title: Exercise and cancer: return to work as a firefighter with ostomy after rectal carcinoma - a case report.
abstract: BACKGROUND
  Colorectal cancer survivors are deconditioned through anticancer therapy. Furthermore, about 10% of them have a permanent ostomy which is associated with weakened abdominal muscles and an increased risk of a hernia. This case study reports on how a firefighter with rectal carcinoma and ostomy was trained to regain operational fitness.
  
  
  METHODS
  A 44-year-old firefighter (178 cm, 82 kg) with an adenocarcinoma of the rectum (diagnosed 24 months prior) had been treated with neoadjuvant radiochemotherapy and surgery. After 2 temporary ileostomies, a permanent colostomy was performed 14 weeks before the start of a 9-months training program. The program included sensorimotor, endurance, and strength training of increasing volume and intensity. Endurance, strength, and patient reported outcomes were assessed every 2 to 3 months.
  
  
  RESULTS
  Training frequency varied from 1 to 3 sessions/week, although 3 to 5 sessions/week were prescribed. Peak power output was 150, 158, 167, 192, and 175 watts at baseline, 2, 4, 6, and 9 months. Maximal oxygen uptake increased from 1.56 L/min (19.0 mL/min/kg) to 2.39 L/min (28.8 mL/min/kg) after 6 months. Maximal isokinetic peak torque (MIPT) of the knee extensors were 138.0 and 196.5 Nm (Newton meter) at baseline and 6 months. MIPT of the elbow and hip flexors increased from 51.8 to 66.0 Nm and 213.8 to 239.7 Nm, respectively, after 6 months. Physical fatigue decreased by 65% and distress by about 50% after 9 months. The firefighter passed a test for occupational fitness after 6 months and was permitted to work with an exterior crew on a pump truck.
  
  
  CONCLUSIONS
  It is possible for colorectal cancer survivors with ostomy to regain occupational fitness for physically demanding tasks like firefighting through an individually tailored and supervised training program.
authors.affiliation: Department of Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg Department of Sports Medicine, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Wiskemann
authors.forename: Kai
authors.initials: K
authors.lastname: Schommer
authors.forename: Dirk
authors.initials: D
authors.lastname: Jaeger
authors.forename: Friederike
authors.initials: F
authors.lastname: Scharhag-Rosenberger
mesh_terms: D000328:Adult; D002173:Cancer Care Facilities; D003125:Colostomy / Q000534:rehabilitation*; D004185:Disability Evaluation; D005080:Exercise Test; D005081:Exercise Therapy; D061388:Firefighters; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000534:rehabilitation*; D012004:Rectal Neoplasms / Q000601:surgery*; D012050:Rehabilitation, Vocational; D062707:Return to Work; D014938:Work Capacity Evaluation