SHSM022/ BJ EXERCISE AND CANCER

SHSM022/ BJ Exercise and Cancer Survivorship

Overview

Primary Cancer Prevention Rationale for using exercise Exercise as a form of treatment

Contraindications Implications

The use of interventions

SHSM022/ BJ Exercise and Cancer Survivorship

Cancer

Cancer is a general term for a number of conditions in which cells grow out of control. Partial or complete lack of structural organisation Lacks functional coordination with the normal

tissue Usually forms a distinct mass of tissue that may

be either benign or malignant 2 million survivors in UK 46% female C breast/31% male C prostate Colon, hematological, endometrial each 10%

SHSM022/ BJ Exercise and Cancer Survivorship

Stem Cells

http://stemcells.nih.gov/info/Regenerative_Medicine/pages/2006chapter9.aspx

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SHSM022/ BJ Exercise and Cancer Survivorship

Primary Prevention

Colorectal Cancer (Thune & Furberg, 2001)

40,000 patients; 10%-70% reduction in incidence

Decreased bowel transit time Breast Cancer (Thune & Furberg, 2001)

108,000 patients; 30% risk reduction (In 26/41 studies)

Endometrial 8/12 studies show 20-80% reduction

Prostate, Ovarian, Testicular Possible inconclusive reductions

SHSM022/ BJ Exercise and Cancer Survivorship

Potential Mechanisms

Modulation of reproductive hormone levels

Decrease in body weight and adiposity Changes in levels of IGFs and binding

proteins Decrease in inflammation Decrease in intestinal transit time Enhanced immune function

(Bouchard et al 2012)

SHSM022/ BJ Exercise and Cancer Survivorship

Breast Cancer

Menarche,1st pregnancy, Menopause, Postmenopause

SHSM022/ BJ Exercise and Cancer Survivorship

PA & Cancer: after diagnosis

SHSM022/ BJ Exercise and Cancer Survivorship

Cancer Treatments

Surgery Radiation Therapy Chemotherapy Immunotherapy

(Durstine et al, 2009)

SHSM022/ BJ Exercise and Cancer Survivorship

Cancer Effects (cancer or treatment)

Fatigue Weight changes Urinary bowel problems Peripheral neuropathy Osteoporosis Cardiotoxicity Lymphoedema Hot flushes Night sweats Anxiety Depression Difficulty with memory

SHSM022/ BJ Exercise and Cancer Survivorship

Exercise and survival

Evidence that Cancer survivors die of non-cancer causes at a higher rate than general population.

Those that exercise... Breast Cancer

24-67% reduction in total deaths 50-53% reduction in risk of breast cancer deaths

Colon Cancer 50-63% reduction in risk of total deaths 39-59% decrease risk of colon cancer deaths

(see Irwin, 2009)

SHSM022/ BJ Exercise and Cancer Survivorship

Exercise as a treatment

(Speck, 2010)

SHSM022/ BJ Exercise and Cancer Survivorship

Biological Markers

Insulin Insulin levels linked to risk of death 25% in insulin levels = 5% in survival

rate

Overweight Breast and prostate may be overweight Head, neck, gastric may be underweight

SHSM022/ BJ Exercise and Cancer Survivorship

Fatigue

Up to 70% of patients report loss of energy.

1/3 of survivors experience fatigue for years (Dimeo, 1999)

Multi-faceted Tumour-related Conditional-related Disease-related

Evidence by site of cancer

SHSM022/ BJ Exercise and Cancer Survivorship

Breast Cancer

Large number of studies Lymphedema... Caution taken with pain in arm or

shoulder Compression garments Increased risk of fracture

SHSM022/ BJ Exercise and Cancer Survivorship

Breast Cancer

SHSM022/ BJ Exercise and Cancer Survivorship

Prostate Cancer

By the age of 80, about half of all men will have some cancer cells in their prostate

Only 1 in 25 of them will die from prostate cancer.

Leading cause of death in prostate is Cardiovascular disease

Screening

SHSM022/ BJ Exercise and Cancer Survivorship

Prostate Cancer and exercise Aerobic Fitness Muscular Strength Body Size and composition QOL Fatigue Physical Function – Pelvic Floor Exercises

Sexual function Fracture Potential

Considerations for interventions

SHSM022/ BJ Exercise and Cancer Survivorship

Physical Activity Levels in survivors Many not be active enough pre-cancer Reduction in activity levels on diagnosis Intuitive/medical advice to “take it easy” Less than ½ return to pre-diagnosis levels A teachable moment?? (Demark-Wahnefried et al, 2005)

SHSM022/ BJ Exercise and Cancer Survivorship

Barriers to activity

(Irwin, 2009)

