第82集：癌症护理中的运动处方

您正在收听肿瘤护理播客，这是来自肿瘤护理学会的资源，由ONS专家探讨癌症相关话题。

You're listening to the Oncology Nursing Podcast, where ONS voices talk cancer, a resource from the Oncology Nursing Society.

通过与领域专家的对话，我们探讨肿瘤护理中的重要议题，包括新疗法、以患者为中心的研究以及临床实践的进展。

Through conversations with subject matter experts, we examine the important issues in oncology nursing, from new treatments to patient centered research to advancements in clinical practice.

加入我们，倾听来自肿瘤护理各个领域的护士声音，从实验室到病床，以及其间的所有环节。

Join us as we hear from nurses in all facets of oncology care, from bench side to bedside and everywhere in between.

欢迎收听肿瘤护理播客。

Welcome to the Oncology Nursing Podcast.

请务必完成我们节目笔记中的评估链接，以获取免费的护理继续专业发展学时。

Be sure to complete the evaluation link in our episode notes to earn free contact hours for nursing continuing professional development.

您好，欢迎收听肿瘤护理播客。

Hello and welcome to the Oncology Nursing Podcast.

我是您的主持人克里斯·佩尔舍尔。

I'm your host, Chris Perschell.

今天，我们邀请到Revital癌症康复中心的教育与质量总监梅丽莎·泰斯和实施总监阿曼达·霍奇斯，共同讨论癌症护理中的体力活动建议、护士如何鼓励患者锻炼，以及更多内容。

And today we're joined by Melissa Thess, Director of Education and Quality and Amanda Hodges, Director of Implementation from Revital Cancer Rehabilitation to discuss physical activity recommendations in cancer care, how nurses can encourage exercise in their patients, and much more.

非常感谢你们再次加入我。

Thank you both so much for joining me again.

谢谢，克里斯。

Thanks, Chris.

很高兴能回来。

We're happy to be back.

太好了。

Excellent.

嗯。

Yeah.

不。

No.

我的意思是，我们非常期待进一步讨论运动及其在肿瘤护理中的作用。

I mean, we're very excited to, to discuss more about exercise and its role in oncology care.

所以，阿曼达，首先想问问，目前医疗提供者是如何与癌症患者讨论运动这一话题的？

And so, Amanda, to get started, you know, currently how are providers approaching the topic of exercise with their patients with cancer?

我认为，这个话题非常依赖于肿瘤科医生和患者本人。

You know, I believe that this is a topic that is very dependent on the oncology provider and the patient.

在进行生存者随访时，运动通常会被提及，但讨论的详细程度取决于患者的参与度。

When a survivorship visit is performed, exercise is usually a topic that's reviewed but the amount of detail is based on the patient's engagement.

在积极治疗期间，如果患者表达出希望继续或参与运动计划的意愿，医生就会介入讨论。

During active treatment, if a patient verbalizes they want to continue or participate in an exercise program, then the provider is engaged to discuss that.

多年来，我听到过医生们很多类似的建议，比如：做你力所能及的事，我鼓励你尽可能多活动，按照外科医生说的去做，或者先去问问你的外科医生？

You know, there are many comments that I've heard over the years from providers such as, you know, do what you feel you can, I encourage you to move as much as possible, Do it as much as the surgeon says that you can or be sure and go ask your surgeon first?

为此，我过去的工作单位曾聘请了一名运动专业人士，每周举办一次团体课程。

With that, my past practice employed an exercise professional who held group classes once a week.

有一段时间，我们几乎连容纳所有参与者的房间都不够。

At one point, we barely had a room big enough to hold all the attendees.

但不幸的是，像许多项目一样，这个项目时起时落，最终因资金短缺、参与人数下降以及团体课程时间安排缺乏灵活性而被取消。

But unfortunately, like a lot of programs, it was a program that ebbed and flowed and was eventually discontinued due to lack of funding, attendance was down, and flexibility around the time available to hold the group classes impacted the program.

历史上，我见过患者被转介到社区项目寻求指导，但这些指导通常并不具有明确的处方性质，也未基于筛查指南，因为我们当时根本没有这些指南。

Historically, I've seen patients referred to community based programs for guidance and it's not always been prescriptive in nature, and it was not based on screening guidelines simply because we just didn't have them.

没错，你提到了一个非常有趣的词，就是这种指导性的性质，还有关于指南的问题，我认为这两点我们稍后会进一步探讨。

Right, you hit on a really interesting word there too, is kind of this prescriptive nature of this too and then talking about the guidelines as well, which I think are two things that we're gonna really cover a little bit later on too.

作为对那个问题的跟进，这个话题在实际中有多常见？还是说它仍然没有被纳入标准护理之中？

And as kind of a a follow-up to that question, you know, how commonly does this topic come up in practice, or or is it still still something that isn't included in the standard of care?

是的。

Yes.

就像我之前提到的，这真的取决于患者、诊所和医生。

Like I mentioned before, it really depends on the patient, the practice and the providers.

我认为，如今这还远未成为标准护理，但这并不是肿瘤科医生的错。

I don't believe we're close to it being standard of care today, but this isn't the fault of the oncology providers.

他们专注于挽救患者的生命，而且日程安排非常紧张。

They are so focused on saving patients' lives and they have such busy schedules.

有时，一些关于癌症康复后生活的话题根本排不上讨论的优先级。

At times, some of these life after cancer topics just don't come up to the top of the list for discussion.

