associate professor & co-director of cancer prevention & control at vcu massey cancer center
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“ Living Your Best After Cancer: Being Physically Active as a Survivor.” Diane Baer Wilson, EdD, MS, RD. Associate Professor & Co-director of Cancer Prevention & Control at VCU Massey Cancer Center - PowerPoint PPT PresentationTRANSCRIPT
“Living Your Best After Cancer: Being Physically Active as a Survivor.”Diane Baer Wilson, EdD, MS, RD
• Associate Professor & Co-director of Cancer Prevention & Control at VCU Massey Cancer Center
• Extensive research in cancer risk-reduction, with a focus on the roles of exercise and lifestyle modifications in cancer survivors
• Co-director of Cancer Survivors Symposia Series
Being Physically Active as a Cancer Survivor
Dr. Diane Baer WilsonAssociate Professor
Department of Internal MedicineProgram Leader Cancer Prevention and Control
Massey Cancer CenterVirginia Commonwealth University
Tonight
• Health benefits of being more physically active
• Research examining exercise and its impact on cancer survivorship
• How to start being more physically active
Cancer risk factorsNon-modifiable
Family History
Age
Gender
Modifiable
Tobacco use
Diet/exercise-Energy Balance
Alcohol over-consumption
Other
Preventable causes of death in the US
Regular exercise reaps more benefits than most other health habits because of its systemic effect on the human body.
Brain
Muscles
Bones
HeartPhysical, Physiologic, and Psychological Benefits of Exercise
Blood Pressure
Lower Cholesterol
Improved immune response
Better QOL
Less depression
Higher self- efficacy
Higher Psych well-being
People who exercise regularly are less likely to develop cancer and tosurvive longer after a cancer diagnosis
Why is it important to be physically active?
• Overall individuals who are more physically active:– are more likely to maintain
a BMI >25 kg/m2
– are less likely to develop chronic diseases,
– are likely to recover faster from surgeries,
– report a better daily quality of life
– live longer
0
5
10
15
20
25
30
35
40
45
50
No leisure timephysical activity
Moderate Vigorous
VirginiaUS
Percent Adults Engaging in Physical Activity, Virginia and US
Virginia ranks 23rd in the nation, Colorado ranks 1st
Exercise in cancer survivors: What the science says
Limitations of the research:• Few well-designed, long-term studies have
been done to date• Most studies are observational; cannot
draw cause and effect conclusions• Few studies have examined the effect on
cancer outcomes• Most studies conducted in one or two
types of cancer
Exercise in women with breast cancer, Stage I, II, III, Holmes et al, 2006
• Research to study the relationship between exercise and brca survival (stages I,II, and III) in 4400 women, Nurses Health Study (121,700) since 1976
• Results-women in any category of activity higher than 1hr/wk, had better survival rates compared with those exercising less.
• Comparing the highest with lowest categories of PA, there was a 26-40% lower relative risk of adverse outcomes in those in the highest category of PA. (Association particularly apparent in women with hormone (+) tumors, and those with Stage III cancer)
24 hr Tandem record Anna Schwartz, Betsy King, 436m
Research-Exercise in colon cancer survivors
• Meyerstadt, et al (2006)-2 studies in colon cancer survivors
• Examined association between PA after diagnosis and mortality (Nurses Health Study data).
• Results-significant reduction in cancer mortality for those exercising > 5-6 hours /week. (Independent of pre-dx PA)
Relevant issues remain:• What dose is required
for benefits?• Is there benefit across
types of cancer?• What are the
characteristics of individuals most likely to exercise?
• Is the positive effect of exercise exerted through weight control or some other molecular or metabolic mechanism?
Determinants of exercise in patients with multiple myeloma
• Jones et al. (2006) studied the determinants of intention to exercise in patients (n=77).
• In examining demographic, medical and social/cognitive factors results were:– Being more likely to see exercise as beneficial
and– Perceiving exercise being easy rather than
difficult were the strongest predictors• Neither age, race, gender, nor stage of
cancer was related.
ACS Guidelines for Exercise
• Adults- Engage in at least 30 minutes of moderate to vigorous physical activity, above usual activities, on 5 or more days of the week, 45-60 minutes are preferable
• Children and teens-Engage in at least 60 minutes/day of moderate to vigorous physical activity at least 5 days/week
• American Cancer Society-www.cancer.org
How to start being more physically active
• Make the decision• Determine a schedule• Use a calendar or a
daytimer• If you are currently
sedentary, walking is a good choice
• Start with walking 15 minutes 3 days/week
• A pedometer is useful
Exercise Intervention• To address energy balance in African American
breast cancer survivors we developed a cognitive behavioral, theory based walking intervention, Walking Counts! (Wilson, et al).
• Study tested feasibility, recruitment/retention, use of pedometers, attending weekly classes, and impact of self-assessment, education, motivation.
• Test for effect on level of exercise, anthropometric, attitudinal and related measures in a group of African American breast cancer survivors recruited for the study in Richmond.
Walking Counts! InterventionCharacteristics of the Sample
Age (yrs) 55 (39 – 66)
Weight (lbs) 191 (142 – 271)
BMI (kg/m2) 32.7 (25.2 – 47.2)
Education: (%) Post high school
91.0
Marital Status: (%) Married Single/Divorced/Widowed
50.0 50.0
Characteristics of the SampleMenopausal Status (%) Post
86.4
Time Since Diagnosis: (%) 1-6 years 7-10 years More than 10 years
59.1 13.6 27.3
Type of Treatment: (%) Chemotherapy Radiation therapy Both Neither
18.2 18.2 45.5 18.2
Tamoxifen: (%) No
77.3
Alcohol: (%) No
72.7
Smoking: (%) No
91.0
Study ResultsBaseline (N=22) Post p value*
Exercise Measure Steps/day 4791 8297 <0.001*
Anthropometric measures BMI (kg/m2) 32.7* Weight (lb) 191.2* Body Fat (%) 40.1* Waist circumference (in.) 39.7* Hip circumference (in.) 47.2* Arm circumference (in.) 13.9* Systolic B/P (mm Hg) 140.9* Diastolic B/P(mm Hg) 80.1* Attitudinal measures: Exercise Attitude Total 66.2* Cancer Worry Total 6.8 * Paired “t-test” for difference in group means
Steps/day at Baseline,Post and 3 Month Post Intervention
3 MonthsPostBaseline
Mea
n St
eps
Per
Day
9000
8000
7000
6000
5000
4000
3000
p<.001 B/P***, p=.001*** B/3mth
Summary• Exercise has multiple benefits to mental and
physical health• Individual who exercise have more positive
health outcomes• Research with cancer survivors has shown that
survivors who exercise after diagnosis may have fewer recurrences and better clinical outcomes
• Walking is a recommended activity-work towards a goal of 30 minutes/day and then 10,000 steps or 60 minutes long term
Include daily exercise on your path to optimal health!
“Living Your Best After Cancer: You and Your Primary Care Doctor Working Together"
Mary Helen Hackney, MD
• Associate Professor of Hematology/Oncology at VCU Massey Cancer Center
• Specialist in treatment for all stages of breast cancer
• Treats cancer of all types through Massey’s Rural Cancer Outreach Program
• Teaches residents and health professionals about prevention, long-term patient management and survivorship issues.