Safely Training Cancer Survivors

I have been an IDEA member for 13 years and look forward to receiving IDEA Fitness Journal every month. I read the news item “Weightlifting and Lymphedema Debate Continues” (Making News, April 2011) with interest and would love to add an additional perspective as an ACSM personal trainer with a primary focus on working with cancer patients and survivors. My training and experience in this area are through the University of Northern Colorado’s Rocky Mountain Cancer Rehabilitation Center, where I received a cancer exercise specialist title. To date, I have trained and worked with more than 300 cancer patients from the time of diagnosis through survivorship.

With 28 million people [worldwide] living with cancer—and that number steadily growing—it’s imperative to educate personal trainers and provide the tools they need to work safely and effectively with their cancer-survivor clientele. This article on lymphedema did a great job educating readers that exercise should be initiated at a low intensity and increased gradually. However, I think it’s worth mentioning the other precautions and guidelines that are advised to further reduce any risk of developing lymphedema.

The National Lymphedema Network [NLN] guidelines state, “The majority of individuals who are at risk for developing lymphedema can safely perform aerobic and resistive exercise using the ‘at risk’ body part when . . . wearing a compression garment.”

Although lymphedema may not be evident in “at risk” individuals, the lymphatic system may function well below the normal range (Goltner et al. 1988). Exercise can trigger lymphedema by increasing lymph production to the point where it exceeds the lymphatic system’s ability to remove fluid. The temporary overload may not produce immediate swelling. However, repeated episodes may add up and lead to chronic lymphedema. Therefore, the [NLN] recommends that “even ‘at risk’ individuals may reduce their risk of developing lymphedema during exercise by wearing a well-fitted compression garment.”

Other considerations to reduce the risk of lymphedema while exercising include the following:

• Exercise in a temperature-controlled environment. It is not advised to exercise in extreme temperatures. Exercising in cold temperatures can cause dryness and cracking of the skin, increasing the chance for infection and lymphedema. Exercising in extreme heat can cause the “at risk” limb to swell.
• Exercise in moderation, making sure to have 48 hours of rest between sessions.

The jury might be out about whether or not exercise may or may not decrease the risk for lymphedema. Either way, the myriad benefits of exercise far outweigh any possible risks for cancer survivors. Exercise has been shown to decrease the chance of recurrence by [as much as] 50%; reduce the risk for osteoporosis; help stave off unwanted weight gain; and improve body image, self-confidence and overall quality of life. Exercise dramatically improves cancer survivors’ lives!

Laura Rosencrantz
Owner, Inpower
Portland, Oregon

References

Burt, J., & White, G. 2005. Lymphedema: A Breast Cancer Patient’s Guide to Prevention and Healing (2nd ed). Alameda, CA: Hunter House.

Goltner, E., et al. 1988. The importance of volumetry, lymphscintigraphy and computer tomography in the diagnosis of brachial edema after mastectomy. Lymphology, 3, 134–43.

Teaching Mind-Body Skills to Combat Chronic Pain

Editor’s Note: May’s Mind-Body-Spirit News column asked readers what programs they were offering to help members with chronic pain. Petrina Blakely shared this programming format:

I have melded several different workouts and modalities into a class I call Core/Stretch. It is the most popular format I currently teach, with a large age range of devotees. I use my background in teaching Mat Science (an AFAA program mixing yoga and Pilates), stability ball, small foam ball, self-massage and active isolated stretching, along with general fitness stretching with and without a yoga strap—all set to ambient music. I also incorporate Egoscue® and McKenzie Method® exercises, ideally ending with a visualization and meditation segment. My students leave refreshed, recharged and rebalanced. I remind them throughout the class to scan and tune into their bodies to assess how stretches or exercises feel, as well as [to ask themselves] how they are feeling physically and emotionally. This is a reflective class with a sense of humor. Since laughter is the best medicine, I always try to incorporate levity when teaching.

I encourage my students to listen to how their bodies are doing that day and to adjust workout levels accordingly. Most sessions end reluctantly with comments as to how much better students feel upon leaving versus when they arrived. They have reported long-term benefits such as stronger cores, stabilization for the low back, and improved flexibility and range of motion. Students have learned to use exercises/stretches independently to manage chronic or acute conditions. It is very rewarding to teach such an obviously beneficial format.

Petrina Blakely
Kauai Bodywork
Princeville, Kauai

“Props” for IDEA FitnessConnect and IDEA

I finally took the time to enter all my information into IDEA FitnessConnect and set up the Client Newsletter to go out to my clients—I love it! The first one I sent was in April. Most of my clients are very educated, so it will be great for them to get some of the articles. Some of the previous articles I would love to see included are the ones on fiber, protein, interval training, etc. And of course, I love the recipes you are including!

Now I only wish you had a “coaching client” version of the Client Newsletter that I could send to my coaching clientele. I love what IDEA has created for us to use—for free! Contacting prospects and clients on a monthly basis is critical to successful marketing.

Kay Cross, MEd, ACC
Cross Coaching & Wellness
North Richland Hills, Texas

I am pleased personally and professionally with IDEA FitnessConnect. I feel strongly that [serious] fitness professionals owe it to themselves to use this complimentary resource. Since the inception of IDEA FitnessConnect, I’ve received many hits on my profile as well as contacts that have resulted in new clients. I can’t say enough about how impressed I am with IDEA FitnessConnect. It does much to help facilitate the growth of both fitness professionals and fitness- and health-related businesses. What’s wonderful is that it works for me 24/7! IDEA FitnessConnect is a boon to the fitness and wellness industry.

