In last week’s episode, we discussed a recent case study with some really problematic results – check it out here. So how are we supposed to be safe when dosing exercise for our patients, to avoid DISASTROUS results (see Ep. 130)?
By dosing safely & smartly. By answering these five questions, you’ll be able to do exactly that.
What is the goal of the exercise?
Goals of exercise can include to build strength, improve endurance, increase power, improve balance, increase flexibility, etc. What is your plan of care actually trying to accomplish with this person?
Here’s a resource on ACSM guidelines for dosing for various goals (general population).
Where is the person in their cancer journey?
Are they currently undergoing treatment? What treatments have they undergone? It’s important to consider what treatment the patient has undergone but also what they will undergo. Notice I didn’t say finish – sometimes patients don’t finish treatments due to poor tolerance, insurance limitations, etc., but that doesn’t mean that the side effects of those treatments don’t count anymore.
What does your pre-treatment assessment tell you?
The subjective isn’t just an opportunity to say hello & ask about their family. Use this time to assess how they are feeling, how they responded to your last session (as applicable), & what their goals are for this session. Checking lab values, vitals, & general physiological status will help guide your prescription as well. I use the Maltser article & the Academy of Acute Care Physical Therapy Lab Values Interpretation Resource document as guidance. Your specific facility may also have reference norms for hematological & other lab values.
What other comorbidities/impairments does the person have?
Common other impairments in oncology include lymphedema, chemotherapy-induced peripheral neuropathy (CIPN), & osteoporosis. Remember, we are excluding metastases in this episode on purpose; we will cover them in Ep. 132.
How is the person responding to the exercise so far?
During exercise, it’s important to monitor vitals, rate of perceived exertion (RPE), & how the patient is feeling with the activity. Adjust accordingly & monitor for developing issues, such as oncologic emergencies or poor tolerance to exercise.