Meeting the Challenge of Daily Physical Activity

Nursing is a demanding profession, especially for oncology nurses who often deal with depressed, angry, and frightened patients. Due to the harried and often stressful nature of the job, many nurses end up neglecting their own health, which can increase their risk for chronic diseases. According to an article published in the Journal of the American Academy of Nurse Practitioners, approximately 54% of nurses randomly surveyed (a total of 760 of 4980 took the survey) were overweight or obese, of whom 53% lacked the motivation to make a lifestyle change, such as being more physically active outside of the job.¹ Because patients often look to nurses for guidance regarding lifestyle issues, such as physical activity, it is especially important for nurses to be aware of the latest health-related guidelines and to set a good example for their patients. After all, if a patient does not think their nurse practitioner is exercising or eating healthfully, then why should they follow their nurse’s recommendations? Let’s examine how both you and your patients can meet the challenge of getting enough physical activity on a daily basis, as well as factors you should consider when helping your patients establish a regimen.

What does it mean to be physically active?

According to the American College of Sports Medicine (ACSM), any “bodily movement that is produced by the contraction of skeletal muscle and that substantially increases energy expenditure” is considered physical activity.² These activities can be divided into two types: (1) the activities of daily living, which includes occupational activity, chores done in and around the house, and transportation-related activities, such as biking or walking; and (2) leisure activities, which includes competitive sports and recreational activities, such as gardening or strength training. Based on the ACSM definition, it is clear there are numerous creative ways to be physically active; however, to reap the greatest health benefit, regular cardiovascular and strength training components are essential.

Both activities of daily living and leisure can provide a cardiovascular workout, but to maximize the benefits, the intensity level of these activities should be either “moderate” or “vigorous,” with moderate intensity being ideal for most individuals. This means an individual is working hard enough to increase their heart rate and break a sweat, but they still maintain the ability to carry on a conversation. Strength training, which focuses on developing the major muscle groups of the lower body, upper body, and core, is also essential because it prevents against weakness and the loss of bone density, muscle mass, and flexibility that occur as we age and that are often accelerated in cancer patients due to their treatments.

What are the current physical activity guidelines?

The daily dose of physical activity required depends on the individual, their health status, and their goals. Table 1 lists the current ACSM/AHA (American Heart Association) guidelines for physical activity for healthy individuals younger than 65 years of age. Adults who are currently undergoing or who have recently completed cancer treatment can modify their activities to attempt to meet these guidelines. Table 2 off ers some suggestions for patients with cancer and survivors; however, every case is unique and it is essential for any physical activity regimen to be tailored to the individual patient. When helping your patients establish a regimen, take the time to learn more about your patients’ and their families’ preferences for physical activity. An individual is more likely to stick with a program if it is tailored to meet their needs.

Special considerations in patients with cancer

Although a moderate intensity level may be ideal for most individuals, patients with cancer may become fatigued if they are working at this level, which could result in them becoming discouraged and discontinuing such activities. Patients should never feel compelled to achieve 30 minutes each day, but some activity of short duration may be doable on most days. Encourage your patients to always listen to their bodies before, during, and after the physical activity, and let them know that it is okay to scale back the frequency and duration of the activity to a level that they are comfortable with. Paying attention to their bodily cues will help mitigate any resulting fatigue and improve their general outlook. Suggest that they involve their family and friends in the activities, which will keep everyone engaged and positive.

Useful online sources for healthy individuals and cancer patients

Exercise plays an important role in maintaining and improving health in all individuals, but the type and level of activity performed will depend on a person’s goals, age, and health status. There are an abundance of exercise Websites available that can be used for guidance, but one of the most useful and trustworthy sources is the ACSM Website, which can be accessed at www.acsm.org. You can also check out the exercise library on the American Council on Exercise Website at www.acefitness.org/exerciselibrary/default.aspx, where you can search for exercises by body part and receive step-by-step instructions on how to perform these exercises properly. If you are looking for a resource to chart your progress, visit smallstep.gov, which provides an activity tracker that can be used to help you reach your goals. While these sources can be used by your patients, the American Cancer Society Website (www.acs.org) is the best place for them to start, as it is the most comprehensive source available on how they can remain active both during and after treatment.

Lisa Marie Bernardo, PhD, MPH, RN, HFS, is an associate professor at the University of Pittsburgh School of Nursing. She is an ACSM- certified Health Fitness Specialist and ACSM/ACS Cancer Exercise Trainer and an ACSM-licensed Wellness Coach.

REFERENCES

1. Miller SK, Alpert PT, Cross CL. Overweight and obesity in nurses, advanced practice nurses, and

nurse educators. J Am Acad Nurse Pract. 2008;20(5):259-265.

2. American College of Sports Medicine. ACSM’s Guidelines for Exercise Prescription and Testing. 7th

ed. Philadelphia, PA: Lippincott-Williams & Wilkins; 2006:3.