Download Physical Activity and Cancer

Jill Mayer PT, DPT
Ithaca College
Objectives
 Briefly discuss the benefits of physical activity and its
role in cancer prevention
 Determine the effects of physical activity during and
after cancer treatment
 Determine the effects of physical activity on cancer
recurrence and survival
 Review exercise guidelines and precautions for cancer
survivors
 Determine the role of PT in cancer treatment
 Discuss opportunities for community outreach and
student involvement
Benefits of Exercise/ Physical Activity 1
 Control Your Weight
 Reduce Your Risk of Cardiovascular Disease
 Reduce Your Risk of Type 2 Diabetes and Metaboloic
Syndrome
 Strengthen your Bones and Muscles
 Improve your mental health and mood
 Improve function and balance
 Increase your chances of living longer
Physical Activity and Cancer
Prevention
 Center for Disease Control: Physical activity is connected
to a lower risk of breast and colon cancer 1
 National Cancer Institute: Physical activity is connected to
a lower risk of breast, colon, possibly lung and endometrial
cancers 2
 American Cancer Society: Physical activity may reduce the
risk of breast, colon, endometrial, and prostate cancer 3
Physical Activity and Cancer
Prevention4,5
 Global data indicates a 25% reduction in breast cancer
risk in physically active women compared to those who
are least active 4
 It is estimated that 20-30% of cancers may be related to
being overweight and/or lack of physical activity 5
 Prolonged sitting (>4 hours per day) has been
associated with increased risk of cancer even with
regular exercise 4
We don’t always have control! 3
 Odds of being diagnosed with cancer in lifetime:
 Males 1 in 2
 Females 1 in 3
 Odds of dying from cancer:
 Males 1 in 4
 Females 1 in 5
What if you already have a
Diagnosis?
 It is estimated that women decrease their activity level by 2
hours per week after a diagnosis of breast cancer6
 What actions can we take?
 Up until the late 1980s, standard recommendation was to
rest and avoid exercise 7
 It’s time to change our way of thinking and get involved!
Systematic Review: Physical exercise in cancer
patients during and after medical treatment 8
 Exercise improved the following during breast, mixed
solid tumor and blood cancer treatment :
 Improved QOL- mood, psychological well being
 Increased aerobic capacity (endurance, breathing)
 Increased muscle strength
 Symptom relief- fatigue, nausea, pain, difficulty
sleeping, diarrhea
 Increased bone mineral density in patients with breast
cancer and solid tumors
 Improved body composition in patients with breast and
blood cancer
Systematic Review: Physical exercise in cancer
patients during and after medical treatment
 Mixed Solid Tumor:
 Boosts natural-killer cell activity
 High-Dose Chemotherapy following Bone
Marrow and Bone Stem Cell Transplant:





Days in the hospital
Creatinine exertion (Kidney Function)
Neutropenia (low white blood cell count)
Hemoglobin (carry oxygen)
Lymphocytes and cell counts improved
Systematic Review: Physical exercise in cancer
patients during and after medical treatment 8
 Breast Cancer and Mixed Solid Tumors:
 Aerobic capacity
 Fatigue, anxiety, depression
 Self Reported Quality of Life, including mood and
self- esteem
 Increase in physical strength and walking distance
Systematic Review: Physical exercise in cancer
patients during and after medical treatment 8
 Following Breast cancer treatment:
 Positive cardiopulmonary changes
 Positive changes in Insulin-like growth factors (IGF1) and
Binding Proteins (IGFBP-3and -1)- High levels of IGF1 and Low
levels of IGFBP-3 are associated with cancer recurrence and an
adverse prognosis
 Following Mixed Solid Tumor Treatment
 Decrease in body fat
 Increased flexibility
 Improved body avoidance
 Increased “fighting spirit”
New Research: The Journal of National Cancer
Institute- March 20159
 Hypoxic tumors can be relatively impervious to
treatment
 Exercise improves post-ischemia to normal tissue…what
about tumors?
