Cancer Program

Mission: This program will provide a 12-week individualized exercise program

Location: Riverside Health and Wellness Center (Newport News)
Times: TBD
Instructor: TBD
Assistants: 1 (Group Fitness Instructor and/or and intern)
Minimum Number of Participants: 8
Max Number of Participants: 12

Assessment

Demographic:
1. Patient Population: The population that this program will focus on are cancer
patients that have received a referral from a physician to exercise. This
population will have already gone through treatment that can come with side
effects such as anemia, loss of appetite, fatigue, and difficulty sleeping. These
side effects not only affect the patient’s social interactions but also their ability
to perform daily activities.
2. Patient Flow: The goal of this program is to allow for Cancer patients to flow
from the treatment segment to a supervised exercise program to allow for
longevity and easing of symptoms that may still affect the patient.

Institutional Analysis:
 Strengths: Riverside has on-site staff members that can run this Cancer Program
along with other resources that Riverside provides such as equipment for the
clients to use, staff members that will oversee all the clients while they are
exercising, an on-site Massage Therapist as well as an on-site Yoga Class
instructor.
 Weaknesses: There is limited staff available so finding a staff member to run this
program may be difficult as well as limited knowledge pertaining to Cancer.
Therefore, we will rely on other resources, such as Physical Therapy and
Oncology, for help.
 Opportunities: With all of the Riverside Wellness and Health Systems, specifically
Riverside Wellness and Fitness Center, being known for well-rounded facilities,
adding a Cancer Exercise Program will not only further increase our resources
that are available to the community but also increase our public relations with
other facilities that may refer their patients to our program.
 Threats: The success of this program is based off how many referrals physicians
write for these cancer patients after they finish treatment.

Resources:
 Internal: Management staff, exercise physiologists, exercise specialists, desk
staff, membership staff, space, equipment, classes, other departments.
 External: Riverside Management, Riverside Cancer Care Center, Riverside
Medical Group, Riverside Regional Medical Center, Riverside Walter Reed
Hospital, and other community resources.
Plan

S.M.A.R.T. Goals
 Specific: By the start of the program, we are striving for 4 to 6 participants to
sign up within the first 4 weeks of marketing the Cancer Program. (Minimum
number: 8, goal number: 12, maximum number: 12); starting out we could have
the program referred-based and have the ability to sign up. This is because with
it being a new program and the YMCA Livestrong Program being free, you need
to build up a base to get the program “rolling”. Then after a year change it to
strictly a referred program.
o This program is designed for Cancer patients to allow for a supervised
and regulated exercise protocol to increase longevity of the client as well
as to alleviate any symptoms an individual may be experiencing.
 Measureable: This will be measureable by keeping a file on record of who has
signed up that way at the end of the first 4 weeks of marketing we know how
many we have signed up so far.
o The success of this program will be determined by the number of patients
we start with and the number of patients that still come to the program
at the end of the 12 weeks.
o Survey Monkey will also be used to determine the satisfaction of the
surveys. Here is the link for the survey I created:
https://www.surveymonkey.com/r/93KV8B7
 Attainable: This is an attainable goal due to the small number of patients we
would like to have signed up. Having one full class at the start of the program
would be a great driving force to keep advertising and getting new clients.
o With every other week focused on a certain topic, it sets up the clients
with a reasonable amount of time to learn the topic and be able to
perform it.
 Realistic: Starting off with having reached our small goal number of participants
for a class is a very realistic goal. Especially when the program is brand new for
an area that only has one other major Cancer Program.
o
 Timely: Having a 4-week window is an adequate amount of time to accept at 4 to
6 applicants due to the fact that advertising will already be out for the program.

Program

Specifications:
 Duration:
o This exercise program is 12-weeks long that meets 3 times per week (two
within the program and one outside of the program) with a duration of 1
hour per session
o which days of the week it runs and who will run it.
 Prior to the start of the program:
 o Create a folder to keep on file for the patient that includes:
 Physician referral (must have before participation/acceptance into
the program)
 Exercise Assessment Results
 Karnofsky Survey Pre-Program Test & Post-Program Test
 Rotterdam Post-Program Test
o Assess the client with a pre-examination
 Aerobic Fitness
 6 minute walk test
 Strength
 Arm Curl Test
 Chair Stand Test
 Handgrip Test
 Flexibility
 Floor Sit and Reach Test/Chair Sit and Reach Test
 Back Scratch (flexibility)
 Weekly Basis: (*BOLD days = extra 30 min. for support & talking afterwards)
- Massages on most strength training days
o Week 1: Testing
 Day 1: Introduction to the class
 Day 2: Pre-Program Testing
 Day 3: Attend Yoga Class/Mindful Class (together)

