6
How you feel when lying in bed or sitting in a chair, relaxed. Little or no effort
7
Very, very light
8
9
Very light
10
11
Fairly light
12
Target range: how you should feel with exercise or activity
13
Somewhat hard
14
15
Hard
16
17
Very hard
How you felt with the hardest work you have ever done
18
19
Very, very hard
20
Maximum exertion
Table 8.2
Recommendations for physical exercise. (Reprinted by permission from Macmillan Publishers Ltd: [BONE MARROW TRANSPLANTATION] Wiskemann and Huber (2008))
Phase of therapy | Type of exercise |
|---|---|
Before HSCT | Mixed exercise (3–5×/week) |
Duration (session): up to 30 min | |
Intensity: moderate (12–14 Borg scale, 70–80 % maximum HR) | |
During HSCT | Starting with endurance training (5×/week up to daily), adding resistance training with increasing platelet counts in the last third of hospitalization (2–3×/week) |
Duration (session): 10–15 min at the beginning (if helpful use the interval method), up to 30 min in the end | |
Intensity: moderate (12–14 Borg scale, 70–80 % maximum HR) | |
After HSCT | Mixed exercise (3–5×/week) |
Duration (session): up to 30 min and more | |
Intensity: moderate (12–14 Borg scale, 70–80 % maximum HR) |
8.3 The Role of Rehabilitation Services
Rehabilitation services consist of occupational therapy (OT) , physical therapy (PT), and speech therapy services. This section focuses on the role of OT and PT in assisting in prevention, remediation, and compensation. These two specialties complement each other; both services are beneficial and are invaluable members of the treatment team :
1.
Occupational therapy:
a.
Defined by the American Occupational Therapy Association as the “therapeutic use of occupations, including everyday life activities.”
b.
OT services are provided for “habilitation, rehabilitation, and the promotion of health and wellness to those who have or are at risk for developing an illness, injury, disease, disorder, condition, impairment, disability, activity limitation, or participation restriction.”
c.
Addresses the “physical, cognitive, psychosocial, sensory-perceptual, and other aspects of performance to support engagement in occupations that affect physical and mental health, well-being, and quality of life.”
d.
The occupational therapist strives to assist those with cancer to live within the limitations of the diagnosis itself as well as the side effects of the treatment.
e.
The individual undergoing treatment for his/her disease faces many burdens including fatigue, loss of strength, loss of independence, cognitive deficits, and anxiety. These areas may be addressed by utilization of the following methods:
i.
Adaptation and management of ADLs including but not limited to the use of adaptive techniques to both task and environment, adaptive equipment, and caregiver training to promote independence.
ii.
Utilization of energy conservation techniques via a variety of techniques including pacing, planning, delegation, and priority setting.
iii.
Addressing psychosocial concerns by engaging in lifestyle changes, relaxation techniques, coping strategies, and exploration of new valuable occupations.
iv.
Implementation of cognitive strategies to address “chemo brain” via compensatory techniques and the use of a variety of aids and adaptations.
v.
Use of physical activity including exercise , range of motion, stretching, and strengthening.
f.
Utilizes a collaborative and client-centered approach to address the side effects of cancer. The holistic nature of OT brings a broad view of the individual’s needs beyond the cancer treatment. This allows the individual to be able to successfully participate in many areas of life.
2.
Physical therapy:
a.
PT is defined by the World Confederation for Physical Therapy as “services to individuals and populations to develop, maintain and restore maximum movement and functional ability throughout the lifespan. This includes providing services in circumstances where movement and function are threatened by aging, injury, pain , diseases, disorders, conditions or environmental factors.”
b.
The general goals of PT include the prevention and reduction of weakness, avoidance of loss of pulmonary function, maintenance of range of motion and joint integrity, and preservation of balance, coordination, and endurance.
c.
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The physical therapist may address these aims in the following ways:
i.
Functional rehabilitation and exercise including, but not limited to, aerobic activity and strengthening while monitoring the medical effects of the physical activity including cardiac and pulmonary function.
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