Kanserli Olgularda Kardiyak Rehabilitasyon Perspektifi

Abstract

Kanser, vücuttaki hücrelerin kontrolsüz şekilde bölünmesi ve çoğalmasıyla karakterize ülkemizde ve dünyada insidansı ve prevelansı gün geçtikçe artan önemli ve kompleks bir sağlık sorunudur. Hastalığın görülme sıklığına paralel olarak yeni tedavi yöntemleri geliştirilmiştir. En yaygın olarak uygulanan tedavi yöntemleri; kemoterapi, radyoterapi ve cerrahi yöntemlerdir, bunların yanında biyolojik tedaviler de kullanılmaktadır. Yapılan çalışmalara göre, kemoterapi ve radyoterapi ajanlarının uzun süreli kullanımı kanser hastalarının ve kanserden sağ kalan bireylerin kardiyovasküler sistemi üzerinde kardiyotoksisite adı verilen toksik etkilere neden olmaktadır. Kardiyotoksisite sonucunda hastaların ventriküler fonksiyonları, kardiyorespiratuar uygunlukları ve fiziksel kapasitelerinde önemli ölçüde azalma ile birlikte kalp yetmezliği riskinde artış meydana gelmektedir. Bu negatif etkilerin önlenmesi veya hafifletilmesi için hastalara bütüncül bir yaklaşım olan kardiyak rehabilitasyon programları önerilmektedir. Kardiyak rehabilitasyon programları egzersiz desteği, nutrisyonel destek, psikolojik destek, sigarayı bırakma desteği ve yaşam tarzı modifikasyonlarının önerilmesi şeklinde alt gruplara sahiptir. Bu derlemede kardiyak rehabilitasyonun egzersiz bölümüne odaklanılmıştır. Amerikan Spor Hekimliği Koleji tarafından yayınlanan kılavuzda, egzersizin kardiyorespiratuar uygunluğu ve fiziksel kapasiteyi iyileştirdiği belirtilmektedir. Bunun yanında kalp yetmezliği hastalarında oluşabilecek sarkopeni durumlarında kas kuvvetinde ve yaşam kalitesinde meydana gelebilecek azalmaların hafifletilmesinde hastalara sıklıkla dirençli egzersizler, aerobik egzersizler ve bu iki egzersiz çeşidinin kombinasyonu önerilmektedir. Literatürdeki çalışmalar incelendiğinde, kanser hastalarına veya kanserden sağ kurtulan bireylere uygulanan kardiyak rehabilitasyon yaklaşımlarının hastaların kardiyorespiratuar uygunluklarını iyileştirdiği, metabolik sendrom geliştirme riskinin önüne geçtiği, kanser hastalarında sıklıkla meydana gelen yorgunluk ve kas kütlesi kaybı gibi fiziksel performans parametreleri üzerinde olumlu etkileri olduğu görülmektedir. Bu derleme, kanser hastalığı sonucunda bireylerde meydana gelen kardiyovasküler değişimleri, bu bireylerin değerlendirilmesi ve rehabilitasyonunu içermektedir.

Keywords

• Fizyoterapi ve rehabilitasyon
• kanser
• kardiyak rehabilitasyon

Cardiac Rehabilitation Perspective on Cancer Patients

Abstract

Cancer is an important and complex health problem, the incidence and prevalence of which are increasing day by day in our country and the world, characterized by the uncontrolled division and proliferation of cells in the body. In parallel with the incidence of the disease, new treatment methods have been developed. The most commonly applied treatment methods are; chemotherapy, radiotherapy, and surgical methods, as well as biological treatments, are used. Studies have shown that long-term use of chemotherapy and radiotherapy agents can cause toxic effects, called cardiotoxicity, on the cardiovascular system of cancer patients and cancer survivors. As a result of cardiotoxicity, there is a significant decrease in the ventricular functions, cardiorespiratory fitness, and physical capacity of the patients, and an increase in the risk of heart failure occurs. To prevent or alleviate these negative effects, cardiac rehabilitation programs, which are a holistic approach, are recommended. Cardiac rehabilitation programs have divisions such as exercise support, nutritional support, psychological support, smoking cessation support, and lifestyle modifications. This review focuses on the exercise part of cardiac rehabilitation. According to American College of Sports Medicine guideline, exercise improves cardiorespiratory fitness and physical capacity. In addition, resistance exercises, aerobic exercises, and combined exercises are often recommended to patients to alleviate the decrease in muscle strength and quality of life in sarcopenia that may occur in patients with heart failure. Previous studies have shown that cardiac rehabilitation improves cardiorespiratory fitness, prevents the risk of metabolic syndrome development, and decreases muscle mass loss and perceived fatigue in cancer patients. This review includes cardiovascular changes in individuals as a result of cancer disease, evaluation, and rehabilitation of these individuals.

Keywords

• Cancer
• cardiac rehabilitation
• physiotherapy and rehabilitation

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