在全美许多肿瘤科诊所中，实施康复讨论和项目（包括运动）一直非常具有挑战性。

Implementing survivorship discussions and programs, including exercise, has been very challenging for many of the oncology practices across the country.

这就是为什么我坚信，采用包括筛查和转诊指南以及运动专业人士在内的团队方法，对患者会带来极大的益处。

This is where, you know, I truly believe a team approach that includes screening and referral guidelines along with using exercise professionals can be tremendously beneficial to patients.

毫无疑问。

Most definitely.

我认为这种关键的团队合作是必不可少的。

I think that crucial team approach is so necessary.

你提到的这一点，我听出来背后还有一个潜台词，那就是时间始终是个因素。

You touch on what I hear kind of as as a subtext there too is that time is always kind of a factor.

因此，将任务分摊给团队，似乎能够更恰当地应对这个问题。

And so being able to spread it across a team, it seems like being able to to address it appropriately.

这是一个非常重要的观点。

And so that's that's a that's a really important point to make.

那么，将运动纳入治疗计划有哪些好处呢？

And so, you know, what are some of the benefits of incorporating exercise into a treatment plan?

梅丽莎，我把这个问题交给你了。

Melissa, I'm going to pitch that one over to you.

是的，绝对如此。

Yeah, absolutely.

简短的回答是，好处非常多，贯穿癌症护理的各个阶段。

And the short answer is there's a lot of them and at all phases of the cancer care continuum.

有大量的证据支持体育活动和锻炼在降低某些癌症发病风险方面的益处。

So there's a strong body of evidence to support the benefits of physical activity and exercise in reducing risk of onset for some cancers.

我们知道，锻炼有助于在癌症治疗期间减轻与治疗相关的健康和功能下降，也对癌症幸存者有益。

We know that exercise can help mitigate treatment related declines in health and functioning during cancer treatments and for those living with and beyond cancer.

我想澄清一下锻炼与体力活动之间的一个重要区别。

I want to clarify an important point about exercise versus physical activity.

锻炼指的是我们传统上所理解的有氧运动，比如步行、慢跑、游泳、骑自行车，以及抗阻运动如举重，还有瑜伽等伸展和强化活动。

So exercise refers to what we all traditionally think of aerobic activities, things like walking, jogging, swimming, riding a bike, resistance activities like lifting weights, and stretching and strengthening activities such as yoga.

最好的理解方式是，我们进行锻炼是为了有意识地改善身体的某些健康状况。

The best way to think of exercise is that we perform it to intentionally improve some aspects of our health.

体力活动则指任何需要身体移动的活动，比如往返商店走路、在院子里干活、和孩子或孙子孙女玩耍。

Physical activity refers to really anything that requires bodily movement, So things like walking to and from a store or working in the yard, playing with children and grandchildren.

锻炼和体力活动都应像《美国体力活动指南》所推荐的那样，融入我们的日常生活中。

Exercise and physical activity are both things that we should incorporate into our daily routines as recommended by the Physical Activity Guidelines for Americans.

因此，如果我们查看最有力的证据，我们知道它支持将锻炼作为管理癌症相关疲劳的一线治疗方法。

So if we look at the strongest body of evidence, we know that it supports exercise as first line treatment for management of cancer related fatigue.

锻炼和体力活动还被证明可以减轻焦虑和抑郁，改善功能，减轻疼痛，并提高多种癌症患者的整体生活质量。

Exercise and physical activity have also been demonstrated to reduce anxiety and depression, improve function, decrease pain, and improve overall quality of life in people treated for numerous types of cancers.

加上锻炼带来的诸多其他益处，这为ONS的‘起身行动’倡议提供了合理依据和支持。

This, along with so many other benefits that exercise provides, gives the rationale and support for the ONS Get Up, Get Moving initiative.

锻炼有助于减轻治疗期间的某些副作用，例如芳香化酶抑制剂引起的关节疼痛，这种疼痛常导致药物减量、停药或完全停用。

Exercise can help reduce certain side effects during treatment, such as joint pains associated with aromatase inhibitors that often cause dose reductions, medication holidays, or even cessation of those meds completely.

由于我们知道，任何对这些芳香化酶抑制剂用药方案的改变都可能影响患者的生存率，因此我们知道锻炼是有帮助的。

And since we know that any changes to those AI schedules have potential implications for survival rates for those that have to take them, we know that exercise can help.

正如我之前提到的，证据表明锻炼可能有助于降低多种癌症的发病风险。

As I mentioned before, evidence demonstrates that exercise may contribute to risk reduction for multiple types of cancer.

此外，新兴证据还表明，锻炼可能改善乳腺癌和结肠癌患者的生存率。

And there's also emerging evidence suggesting that exercise may improve survival rates in people treated for breast and colon cancers.

所以正如你所见，运动非常重要，正如我之前提到的，它贯穿癌症治疗的各个阶段。

So as you can see, exercise is really important, really like I mentioned, all phases of the cancer continuum.

我认为还有一个值得提及的最终益处，就是运动对患有乳腺癌或乳腺癌康复后、同时面临淋巴水肿风险的女性的影响。

I think one final benefit worth noting is the effects of exercise in women living with or beyond breast cancer who are also at risk for or have lymphedema.

研究表明，循序渐进的力量训练不仅安全，还能降低淋巴水肿的发生风险，并减轻已有淋巴水肿患者的症状加重。

Research shows that slowly progressed weight training is not only safe, but may also reduce risk of onset and reduce exacerbations for those that have lymphedema.

