The Oncology Nursing Society (ONS) is gearing up to launch its “Get Up, Get Moving” campaign in the fourth quarter of 2014. This initiative is aimed at increasing physical activity in patients with cancer, with the goal of improving outcomes.
At the ONS 39th Annual Congress, Katrina Fetter, RN, BSN, OCN, of Lancaster General Hospital, Pennsylvania, gave attendees an overview of the rationale for the campaign.1
“Physical activity provides a big bang for the buck. For many years we were taught to encourage cancer patients to rest, but the reality is that we should be letting them know that physical activity can help them,” Fetter said.
Physical activity is included in the ONS Putting Evidence Into Practice (PEP) resource as an evidence-based recommendation to help alleviate fatigue, anxiety, depression, and lymphedema, and emerging evidence suggests that physical activity can also improve sleep/wake disturbances and cognition, Fetter said.
The US Department of Health and Human Services (HHS) recommends that all Americans exercise a minimum of 2.5 hours per week, but even some activity is better than none, she said. The HHS-recommended exercises have been adapted for cancer patients.2
“The benefits of exercise far outweigh the risks. Patients don’t need a lot of testing or referrals prior to recommending walking, and strength and flexibility training. For patients with special considerations, such as decreased bone density, fracture, or range of motion problems, be sure to recommend physical activity that is appropriate to their situation,” Fetter continued.
Few long-term studies have evaluated physical activity in cancer patients. Studies suggest that physical activity will decline after a diagnosis of breast cancer, and it may take patients a long time to restart exercising, she noted.
Although physical exercise has many benefits for patients with cancer, it appears that few physicians recommend physical activity. A 2010 ONS survey that included more than 1000 cancer patients and 39 practice sites found that only 9.79% of patients received a recommendation to exercise.
“There is a lot of room for nurses to fill this gap and help our patients,” Fetter told the audience.
Barriers to recommending exercise include the false belief that cancer patients need rest. In addition, some nurses may feel that a recommendation to exercise falls within the physicians’ scope of practice.
The “Get Up, Get Moving” awareness campaign hopes to encourage nurses to become actively involved with recommending exercise to their patients. The program will include an online education course, video, teaching scripts, and resources that will be available through local ONS chapters.
“If every one of us told each of our patients that if they exercised they could improve outcomes, that would make a tremendous difference,” said Kristen Fessele, PhD, RN, AOCN, a research associate at ONS. “Be their cheerleader on a regular basis—even if you work in an outpatient setting. Encourage them. Exercise should be part of your patient education and symptom management,” she stated.
When Fessele polled the audience, only about 20% of nurses said they recommend exercise routinely. Very few nurses said that their patients did any kind of exercise, and those who did were exercisers before their diagnosis. Patients who exercised before and after diagnosis felt better than those who didn’t exercise or those who started to exercise only after diagnosis, said members of the audience.
Program, Visalia, California) said that her facility offers a free gym membership as part of the cancer patient’s packet, and 90% of patients take advantage of this program. Fessele said that every institution should offer a free gym membership as part of their services for cancer patients, as well as a pedometer.
“Even a little exercise is better than none. Patients will believe it is important if you ask them about it at every visit. Believe in the power of what you say. Nurses can make a big difference in symptom management,” Fessele continued. “Exercise is low tech and low cost. Most patients can walk and do simple exercise. Obviously use your clinical judgment about which patients are ready to exercise,” she said. It is advisable to wait 8 weeks after surgery.
1. Fetter K. Don’t just sit there: ONS says “get up, get moving” to improve patient outcomes. Presented at: Oncology Nursing Society 39th Annual Congress; May 1-4, 2014; Anaheim, CA.
2. Schmitz KH, Courneya KS, Matthews C, et al. American College of Sports Medicine roundtable on exercise guidelines for cancer survivors. Med Sci Sports Exerc. 2010;42(7):1409-1426.