• Defining Moment

    Class Action

    Students identify and meet a need. Patients with cancer benefit.

    Listen to 'Defining Moment'

    A week before final exams during the second year of our doctor of physical therapy (DPT) program this spring, we slipped out of a lecture on vestibular disorders 15 minutes early and nervously walked over to the cancer center at Columbia University Irving Medical Center (CUIMC). We were about to host our first complimentary exercise class for patients with breast cancer.

    We had talked about offering the class for nearly 2 years, since our first semester in school. Working together during class breaks and late at night, we had written numerous proposals and emails, sought out meetings with physicians and researchers at several medical centers, researched exercise in patients with cancer, and spent hours posting flyers about the class and rehearsing exercise routines.

    Developing an exercise program for people with cancer seemed like a no-brainer from a need standpoint: Numerous studies show the benefits of cardiovascular training for this population—both to counter the effects of cardiotoxic chemotherapy agents and to potentially reduce cancer recurrence and improve survivorship. Similarly, data show that yoga can decrease anxiety and possibly reduce neuropathy. Many patients with cancer want to participate in exercise classes with other patients because the group dynamic allows them to feel less self-conscious and offers an organic support network.

    Still, starting an exercise program for this population at a major medical center proved challenging. We struggled to obtain meetings with busy physicians whose approvals we required. We had difficulty securing an appropriate space for the class. We needed a licensed physical therapist (PT) to supervise us. And of course, we needed patients. Last, we needed to fit all of this into our busy schedules of classes, exams, and clinic work.

    Our task was further complicated because neither of us has training in leading fitness classes. Yes, we are physically fit and exercise regularly. And we both have personal experience with cancer and the benefits of exercise in that context. Sarah lost her father to cancer during her first year in the DPT program, and during her undergraduate years she volunteered in the University of Southern California's exercise program for patients with cancer. Barbara's experience was even more direct: She had participated in fitness classes at Memorial Sloan Kettering Cancer Center when she was being treated for cancer prior to beginning the DPT program. Neither of us, however, had ever led a fitness class, and we knew that it would be very different from simply participating or assisting.

    So, on that spring day when we walked over to the cancer center to lead the first class, we were nervous. Our biggest fear was dispelled, however, when 3 women arrived to take the class. The next week we attracted 4 more. Some women even came to the medical center specifically to take the class—not because they happened to be on campus for other appointments. They were a mix of ages and backgrounds. As it turned out, our worries about participants finding enough value in the class to keep coming back were groundless.

    In fact, they loved it! Thirty minutes into one of the classes, a young woman burst into the room, visibly upset because her radiation treatment had run late, causing her to miss the first half of our class. We, along with the participants, encouraged her to join in. She put her bag down and, still wearing the work clothes she'd worn to radiation therapy, jumped right in. As she exercised and stretched with us, we could see her breathing relax and her anxiety diminish. By the end of the class, she was engaged and much more at ease.

    As we had hoped, the class quickly evolved into a lot more than simply an exercise class for patients with breast cancer. At the beginning of the second class, we explained why we'd started the class and offered the patients a chance to share their reasons for attending and what they hoped to gain. They really opened up, sharing their cancer treatment experiences and discussing the physical and emotional challenges they'd been facing.

    One woman recounted the frustration of trying to exercise while undergoing chemotherapy and fighting a persistent infection related to her abdominal flap breast reconstruction. She told the group that she had been afraid to work out independently or at a gym because she worried that she would exacerbate the delayed healing of her flap site. She added, however, that she felt confident joining our class because it was targeted specifically to individuals with breast cancer. She knew that those in the room would understand her physical limitations.

    Her story and those of all the other patients were moving. When we turned on the music and got everyone on their feet, we could see the women relaxing and enjoying themselves. We laughed together and made fun of ourselves for feeling sore and struggling to do some of the activities. The good vibes in the room were palpable. By the end of each class, everyone was sweating and smiling.

    Sometimes the challenges of our lives as DPT students can blur our vision of why we want to become PTs. We spend so much time in the classroom far from patients. Studying late at night and on weekends, we can forget what it feels like to help people recover from an injury or illness. Our CUIMC CancerFIT classes reminded us why we chose this occupation.

    People with cancer, like so many individuals who seek out physical therapy, have very little control over their disease and treatment. They often feel frightened and helpless. Participating in physical exercise is a form of treatment from which they benefit enormously, and one they cannot get from traditional medicine and physicians. It allows them to be proactively involved in their treatment, actively healing their bodies and minds. During the 60 minutes of exercise class, they leave their challenges, fears, and to-do lists at the door, focusing solely on being present with the group.

    We have big dreams for CUIMC CancerFIT. Our pilot program was a success. This fall we will roll out the program on a larger scale for more people, with a goal of ultimately providing fitness classes for all CUIMC patients with cancer. We envision offering a variety of classes, including instruction focused on cardiovascular exercise, strength, and yoga. All classes will be led by students in the university's DPT program. This will have the dual benefit of offering students more exposure to patients and ensuring the classes remain free for participants.

    As we begin the final year of our DPT program, we are more excited than ever about our career choice. Our classroom time and clinical rotations have provided us with much of the knowledge and many of the skills we will need to be successful as entry-level PTs, and our experiences with CUIMC CancerFIT have reinforced that there are many ways in which PTs can use their skills and knowledge to benefit patients.

    Sometimes—as we've experienced—dancing to pop music and joyfully laughing along with a bald woman who recently underwent a mastectomy is exactly the right exercise protocol.

    Barbara Trencher, SPT

    Barbara Trencher, SPT, physical therapist student at Columbia University in New York City.  

    Sarah Urke, SPT

    Sarah Urke, SPT, physical therapist student at Columbia University in New York City.  


    Comments

    This is wonderful!! There is so much potential to expand PT delivery of care by innovating and creating group programs! Changing the way we practice. An alternative model of physical therapy care can include individual treatment and small group exercises classes for specialized populations, individuals with complex medical needs. Group exercise design and use of music therapeutically could be included in our DPT training. An abundance of research overwhelming supports the benefits of group exercise both from a psych/social aspect and a physical aspect -as we know both are inter-related. Our profession needs to expand our reach and innovate with programs like this. I am so excited to see this article with students advancing our profession, transforming society! Patrice Hazan GroupHab Physical Therapy
    Posted by Patrice Hazan -> @GT^@ on 8/31/2018 8:50:03 AM
    Great article! During rotations my CI asked what PTs do for patients experiencing cachexia. This condition can result from a multitude of health diagnoses (cardiac, respiratory, cancer,GI, etc). I found out there are staging tools to determine cachexia severity and some suggestions for treatment but no specific protocols for PT intervention at each stage. Really excellent job by these students. Maybe the work they’ve begun will translate into better answers for patients experiencing cachexia too!
    Posted by Margaret McConville -> CIX\?F on 9/30/2018 12:44:17 PM

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