cutting down on sitting down: the world’s first evidence-based sedentary behaviour guidelines released: Canadian Society of Exercise Physiologists.

Image: “The Athlete” by Bill Fleming (©2010-2013)

Image: “Dandelion” by mechtaniya (©2010-2013)