o Week 2: Aerobics
 Day 1: Aerobics Training
 Day 2: Aerobics Training
 Day 3: Attend Yoga Class/Mindful Class (together)

o Week 3: Aerobics
 Day 1: Aerobics Training
 Day 2: Aerobics Training

o Week 4: Resistance Training

 Day 1: Introduction to Resistance Training (Machines)
 Day 2: Resistance Training (Machines) & Massages
 Day 3: Attend Yoga Class/Mindful Class (together)

o Week 5: Resistance Training

 Day 1: Resistance Training (Machines)
 Day 2: Resistance Training (Machines) & Massages

o Week 6: Stretching (Flexibility)

 Day 1: Aerobics
 Day 2: Resistance Training (Introduction to Stretching included)
  Day 3: Attend Yoga Class/Mindful Class (together)

o Week 7: Stretching (Flexibility)

 Day 1: Aerobics
 Day 2: Resistance Training (Stretching included) & Massages

o Week 8: Balance
 Day 1: Aerobics (Balance Introduction)
 Day 2: Resistance Training (Stretching after) & Massages
 Day 3: Attend Yoga/Mindful Class (together)

o Week 9: Balance
 Day 1: Aerobics (Balance)
 Day 2: Resistance Training (Stretching after)

o Week 10: Nutrition

 Day 1: Aerobics
 Day 2: Resistance Training (Stretching after) & Massages
 Day 3: Attend Yoga/Mindful Class (together)

o Week 11: Active Lifestyle

 Day 1: Resistance Training & Stretching & Massages
 Day 2: Aerobics

o Week 12: Last Week

 Day 1: Post-Program Testing
 Day 2: Celebration

Financial (examples)

o Cancer Exercise Program

 Free Massages
o Payment Options
o Up Front
 $150 for 12 weeks
o Pay Per 6 Sessions
 $70 for 6 sessions
o Marketing
o in Cancer Treatment Centers
 Bulletin Boards
 Flyers
  Brochures
o Other Avenues
 NPR
 Gloucester Radio
 Marquees
 Physician Offices
 TV Screens in RWFC-P/RWFC-MP
 Equipment Screens
 Staff Meetings
 Community Bulletin boards
 Support Groups

6 Minute Walk Test

Purpose: To measure aerobic fitness

Equipment needed: Measuring tape, cones, stopwatch, tape

Where?: The open court in between the basketball court and cardio equipment

Setting Up: Measure out a box of 20 meters by 5 meters and put tape every 5 meters. The

participants will walk around the box (oppose to a line; research shows this can cause dizziness

in the older population) for 6 minutes while counting the number of laps they complete. This can

be done in a group setting.

Handgrip Test

Purpose: Forearm strength and an indication of overall strength

Equipment needed: Hand dynamometer

Where?: TBD (group fitness floor?)

Setting Up: Have the group pass the hand dynamometer around to measure their handgrip

strength. Each program participant will measure their left hand first then their right hand (record

each measurement for each participant). The hand dynamometer will then be passed to the next
individual. Once every participant has done the test once, have them go through one more time

and record the scores.

Reference: Costanzo DG. ACSM certification: The evolution of the exercise professional.

ACSM

Health Fitness J. 2006;10(4):38-9.

Chair Stand Test

Purpose: To measure strength in the lower body

Equipment needed: A chair with a straight back, a stopwatch

Where?: The fitness floor in the corner (where the R.I.S.E. program takes place), in a classroom,

or on the group fitness floor

Setting up: Have enough chairs adequately spaced out for the participants in the program. Have

the participants count of the number of times they can stand up out of their chair in 30 seconds.

This can be done in a group setting all at once. Once the test in complete, have each participant

tell the instructor their score.

Arm Curl Test

Purpose: To measure strength in the upper body

Equipment needed: A chair with a straight back, stopwatch, 5lb dumbbells for women, and 8lb

dumbbells for men

Where?: The fitness floor in the corner (where the R.I.S.E. program takes place or in a classroom
Setting Up: Have numerous dumbbells for each client to perform the test at the same time. Have

the client count the number of times per arm they can lift the weight in 30 seconds. At the end of

the 30 seconds have each participant tell the instructor their score.

Chair Sit-and-Reach Test

Purpose: To measure lower body flexibility

Equipment needed: A chair, a stopwatch

Where?: The fitness floor in the corner (where the R.I.S.E. program takes place or in a classroom

Setting Up: Have each participant of the program sit in a chair and reach to touch their toes and

take the measurements for that individual. Then proceed to move down to the line until you

record all of the participants’ assessments.

