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com/hwrxeq3).
he benefits of regular physical activity are well Cardiac rehabilitation programmes have been in place in
known, and leading an active lifestyle is important the UK for over 20 years and there is robust clinical evidence
for many physiological, psychosocial and health of their effectiveness including reduced mortality, reduced re-
reasons (Department of Health (DH), 2011). admission to hospital, reduced anxiety, stress and depression and
There is convincing evidence that being physically improved quality of life in the long term (Anderson et al, 2014).
active protects against obesity and becoming overweight, as well The issues faced by stoma patients after surgery are similar
as reducing risk factors and chronic health conditions such as to those experienced by cardiac patients, and involve recovery
type 2 diabetes, cancer, heart disease and stroke for people of all from major surgery, physical deconditioning, weight loss/gain,
ages (DH, 2011). In particular, there is strong evidence of the comorbidities, lack of confidence and body image issues along
link between physical activity and the prevention of colorectal with lifestyle behaviour changes to be implemented. However
cancer. A 2009 meta-analysis found that the most physically the provision of a rehabilitation intervention for stoma patients
active people had a 24% lower risk of colon cancer than those using a similar model does not exist in the UK.
who were the least active (Wolin et al, 2009). Cancer rehabilitation services (which use a similar model
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5
0
closely by 7079 year olds (29%). The main reason for stoma
surgery was ulcerative colitis (29%), followed by colorectal cancer
Much less A little less About A little more Much more
active active the same active active (23%) and Crohns disease (16.3%), with other conditions/
trauma making up the remainder.
Figure 1. Physical activity after surgery A total of 46% of respondents had had their stoma for 10years
or more, followed by 16% each of those ranging from 1-3years is important to acknowledge the long-term psychological
and 5-10years. impact of a cancer diagnosis and how this may impact
self-confidence and the ability to be physically active. This
General physical activity illustrates that people who have a stoma because of cancer
In response to the question Are you more or less active than may need additional support, guidance and encouragement
you were before your surgery? (Figure1), although 37% of from health professionals.
people reported being about the same, the main trend was A total of 67.7% of respondents said they had not been
that people became less active after their stoma surgery with given information about physical activity at any stage of their
19.5% saying they are much less active and a 18.8% saying surgery or recovery, and a further 82.3% had not received
they are a little less active. advice about core or abdominal exercises (Figure3), despite
This is a significant finding but perhaps not that surprising. ASCN (2016) guidelines recommending that patients receive
When investigated further, responses pointed to having another this information.
medical condition (39%), not having enough energy (17%) and This is reflective of individual experiences, with comments
worries about the bag leaking or coming loose (19%). However, from patients such as:
qualitative data and comments in the survey strongly indicated
I was never given advice about exercise.
that people were scared of doing damage by exercising and
developing a hernia with many comments such as I refrain
Your survey made me realise how little advice
from exercise in case I get a hernia.
there is.
Age groups
There is a need for much more support and
Looking at the different age groups in more detail, the general
advice about exercise.
trend was that younger patients typically reported being more
active than those in older groups. In particular 27.9% of 20
29year olds indicated they were much more active compared to
Patients with cancer (777) Patients with other conditions (1672)
4.1% of those 7079 years old, which is perhaps to be expected.
And conversely, 8.8% of the 3039 year age group reported being 45 41.7%
a little less active compared to 20% of the 6069 year old group. 40 37.26%
0
64years old) and 86% of those aged over 65years living with
and beyond cancer do not meet recommended levels of physical Yes No Cant remember
activity in the UK (Campbell, 2016).
Side effects of cancer treatment, such as fatigue, are likely Figure 3. Were you given advice about physical activity or abdominal exercises by
to be a barrier to physical activity in the short term, but it a health professional?
Conclusion lead an active lifestyle during the recovery period and beyond.
Physical activity levels drop significantly after stoma surgery, Patients should be supported to overcome any barriers to
and the vast majority of people living with a stoma do not physical activity; and given advice about leakage management
meet UK guidelines for physical activity. Those with a cancer with an alternative pouch/appliance and advice on hydration
diagnosis or a parastomal hernia are even less active. and nutrition to support a more active lifestyle.
Patients report being fearful of exercise, physical activity and Much more emphasis needs to be given to the importance
of developing a parastomal hernia.The majority of stoma patients of physical activity and an appropriate movement/rehabilitation
are not given advice about the benefits of physical activity or intervention for stoma patients, sign-posting to appropriate
appropriate exercises for abdominal wall rehabilitation. They cancer rehabilitation services or GP exercise referral schemes
are not being given guidelines/encouragement about how to where available. Further research is needed to provide evidence
engage in general physical activity, despite guidelines to the on the effect of physical exercise on parastomal hernia. BJN
contrary from ASCN, ACSM and Macmillan.
All health professionals, including SCNs and surgeons, need to Declaration of interest: this article has been supported by ConvaTec
become more familiar with UK guidelines for physical activity,
and Macmillan and ACSM guidelines about physical activity for Acknowledgements: the author would like to thank The Ileostomy
cancer patients, and then advise and support patients appropriately. Association, Stomawise, Crohns and Colitis UK, Colostomy
Patients should be advised to return to normal activities as Association, Urostomy Association, Beating Bowel Cancer, Bowel and
soon as they feel able (if appropriate) after surgery/treatment Cancer Research and Professor Sina Dorudi, Consultant Colorectal
and to engage in appropriate abdominal and core exercises Surgeon,The Princess Grace Hospital, London.
to rehabilitate the abdominal wall as stated in ASCN (2016) Anderson L, Taylor RS (2014) Cardiac rehabilitation for people with heart
guidelines. If they are not sure how to advise, SCNs should disease: an overview of Cochrane systematic reviews. Cochrane Database
refer to a physiotherapist, experienced exercise professional Syst Rev (12): CD011273. https://dx.doi.org/10.1002/14651858.
CD011273.pub2
or qualified Pilates instructor with knowledge of post-natal Arem H, Pfeiffer RM, Engels EA et al (2015) Pre- and postdiagnosis physical
rehabilitation for advice. Stoma patients should be advised to activity, television viewing, and mortality among patients with colorectal
cancer in the National Institutes of Health-AARP Diet and Health Study.
avoid inactivity and sedentary behaviours and encouraged to
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