这项研究在2010年发布时意义重大，因为此前许多淋巴水肿患者一直被告诉不能进行运动。

This was huge when it was released in 2010 because so many individuals with lymphedema had previously been told they couldn't exercise.

我永远不会忘记我的一位患者克里斯，她因为淋巴水肿诊断而停止举重整整十一年，而那正是她最爱的运动。

I'll never forget one of my patients, Chris, she'd stopped lifting weights eleven years ago because of the lymphedema diagnosis and it was something that she absolutely loved.

所以当我告诉她把那些哑铃从壁橱里拿出来，掸掉灰尘，教她如何安全使用时，她感动得流下了喜悦的泪水。

So when I told her to break those puppies out of the closet, dust them off and let's show her how to safely use them, she literally cried tears of joy.

能够为那些生活受到极大影响的人提供这种掌控感，真的令人无比欣慰。

It's just so gratifying to be able to provide that sense of empowerment for for people, you know, whose lives have been so tremendously affected.

完全正确。

Absolutely.

嗯。

Yeah.

我的意思是，你提到了很多非常好的观点，比如现有的证据体系，运动和体力活动之间的区别，但你也提到了一个有趣的观点，即运动如何真正影响我们一些患者的生活质量，尤其是那些原本习惯于活跃、行动自如并定期锻炼，却感觉这些已被剥夺的人。

I mean, I you touched on a lot of a lot of great points there, you know, the body of evidence that exists, the difference between exercise and physical activity, but also, you know, touch on an interesting point of how this can really impact the quality of life of some of our patients, especially if they're used to being active and mobile and exercising on a regular basis and then feeling like maybe that had been taken away from them.

因此，你提出的这一点也很重要。

And so it's it's an important point that you make there too.

我觉得你提到这一点真的非常好。

I think that that that's really great that you bring it up.

作为对那个问题的跟进，美国运动医学学院召集了一个专家小组，讨论运动与癌症治疗方案，并于2019年11月发布了相关发现。

You know, as a follow-up to that question, the the American College of Sports Medicine kind of convened an expert panel to discuss exercise and cancer treatment plans and just reported on the findings in November 2019.

那次讨论的结果是什么？护士们应该了解哪些内容？

But what were the outcomes from that discussion and what should nurses know?

是的，绝对如此。

Yeah, absolutely.

关于美国运动医学学院专家小组的三篇最新论文的发布，确实是肿瘤学领域的一个重要里程碑，也是所有参与者的巨大成就。

You know, the recent release of the three papers around the ACSM expert panel was really a huge landmark in oncology and a tremendous accomplishment by all involved.

我们衷心感谢所有专家所承担的艰巨任务以及他们制定的重要指南。

We really commend all of the experts for really the difficult tasks that they tackled and the important guidelines that they created.

自最初的ACSM圆桌会议发表以来，针对癌症患者的身体活动建议已实施了大约十年。

So exercise recommendations have been in place for people affected by cancer for about a decade with the original ACSM round table publications.

2019年11月的圆桌会议论文对这些原始文件进行了一些更新。

The November round table paper itself contained a few updates to those original documents.

我们此前缺乏且亟需的是，为肿瘤专业人员提供更明确的指南，说明如何以及何时推荐运动，以及应将患者转介给哪些专业人员以确保运动安全。

What we didn't have and what was greatly needed are better guidelines for oncology professionals around how and when to recommend exercise and to what professionals to refer their patients for ensuring safety when exercising.

这些推荐正如我所说，是专家组的一项巨大成就。

So these recommendations were part of, like I said, just a huge accomplishment of the panel.

其中有几项重要的关键要点。

There were a few important key takeaways.

首先，这些论文强化了现有文献对运动和身体活动在癌症治疗全过程中的益处的支持。

First, the papers reinforce the literature support of the benefits of exercise and physical activity at all phases of the cancer care continuum.

其次，针对不同癌症患者在进行运动时所需的预防措施已有明确指南。

Second, guidelines exist for necessary precautions when prescribing exercise for people affected by various cancers.

第三，肿瘤科工作人员，包括护士，应筛查患者的活动水平和功能下降风险，并在需要更多监督和干预时转介给专业人员。

Third, that it's important for oncology staff, including nurses, to screen for activity level and risk for functional decline and refer to the appropriate professionals when more supervision and intervention are needed.

最后，它建议使用ECOG评分（一种大多数肿瘤科护士都熟悉的筛查工具）来确定何时应将患者转介至癌症康复专业人员，而非社区锻炼专业人员。

And finally, it recommends thresholds within the ECOG, which is a screening tool that most oncology nurses are familiar with for when to refer to cancer rehabilitation professionals versus community based exercise professionals.

非常好。

Excellent.

这些似乎是对肿瘤科实践至关重要的建议。

Sounds like really crucial recommendations for oncology practice there.

我也会确保在本集的笔记中附上这份报告的链接。

And I will make sure to include a link to the report in the episode notes here too.

因此，如果有人想了解，可以去阅读更多相关内容，但听起来这确实是一个非常出色的小组，取得了许多有趣的成果。

So if anybody's looking for that, they can go out and read some more about it, but it sounds like it was a really great panel and some really interesting outcomes from that.

那么，对于癌症患者来说，有哪些从轻度到中度的有氧或抗阻运动是可行的呢？

And so what are some examples of exercise ranging from mild to moderate aerobic or resistance based that would be doable for patients with cancer?

梅丽莎，你怎么看？

Melissa, what do you think?

好消息是，一般来说，大多数形式的运动都适合癌症患者。

So the good news is in general, most forms of exercise can be appropriate for people affected by cancer.