SHSM022/ BJ Exercise and Cancer Survivorship

Cancer & Exercise Guidelines Broadly the same as population

guidelines Avoid inactivity

SHSM022/ BJ Exercise and Cancer Survivorship

Contraindications (in addition to CV)

Heamoglobin Level < 8.0 g/dL Absolute neutrophil count <0.5 x 109/mL Platelet count <50 x 109/mL Fever>38C (100.4F) Ataxia, dizziness, or peripheral sensory neuropathy Severe cachexia (loss of >35% premorbid weight) Dyspnea Bone Pain Severe Nausea Extreme Fatigue and/or muscle weakness

SHSM022/ BJ Exercise and Cancer Survivorship

Considerations for exercise programming

Fatigue  Pain Nausea Mouth Sores Lymphedema Peripheral Neuropathy Radiation Dermititis Constipation Diarrhoea Infection Mode of activity Falls (Schwartz,

2005)

SHSM022/ BJ Exercise and Cancer Survivorship

Psychosocial benefits

MoodFunctional IndependenceSelf-esteemSense of control

SHSM022/ BJ Exercise and Cancer Survivorship

Our work

http://vimeo.com/69834141

SHSM022/ BJ Exercise and Cancer Survivorship

Health Behaviour Change

Transtheoretical model. What stage? Social Cognitive Theory

Mastery experiences Modelling Verbal persuasion Physiological states and affect

SHSM022/ BJ Exercise and Cancer Survivorship

Strategies to increase PA

(Irwin, 2009)

SHSM022/ BJ Exercise and Cancer Survivorship

Jones’ experiences

311 survivors (breast, prostate colorectal, lung) 84% would prefer to receive ex counselling during cancer

experience. Only 28% reported that oncologist raised issue of exercise. 14% raised issue themselves. Of 42%, 14% referred to ex specialist Only 16% in total reported exercising at recommended level

(Jones et al, 2002)

Most want to receive exercise counselling but variety of interventions and methods key

SHSM022/ BJ Exercise and Cancer Survivorship

Intervention Content

Group v Individual Adherence rates high “brothers in arms” (Adamsen et al, 2001)

Home Exercise Adherence acceptable

SHSM022/ BJ Exercise and Cancer Survivorship

Adherence (Vallance et al , 2008)

Exercise promotion booklet (n=377) Random allocation

Booklet Pedometer Booklet and pedometer Standard recommendation to increase PA

PA ↑ ~90min/wk in 2 pedometer groups 6 months later

↓ in all groups Pedo’s ~50 min/wk more than baseline but standard 9

min/wk more (not sign diff.)

Click the booklet to go to it online

SHSM022/ BJ Exercise and Cancer Survivorship

Implications of evidence

“What can I do to improve my survival?”

Improved treatment Return on investment for NHS funding??

SHSM022/ BJ Exercise and Cancer Survivorship

Marjon Projects

Prostate Cancer Hematological Cancer Exercise Referral Scheme for Cancer

Survivors

SHSM022/ BJ Exercise and Cancer Survivorship

Conclusions

Stage Evidence

During Cancer treatment PA improves, or prevents the decline of physical function without increasing

After cancer treatment PA helps recover physical function

During and after cancer treatment

PA can reduce the risk of cancer recurrence and mortality for some cancers and can reduce teh risk of developing other long term conditions

Advanced cancer PA can help maintain independence and wellbeingClick here for link

SHSM022/ BJ Exercise and Cancer Survivorship

Issues with evidence

QoL, fatigue subjectively measured Multiple natures of diagnosis, conditions,

ages PA at different stages of life

SHSM022/ BJ Exercise and Cancer Survivorship

Further reading

Click the journal to read it

Click the journal to read it

Click the book for amazon

SHSM022/ BJ Exercise and Cancer Survivorship

Further reading

www.benjanefitness.com – Click here for Exercise and Cancer page Ehrman, J., Gordon, P., Visich, P.S., Keteyianby, S. (2009) Clinical Exercise

Physiology (2nd Ed) Champaign IL: Human Kinetics Durstine, J.L. et al (2009) ACSM's exercise management for persons with

chronic diseases and disabilities (3rd Ed) Champaign, IL: Human Kinetics [google books]

Irwin, M.L. (2009) Physical activity interventions for cancer survivors. Br J Sports Med Vol.43, 32-8 [full text]

Schwartz, A.J. (2005) Cancer Fitness: Exercise Programmes for patients and survivors. New York, NY: Fireside [amazon][amazon preview]

Swain, D.P. & Leutholtz, B.C. (2007) Exercise Prescription: A case study approach to the ACSM Guidelines (2nd Ed). Champaign, IL: Human Kinetics.

SHSM022/ BJ Exercise and Cancer Survivorship

Ted’s story