Exercise for life.
In 2001, as a retired oncologist, I started the program in Tyler, Texas, a community of 100,000 with a service area of over 600,000. It began in one location in the family life center of a local church. Over the past nine years FSFL has expanded to nine locations in the Dallas Metroplex and eight locations in East Texas and surrounding communities. Facilities hosting the FSFL program include churches, cancer centers, hospital wellness centers, commercial fitness centers, community centers, and a hospital inpatient oncology floor.
All patients are physician referred, and the program is provided without charge. FSFL is an individualized, structured program with no limit to duration of participation. All referred patients are encouraged to remain in the program permanently to achieve maximum benefits and incorporate exercise as a lifestyle behavior change.
Exercise components are easily mastered and consist of aerobic activity (treadmill and elliptical machines), muscle strengthening (stability ball, stretch bands, dumbbells, and squat machine), and flexibility exercises. Measured metrics during exercise include pulse oximetry, heart rate, blood pressure, and heart rate recovery. Group sessions using the stability ball and Pilate's technique are also provided. Home exercise components include stability ball, stretch bands, dumbbells, and pedometer use.
The clinical staff is degreed in kinesiology and trained and certified to ensure competency in program administration.
Participant adherence is encouraged through relationship building, goal setting, building self-efficacy, and accountability through exercise logs and frequent telephone communication. Research evaluating the effectiveness of the FSFL program is done in collaboration with University of Texas at Tyler. Over the past two and a half years, data analysis from survey forms (see table on page 6) have demonstrated remarkable benefit in physical and mental functioning within the first month of participation, which is sustainable. In addition, FSFL incorporates social Cognitive Theory (3) techniques and empowerment (4) to change the devastating cancer experience by inspiring new hope and meaning in the lives of participants.
Medical Outcomes Survey Short Form (SF-36 and SF-8) Concept/Subscale Low High Physical Functioning Limited a lot if Performs all types of performing physical physical activities, activities (bathing, including vigorous dressing) Role-Physical Problems with work or No problems with work daily activities due to or daily activities due physical health to physical health Bodily Pain Severe and limiting No limitations due to pain pain General Health Evaluates personal Evaluates personal health as poor and health as excellent believes it will get worse Vitality Tired and worn out all Full of energy the time Social Functioning Interference with Normal social social activities due activities to physical or emotional problems Role-Emotional Problems with daily No problems with daily activities as a result activities of emotional problems Mental Health Feelings of Feelings of peace, nervousness, happiness, calmness depression
Since 2004, 890 different physicians including 170 oncologists have referred over 6,000 patients. Annually there are approximately 2,500 new patients referred and 60,000 visits to our facilities.
Financial support for the program is provided by physician and health care provider contributions, participant contributions, grants, and private donations. In-kind contributions are significant as all host facilities provide free space.
In conclusion, FitSTEPS for Life[R] represents a community-based exercise model that is effective, cost efficient, and applicable to most any community setting. It is recommended as a model for "standard of care" for implementation of exercise into the clinical practice.
Dr. Kimmel is a retired physician of medical oncology and hematology and is the founder of Cancer Foundation for Life[R] and FitSTEPS for Life[R]. He receives no compensation from FitSTEPS for Life[R]. If you have questions for Dr. Kimmel regarding the program, please contact him at firstname.lastname@example.org or visit the website www.fitstepsforlife.org.
(1.) Holmes MD, et al. Physical activity and survival after breast cancer diagnosis. JAMA 2005; 293(20); 2479-2486.
(2.) Meyerhardt JA, et al. Physical activity and survival alter colorectal cancer diagnosis. J Clin Oncol 2006: 24(22): 3535-3541.
(3.) Bandura A. Social Foundations of Thought and Action: A Social Cognitive Theory. Englewood Cliffs, NJ: Prentice-Hall, 1986.
(4.) Frankl V. Man's Search for Meaning: An Introduction to Logotherapy. Boston, MA: Beacon Press, 1992.
By Gary T. Kimmel, MD
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|Title Annotation:||EXPERIENCE TELLS US|
|Author:||Kimmel, Gary T.|
|Date:||Mar 22, 2010|
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