Monday, September 27, 2010

Goodbye Breast Cancer, Hello Exercise!

What:  As the director of an exercise program for breast cancer survivors, it is up to me to develop a program that improves not only the participant’s physical health, but also their mental health and Quality of Life (QoL).  The physical activity will incorporate yoga, tai chi, as well as various aerobic and anaerobic exercises.  The participants undoubtedly have experienced great amounts of stress, anxiety, pain, and possibly depression in the recent past; therefore it is imperative for this exercise program to avoid all of these negative aspects of emotion and to promote positive ones in their daily lives.

So What:  The overall goal of this program is to use exercise to decrease the amount of stress, anxiety, and depression these breast cancer survivors may be experiencing.  Gill and Williams (2008) discuss many different ways that exercise can benefit people mentally, and that those who are physically fit respond less to stress and can prevent injury and illness in the future.  Gill and Williams (2008) also mention that physical activity can serve as a coping mechanism in rehabilitation, something that can probably assist most of these breast cancer survivors.   

One vital aspect to keep in mind is that emotions vary greatly from person to person.  Gill and Williams (2008) point out that “the emotion process is different for everyone, even in the same situation” and that “the importance of individualizing training and intervention is a key element of stress management in addition to the cognitive-psychological skills” (Gill and Williams, p.167).  Knowing this, I suggest that it may be very beneficial to address each breast cancer survivor’s plan individually.  Each member will still participate in the same general program (using yoga, tai chi, aerobic and anaerobic exercises), but each person will have their program tailored to their own individual differences and needs to benefit them both mentally and physically.

Now What:  Gill and Williams (2008) spent the better part of chapter eleven explaining that various forms of physical activity have been shown to benefit people by: decreasing cardiovascular disease, increasing immune function, making someone less responsive to stress, preventing illness and injury, reduces depression following prolonged life stress and reduces anxiety.  All of these things would be desirable for anyone, especially someone recovering from breast cancer.  Drop out in the early stages would be very detrimental to the cancer patient’s long term health.  According to Gill and Williams (2008) “moderate-intensity exercise is likely to make people feel better and thus keep them coming back.  On the other hand, if the trainer pushes high-intensity exercise, clients may feel worse and soon drop out” (Gill and Williams, p.169).  I feel this is especially true for someone who has already endured great amounts of stress.  Knowing this, I would do my best not to overwork any of the patients in the first week or two and possibly observe them to see where they are in terms of strength and endurance. 

It is important to remember that the patients are probably at different levels of their recovery, vary in age, athletic ability, and exercise experience.  Some patients may have taken part in yoga, tai chi, aerobic and anaerobic exercises before, during and after their cancer so it would be very important to have different levels of these exercise programs available. 

It would be at this point where I would sit down with each patient and design a personal program.  Visovsky and Dvorak (2005) mention that low intensity aerobics, such as walking or tai chi, have been shown to decrease levels of fatigue in cancer patients.  If I observe that certain patients became easily fatigued I would start their program with low intensity aerobics until they exhibited more endurance.  On the other hand, if a patient already showed good levels of endurance, they should start with moderate-intensity aerobics as well as various anaerobic exercises.  Also, I would assign patients to yoga and tai chi classes based on their how experienced they are at these exercises. 

In regards to Quality of Life and physical health, I would expect to see both of these increase over time.  QoL, according to Gill and Williams (2008), includes the person’s perceived physical, social, and psychological well-being.  The patients may be weak at first due to their cancer treatment, and have low levels of physical well-being.  This will hopefully increase due to the anaerobic workout as they build muscle.  The social and psychological well-being of the patients will hopefully increase due to not only the workouts themselves, but also from being with other cancer survivors.  Courneya et al (2003)  conducted a study in which cancer survivors participated in not only ten weeks of exercise, but also group psychotherapy and the results were promising as the participants had significantly higher QoL than did the control group which did not take part in exercising.  This suggests that it may be beneficial to have the cancer survivors take part in group therapy with a qualified counselor regularly in addition to regular exercise at the cancer clinic. 

Conclusion:  In conclusion, there are many factors to think about when designing an exercise program for breast cancer survivors.  First off, individual differences vary greatly in regards to emotions, so it is important to design specific programs for each patient in order for them to best benefit both physically and mentally.  Secondly, research shows that exercise along with group psychotherapy can be very successful in increasing QoL in cancer survivors; therefore having the patients take part in group therapy would also help their rehabilitation.