不过，需要注意的是，在某些情况下，比如存在骨转移、多种合并症、跌倒风险、免疫功能低下或血细胞计数低时，需要采取相应的预防措施。

Now, that being said, there are certain precautions that should be taken in various situations such as presence of bone met, bone full comorbidities, fall risk, immunocompromised and low blood counts.

对于骨转移的患者，我们在开具运动处方时，应避免在受影响区域进行某些抗阻训练或极端范围的活动。

For individuals with metastatic disease in the bones, we would consider avoiding certain types of resistance activities in the area or extreme ranges of motion when prescribing exercise.

对于有多种可能影响运动耐受性的合并症的患者，我们需要进行相应评估，并可能将目标心率范围调低，使其既能维持完成日常活动和参与生活角色的能力，又能实现运动时各系统所需的生理反应。

For individuals with multiple comorbidities that may affect activity tolerance, we need to evaluate accordingly and may consider lowering their target heart rate ranges to ones that still promote ability to complete daily activities, participation in life's roles, but still achieve the desired physiological response of all of the involved systems when we exercise.

对于有跌倒风险的人群，应避免可能加剧跌倒风险的运动形式，同时通过训练帮助他们改善平衡能力，降低跌倒风险。

For people at risk for falls, would avoid forms of exercise that could exacerbate that risk, but also while working with them on activities to help improve their balance and reduce that risk.

最后，对于免疫功能低下或血细胞计数低的患者，我们可能会建议以居家或分散在全天多次进行的间歇性活动为主，而不是单一的长时间健身房训练方案。

And then finally for individuals who are immunocompromised or have low blood counts, we might consider home based or intermittent activities dispersed throughout the day versus a gym based or one longer session type program prescription.

但对所有癌症患者而言，在为其开具运动处方时，采用多方面的方案至关重要。

But really it's important for everyone affected by cancer when we are prescribing exercise for them for it to be multi pronged.

因此，应包含有氧运动、抗阻训练和拉伸活动，但同时也很重要的是，这些运动应该是他们喜欢的，对吧？

So include some form of aerobic resistance and stretching activities, but it's also important for it to be something that they enjoy, right?

因为在许多情况下，这需要改变习惯。

Because in many cases it takes habit change.

所以，有趣的是，当你将锻炼和身体活动结合起来时，有很多好处。

So, you know, the nice thing is there's so many things when you combine exercise and physical activity that have benefit.

很多人听到需要锻炼，就会想到去健身房，这完全让他们望而却步。

Know, a lot of people they hear you need to exercise and they think of that going to the gym and that just completely turns them off.

好消息是，属于锻炼范畴并能为患者带来益处且安全的活动还有很多。

So the good news is there's so many more things that fall under that category of exercise that bring benefit and can be safe for patients to do.

你关于身体活动和锻炼的愉悦性这一点说得非常好。

You make a really great point there about kind of the enjoyability of the physical activity, the exercise that that we're talking about here.

我知道，就我个人而言，当我想到锻炼时，骑自行车沿着小道骑行10英里对我来说根本不是问题。

You know, I know personally when I'm thinking about exercise, I have no problem jumping on a bike and riding 10 miles, you know, down a trail.

但一想到在健身房骑10英里，我的兴趣就全没了。

But the second I think about riding 10 miles at a gym, my mind just melts.

所以我认为这是这个对话中非常重要的一部分。

So I I think that's a really important part of this conversation.

而这恰恰表明了这种锻炼计划的高度个性化，确保您考虑了您提到的注意事项和合并症。

And that, you know, signals a bigger portion of of how individualized this exercise plan can be and and making sure that you're taking into account, you know, precautions and comorbidities like you had mentioned.

所以，是的，这方面有很多内容，但对患者来说真的很有益处。

So, yeah, facets lot to this, but it can be really beneficial for the patient.

所以我认为这是一个很好的观点。

So I think that's a great point to make.

那么，锻炼可以帮助缓解癌症患者的哪些副作用和症状呢？

And so what are the side effects and symptoms that exercise can help ameliorate in patients with cancer?

我们之前已经稍微提到过疲劳，但您还想进一步展开其他方面吗？

We had kind of already touched on fatigue a little bit, but was there anything else you wanted to expand on there?

是的，绝对如此。

Yeah, absolutely.

你知道，简短的回答是：很多方面。

You know, again, the short answer is lots of them.

文献中已经证实，锻炼可以减轻疼痛、降低跌倒风险、缓解焦虑和抑郁，并改善行动能力、功能和生活质量。

We see in the literature, it's been demonstrated to reduce pain, fall risk, anxiety, and depression, as well as improve mobility, function, and quality of life.

非常好，非常好。

Excellent, excellent.

是的，那么在患者运动方面，评估的作用是什么？

Yeah, and so what is the role of assessment then when it comes to exercise for patients?

是的，正如我们几分钟前提到的，运动前的评估非常重要，这实际上应从肿瘤科医护人员开始。

Yeah, assessment prior to exercise, kind of as we've alluded to a couple minutes ago, is extremely important, and really it begins with the oncology staff.

应定期评估患者的活动水平，以确定何时需要调整活动建议，识别活动水平发生变化的患者，并判断哪些人需要在开始运动计划前接受运动专业人士的筛查。

Patient activity levels should be regularly assessed to determine when activity recommendations need to be made, where there may have been a change in activity level and who needs to be referred for screening with an exercise professional before they would begin an exercise program.

