Dr Ian Lahart

Dr Ian LahartFaculty of Education, Health and Wellbeing (FEHW)

Dr Lahart is a Senior Lecturer in Exercise Physiology a committee member of HEAT and the course leader for BSc Sport and Exercise Science at the University of Wolverhampton.

Ian completed his PhD on physical activity and breast cancer in 2014. He has a number of publications in peer-reviewed journals with high im­pact factors in the area of exercise and chronic disease, and has presented his work at a number of research conferences, including the British Association of Sport and Exercise Science, American College of Sports Medicine and Physiology Society annual conferences.

He is currently working on a Cochrane Collaboration Systematic Review on exercise and breast cancer. Through his role as a research fellow at Russells Hall hospital, Dudley, he works with cardiovascular disease, cancer and rheumatoid arthritis patients. He was involved in the setting up of and helps manage a MacMillan funded exercise-based cancer rehabilitation service in Action Heart, a cardiac rehabilitation centre in Russells Hall Hospital.

Ian provides exercise testing and sports science support to athletes, including runners, triathletes and cyclists, and has previously provided physiological testing for Wolverhampton Wanderers FC and Walsall Town FC. 

The use of exercise-based cardiac rehabilitation services for cancer patients: a pilot study

Background:

In the UK in 2012, there were 327,812 new cancer diagnoses. Due to advances in cancer screening and prevalence of societal cancer risk factors, cancer incidence has increased by 23% in males and 43% in females during the period 1975-1977 to 2009-2011 in Great Britain1. In the UK, with advances in both diagnosis and treatment, mortality rates for most cancers are improving2, and consequently, cancer prevalence has increased. There are 827,126 UK citizens living with a diagnosis of cancer within the last five years3. With increasing numbers of cancer survivors there is a growing awareness of the physical and psychological long-term and late-term effects of cancer and its treatments. Cancer survivors require rehabilitation. In the cancers most influenced by lifestyle factors (breast, colorectal, lung, prostate and endometrial cancers) poorer prognosis is associated with a number of potentially modifiable lifestyle factors obesity, weight gain after diagnosis, smoking, excessive alcohol consumption, psychological stress, low cardiorespiratory fitness and insufficient physical activity4,5. Cancer treatment often results in the patient reducing her/his physical activity and as a consequence, heart and lung function deteriorates and people gain weight; in short, activities which are part of daily life such as walking up a flight of stairs can be perceived to be physically daunting

Cardiac rehabilitation is an intervention that improves cardiovascular fitness and well-being, and significantly improved cost associated with healthcare provision6. The core components of a rehabilitation programme, such as physical activity (PA), exercise tolerance, diet modification, smoking-cessation and weight management, are also important to the rehabilitation of cancer survivors7. Therefore, a common rehabilitation programme may be appropriate for meeting many of the needs of both cardiac and cancer patients.

Research aim:

To examine the effectiveness of utilising an existing exercise-based cardiac rehabilitation service to improve health outcomes associated with poorer cancer prognosis and cardiovascular disease risk.

Methods:

Twenty three post-adjuvant therapy cancer patients (female=96%; breast cancer=70%; age=55.1±8.2 y;height=1.64±0.1m; mass=78.2±17.0kg; BMI=29.0±6.5kg/m2) completed a 12-week supervised facility-based exercise intervention.  

Intervention:

The intervention mimicked a phase II (early post-discharge) cardiac rehabilitation programme. Phase II (immediately post-adjuvant therapy in the case of cancer patients) consisted of a 3-month supervised facility-based intervention, involving structured and closely monitored PA, psycho-educational activities and lifestyle modification counselling.

Outcome assessment:

All patients were evaluated for our primary outcome, Health-related quality of life (HRQoL) via European Organization for Research and Treatment of Cancer QLQ-C30 Global Health scale, and secondary outcomes, physical function (PF) and mental health (MH) (via PF and MH composite scores of the Medical Outcome Survey Short Form-12), self-esteem (via Rosenberg Self-Esteem Scale), PA (via International PAQuestionnaire), and mass were assessed at baseline and at 12-weeks.

Results:

We foundmoderate pre to post-intervention improvements in HRQoL global health [mean difference (MD), 95% confidence intervals (CI) = 7.6; 95% CI 1.09 to 14.12; d = 0.51]. There were moderate and large pre-post intervention effects on physical function and mental health, respectively (MD = 4.81; 95% CI 0.40 to 10.03; d = 0.42 and MD = 7.45; 95% CI 3.31 to 11.77; d = 0.81, respectively). Participants reported large pre-post intervention effects on self-esteem (MD = 3.05; 95% CI 1.40 to 4.70; d = 0.82). Moderate and large increases in self-reported leisure and total PA (MET-min/week) were observed from pre to post-intervention, respectively (MD = 1201, 95% CI 194 to 2209; d = 0.53 and MD = 2317, 95% CI 1153 to 3481; d = 0.88).

Summary:

The patients who participated in an exercise-based cancer rehabilitation experienced large changes in mental health, self-esteem, and total PA, and moderate changes in HRQoL, physical function, and self-reported leisure-time PA.

References:

  1. Cancer Research UK, http://www.cancerresearchuk.org/health-professional/cancer-statistics/incidence/all-cancers-combined#heading-One, Accessed 24th June 2014. 
  2. Bray, F., Ren, J. S., Masuyer, E., & Ferlay, J. (2013). Global estimates of cancer prevalence for 27 sites in the adult population in 2008. Int J Cancer, 132(5), 1133-1145. doi: 10.1002/ijc.27711
  3. Ferlay, J., Steliarova-Foucher, E., Lortet-Tieulent, J., Rosso, S., Coebergh, J. W., Comber, H., Bray, F. (2013). Cancer incidence and mortality patterns in Europe: estimates for 40 countries in 2012. Eur J Cancer, 49(6), 1374-1403. doi: 10.1016/j.ejca.2012.12.027
  4. World Cancer Research Fund & American Institute for Cancer Research. (2007) Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective. Washington DC: AICR, 2007
  5. Schmid, D., & Leitzmann, M. F. (2014). Association between physical activity and mortality among breast cancer and colorectal cancer survivors: a systematic review and meta-analysis. Ann Oncol, 25(7), 1293-1311. doi: 10.1093/annonc/mdu012
  6. Heran, B. S., Chen, J. M., Ebrahim, S., Moxham, T., Oldridge, N., Rees, K., Taylor, R. S. (2011). Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database Syst Rev(7), CD001800. doi: 10.1002/14651858.CD001800.pub2
  7. Smith, S. C., Jr., Benjamin, E. J., Bonow, R. O., Braun, L. T., Creager, M. A., Franklin, B. A., Taubert, K. A. (2011). AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update: a guideline from the American Heart Association and American College of Cardiology Foundation endorsed by the World Heart Federation and the Preventive Cardiovascular Nurses Association. J Am Coll Cardiol, 58(23), 2432-2446. doi: 10.1016/j.jacc.2011.10.824