exeter exercise and cancer oct 13
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SHSM022/ BJ EXERCISE AND CANCER
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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
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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%
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SHSM022/ BJ Exercise and Cancer Survivorship
Stem Cells
http://stemcells.nih.gov/info/Regenerative_Medicine/pages/2006chapter9.aspx
Image from:
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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
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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)
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SHSM022/ BJ Exercise and Cancer Survivorship
Breast Cancer
Menarche,1st pregnancy, Menopause, Postmenopause
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PA & Cancer: after diagnosis
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SHSM022/ BJ Exercise and Cancer Survivorship
Cancer Treatments
Surgery Radiation Therapy Chemotherapy Immunotherapy
(Durstine et al, 2009)
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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
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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)
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Exercise as a treatment
(Speck, 2010)
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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
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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
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Evidence by site of cancer
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Breast Cancer
Large number of studies Lymphedema... Caution taken with pain in arm or
shoulder Compression garments Increased risk of fracture
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Breast Cancer
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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
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Prostate Cancer and exercise Aerobic Fitness Muscular Strength Body Size and composition QOL Fatigue Physical Function – Pelvic Floor Exercises
Sexual function Fracture Potential
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Considerations for interventions
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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)
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Barriers to activity
(Irwin, 2009)
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Cancer & Exercise Guidelines Broadly the same as population
guidelines Avoid inactivity
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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
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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)
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Psychosocial benefits
MoodFunctional IndependenceSelf-esteemSense of control
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Our work
http://vimeo.com/69834141
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Health Behaviour Change
Transtheoretical model. What stage? Social Cognitive Theory
Mastery experiences Modelling Verbal persuasion Physiological states and affect
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Strategies to increase PA
(Irwin, 2009)
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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
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Intervention Content
Group v Individual Adherence rates high “brothers in arms” (Adamsen et al, 2001)
Home Exercise Adherence acceptable
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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
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Implications of evidence
“What can I do to improve my survival?”
Improved treatment Return on investment for NHS funding??
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Marjon Projects
Prostate Cancer Hematological Cancer Exercise Referral Scheme for Cancer
Survivors
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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
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Issues with evidence
QoL, fatigue subjectively measured Multiple natures of diagnosis, conditions,
ages PA at different stages of life
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Further reading
Click the journal to read it
Click the journal to read it
Click the book for amazon
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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.
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Ted’s story