功能状态，即一个人照顾自己、照顾他人以及在环境中正常活动的能力，对于确定一个人能否安全运动至关重要。

Functional status, so in other words, a person's ability to take care of themselves, take care of others and function in their environment, is important in determining a person's ability to safely exercise.

最近的美国运动医学会（ACSM）论文推荐了ECOG评分的阈值和 cutoff 值，以帮助肿瘤科医护人员判断患者是否需要先转诊至肿瘤康复专业人士。

So the recent ACSM papers recommended thresholds and cutoffs from the ECOG to help oncology staff determine when a patient may need to be referred to an oncology rehab professional first.

我们提到，ECOG评分通常对护士来说比较熟悉。

You know, we mentioned ECOG is generally pretty familiar to nurses.

但我们确实担心，推荐的阈值过低，可能会漏掉一些真正需要在进行独立运动前接受癌症康复干预的患者。

We do have some concerns that the recommended thresholds are too low and they actually miss some individuals who really need cancer rehab intervention before proceeding to independent exercise.

因此，一些其他肿瘤科护士熟悉的工具，如pro CTCAE和ESAS，已经内置了相关问题以帮助进行筛查。

So some other familiar tools for oncology nurses that already have questions built in to help with that screening are the pro CTCAE and the ESAS.

我们知道，许多癌症治疗方法可能会影响功能。

We know that many treatments for cancer may affect function.

例如，接受乳腺癌治疗的患者如果仍存在关节活动范围受限，可能导致穿套头毛衣或够取冰箱高处物品困难，若在开始包含肩部强化或游泳的运动计划前未解决此问题，可能会增加肩部问题的风险。

For example, a person treated for breast cancer who still lacks some end range of motion causing difficulty with pullover sweaters or reaching items high in the refrigerator could also be at risk for shoulder issues if that isn't addressed before starting an exercise program that includes shoulder strengthening or swimming.

接受过影响躯干和腹部癌症治疗的患者，在开始运动计划前应评估核心力量、姿势和脊柱活动度。

Someone who's been treated for cancers affecting the trunk and abdomen should have core strength, posture, spinal mobility assessed prior to starting an exercise program.

这显然不是一份包含所有可能需要进行的功能性筛查的完整清单，但您显然突出了我的观点。

And this is obviously not an all inclusive list of the functional screenings that may need to occur, but you obviously highlight my point.

事实上，许多癌症患者或康复后患者在参与社区运动计划前，都受益于癌症康复专业人员的筛查或评估。

Really many individuals living with or beyond cancer would benefit from screening or evaluation by cancer rehab professionals prior to starting a community based exercise program.

儿童康复专业人员专门负责评估和改善功能障碍，因此对于至少高风险患者而言，他们是作为社区运动前准备的绝佳选择。

Kids rehab professionals specialize in the evaluation and remediation of functional impairments and therefore are a great option to use as a predecessor to community based exercise for at least high risk patients.

文献也强有力地表明，有监督的运动效果更佳。

The literature also strongly demonstrates exercise benefits are more effective when supervised.

因此，我们与社区锻炼项目密切合作，以确保在患者继续进行独立活动时实现顺畅的交接和沟通。

So we work closely with community based exercise programs to ensure proper handoffs and communication as patients continue with independent activity.

对。

Right.

对。

Right.

而这实际上让我想到了下一个问题：护士应该多久随访一次患者？

And that, you know, that kinda leads me into my next question as a matter of fact, is just how often nurses should be following up with their patients.

听上去，从评估的角度来看，似乎需要非常频繁地跟进。

And from the sounds of it, it sounds pretty pretty regularly as far as the assessment goes.

所以我不确定你是否想进一步展开这个话题。

So didn't know if you wanted to expand on that topic at all.

非常频繁。

Really often.

我们这样说不仅是为了及时发现体力活动水平或功能的任何变化，也是因为患者信任他们的肿瘤治疗团队，并重视他们的建议。

And we say that not only to ensure any changes in physical activity level or function are detected, but also because people trust their oncology team and they value their recommendation.

例如，研究表明，当肿瘤科医生讨论运动时，人们更有可能认为运动很重要。

So for example, we know from the research that people are more likely to think exercise is important when discussed by an oncology provider.

当癌症患者经常听到他们的护士和医生询问他们的活动水平时，他们会意识到运动的重要性，从而更有可能去践行。

When people affected by cancer hear their nurses and doctors asking about activity level often, it shows them that it's important and may make them more likely to pursue it.

我们之前提到过，对许多人来说，这是一种生活方式和行为的改变，我们希望他们能够长期坚持。

We mentioned before for a lot of individuals, this is a lifestyle change and a behavior change and something that we want them to sustain.

因此，他们非常需要看到那些参与他们护理的人也认为运动很重要。

So they really need to see that it's important to people that are involved in their care.

经常听到这样的建议对于强化这一信息至关重要。

And hearing about it often is just really important to support that message.

完全正确。

Absolutely.

是的，这涉及到在整个过程中不断强化这一信息，确保我们在护理过程的多个节点上进行随访。

Yeah, it kind of goes into the idea of reinforcing that message throughout the process and making sure that we're following up at many different points in in in the care process.

确实如此，我觉得你提到了一些非常棒的观点。

So, absolutely, I think you you hit in some really great points there.

那么，阿曼达，回到你这里，护士可以通过哪些方式与癌症康复同事合作，帮助将活动融入患者的日常生活中？

And so, Amanda, coming back over to you, what are some ways that nurses can work with their cancer rehabilitation colleagues to help incorporate activity into a patient's daily life?