 Study focused on:
 Improving oxygen to tumors through aerobic exercise in
mice


Estrogen Receptor (+) and (-) tumor cells
4 groups: sedentary, exercise, sedentary + chemo, exercise +
chemo
New Research: The Journal of National Cancer
Institute- March 2015
 Aerobic exercise slowed the growth of breast cancer tumors
AND made the cancer more sensitive to chemotherapy
Decrease Tumor Growth
1.4 fold increase in apoptosis
Physical Activity and Survival 10
 Nearly 3,000 female nurses with Stage I, II, or III breast
cancer followed from 1984 to 2004 through questionnaires
 Studied reoccurrence and mortality
 Physical activity was re-assessed every 2 years through a
questionnaire
 Recorded number of hours per week walking at an average
pace (2-2.9mph)
Physical Activity and Survival: Results
 5 Year Survival Rates:
 1-5 hours a week = 97%
 <1 hour per week = 93%
 Absolute Risk Reduction: 4%
 10 Year Survival Rates:
 3-5 hours per week = 92%
 1-3 hours per week = 89%
 <1 hour per week
= 86%
 Absolute Risk Reduction: 6%
Physical Activity and Survival: Results

Beneficial to all women regardless of:
 Stage of disease
 Menopause status
 Activity level prior to diagnosis
 Weight
Physical Activity and Survival: Results
 The reduction in risk of adverse outcomes including
mortality and breast cancer recurrence was 26-40%
 Women who engaged in physical activity equivalent to
walking 1 or more hours per week had better survival
compared to those who exercised less or not all.
 Maximum Benefit walking 3-5 hours per week at an
average pace (2-2.9mph)
Variations in physical activity
dosage
4,11,12,13,14
Breast Cancer
Colon Cancer
Prostate Cancer
2.5hr/wk
5hrs/wk
1.5hr/wk
67% risk reduction
34-40% risk
reduction
Not significant to
reduce cancer
specific mortality
>7hrs/wk
3hrs/wk of Vigorous
Activty for 61% risk
reduction
>6hr a week for
significant
reduction
~40% risk reduction
Physical activity and prognosis 12
 75% of studies conducted in patients with breast,
prostate, GI, ovarian, glioma, and non-small cell lung
cancer found a significant inverse relationship
between exercise and prognosis
 Range of risk reduction for cancer specific or all cause
mortality: 15- 67% and 18%- 67% respectively
What Should We Recommend?
 The extent of risk reduction is dependent on many
variables 8, 12:
 Type of cancer
 Stage of disease
 Exercise prescription and type
 Study design
 Patient lifestyle
 Genetics?
 American College of Sports Medicine (ACSM)
Guidelines- Adopted by the American Cancer Society
(ACS)
ACSM:Exercise Guidelines15,16
ACSM Guidelines (2010) and ACS (2012) for the Cancer Survivor
Avoid Inactivity
Aerobic Exercise: 150 minutes/week of moderate-intensity
aerobic activity (30min 5 d/wk) OR- 75 minutes per week of
vigorous intensity- More for additional health benefits
Resistance Exercise: 2x per week, Exercise and Sport
Science Australia (ESSA) recommends 6-10 exercises, 1-4 sets
per muscle group (6-12 RM)- Focus on Major mm groups
ACSM: Cancer Specific Considerations
Considerations
Prostate Cancer
Incorporate Pelvic Floor exercises
Colon Cancer
Start with low resistance and
progress slowly to avoid herniation
Breast Cancer
Start with supervised program of at
least 16 sessions and very low
resistance
Stem Cell Transplant
OK to exercise everyday but lighter
intensity and lower progression
Bone Marrow Transplant
Resistance > Aerobic
Gynaecologic Cancers
If morbidly obese may require
additional supervision and altered
program
ACSM: Precautions for Exercise
Precautions for Exercise for the Cancer Survivor
Breast and Prostate and/or Bone
metastases
Beware of fracture risk in patients treated with
hormone or angrogen deprivation therapy, or dx
with osteoporosis or bone metastasis
Breast Cancer
Women with UE problems secondary to txmnt
should seek medical care prior to exercising
training the upper body
Colon Cancer
If ostomy is present  physican permission
recommended, excessive intra-abdominal
pressure should be avoided
Stem Cell Transplant
Avoid overtraining- immune system effects
Gynaecologic Cancers
Beware of potential peripheral neuropathy and
women with swelling in the groin, abdomen or
LEs should seek medical care prior to exercise
training of the lower body
Patients undergoing chemo,
radiation or who have
compromised immune function
Care should be taken to reduce infection in fitness
centers
TABLE 3. Exercise prescription for cancer survivors.15
ACSM Guidelines: other
considerations15
 Cardiac conditions will require modifications and may
require increased supervision
 Allow adequate time to heal after surgery
 Avoid exercise during periods of extreme fatigue,
anemia, dizziness, low platelet count, nausea, or ataxia
Physical Therapy Role
 Supervised vs Home Based vs Usual care 7, 18
 Exercise Prescriptions should be individualized 15, 17
 Most patients were interested in receiving physical
activity information preferably by an exercise
specialist. 15
 Adherence: only about ½ of patients who were offered
an exercise program actually undertook and completed
it. 19
Physical therapy Role
 APTA Cancer EDGE Task Force
 Outcome Measures: 6MWT, QOL, Balance, Strength
 PT concerns:
 Lymphedema management
 Cardiovascular care
 Neuropathy/ neurological involvement
 Chemotherapy Toxicity
 General Debility
 Exercise progression
 Pelvic Floor
Community Involvement
Questions???
