Alternative Exercise Traditions in Cancer Rehabilitation.
Author: Ruddy KJ1, Stan DL2, Bhagra A2, Jurisson M3, Cheville AL4
Affiliation:
1Department of Oncology, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, USA.
2Department of General Internal Medicine, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, USA.
3Department of Physical Medicine and Rehabilitation, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, USA.
4Department of Physical Medicine and Rehabilitation, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, USA. Electronic address: Cheville.andrea@mayo.edu.
Conference/Journal: Phys Med Rehabil Clin N Am.
Date published: 2017 Feb
Other:
Volume ID: 28 , Issue ID: 1 , Pages: 181-192 , Special Notes: doi: 10.1016/j.pmr.2016.08.002. , Word Count: 292
Alternative exercise traditions (AETs) such as Pilates, yoga, Tai Chi Chuan, Qigong, and various forms of dance offer the potential to improve diverse outcomes among cancer survivors by reducing adverse symptoms and mood disorders, and by enhancing function. Additionally AETs have emerged as a potential means to address deficits in current disease-focused care delivery models which are marked by prevalent under-treatment of symptoms and physical impairments. Relative to therapeutic exercise in allopathic models, many AETs are comparatively affordable and accessible. AETs have the further potential to simultaneously address needs spanning multiple domains including social, physical, and psycho-emotional. AETs additionally offer the salient benefits of promoting integrated whole body movement and concurrently enhancing strength, coordination, balance, posture, flexibility, and kinesthetic awareness. Despite AETs' benefits, compelling concerns leave many clinicians ambivalent and reluctant to endorse or even discuss them. One issue is the extensive heterogeneity across and even within specific AETs. An additional concern is that the one-size-fits-many nature of AET group classes undermines an instructor's capacity to individualize dose, type, frequency, and intensity, which are cornerstones of effective therapeutic exercise. Inconsistencies in AET practitioner expertise and certification, as well as the extent of practitioner familiarity with vulnerabilities unique to cancer populations, may also be problematic. At this juncture, an extensive literature of inconsistent quality that spans diverse cancer populations frustrates efforts to precisely determine the effect size of any specific AET in improving a specific outcome; Although systematic reviews and meta-analyses have concluded that AETs have beneficial effects, they consistently identify a high risk of bias in a majority of trials related to a lack of blinding, poor allocation concealment, small sample sizes, and incomplete outcome data.
Copyright © 2016 Elsevier Inc. All rights reserved.
KEYWORDS: Alternative exercise traditions; Cancer; Rehabilitation
PMID: 27912996 DOI: 10.1016/j.pmr.2016.08.002
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