University of Waterloo Well-Fit and Hardy Hearts: Exercise is treatment
University of Waterloo Well-Fit and Hardy Hearts
Exercise is treatment
By: Philip Rouchotas, MSc, ND
Issue: September 2010
Lifestyle counseling, notably recommendations for smoking cessation, physical activity, and diet modification have been recognized as effective treatment for both established cardiovascular disease and cancer. Lifestyle modification is not only for prevention. It delivers outcomes to all cause mortality in many settings superior to outcomes achieved with established pharmacotherapeutic interventions alone. Cardiac and cancer rehabilitation work on many levels.
Cardiovascular disease remains the realm with the strongest evidence-base concerning “hard” endpoints achieved through lifestyle modification strategies. Modest success with diet recommendations, in the absence of exercise prescription, achieved a 56% reduction in risk of all cause mortality among a population of MI survivors followed for two years (de Lorgeril 1999). Participation in cardiovascular rehabilitation programs focused on exercise have been estimated to impart a reduction in risk of all cause mortality of 24% (Riedel 2004).
To put these values in perspective, beta blockers are estimated to reduce all cause mortality risk 22% per 10 beat per minute (BPM) reduction in resting heart rate (Cucherat 2007), statins are estimated to reduce all cause mortality risk 12% per 1mmol reduction in LDL-C (Baigent 2005), and antiplatelet therapy is estimated to reduce all cause mortality risk 13% (Berger 2008), respectively, among individuals with established heart disease.
As impressive as these outcomes are, Suaya et al found that only 13.9% of eligible candidates are enrolled in a cardiovascular rehabilitation program following an acute MI (Suaya 2007). Referral rates to cardiac rehabilitation remain disappointingly low in Canada and elsewhere (Dafoe 2006).
Evidence of lifestyle modification as treatment for cancer is not as well developed as the evidence-base concerning cardiovascular disease. Nonetheless, the American Cancer Society has taken an aggressive stance on the importance of lifestyle modification during the full continuum of the cancer process (Demark-Wahnefried 2008, Doyle 2006). Most recently, The American College of Sports Medicine Roundtable on Exercise Guidelines for Cancer Survivors was released. This provides the literature on the safety and efficacy of exercise training during and after adjuvant cancer therapy and provides guidelines for exercise professionals.
Rehabilitation programs are a very different form of medicine relative to pharmacotherapeutic approaches. Their efficacy is undisputed… The challenge is compliance! The solution; fitness heroes!
IHP is honoured to have the privilege of introducing you to two teams of such heroes… The Hardy Hearts program operating out of Grand River Hospital in Kitchener, Ontario, and the University of Waterloo (UW) Well-Fit program. The two sister programs run independently, but with important overlap in directors and fitness supervisors. Hardy Hearts, the elder of the two sisters, focuses on cardiovascular rehabilitation. UW Well-Fit focuses on rehabilitation of cancer patients in treatment. Together, the team brings fitness, health, and hope to thousands of cardiovascular disease and cancer patients across the Kitchener-Waterloo region.
Hardy Hearts
Waterloo Regional Cardiac Rehabilitation Inc. (WRCRFI) was founded as a charitable organization by Dr. Ron Fowlis, MB, CHB, FRCPC, and Dr. Michael Sharratt, PhD in 1975. This program is known throughout the community as “Hardy Hearts” and has operated for the past 35 years out of Grand River Hospital. Hardy Hearts is independent and not funded by the hospital or government in any way. Charitable donations and an annual “Walk” provide funding for this program. Exercise professionals, nurses, a medical director and 60 kinesiology student volunteers provide the expertise to run a safe and effective program.
Hardy Hearts provides supervised cardiac rehabilitation for patients recovering from heart attacks, cardiac interventions and those with significant risk factors for cardiovascular disease. By providing continuous care to patients, Hardy Hearts has enabled its members to benefit from this program to maintain a healthy lifestyle for many years. Hardy Hearts is about education, exercise and support for lifestyle choices to rebuild and maintain healthier bodies. http://hardyhearts.uwaterloo.ca
UW Well-Fit
UW Well-Fit is a unique exercise program for individuals undergoing chemotherapy, radiation, or hormonal therapy treatment for various cancers. It is currently funded jointly by UW Fitness, Grand River Regional Cancer Center and charitable donations. UW Fitness initiated the program in partnership with medical staff at the Grand River Regional Cancer Center in January 2002. The main objective of the UW Well-Fit exercise program is to minimize the negative side effects that individuals experience with cancer treatments, as well as improve quality of life for cancer patients.
Negative side effects of cancer treatment may include fatigue, muscle weakness, nausea, depression, lymphodema, decreased immune system function, weight gain or loss, and decreased aerobic capacity. Appropriate, individualized exercise programs can help reduce the severity of these symptoms, as well as help individuals with cancer maintain function in day-to-day activities. Many participants report an improvement in physical function with the exercise program, and also appreciate the positive social support network that develops through interactions with others undergoing similar cancer treatment.