护士可以与当地的癌症康复同事紧密合作，共同制定谈话要点，帮助开启与患者的对话。

The nurses can work right alongside cancer rehab colleagues in the area to really develop those talking points to help start that conversation with their patients.

他们可以提供关于安全通用干预措施的信息，这些措施可以在患者治疗过程中的多个不同阶段实施。

They can provide information around safe universal interventions that can be implemented with patients at many different phases of their treatment continuum.

最后，你知道，他们可以帮助护士确定哪些患者可能在开始锻炼或体育活动计划前，从运动专业人士的初步评估中受益。

And finally, you know, they can assist nurses in determining who those patients are that may benefit from that initial evaluation by an exercise professional prior to starting an exercise or physical activity program.

你知道，与康复同事合作似乎确实有助于消除护士在整个过程中可能遇到的一些疑问。

You know, it seems like working together with those rehabilitation colleagues really helps to take away some of the questions that nurses might have in this whole process.

你提到了与患者创建一些谈话要点。

You mentioned bringing up, creating some talking points with patients.

这似乎是一个很好的开始对话的地方，但识别出谁能从中受益以及类似的事情在实践中可能非常有帮助。

It seems like a really great place to start the conversation, but also identifying who can benefit and things like that is probably so helpful in practice.

我想知道，将运动纳入癌症护理计划有哪些常见的误解？

Know, and I'm curious as to what are some of the common misconceptions about incorporating exercise into cancer care plans?

阿曼达，我想知道你的看法。

Amanda, I was curious what you thought.

克里斯，关于这个问题，我其实可以讲很久。

And Chris, I could actually go on for quite a while on the answer to this question.

所以我会尽量让列表简短一些。

So I'm gonna try to keep the list short.

我们经常听到的一个观点，正如梅丽莎提到的，是乳腺癌患者永远不能举重。

So, you know, one of the big things that we hear very often, Melissa alluded to, is breast cancer patients cannot ever lift weight.

另一个误区是，我的病人不能锻炼，因为他们太虚弱或太疲惫了。

Another one would be my patients can't exercise because they're too sick or too tired.

锻炼会加重疲劳或导致受伤。

And let's see, exercise can make fatigue worse or cause injury.

锻炼是给运动员或年轻人的。

Exercise is for athletes or young people.

还有一个可能是，如果你在得癌症前从不锻炼，那就太晚了，无法获得任何益处。

And another one may be that if if you didn't exercise precancer, it's too late to receive any of the benefits.

这些误解中的每一个，都可以通过与了解运动的专业人士交谈来轻松驳斥。

You know, each of these misconceptions can be debunked simply by talking with a knowledgeable exercise professional.

在我看来，患者如果对这方面有疑问，真的可以从与护士交谈中获益，甚至护士也可以主动提出：‘你对在癌症治疗计划中加入运动这个想法有什么想法吗？’

And it seems to me that patients can really benefit from talking to their nurses, you know, if they are having questions about this or maybe even nurses just bringing up, hey, do you have any, you know, thoughts about this whole idea of exercising your cancer care plan?

我们可以一起探讨这些误区，因为长期以来，人们一直认为要休息、量力而行、放轻松，但这反而会导致疲劳加剧，因为他们的治疗计划中缺乏足够的身体活动或运动。

We can talk through, you know, some of those myths because I know for such a long time it was, you know, rest, do what you can, take it easy, which also kind of leads into greater fatigue, you know, because there's there's not a level of physical physical activity or exercise in in their plan.

因此，直接面对这些问题，似乎是帮助患者克服这些误区、并让他们接受运动理念的绝佳方式。

And so, you know, just kind of addressing those things head on, it seems like is is a really great way to to help overcome them as you're working with patients and kind of getting them on board with this whole idea.

那么，阿曼达，你推荐哪些资源给那些希望在实践中融入更多运动建议的听众呢？

And so, you know, Amanda, what resources would you recommend to our listeners who are interested in incorporating more exercise recommendations into their practice?

首先，我建议大家熟悉ONS的‘站起来，动起来’项目，如果你还不了解的话。

Yeah, first and foremost, I'd recommend becoming very familiar with the ONS Get Up, Get Moving program if you're not already familiar with it.

这是一个非常适合护士的优秀资源。

It is an excellent resource for nurses.

其次，与当地癌症康复专业人员建立联系，因为他们是关于患者功能与活动方面的专家，能提供大量信息。

Second, inform that relationship with that local cancer rehab professional because, again, they are going to be a wealth of information as they're the experts in function and moving for patients.

我还建议与你们的管理层沟通，考虑将癌症康复专业人员或社区健身合作伙伴引入你们的护理团队，直接在院内为所有患者提供综合护理服务。

And I'd also recommend talking to your practice leadership about possibly bringing in a cancer rehab professional and or community exercise partner right into your care team to help work directly with your patients on-site for that comprehensive care approach for all of your patient population.

是的。

Yeah.

一些非常好的想法和资源。

Some great ideas and and some great resources there.

你说得对。

You're absolutely right.

还有，梅丽莎，轮到你了。

And and and, Melissa, over to you.

同样的问题。

Same question.

你有什么推荐的资源吗？

You know, what are some resources that you would recommend?

是的。

Yeah.

此外，根据美国运动医学学会专家小组最近发布的三篇论文，是很好的起点。

And and to add to Amanda's list, the three recently released papers from the ACSM expert panel are an excellent place to start.

