Download “Living Your Best After Cancer: Being Physically Active as a Survivor

“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 riskreduction, 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 Wilson
Associate Professor
Department of Internal Medicine
Program Leader Cancer Prevention and Control
Massey Cancer Center
Virginia 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 factors
Non-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.
Better QOL
Physical,
Physiologic,
and
Psychological
Benefits of
Exercise
Brain
Less depression
Blood Pressure
Higher
selfefficacy
Higher
Heart Psych
wellbeing
Improved immune
response
Bones
Lower Cholesterol
Muscles
People who exercise regularly are less likely to develop cancer and to
survive 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
Percent Adults Engaging in Physical
Activity, Virginia and US
50
45
40
35
30
Virginia
US
25
20
15
10
5
0
No leisure time
physical activity
Moderate
Vigorous
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 2640% 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! Intervention
Characteristics of the Sample
Age (yrs)
Weight (lbs)
55 (39 – 66)
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 Sample
Menopausal 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 Results
Baseline (N=22)
Exercise Measure
Steps/day
Anthropometric measures
BMI (kg/m2)
Weight (lb)
Body Fat (%)
Waist circumference (in.)
Hip circumference (in.)
Arm circumference (in.)
Systolic B/P (mm Hg)
Diastolic B/P(mm Hg)
Attitudinal measures:
Exercise Attitude Total
Cancer Worry Total
* Paired “t-test” for difference in group means
4791
32.7*
191.2*
40.1*
39.7*
47.2*
13.9*
140.9*
80.1*
66.2*
6.8
Post
8297
p value*
<0.001*
Steps/day at Baseline,Post and 3
Month Post Intervention
9000
8000
7000
6000
5000
4000
3000
Baseline
p<.001 B/P***, p=.001*** B/3mth
Post
3 Months
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.