UW Well-Fit provides an opportunity for individuals with cancer to participate in supervised exercise in a safe, private, supportive small group environment. All participants require clearance from their oncologist prior to participating in UW Well-Fit, and are closely monitored by certified exercise professionals. Over 100 kinesiology students volunteer to support the 12,000 patient visits
per year.
UW Well-Fit has successfully collaborated with the Active Living Coalition for Older Adults (ALCOA) on a grant from the Public Health Agency of Canada, to create a manual allowing for the key features of the UW Well-Fit program to be effectively reproduced by other rehabilitation centres. The document is an incredible asset to any physician who promotes lifestyle management as part of systematic rehabilitation for cancer patients. It highlights suggestions for overcoming challenges of establishing rehabilitation programs, key referral networks to ensure the community is aware of the program, assessment/screening/eligibility criteria for candidates of rehabilitation, considerations of equipment costs, safety, and staffing requirements, and also includes a series of key, validated questionnaires and assessment tools for objective tracking of participants’ success. The manual is available online by visiting http://uwfitness.uwaterloo.ca. Click on the right side menu bar “Active Living for Older Adults Living with Cancer.”
Moving forward, the UW Well-Fit program is hoping to establish additional sister programs; diabetes and childhood/teenage obesity are highest on the radar of future program development.
IHP is grateful to Caryl Russell, MSc Kin, Director, UW Well-Fit and Vice-Chair Hardy Hearts for taking the time to educate us about these two tremendous initiatives. Caryl and her team of heroes deliver an impressive quality of healthcare to the thousands of people who have utilized Hardy Hearts and UW Well-Fit over the years. There is an urgent need to multiply programs such as the two described above. Their impact to participants can not be paralleled by any other system of medicine we possess. Furthermore, there needs to be aggressive education to the medical community of the immense magnitude of impact of such programs. Referral rates to rehabilitation programs are inexcusably low. Their success depends on creation of community within the program, and as the membership of the program grows, the success of each individual member also grows. In an environment of exponentially escalating healthcare costs, more attention needs to be paid to these simple, safe, pleotrophic, and cost effective strategies.
The Hardy Hearts Team:
- Katie Gibson, BSc Kin - Program Director
- Dr. Ron Fowlis - Medical Director/President
- Caryl Russell, MSc Kin, Exercise Specialist - VP
- Registered Nurses and Kinesiology Student Exercise Leaders
The UW Well-Fit team:
- Caryl Russell, MSc Kin, Exercise Specialist - Director
- Dr. Michael Sharratt, PhD Kin - Faculty Liaison
- Lori Kraemer, BSc Kin, CEP
- Erin Smith, BSc Kin, CEP
- Madeleine Noble, MSc Kin, CEP
- Katie Gibson, BSc Kin, CPT
References:
Baigent C, Keech A, Kearney PM, Blackwell L, Buck G, Pollicino C, Kirby A, Sourjina T, Peto R, Collins R, Simes R; Cholesterol Treatment Trialists’ (CTT) Collaborators. Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomized trials of statins. Lancet. 2005 Oct 8;366(9493):1267-78.
Berger JS, Brown DL, Becker RC. Low-dose aspirin in patients with stable cardiovascular disease: a meta-analysis. Am J Med. 2008 Jan;121(1):43-9.
Cucherat M. Quantitative relationship between resting heart rate reduction and magnitude of clinical benefits in post-myocardial infarction: a meta-regression of randomized clinical trials. Eur Heart J. 2007 Dec;28(24):3012-9.
de Lorgeril M, Salen P, Martin JL, Monjaud I, Delaye J, Mamelle N. Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: final report of the Lyon Diet Heart Study. Circulation. 1999 Feb 16;99(6):779-85.
Demark-Wahnefried W, Rock CL, Patrick K, Byers T. Lifestyle interventions to reduce cancer risk and improve outcomes. Am Fam Physician. 2008 Jun 1;77(11):1573-8.
Doyle C, Kushi LH, Byers T, Courneya KS, Demark-Wahnefried W, Grant B, McTiernan A, Rock CL, Thompson C, Gansler T, Andrews KS; 2006 Nutrition, Physical Activity and Cancer Survivorship Advisory Committee; American Cancer Society.Nutrition and physical activity during and after cancer treatment: an American Cancer Society guide for informed choices. CA Cancer J Clin. 2006 Nov-Dec;56(6):323-53.
Riedel R, Kelsberg G, Greenley S, Kerns B. Clinical inquiries. Does moderate exercise prevent MI for patients with coronary heart disease? J Fam Pract. 2004 Jul;53(7):585-6.
Suaya JA, Shepard DS, Normand SL, Ades PA, Prottas J, Stason WB. Use of cardiac rehabilitation by Medicare beneficiaries after myocardial infarction or coronary bypass surgery. Circulation. 2007 Oct 9;116(15):1653-62.