Courneya, K. S., Friedenreich, C. M., Sela, R. A., Quinney, H. A., Rhodes, R. E. and Handman, M. (2003), The group psychotherapy and home-based physical exercise (group-hope) trial in cancer survivors: Physical fitness and quality of life outcomes. Psycho-Oncology, 12: 357–374. doi: 10.1002/pon.658.
Gill, D.L., & Williams, L. (2008). Psychological dynamics of sport and exercise (3rd Ed.).Champaign, IL: Human Kinetics
Visovsky, V., Dvorak, C. (2005), Exercise and cancer recovery.  Online Journal of Issues in Nursing. Kent State University  College of Nursing.

Monday, September 20, 2010

Lets Both Self-Talk Through This!

WHAT:  As an athletic trainer, a volleyball player comes to me with a torn ACL and is expected to be out 6 to 8 weeks.  Since an ACL injury is quite serious she probably has great concern about whether it will affect her long time playing ability in terms of mobility and her ability to play aggressive in the future without re-injuring her ACL.  As with any injury it is vital to use various cognitive skills to keep the attitude of the athlete optimistic and focused on the rehabilitation at hand. 

SO WHAT:  As a trainer I think it is most important to develop specific long term and short term goals.  The long term goal is already in place as a physician estimated her return to be 6-8 weeks.  The short term goals, according to Gill (2008), provide instant feedback and are important for keeping the athlete on track in regards to meeting their long-term goals.  Self talk will also be a vital part of the rehabilitation process in order to reach both short and long term goals.  Self talk can be used by both the volleyball player and myself in order to work quickly and efficiently towards re-habilitating the ligament. 

NOW WHAT:  Goal setting is a very valuable tool if used right; if used wrong it can be detrimental to the athletes rehabilitation.  As a trainer I would first sit down with the volleyball player and implement weekly or bi-weekly goals.  The key is to avoid making the goal so easy it does not benefit or challenge her, or so hard it is un-attainable or puts an excess amount of stress on the ligament.  The goals created at the beginning are not set in stone.  If she experiences minor setbacks, the future goals can be easily adjusted if needed.  On the other hand, the goals can also be made more difficult if needed, but it’s important to not try to move too fast and cause further damage to the ligament. The ultimate goal is obviously getting back full mobility of the knee and being able to play with the same level of confidence and skill as she had pre-injury.  If she were to begin doubting her ability to make a full comeback and play at a high level again, similar to Rob from last week’s case study, she may be losing some of her athletic identity.  That is why it is vital to be optimistic as a trainer and encourage her meet each individual goal in order to make a full recovery to get back to playing volleyball with her team on time.

Self-talk is generally something that comes naturally for people, therefore I don’t think much needs to be done in terms of making it a vital part of the rehabilitation as it will most likely already be present.  From the volleyball players point of view I think Gill (2008) mentions some good points in that it can be used to change negative thoughts into positive ones.  In any rehabilitation setting it’s far too easy to think about the negative aspects of the recovery because it can be so painful and difficult to improve.  I would reassure the volleyball player that the process WILL work and that if she encounters any negative thoughts to regroup herself and tell herself that everything will be okay. Self-talk is obvious and useful on the athletes end, but I thought it might be interesting to also incorporate it into my strategy as well.

Thelwell et al. (2008) discusses various psychological-skills utilized by coaches that can be utilized by me, the trainer in this situation and I believe self-talk was the most useful.   As mentioned before, self talk comes naturally for most of us.  When most people think of self-talk they think of it as being only used by the athlete, but Thelwell et al. (2008) brought up many scenarios in the coaching and training realm we may not think of.  One of the coaches in the article mentioned telling himself to “keep it simple” as to not provide the athlete with so much information that their brain was flooded with information.  I think it would be important to tell the athlete just what she needed to know while performing different exercises.  If I were to tell the volleyball player what could go wrong during training she may be overly-cautious and not perform the workouts to their fullest as her thoughts would be focused on the negative aspects instead of the positives. This is one area where you could encourage her to use imagery or vicarious experience so she could better perform the task at hand.  Another coach used self-talk to get through difficult sessions.  ACL rehabilitation would be a painful and strenuous ordeal, so it would be important to remember to tell myself that things will be okay and she will get through it, and hope she has the same frame of mind. 

CONCLUSION:  In conclusion, I think it would be vital for the athlete, and myself (the trainer) to utilize various cognitive skills.  Goal setting is the most important aspect of the recovery plan, and both short-term and long-term goals need to be implemented.  It would also be important to remind the volleyball player to use self-talk when negative thoughts are present.  From a slightly different perspective I think it would be useful for myself to utilize self-talk strategies in order to not let my knowledge cloud the conscious of the volleyballs player and have her worry about what could go wrong.  There are many ways a trainer could utilize all sorts of cognitive skills while assisting in rehabilitation, and no single strategy is right or wrong.  It would be important to always consider individual differences with each person, and then to act and train accordingly.