他们出色地总结了当前关于运动处方的证据、必要的知识和注意事项，并建立了我们此前一直缺失的筛查和转诊框架。

They really did a wonderful job of summarizing the current evidence, the necessary knowledge and precautions when it comes to exercise prescription, and then creating that framework for screening and referral that we've been missing prior to this panel.

美国运动医学学会的网站上也有一些非常棒的资源。

The ACSM website also has some really great resources.

在康复领域，美国物理治疗协会、美国职业治疗协会和美国康复医学学院在其网站上也为患者提供了丰富的资源。

In more of the rehab realm, the American Physical Therapy Association, American Occupational Therapy Association, and American College of Rehabilitation Medicine also have tremendous resources for consumers on their website.

而且

And

如果临床医生想了解更多关于癌症康复在帮助患者开始或重返运动计划方面的益处，可以访问我们的网站：revitalcancerrehab.com。

then if clinicians would like to learn more about the benefits of cancer rehab for helping patients begin or return to an exercise program, they can always go to our website at revitalcancerrehab.com.

这些资源都非常好，我也会把它们列入我们的节目笔记中。

Some great resources there that I'll include in our episode notes too.

那么，Melissa，关于癌症护理中运动的重要性，有哪些很少被讨论但你认为值得更多关注的方面？

And so Melissa, what's something about the importance of exercising cancer care that isn't often discussed but you think deserves more attention?

是的，克里斯，我想回到运动和体力活动之间的区别这个观点，两者都被证明对癌症患者有益。

Yeah, Chris, I go back to the point of the differences between exercise and physical activity, and that both have demonstrated benefits in people affected by cancer.

我们讨论了一些可能让人在癌症诊断后犹豫是否开始或恢复运动的误解。

We talked about some of the misconceptions that may make people hesitant to start exercising or resume exercising after they've been impacted by a cancer diagnosis.

但必须强调的是，最重要的是让人们站起来活动起来。

But it really is important to stress that ultimately what is most important is that people get up and move.

无论功能水平如何，任何人都可以进行一些有益的运动和活动，只要合理制定方案。

There are movements and activities that can be performed by anyone at any level of function that have benefit if they're prescribed appropriately.

所以，我想强调，即使是小事也有帮助。

So just really to stress that even the little things help.

对。

Right.

对。

Right.

这是一个非常好的观点。

What a great point to make.

我喜欢你使用的那个关键短语：站起来活动起来。

And I love the key phrase that you use to get up and and move.

你知道，ONS的‘站起来，动起来’活动正是为了帮助患者找到适合他们的运动和体力活动水平。

And, you know, that's part of ONS' Get Up and Get Moving campaign is, you know, just finding that that right level of physical activity and exercise that that patients can handle.

我认为，每个人可能都能找到适合自己的方式，这是一种很好的看待方式。

And there's something maybe for everybody, I think, a good way of looking at it.

你提出的这一点非常好。

So great point that you make there.

有时候，如果我们自己平时不太注重锻炼，向患者推荐活动可能会有些困难。

And and sometimes it might be hard to recommend activity to a patient when we haven't been very good about exercising ourselves.

我知道我也有这个问题。

I know I'm guilty.

对于那些犹豫是否要提出运动建议的临床医生，你有什么鼓励的话想分享吗？

And so what words of encouragement would you share with clinicians who are hesitant to make that recommendation?

阿曼达，我想知道你怎么看？

Amanda, I was curious what you thought.

当然，克里斯，我完全同意你的观点。

Sure, I'm right with you, Chris.

多年来，我在这方面确实做得不够好。

Been built very, very guilty of that over the years.

没错。

Right.

但我只想强调，开始永远不晚。

But I just want to stress, it's never too late to start.

任何人都可以在任何时间开始。

Anybody can start at any point in time.

正如梅丽莎提到的运动与体力活动之间的区别，你知道，大多数护士每天都在为患者提供护理，不停地走动。

You know, going back to what Melissa said about the differences between exercise and physical activity, you know, most nurses are moving around every day, all day caring for their patients.

这就是体力活动，它具有益处。

That's physical activity and it has benefit.

所以，先从与患者交谈开始，鼓励他们进行自己能承受的少量体力活动，然后逐步推进；要进一步深化这一对话，你就需要引入相关专家。

So start there with talking to your patients, just encourage that little bit of physical activity that they can tolerate and then progress up from there and to take that conversation to the next level, you know, that's where you bring in those experts.

与你的癌症康复伙伴沟通，与你的运动专业人士交流。

Talk to your cancer rehab partners, talk to your exercise professionals.

他们都很乐意提供资源和谈话要点，以帮助你与希望获得更多信息的患者进行更深入的对话。

They all would be happy to provide resources and talking points to assist with those deeper conversations with patients who want more.

我觉得这些建议非常好。

Some great ideas there, I think.

你说得对，要依靠你的同事并与他们交流。

And you're right, leaning on your colleagues and talking to them.

我肯定你不必独自面对这一切，尤其是在与患者讨论这个问题时。

I'm sure you don't have to do this alone, especially when you're talking to patients about it.

但你说得对，指出哪怕只是少量的体力活动，也可能在患者能承受的前提下，引发更大更好的改变。

But you're right, point out that just some small amount of physical activity can really kind of cascade into bigger and better things if that's what the patient can tolerate.

梅丽莎也向你提出了同样的问题。

And Melissa, know, had the same question for you as well.

这可能有些困难，但你有什么建议吗？

You know, it could be difficult, but what tips might you have there?

正如我们提到的，人们通常信任他们的肿瘤护理团队，并且大多数情况下会听从他们的建议。

You know, like we mentioned, people tend to trust their oncology care team, and for the most part are going to listen to what they say.