Joanne Duncan-Carnesciali, MS
New York, New York

I continue to be amazingly impressed with IDEA. You are so “on top” of the fitness industry. I truly feel nobody else comes close. My vote is for the next IDEA Personal Trainer Institute™ conference to be in the New York area . . . please?!

Susan Yedibalian
Wyckoff, New Jersey

Using Client Music Mixes

Editor’s Note: April’s Mind-Body-Spirit News column asked readers if they were using any special or unusual music to enhance clients’ exercise experiences. Phillip Korrey shared his idea:

Great articles this month. I had been getting burned out, but after reading this month’s magazine I felt rejuvenated.

At the Parkwood YMCA in our Friday morning group cycling class, we ask a different member [each week] to bring in the musical selection via mixed CD or MP3 player. This has brought a new level of excitement to the class. Music is so personal, [and this idea] gives members the opportunity to share a piece of themselves. It’s also great for me because I enjoy the challenge of listening to the tempo changes and creating a challenging workout on the fly. Plus, I teach a number of classes during the week, and I get sick of my music.

Phillip Korrey
East Lansing, Michigan

Core Performance Study Faulty?

Regarding the article “Core Strength Unrelated to Performance?” (Making News, May 2011), the reader may incorrectly understand that the authors of the underlying research [published in the Journal of Strength and Conditioning Research 2011; 25 (1)] found no correlation between functional movement and core strength. This is not true. The authors found no correlation between core endurance and a particular set of tests used to measure functional movement in injured people. The study population was young (24.4 years old), healthy “recreational athletes,” so using tests designed for an injured population may have been inappropriate.

Second, in my opinion, the study subjects were simply not challenged enough by either the core stability assessment or the functional movement screen to elicit any pattern that could be meaningfully correlated with the much more challenging performance assessments. The raw data were not published in the article, so my opinion is based on assumption.

Third, at least two of the three performance assessments required leg strength and balance or agility in order to score well. These variables may have confounded the study. Therefore, a poor or excellent score on the performance assessment may have been more heavily influenced by the subject’s leg strength and balance/agility vis à vis core endurance.

Fourth, I disagree with the researchers’ conclusion: “The core assessment was an isometric, muscle endurance test, whereas the performance tests involved dynamic movement. Therefore, it is safe to say that isometric training of the core provided little if any benefit to dynamic performance.”

Just because this investigation found no correlation does not mean that cause and effect are absent. It means that this study failed to find a correlation. This conclusion might have been valid had subjects with weak core endurance been randomly assigned to a core-strengthening intervention (test and control design) and then had their pre- and post-intervention performance scores statistically analyzed. This study did not do that.

Finally, I distrust a study in which 86% of the variability in performance is partially explained by being right-handed. I find that very interesting.

The authors of this study have published several previous journal articles that were valuable and interesting to me. I apologize to them if I’ve completely missed the point of this study.

Jim Junio, CSCS
Riverside, California

Keeping Clients Motivated

I was thrilled to see the excellent article “Help for Discouraged Clients” by Christopher Peterson, PhD (Inner IDEA, May 2011)! I appreciate his thoughtful story about positive psychology, and I know it will benefit IDEA members and their students/clients.

I am a long-time IDEA person/fan/friend (member #65). IDEA and IDEA Fitness Journal have been invaluable to me in my career trajectory! I am continually inspired by IDEA’s integrity and leadership in promoting health and fitness in the world.

Elaine O’Brien, MAPP
PhD Student/Teaching Assistant, Temple University (Fall 2011)

The Group Dynamic

A couple of years ago I wrote to ACE saying I had been certified for many years as a group exercise instructor (16 years in August and proud of it) but was finding everything—articles, workshops, etc.—almost exclusively geared toward personal training. So you can imagine my surprise and delight when an article on a company that knows the value of a group instructor appeared in your journal (“Planet Fitness® Eliminates Personal Training,” March 2011)!

I think personal training has a spot in the fitness industry for those who can afford it or are “in training,” or for special populations; however, “average exercisers” need a place where they can exercise and not be intimidated—a place where they can socialize, meet new friends, have fun, get fit and feel good about themselves.

In my opinion, part of the reason people are overweight is because too much pressure is put on obtaining a personal trainer because it’s the “in thing” to do. Although I am sure there are quite a few personable trainers out there, as time passes the novelty of having a personal trainer wears off, and the personal trainee is left feeling let down, alone and not wanting to exercise. Meanwhile, group classes are a place [where] exercisers can socialize, have fun and get fit without being judged or pressured.

Thank you, Planet Fitness, for making the group exercise instructor a star again! It would behoove more fitness organizations, gyms and health clubs to take another look at group exercise instructors because, after all, isn’t that [how] the fitness craze started?

Robin Ann Love
Philadelphia, Pennsylvania

Send your letters and opinions to Ryan Halvorson, IDEA Fitness Journal Fitness Forum, 10455 Pacific Center Ct., San Diego, CA 92121-4339; fax them to him at (858) 535-8234; or e-mail them to [email protected]. You may also leave a voice mail letter in the editorial voice mail box at (858) 535-8979, ext. 239. (For general membership questions or information, however, please e-mail member services at [email protected].) We reserve the right to edit letters for length or clarity.