Back Scratch Test

Purpose: To measure upper-body flexibility

Equipment needed: a measuring tape

Where?: The fitness floor in the corner (where the R.I.S.E. program takes place or in a classroom

Setting Up: This test is done on an individual basis. Have each participant perform the back-
scratch test and record their score as you go down the line of participants.
 Surveys
Fatigue Rating:

1. Rate your level of fatigue on the day you felt most fatigued during the past week:

0 1 2 3 4 5 6 7 8 9 10

Not at all As fatigued as

Fatigued I could be

2. Rate your level of fatigue on the day you felt the least fatigued during the past week:

0 1 2 3 4 5 6 7 8 9 10

Not at all As fatigued as

Fatigued I could be

3. Rate your level of fatigued on the average during the past week:

0 1 2 3 4 5 6 7 8 9 10

Not at all As fatigued as

Fatigued I could be

4. Rate your level of fatigue right now:

0 1 2 3 4 5 6 7 8 9 10

Not at all As fatigued as

Fatigued I could be

5. Rate how much, in the past week, fatigue interfered with your general level of activity:

0 1 2 3 4 5 6 7 8 9 10

Not at all As fatigued as

Fatigued I could be

6. Rate how much, in the past week, fatigue interfered with your ability to bathe and dress
yourself:
 0 1 2 3 4 5 6 7 8 9 10

Not at all As fatigued as

Fatigued I could be

7. Rate how much, in the past week, fatigue interfered with your normal work activity
(includes both work outside the home and housework):

0 1 2 3 4 5 6 7 8 9 10

Not at all As fatigued as

Fatigued I could be

8. Rate how much in the past week, fatigue interfered with your ability to concentrate:

0 1 2 3 4 5 6 7 8 9 10

Not at all As fatigued as

Fatigued I could be

9. Rate how much, in the past week, fatigue interfered with your relations with other
people:

0 1 2 3 4 5 6 7 8 9 10

Not at all As fatigued as

Fatigued I could be

10. Rate how much in the past week, fatigue interfered with your enjoyment of life:

0 1 2 3 4 5 6 7 8 9 10

Not at all As fatigued as

Fatigued I could be

11. Rate how much, in the past week, fatigue interfered with your mood:

0 1 2 3 4 5 6 7 8 9 10
 Not at all As fatigued as
Fatigued I could be

12. Indicate how many days, in the past week, you felt fatigued for any part of the day:

0 1 2 3 4 5 6 7 8 9 10

Not at all As fatigued as

Fatigued I could be

13. Rate how much of the day, on average, you felt fatigued in the past week:

0 1 2 3 4 5 6 7 8 9 10

Not at all As fatigued as

Fatigued I could be

14. Indicate which of the following best describes the daily pattern of your fatigue in the
past week:

0 1 2 3 4 5 6 7 8 9 10

Not at all As fatigued as

Fatigued I could be
Name:
Date: THE
GENERAL HEALTH
QUESTIONNAIRE
(GHQ-28)
Please read this carefully.

We should like to know if you have had any medical complaints and how your health has been in general, over
the past few weeks. Please answer ALL the questions on the following pages simply by underlining the answer
which you think most nearly applies to you. Remember that we want to know about present and recent
complaints, not those that you had in the past.

It is important that you try to answer ALL the questions.

Thank you very much for your co-operation.

Have you recently

Al been feeling perfectly well and in Better Same Worse Much

worse
good health? than usual as usual than usual than
usual
*

A2 been feeling in need of a good Not No more Rather more Much

more
tonic? at all than usual than usual than
usual
*

A3 been feeling run down and out of Not No more Rather more Much
more
sorts? at all than usual than usual than
usual
*

A4 felt that you are ill? Not No more Rather more Much
more
at all than usual than usual than
usual
*

A5 been getting any pains in Not No more Rather more Much

more
your head? at all than usual than usual than
usual
*

A6 been getting a feeling of tightness Not No more Rather more Much

more
or pressure in your head? at all than usual than usual than
usual
*

A7 been having hot or cold spells? Not No more Rather more Much
more
at all than usual than usual than
usual
*

B1 lost much sleep over worry? Not No more Rather more Much
more
At all than usual than usual than
usual
*