因此，我强烈鼓励临床医生主动谈论这个问题，即使你们自己在这方面并不擅长。

So I'd strongly encourage clinicians to go ahead and talk about it, even if you aren't great about it themselves.

我完全同意阿曼达的观点，即从体力活动开始，解释其益处，并鼓励他们找到自己喜欢的活动。

Absolutely agree with what Amanda said about just starting with physical activity and explaining that benefit and encouraging them to find something that they enjoy.

经常谈论这个问题，让他们意识到其重要性。

Talk about it often so they see the importance.

一旦他们告诉您已经开始增加活动量，请询问他们的进展，给予鼓励，并与他们一起庆祝成功。

Once they tell you they've started to become more active, ask them about it, encourage them in it and celebrate the successes with them.

最后，再次支持阿曼达的观点，利用当地癌症康复专业人士来协助传递这些信息。

And then finally, again, to support what Amanda said, tap into local cancer rehabilitation professionals to help with some of that messaging.

仅仅告诉患者，增加活动量并开始锻炼计划，在治疗开始、进行期间，以及在患癌或康复后，都能带来诸多益处，这真的能产生深远影响，而且对不同的人来说，情况也各不相同。

It really can go a long way just to tell patients that increasing your level of activity and starting an exercise program can have so many benefits as you begin and go through treatment as well as when living with or beyond cancer and that that looks different for different people.

不同的人，活跃的方式也不同，因此鼓励他们将自己喜欢的活动作为新习惯或日常生活的一部分融入进来，并强调这正是您的护理团队希望帮助他们成为最好版本自己的重要部分。

Being active looks different for different So encouraging them to try incorporating something that they like as a new habit or part of their routine and just really stressing that it's part of their care team's desire to help them be the best version of them possible.

当然，当肿瘤科专业人员认为有必要引入或患者可能受益于癌症康复或运动专业人士的初步筛查时，只需向治疗师提及：我们将与运动专业人士或癌症康复治疗师合作，帮助您实现目标、助您起步，并指导您如何安全地进行锻炼。

And then of course, when oncology professionals feel that they may want to bring in or that the patient may benefit from that cancer rehabilitation or exercise professional screening first, just mentioning to the therapist, we'll work alongside exercise professionals or cancer rehab therapists that are there to help you achieve your goals, help you get started and guide you through how to exercise safely.

我的意思是，关键信息其实很简单，就是进行这样的对话。

I mean, I think the key message, right, is to just have that conversation.

只要开始就好。

Just start it.

别再纠结于你可能不够擅长运动这种想法，而要专注于患者的好处，并帮助他们逐步适应。

You know, forget about the you know, the the nagging thought that maybe you're not as good at exercise as you should be, and and kind of focusing on the patient benefits and and working them through it.

我认为，正如那句常被引用的话所说，just do it（去做吧）。

And I think that's, you know, to to quote the oft used phrase, just do it.

这似乎是一个重要的信息。

It seems like is an important message there.

是的。

Yeah.

那么，最后总结一下，您对将运动融入癌症治疗计划、运动在症状管理中的作用，或者今天我们可能遗漏的任何其他方面，有什么最终的评论或建议吗？

And so just to wrap up today, you know, do you have any final comments or advice to share about incorporating exercise into cancer treatment plans, the role of exercise in symptom management, or anything else we might have missed today?

是的，我认为只是要

Yeah, I think just to

真正强调运动和体力活动在癌症护理全过程中的重要性，并且有许多优秀的资源和经过培训的专业人士可以帮助肿瘤护士将其融入标准护理中。

really reinforce that exercise and physical activity are so important at all phases of the cancer care continuum and that there's really great resources and trained professionals out there to help oncology nurses integrate it into the standard of care.

这是一个非常棒的观点，也是今天我们结束讨论的绝佳感言。

That's such a great point to make and such a great sentiment to leave us on here today too.

所以，梅丽莎、阿曼达，我非常感谢你们今天参加我的播客，和我们更多地讨论了体力活动和运动在癌症护理中的重要性。

So Melissa, Amanda, I cannot thank you both enough for joining me on the podcast today and talking a little bit more about physical activity and exercise and its importance in cancer care.

我们非常感谢你们分享专业知识。

We really appreciate you guys lending your expertise.

我们希望你们能再次回来，未来我们能继续交流。

And we hope that you'll come back again and we can chat some more in the future.

是的，当然。

Yeah, absolutely.

这是我们两人都非常热衷、作为团队也深信不疑的话题。

This is a topic that we're both and, you know, as a team really passionate about and believe so much in.

是的，我们非常乐意再来。

And yes, we would love to come back.

太好了。

Excellent.

非常感谢你们。

Well, thanks so much.

再次感谢。

Thank you again.

感谢您收听肿瘤护理播客。

Thank you for listening to the oncology nursing podcast.

为了支持我们的工作，请务必在 iTunes、Google Play 商店或您下载播客的任何平台为我们留下评价。

To support what we do, be sure to leave us a review on iTunes, the Google Play Store, or wherever you download your podcasts.

请务必完成我们节目笔记中的评估链接，以获取护理继续专业发展所需的免费学时。

Be sure to complete the evaluation link in our episode notes to earn free contact hours for nursing continuing professional development.

如需更多关于肿瘤护理的资源和信息，请访问 ons.org 或 voice.ons.org。

For more resources and information about oncology nursing, visit us at ons.org or voice.ons.org.