Physical Activity Cancer Macmillan Activity Promotion Programme MAPP

Physical Activity & Cancer Macmillan Activity Promotion Programme (MAPP) South East Wales Helen Tyler Macmillan Therapies Manager Velindre Cancer Centre

Acknowledgements • Siobhan Harkin – Macmillan Physical Activity Lead (0. 5 wte) • Claire Jones – Macmillan Physical Activity Physiotherapist (0. 6 wte) • Margretta Davies – Macmillan Physical Activity Physiotherapist (O. 4 wte) • Patrick Palmer – Macmillan Physical Activity Support Worker (1 wte)

Improves health and wellbeing outcomes Effect size Reduction in the relevant risk of recurrence of breast cancer: • Adjuvant physical activity 40 - 50% • Adjuvant radiotherapy 59% • Adjuvant hormone treatment 29% (after 10 years of treatment) Physical activity guidelines Helping people take control ‘Keeping active has helped me, and my family, through a really difficult time. It’s helped me return to a more normal way of life and has given me a real sense of achievement’.

2 million People Living with Cancer PA levels 1. 6 Million not achieving recommend level of PA 1. 1 million are 65 years and over 0. 4 million achieving recommended level of PA

Meeting Patients Needs Specific needs Physiotherapy Outpatients Additional support requirements Self management MAPP NERS 10 Top tips

MAPP Aims Promote Physical Activity Promote Healthy Living To promote peer support Promote Self management of Cancer related side effects To empower patients to use NERS/independent Activity

MAPP setting up process Develop Promote Champion

Develop • Referral pathways • Stage of cancer care pathway • Patient Measurement tool- EQ 5 D, FACIT, • VAS, TUG • Referral pathways • Professional/self referral • Gateway session Evaluate Identify Establish Expand • Current PA schemes • NERs /Walking groups • Resources needed to run MAPP, staff, equipment • Suitable facilities • Variety of PA sessions • Modify/enhance dependent on patient feedback

Promoting • Hospitalspromotional stand • GP-leaflets • Health and well being days for family/carer /HCP • VCC patient portal • Seminars for GPs MAPP • Written to GPs • Meet them • F/U regularly • Emailed referrals Patient Family Carers Secondary care MDT • Health and social care staff emailed • Learn at lunch • Intra net VCC • Raise awareness NERS/activities local Community • Collaborate CNS link in with Cancer support groups • Attended support group meetings

Championing • Varied menu of PA • Within sports, leisure providers, community room • Carrying pre and post MAPP assessments • F/u in person/phone • Sign posting • • Facilitate sessions Welcoming, friendly Environment Facilitate peer support Advice Education Support Behavioural change model Physical activity Patient Centred • Brief intervention • HNA • Motivational interviewing • Right type of activity

MAPP 6 week course 2 hours Health & wellbeing talk + Physical activity session Beginning of the journey” – why now? Local opportunities & resources Confidence in moving forward with PA DIYHome based PA Pacing, planning, energy diaries Walking NERs Tai chi Relaxation Mindfulness Coping thoughts Healthy Eating

Macmillan Activity Promotion Programme Inclusion criteria • All patients will be screened by a physiotherapist prior to commencement on the MAPP. • All tumour sites • All ages 18+ • All stages of the cancer care pathway • Patient has identified a desire to improve their physical activity levels

Macmillan Activity Promotion Programme Exclusion criteria Many of these exclusions will only be temporary but all must be considered • Patients who are already physically active (we will refer directly on to NERS) • Acute infection • Febrile illness with temperature >38 °c • Symptomatic severe aortic stenosis • Acute myocarditis/pericarditis • Acute uncontrolled psychiatric illness • Diarrhoea and vomiting • Acute chest pain • Dizziness and lightheadedness • Disorientation • Blurred vision • Unstable angina • Unstable/ Acute heart failure • Unstable diabetes • New/ Uncontrolled arrhythmias • Hypertension with a resting SBP > 180 mm. Hg or DBP > 100 mm. Hg • Symptomatic hypotension • <24 hrs since last chemotherapy session • Low blood counts (neutropenia or thrombocytopenia) • Acute PE • Acute MI/ Cardiac event • On antibiotics for active cellulitis • Patients with known MSCC to be discussed with MAPP team on an individual basis.

MAPP Aims/Evaluation Promote Physical Activity 90% attendance 1 non starter due to illness Promote Healthy Living Patients completed ‘Move More’ packs reporting additional activity To promote peer support See patient feedback Promote Self management of Cancer related side effects Health and wellbeing talk To empower patients to use NERS/independent Activity All patients referred to NERS

Patient Feedback – MAPP 1 “Tremendous. I have been able to improve my fatigue level through planning and using some of the activities and ideas gained from the course Given me help to do more exercise and advice on other activities that could help me reassurance to do activities I thought might be damaging or hurt Helped me to think outside the box about physical activity and the restraints of my life It has motivated me to examine how active I am. To realize that just increasing normal daily activities count too. made me more aware of the need for exercise Made me realize doing something a little is better than nothing at all. Something has clicked and I now feel more motivated

MAPP future developments Session locations Friday 11 am -1 pm Cwmbran Stadium Monday am Pont Newydd Medical Centre, Porth Tuesday 2 – 3. 30 pm Whitchurch Rugby Club

THANKS Diolch Any questions?