Gill, D. L., & Williams, L. (2008). Psychological dynamics of sport and exercise (3rd Ed.). Champaign,               IL: Human Kinetics.
Thelwell, R. C., Weston, N. J. V., Greenlees, I. A., & Hutchings, N. V. (2008). A qualitative exploration
of psychological-skills use in coaches. The Sport Psychologist, 22, 38-53.

Monday, September 13, 2010

Re-Establishing Rob's Athletic Identity

WHAT:  Rob’s uncertainty in his recovery and ability to perform at a high level again seem to be normal.  One major challenge Rob is facing, which a therapist needs to address, is to maintain his own personal athletic identity which was developed in high school and not yet established at the collegiate level as he was injured during his first match.  Rob appears to have much lower self confidence and self-efficacy as a result from this injury and in order to him to become an elite player once again he needs to regain these self-perceptions.

SO WHAT:  Gill (2008) explains that self-efficacy and self-confidence are in incredibly important when it comes to self-perceptions in sport and exercise psychology.  Knowing that Rob was performing at a highly ranked institution it’s more than likely that Rob was not only confident in his game, but also had high self efficacy prior to his injury.  If Rob loses this confidence and level of self-efficacy, he will lose many of the attributes of what makes elite athletes’ elite.  This will then lead to a loss of athletic identity if he no longer competes, and similar to retired athletes Lally (2007) speaks of, Rob may redefine his sense of identity.  The case study states that Rob wonders “who he will be and what he will do without tennis (p. 82)” which is consistent with the athletes one month prior to retirement in Lally’s (2007) study. 

NOW WHAT: As a trainer or coach, the first thing to do is recognize Rob’s remarks as him losing his sense of identity and self-efficacy.  As mentioned, Rob states that he is unsure about his future in tennis, and life after tennis.  This is exactly the way that the successful collegiate athletes felt in Lally’s (2007) study in which students were nearing an end to their competitive careers in their respective sport.  In the study, almost all of the athletes were able to make the transition away from sports quite well, as a coach or trainer you want the athlete to make a full recovery and once again compete at a high level.  If negative thoughts and feelings are directed towards the recovery process it is important to intervene promptly and appropriately.

Performance accomplishments, according to Gill (2008), have one of the strongest effects on self-efficacy.  This may explain why Rob is voicing his concern for his future as a tennis player.  Self-efficacy, even in rehabilitation settings, helps determine the physical capabilities of athletes, especially in relation to the speed of recovery.  As a coach or trainer I think you could continue to remind Rob of his past accomplishments and what accomplishments he is still capable of achieving.  Right now Rob appears to be struggling with his physical self-worth as he is doesn’t seem to be satisfied with the rehabilitation and is not expressing feelings of happiness so it vital that he stays positive and motivated towards a specific goal; competing once again.

While motivating Rob to continue his rehabilitation there is still concern about him losing his athletic identity, and if that were to happen it would be unlikely that he come back to the game he loves.  I believe the most effective way for Rob to avoid losing his athletic identity would be to continue to treat him as an athlete and also encourage him to think like an athlete to uphold his athletic schema.  The negative affectivity he is experiencing from not participating in the sport he knows best is slowly deteriorating his athletic identity.  In order to counteract this Rob should continue to participate in practices, workouts, act like and athlete and live like and athlete.   It is possible that this may further frustrate Rob as he is still unable to participate with his teammates, but this can be turned around and used as further motivation to continue working hard in rehab.  Constantly remind Rob where he will fit into the team once he makes his return, make clear to Rob the positive things he is doing in his rehab process, and make an extra point to be positive about his return as a coach or trainer.  If he was to feel any sense of doubt or discourage from those around him, it may completely destroy any self-efficacy he does half.  On the contrary, being upbeat and positive about Rob’s return may bolster his self-efficacy and help motivate him to continue working hard in his recovery. 

CONCLUSION: In conclusion I believe it is vital to recognize thoughts of doubt in relation to making a recovery from serious injuries.  Once this is done the trainer or coach must constantly motivate the athlete by avoiding loss of identity and keeping self-efficacy high.  In order to do this, I believe it would be effective to continue to include the recovering athlete in all of the teams activities and to be positive in reminding the athlete what he has accomplished and what he still has yet to accomplish.  If Rob were to lose confidence in his abilities and redefine his identity, he may never compete at a high level again.

Lally, P. (2007). Identity and athletic retirement: A prospective study. Psychology of Sport and Exercise,
         8, 85-99.
Gill, D. L., & Williams, L. (2008). Psychological dynamics of sport and exercise (3rd Ed.). Champaign, IL:
         Human Kinetics.