B2 had dIfficulty in staying asleep Not No more Rather more Much

more
once you are off? at all than usual than usual than
usual
*

B3 felt constantly under strain? Not No more Rather more Much

more
at all than usual than usual than
usual
*

B4 been getting edgy and Not No more Rather more Much

more
bad-tempered? at all than usual than usual than
usual
*

B5 been getting scared or panicky Not No more Rather more Much

more
for no good reason? at all than usual than usual than
usual
*

B6 found everything getting on Not No more Rather more Much

more
top of you? at all than usual than usual than
usual
*

B7 been feeling nervous and Not No more Rather more Much

more strung-up all the time? at all than usual than usual than
usual

Please turn over

Have you recently

Cl been managing to keep yourself More so Same Rather less Much

less
busy and occupied? than usual As usual than usual than
usual
*

C2 been taking longer over the things Quicker Same Longer Much
longer
you do? than usual as usual than usual than
usual
*

C3 felt on the whole you were doing Better About Less well Much
things well? than usual the same than usual less
well
*

C4 been satisfied with the way More About same Less satisfied Much
less
you've carried out your task? satisfied as usual than usual
satisfied
*

C5 felt that you are playing a useful More so Same Less useful Much
less
part in things? than usual as usual than usual useful
*

C6 felt capable of making decisions More so Same Less so Much

less
about things? than usual as usual than usual
capable
*
C7 been able to enjoy your normal More so Same Less so Much
less
day-to-day activities? than usual as usual than usual than
usual

Dl been thinking of yourself as a Not No more Rather more Much

more
worthless person? at all than usual than usual than
usual
*

D2 felt that life is entirely hopeless? Not No more Rather more Much
more
At all than usual than usual than
usual
*

D3 felt that life isn't worth living? Not No more Rather more Much
more
at all than usual than usual than
usual
*

D4 thought of the possibility that you Definitely I don't Has crossed

Definitely
might make away with yourself? not think so my mind have
*

D5 found at times you couldn't do Not No more Rather more Much

more
anything because your nerves At all than usual than usual than
usual
were too bad?
*

D6 found yourself wishing you were Not No more Rather more Much
more
dead and away from it all? at all than usual than usual than
usual
*

D7 found that the idea of taking your Definitely I don’t Has crossed
Definitely
own life kept coming into your mind? not think so my mind has

(Total scores of <23 non-psychiatric; Total scores of 23< psychiatric)

A B C D Total
 Number of Monday Tuesday Wednesday Thursday Friday Saturday Sunday
hours of sleep
last night
12+

10-11

8-9

6-7

4-5

<4

Sleeping Log:

How would you describe the quality of sleep you experienced last night?

Days Monday Tuesday Wednesday Thursday Friday Saturday Sunday

Very Deep

Normal

Restless

Bad with
Breaks
I did not sleep

Did you take any sort of sleeping aid?

Days: Monday Tuesday Wednesday Thursday Friday Saturday Sunday

Yes/No

Name
Exercise Intake Form
Name: _______________________________Date (DD/MM/YEAR): _____________________

Date of birth (DD/MM/YEAR): _____________________________ Age: ________________

Emergency Contact
Name: ___________________________________ Relationship: ________________________

Home phone number: ___________________________________________________________

Cell phone number: _____________________________________________________________

Medical History – Cancer

1. What was the date of your cancer diagnosis (MM/YEAR)? _____________
2. What type of cancer were you diagnosed with (i.e., breast, prostate, lung)?___________
3. What stage was your cancer? 0 1 2 3

4 5 Undetermined Don’t Know

4. If applicable, which side of the body was your cancer on?

Left Right Both N/A

5. What types of cancer treatments have you received or will you receive in the future?
Surgery: No
Completed: date (MM/YEAR): _________________

Current

From ACSM, 2012, ACSM’s guide to exercise and cancer survivorship (Champaign, IL: Human
Kinetics). Developed by S. Neil, A Kirkham and K. Campbell.
Chemotherapy: No Current Completed: Date (MM/YEAR):___ /____
Future/planned: Date (MM/YEAR):____ /____

Radiation: No Current Completed: Date (MM/YEAR):

___/_____

Future/Planned: Date (MM/YEAR):

___/___

Type of surgery (if known): ________________________________________________

6. Please provide any other comments you have about your cancer or cancer treatment (if
applicable):
________________________________________________________________________

________________________________________________________________________

Medical History – General

7. Do you have any of the current medical conditions? (Please check all that apply)
Hypertension

Diabetes

High cholesterol

Arthritis or joint pain

From ACSM, 2012, ACSM’s guide to exercise and cancer survivorship (Champaign, IL: Human
Kinetics). Developed by S. Neil, A Kirkham and K. Campbell.
 Other (specify): _____________________________________________________

8. Please list your current medications and supplements including any medications that are
part of your cancer treatment, such as hormone therapy. (Please provide the names as
best as you can remember them and what they are for.)
________________________________________________________________________

9. Please list any injuries you have had (past or present) and how they may have limit your
physical activity (if applicable).
________________________________________________________________________

For Staff Use: Medical Notes

From ACSM, 2012, ACSM’s guide to exercise and cancer survivorship (Champaign, IL: Human
Kinetics). Developed by S. Neil, A Kirkham and K. Campbell.
General Information
10. What is your main goal related to starting an exercise program?

