SEATTLE, April 21, 2006 – Can exercise actually reduce fatigue, especially for patients dealing with the rigors of cancer treatment? Swedish Medical Center recently launched a new integrative exercise program for people living with cancer called the ACTIVE (Addressing Cancer Through Individualized Exercise) program that helps prove this point. David Zucker, M.D., Ph.D., a specialist in physical medicine and rehabilitation, is the new program’s medical director.
Because treatments have improved in recent years, cancer is a chronic illness for many people. For others in remission, the effects of treatment may linger and make it difficult to perform even simple everyday activities. The goal of Swedish’s ACTIVE program is to enhance a person’s total quality of life before, during and/or after treatment.
Cancer patients frequently experience fatigue – either alone or more often with weakness – poor endurance, pain and balance difficulties. This makes it difficult to work, interact with family and friends, do household chores or engage in recreational activities. Common barriers to maintaining physical activity, in addition to the cancer disease process itself, come from the side effects of treatment. These include fatigue, nausea, anxiety, depression, disturbed sleep and a loss of confidence and self-esteem.
“Until recently, people believed exercise for cancer patients was unnecessary and perhaps even harmful,” Dr. Zucker said. “We know now that appropriate exercise is safe and, for many patients, crucial to recovery.”
The ACTIVE program has obvious parallels to cardiac rehabilitation. Fifty years ago a heart-attack victim was told to take several weeks or months of rest. Exercise was ‘contraindicated.’ Today, treating heart disease without including appropriate exercise is unthinkable.
“The body is designed to adapt to the stresses placed on it,” Dr. Zucker explained. “Another way of saying this is ‘use it or lose it.’ At complete bed rest, a person deconditions, losing one percent to three percent of strength per day. Most of this loss is in the anti-gravity muscles that allow one to get up from the floor, balance and walk around.”
The ACTIVE program team includes physical therapists, physical therapist assistants, occupational therapists, speech therapists and a clinical coordinator. They collaborate with other providers – such as oncologists, social workers, psychooncologists and naturopaths – in the Integrated Services Program at the Swedish Cancer Institute. The Cancer Institute sees more than 3,700 new patients a year and Dr. Zucker’s team will work with people who have many different forms of the disease.
“Our first job is to give patients healthy options,” said Sarah Morello, M.A., clinic coordinator. “It’s so gratifying when they call and say ‘For that one hour in rehab, I forgot I was sick.’ We help them understand that well-being is possible while living with cancer.”
The ACTIVE Program
Cancer and its treatment can affect the musculoskeletal, cardiovascular and nervous systems – all instrumental to independent activity. After consultation with Dr. Zucker, a cancer physical therapist focuses on assessing muscular endurance, joint range of motion and flexibility, skin integrity and cardiovascular endurance. Combining this information with the person’s activity goals, the ACTIVE team creates an individualized exercise program.
Conditioning exercise directly addresses deconditioning by reversing global loss of muscle strength and endurance. Physical therapy provides additional benefit by focusing on areas of the body where function has been lost or pain is present.
After a mastectomy, for example, many women experience arm swelling and reduced shoulder mobility on the side of the surgery. Physical therapy helps both restore range of motion and control swelling. Stiffness of joints near a surgical site caused by scar tissue is another common problem. Through manual techniques, a physical therapist can stretch scar tissue, which increases mobility and reduces pain.
“Dr. Zucker has made the physical, psychological and emotional ramifications of cancer his passion,” said Michael Richerson, director of Rehabilitation Services at Swedish. “He has done a great deal of research into how cancer devastates the body and the role that physical medicine plays in maintaining or improving quality of life. We think of him as a total ‘mind-body-spirit’ kind of guy.”
A typical course of treatment in the ACTIVE program varies depending on the individual. However, in general, it takes about three months. Rehabilitation medicine visits to physicians are covered by most insurance plans. Coverage of physical therapy visits varies widely, depending on an individual’s insurance plan.
Swedish is committed to being at the forefront of this important area of rehabilitation medicine. Currently, there are only a handful of board-certified physical medicine and rehabilitation physicians in the United States who specialize in this kind of treatment, but interest is expanding rapidly.
There are also a growing number of medical centers in North America where coordinated exercise for cancer patients is offered, but few on the West Coast. In the Seattle area, three well-known community organizations – Team Survivor Northwest, Gilda’s Club and Cancer Lifeline – offer exercise classes.
Dr. Zucker and ACTIVE physical therapist Adrienne DiLiberto trained last year at the Rocky Mountain Cancer Rehabilitation Institute at the University of Northern Colorado in Greeley, a leading facility in this emerging field.
For more information on Cancer Rehabilitation, contact Sarah Morello, M.A., ACTIVE program clinic coordinator, at 206-215-6333 or visit www.swedish.org.
Swedish Medical Center is the largest, most comprehensive, nonprofit health provider in the Pacific Northwest. Founded in 1910, it now has more than 7,000 employees and a medical staff of more than 2,000 physicians, most of which are private practitioners. Swedish now encompasses three hospital campuses (First Hill, Providence and Ballard) totaling 1,245 licensed beds, a new community-based emergency room and specialty center in Issaquah, Swedish Home Care Services and Swedish Physicians – a network of 12 primary-care clinics located throughout the Greater Seattle area. In addition to general medical and surgical care, Swedish is known as a regional referral center, providing specialized treatment in areas such as cardiovascular care, cancer care, orthopedics, high-risk obstetrics, neurological care, sleep medicine, pediatrics, organ transplantation and clinical research. For more information, visit www.swedish.org or call 1-800-SWEDISH (1-800-793-3474).
The Swedish Cancer Institute (SCI) opened in 1932 as the first dedicated cancer-care center west of the Mississippi. Today, it is the largest and most comprehensive cancer-treatment program in the Pacific Northwest, caring for more people with more types of cancer than any other provider in the region. The Institute has a presence on all three Swedish Medical Center campuses: First Hill, Ballard and Providence. A true multidisciplinary facility, the SCI offers a wide range of advanced cancer-treatment options in chemotherapy, radiation therapy and surgery – backed by extensive diagnostic capabilities, patient education and support-group services. The SCI’s clinical-research arm encompasses industry-sponsored and cooperative group therapeutic trials, cancer screening and prevention trials, and investigator-initiated trials. Breast-cancer screening and diagnostics are available through the Swedish Breast Care Centers and mobile mammography units. Swedish radiation therapy is offered at area hospitals including Stevens Hospital (Edmonds); Valley Medical Center (Renton); Highline Community Hospital (Burien) and Northwest Hospital (North Seattle).