References
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Center For Disease Control and Prevention. Cancer Prevention and Control. http://www.cdc.gov. Accessed January 22,
2015.
National Cancer Institute at the National Institutes of Health. Cancer Statistics. http://www.cancer.gov. Accessed January
20, 2015.
American Cancer Society. Explore Research. http://www.cancer.org. Accessed January 20, 2015.
Lemanne D, Cassileth B, Gubili J. The role of physical activity in cancer prevention, treatment, recovery, and survivorship.
Oncology. 2013;27(6):580-585.
American Institute of Cancer Research. Reduce Your Cancer Risk. http://www.aicr.org. Assessed February 2, 2015.
Irwin ML, Crumley D, McTiernan A, et al. Physical activity levels before and after a diagnosis of breast carcinoma: the
Health, Eating, Activity, and Lifestyle (HEAL) study. Cancer. 2003;97(7):1746-1757.
Jones LW, Alfano CM. Exercise-Oncology research: past, present, future. Acta Oncol. 2013;52(2):195-215.
Knols R, Aaronson NK, Uebelhart D, et al. Physical exercise in cancer patients during and after medical treatment: a
systematic review of randomized and controlled clinical trials. J Clin Oncol. 2005;23(16):3830-3842.
Betof AS, Lascola CD, Weitzel D, et al. Modulation of Murine Breast Tumor Vascularity, Hypoxia and Chemotherapeutic
Response by Exercise. J Natl Cancer Inst. 2015; 107 (5). doi: 10.1093/jnci/djv040
Holmes MD, Chen WY, Feskanich D, Kroenke CH, Colditz GA. Physical activity and survival after breast cancer diagnosis.
JAMA. 2005;293(20):2479-2486.
Irwin ML, Smith AW, McTiernan A, et al. Influence of pre- and postdiagnosis physical activity on mortality in breast
cancer survivors: the health, eating, activity, and lifestyle study. J Clin Oncol. 2008;26(24):3958-3964.
Betof As, Dewhirst MW, Jones LW. Effects and potential mechanisms of exercise training on cancer progression: a
translational perspective. Brain Behav Immun. 2013;30 Suppl:S75-87.
References
13. Meyerhardt JA, Giovannucci EL, Holmes MD, et al. Physical activity and survival after colorectal cancer diagnosis. J Clin
Oncol. 2006;24(22):3527-3534.
14. Meyerhardt JA, Heseltine D, Niedzwiecki D, et al. Impact of physical activity on cancer recurrence and survival in
patients with stage III colon cancer: findings from CALGB 89803. J Clin Oncol. 2006;24(22):3535-3541.
15. Buffart LM, Galvao DA, Brug J, Chinapaw MJ, Newton RU. Evidence-based physical activity guidelines for cancer
survivors: current guidelines, knowledge gaps and future research directions. Cancer Treat Rev. 2014;40(2):327-340.
16. Schmitz KH, Courneya KS, Matthews C, et al. American College of Sports Medicine roundtable on exercise guidelines
for cancer survivors. Med Sci Sports Exerc. 2010;42(7):1409-1426.
17. Bourke L, Homer KE, Thaha MA, et al. Interventions for promoting habitual exercise in people living with and beyond
cancer. Cochrane Database Syst Rev. 2013 Sep 24;9:CD010192. doi: 10.1002/14651858.CD010192.pub2.
18. Broderick JM, Guinan E, Kennedy MJ. Feasibility and efficacy of a supervised exercise intervention in de-conditioned
cancer survivors during the early survivorship phase: the PEACH trial. J Cancer Surviv. 2013;7(4):551-562.
19. Maddocks M1, Mockett S, Wilcock A. Is exercise an acceptable and practical therapy for people with or cured of cancer?
A systematic review. Cancer Treat Rev. 2009;35(4):383-90.