Supporting Survivors With Exercise and Nutrition Programs

Survivorship programs are a crucial element of comprehensive cancer care centers. Without them, patients who have finished treatment may have to face unexpected physical and psychological limitations without professional support. This series of posts on innovations in survivorship care features ACCC member institutions that have developed new, innovative programs to benefit the well-being of cancer survivors. Our first post features two integrated exercise and nutritional programs.

Oncology dieticians, physical therapists, and exercise professionals each provide integral services within the multidisciplinary cancer care team. Each of them help develop dynamic supportive care programs—from nutritional therapy sessions that teach healthy eating habits to exercise programs designed specifically for cancer patients during and after treatment. Supportive care services tailored to survivors further diversify the modern cancer program and enhance overall patient experience.

Two ACCC member programs have developed exercise and nutritional courses that have had a direct, positive impact on cancer survivors. “Our participants found a sense of community within our program groups and felt that this was a safe space for them to exercise in because a lot of these women were dealing with new bodies and new physical limitations,” explains Julie Pierce, MS, RN, OCN, CBCN, describing the  eight-week comprehensive exercise program for breast cancer survivors that Virginia Hospital Center’s Cancer Resource Center launched in 2017.

Pierce, a breast health navigator with Virginia Hospital Center, says the hospital’s cancer resource center has since completed three rounds of its exercise program. The project was created by Dawn Marropodi, MPT, CLP-LANA, and Michelle Kondracki, MPT, CLT-LANA—both physical therapists—specifically for breast cancer survivors. Both women sought to improve their patients’ quality of life by focusing on treating the whole body. The program aims to decrease participants’ anxiety about re-learning how to exercise by providing them a supportive group environment. Pierce notes that one program participant who had gone through surgery, chemotherapy, and radiation felt confident enough to complete a couch-to-5K after participating in the program. Program participants take part in a variety of cardio exercise, active stretching, and progressive weightlifting modified to accommodate the needs of individual patients. Instructors survey participants and measure their physical capabilities at the start and completion of the program. The survey includes subjective questions to gauge participants’ psychosocial health. Pre- and post-measures gauge the improvement of participants’ strength and balance. These measurements have indicated that participants’ physical capabilities significantly improve at the close of each program, exceeding the center’s physical therapy goals.

“I think this program really gave the women a sense of self-actualization that they could improve their life post-cancer treatment. They felt that they had the tools to go forward to change their health outcomes,” says Pierce. Although the program is currently on hold due to facility renovations, instructors expect to resume classes once updates are completed.

Adding Variety

Like Virginia Hospital Center, Marian Cancer Center Mission Hope in California recognizes the importance of integrating physical activity and nutrition education into its survivorship programs. John Malinowski, ATC, CET, is an exercise trainer at Mission Hope who has been teaching a 12-week cancer rehabilitation exercise program since 2014. Malinowski also recommends that his survivorship program participants attend the Healthy Eating, Active Living (HEAL) class he co-teaches at Mission Hope with a registered dietician. Participants are also able to schedule appointments with the dietician as frequently as needed.

Upon referral to Malinowski’s exercise program by a clinician or social worker, participants complete a physical therapy evaluation and nutritional assessment that is repeated after the program ends. The physical therapy evaluation allows Malinowski to tailor exercises to individual participants based on their needs. The nutritional assessment allows participants to learn how exercise and nutrition go hand-in-hand.

Anyone who is receiving or has completed treatment at Mission Hope can participate in the exercise program. Malinowski focuses on a variety of exercise, including group exercise, equipment-led exercise, walking groups, aquatic exercise, and golfing. Golfing in particular is a popular class, giving participants the opportunity to socialize and develop supportive communities.

“We try to give participants a variety because not everybody likes the same types of exercise,” explains Malinowski. “Everybody has different goals as well, so we’re trying to meet those specific goals while doing what is safe and healthy for them.”

Surveys completed by exercise program participants four weeks after the program’s completion indicate that 89 percent of program participants continued to exercise after the class. Of returning HEAL participants, 66 percent said they had adopted at least one healthy-eating behavior.

Patient feedback to both centers’ programs has been very positive. In response, Mission Hope has created additional pre- and post-test measurement tools for patients with head, neck, or breast cancers facing new physical limitations in its the exercise program. Virginia Hospital Center is looking to develop exercise programs dedicated to all cancer patients.