Structured Exercise Prescription Program: Targeting Monolingual Spanish-Speaking Patients to Improve Impairments

November 2017 Vol 8, No 11
Keith Argenbright, MD
Moncrief Cancer Institute/UT Southwestern
Fort Worth, TX
Emily Berry, MSPH
Moncrief Cancer Institute/UT Southwestern
Fort Worth, TX
Stephanie Mamantov, ACSM/ACS
Certified Exercise Trainer, Moncrief Cancer Institute/UT Southwestern
Fort Worth, TX
Tracy Mazour, RN, MSN, OCN
Moncrief Cancer Institute/UT Southwestern
Fort Worth, TX
Aurelio Rodriguez
Moncrief Cancer Institute/UT Southwestern
Fort Worth, TX
Lisa Ross, BS, ACSM/ACS
Certified Cancer Exercise Trainer, Moncrief Cancer Institute/UT Southwestern
Fort Worth, TX

Background: Exercise is a multipurpose tool that can be used to help cancer survivors improve their quality of life (QOL) across the cancer continuum. Cancer and its treatments result in a variety of short- and long-term side effects. The proper exercise prescription and supervision can assist cancer survivors in improving their treatment tolerance, recovery, and overall well-being.

Breast cancer is the most commonly diagnosed cancer in Hispanic and Latina women. In 2015, the American Cancer Society reported an estimated 19,800 new cases of breast cancer in Spanish-speaking women and 2800 deaths. For a large portion of survivors in the United States, Spanish is their primary language. These clients often have less access to healthcare than their English-speaking counterparts. This often results in clients presenting postsurgery without range of motion or lymphedema education.

Moncrief Cancer Institute (MCI) identified a gap with Spanish-speaking patients recently treated for breast cancer. By designing a targeted program for Spanish-speaking patients and focusing on the unique needs of this population to address barriers, MCI was able to improve overall QOL for this population.

Objectives: To prescribe a tailored exercise program to improve rehabilitation outcomes in Spanish-speaking patients and provide exercise guidelines to reduce future cancers.

Method: MCI provides grant-funded survivorship services in Fort Worth and rural counties in North Texas. Personalized 1:1 training tailored to the specific needs of the client is among the services offered. MCI specifically targets Spanish speakers through outreach services provided by Spanish-speaking staff, including a bilingual certified cancer exercise trainer. During initial consultation, the trainer reviews cancer history and treatment, general health history, exercise history, and interests, along with physical, cognitive, and socioeconomic factors. Trainers assess for lymphedema or lymphedema risk factors along with the client’s knowledge of the condition and its prevention and management. Functional range of motion of the shoulder is assessed to determine if there are limits in mobility. General health metrics are assessed periodically to monitor status; this includes resting heart rate, blood pressure, weight, and circumference measurements. Clients are typically scheduled for 12 1:1 exercise sessions. During each session, their status is assessed, including shoulder range of motion, lymphedema, improved function, decreased fatigue, and others. Exercise is taught in accordance with American College of Sports Medicine/American Cancer Society guidelines using evidence-based practices from oncology exercise research. The client’s program is progressed with the goal of having a comprehensive exercise program they can do at home upon graduation, with emphasis on minimal or no financial output for equipment. Educational materials are written in Spanish for the client. Upon demonstrating the ability to exercise independently, the client graduates from the program. The client may schedule follow-up sessions for program progression or to assess progression toward their goals. Clients may also attend a free group exercise class taught in Spanish by the trainer. The class format creates a supportive environment for cancer survivors and ongoing education and surveillance.

Results: From September 2016 to June 2017, a total of 190 patients were referred to the exercise program, resulting in 1230 1:1 and group exercise encounters. Each encounter is defined as 1 visit activity per patient, averaging 6 encounters per patient. Factors such as transportation, treatment, and personal responsibilities were factors in how many sessions were attended. During the trial period, 226 encounters in the supervised group exercise program were provided.

Conclusion: Tailoring an exercise program to the specific needs of Spanish-speaking patients is effective and continues to be a standard of practice at MCI. Although Spanish-speaking clients might not benefit more than their English-speaking counterparts, they are receiving therapeutic exercise and education that they would not otherwise receive. MCI is addressing a critical need in the Spanish-speaking breast cancer survivor population.

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