Physical Fitness
Achieve a particular goal (i.e., start a new activity, participate in an event) (specify):
______________________________________________________________________________
Lose weight
Other (specify):
____________________________________________________________

11. Do you anticipate any barriers to starting an exercise program?

Lack of time

Lack of enjoyment

Lack of self-discipline

Lack of equipment

Fatigue or feeling unwell

Weather

Financial

Other responsibilities (e.g., family, job, volunteer position, etc.)

From ACSM, 2012, ACSM’s guide to exercise and cancer survivorship (Champaign, IL: Human
Kinetics). Developed by S. Neil, A Kirkham and K. Campbell.
 Other (specify): _________________________________________________________

12. Do you have any specific cancer-related concerns about exercise?

Type of exercise that is safe during or following cancer treatment

Knowledge of fitness center staff related to working with cancer survivors

Risk of developing lymphedema

Other (specify):__________________________________________________________

13. What types of physical activities do you currently do or have done in the past?

For Staff Use: General Notes

From ACSM, 2012, ACSM’s guide to exercise and cancer survivorship (Champaign, IL: Human
Kinetics). Developed by S. Neil, A Kirkham and K. Campbell.
Exercise Goals
1. To regain and improve physical fitness, aerobic capacity, overall strength, and flexibility.
2. To improve body image and the quality of life.
3. To improve body composition
4. To reduce and prevent the effects of cancer treatment
5. To improve physical and mental health

Contraindications: Cancer Specific

 Breast: Women with immediate arm or shoulder problems secondary to breast cancer
treatment

 Prostate: None

 Colon: Patients with an ostomy should seek clearance before contact sports and weight
training (hernia)

 Adult hematologic (No HSCT): None

 Adult HSCT: None

 Gynecologic: Women with swelling in the abdomen, groin, or lower extremity

Indications to stop an exercise program:
Cancer Specific
 Breast: Changes in arm or shoulder symptoms or swelling
 Prostate: None
 Colon: Hernia, ostomy-related systemic infection
 Adult hematologic (no HSCT): None
 Adult HSCT: None
 Gynecologic: Changes in swelling of the abdomen, groin, or lower body

Alumni
 Alumni Evening
o Once every 6 months (June 1st and December 1st), Alumni come back together to
our Riverside Health and Wellness facility to meet other alumni and walk around
the track to raise money for cancer.
 Graduation T-Shirts
o Once a client “graduates” from the Cancer Exercise Program, they will receive a
free T-Shirt officially making them an Alumni of the program
 Week 1 Week 2 Week 3 Week 4 Wee k Week 6 Week 7 Week 8 Week 9 Week 10 Week 11 Week 12
5
# D1 D2 D1 D2 D1 D2 D1 D2 D1 D2 D1 D2 D1 D2 D1 D2 D1 D2 D1 D2 D1 D2 D1 D2

10

11

12

13

14

Riverside Cancer Program Attendance Sheet

15

16
 Testing Sheet
Name: DOB: / / Gender: Male / Female

Assessment Date: / / Timeline: Pre / Post

6 Minute Walk Test

Beginning HR: Ending HR: # of laps: Total Distance (m):
Beginning RPE:
0 1 2 3 4 5 6 7 8 9 10

End RPE 0 1 2 3 4 5 6 7 8 9 10
Comments:

Strength Testing
Leg Press (1 rep max) Max Weight (lbs):
Chest Press (1 rep max) Max Weight (lbs):
Comments:

Flexibility and Balance

Back Right:
Scratch Left:
Arm Right:
Reach Left:
Single Right:
Leg Left:
Stance
Comments:
 References
Pre-Exercise Assessments:

Karnofsky: Yates, J. W., Chalmer, B., & McKegney, F. P. (1980). Evaluation of patients with
advanced cancer using the Karnofsky performance status. Cancer, 45(8), 2220-2224.

GHQ: Ibbotson, T., Maguire, P., Selby, P., Priestman, T., & Wallace, L. (1994). Screening for
anxiety and depression in cancer patients: the effects of disease and treatment. European
Journal of cancer, 30(1), 37-40.