Cancer Prevention Physical Activity 12 5 16 Colorectal Cancer Diagnosis Regular screening after 50 up to 75 High sensitivity fecal occult blood test FOBT Yearly Flexible sigmoidoscopy Every 5 years with FOBT Colonoscopy Every ten years history will determine frequency and necessity of tests before 50 or after 75 Physical Activity and Colorectal Cancer Case control study Slattery et al 2003 1346 cases of colon cancer 1544 control cases 18 minorites 40 less risk with rectal cancer vigorous activity 20 40 less risk with colon cancer vigorous activity Nurse s Health Study Colon cancer Most studied More than half of all studies report an inverse dose response relationship with confounders accounted for Going from 2 4 MET wk drops substantially More than 21 hours compared to less than 2 45 less risk Consensus evidence suggest 60 mins of moderate vigorous activity significantly reduces risk for colon cancer Lack of PA is related to colorectal cancer 12 14 of colon cancer could be due to lack of vigorous PA 3 4 hr week of vigorous activity optimizes protection RR across all studies 0 7 30 reduction Possible Mechanisms Increases in gut motility Immune system enhancement Decreasing diabetic environment Insulin regulation Decreasing obesity Breast Cancer A cancer that forms in the cells of the breast Ductal carcinoma most common begins in ducts Lobular carcinoma milk glands Facts 1 in 8 women in US will develop 30 of cancers in women are Breast Risk Factors Age Sex Heredity Prior cancer breast ovarian uterine bowel Obesity 9 9kg increase after menopause 18 increase in breast cancer Lack of physical activity Excessive alcohol 12 7 16 Physical Activity and Breast Cancer Nurse s Health Study No best prevention can be moderate or vigorous 20 less risk Don t know what light activity does 10 lower risk 9 RR for 1 6 9 h wk of exercise Women s Health Study et al 2001 Regardless of increasing physical activity there s not reduction in premenopausal group 30 reduction in postmenopausal group from PA Physical activity and breast cancer Evidence suggests that about 30 60 min of mod vig activity significantly reduces risk for breast cancer RR for breast cancer and PA 0 8 20 reduction in risk with 7hr wk 10 reduction with 7h Potential Mechanisms High fat intake Obesity and weight gain Sex hormones Prostate Cancer Increased risk Ancestry african american men Caribbean men of african ancestry 60 years Positive family history High fat diet BMI Alcohol Environmental toxins Most common cancer among men African American men 2x as likely to die from prostate cancer than white men Signs and symptoms Problems urination Blood in urine or semen Erectile dysfunction Weakness or numbness in legs and feet Loss of bladder control Diagnosis Blood test Prostate Specific Antigen PSA 4ng ml normal 15 of men with PSA below will have prostate cancer Digital rectal exam DRE Transrectal ultrasound TRUS When PSA and DRE are normal confirmatory Lifestyle and Prostate Cancer Prevention Maintain a healthy weight Avoid excess weight gain Be physically active Limit sedentary time Avoid processed meat and red mead Vegetarian diet 2 c veggies and fruits day Choose whole grains over refined grains Low fat diet high omega 3FA Limit alcohol intake PA And Prostate Cancer Studies Studies are mixed RR is 0 9 Mechanisms Hormones Decreased obesity Immune system Higher waist circumference related to high prostate cancer incidence Physical Activity and Cancer Treatment Rehabilitation 12 9 16 Cancer treatment Surgery Minor or major Radiation Ionizing radiation 5 appts wk 6 wks Before or after surgery Alone or in combination with chemotherapy Chemotherapy Oral or IV Duration varies Hormone therapy Immune Specific targeted therapy Treatment Side effects Low red blood cells Loss of appetite Easy to bruise and bleed Hair loss Compromised immune system infection Memory lapses Pain Anxiety Depression Fear ACS guidelines Achieve and maintain healthy weight Be physically active Exercise is safe Improves muscle strength balance fatigue depression Eat a healthy diet ACSM Guidelines 2011 Cancer patients should adhere to the 2008 federal PA guidelines for Americans Clinicians should advise cancer survivors to avoid inactivity even for patients with existing disease or who are undergoing difficult treatments Clinicians and fitness professionals should pay close attention to cancer survivors responses to PA Although more research should be done on the effects of strength training on cancer survivors the practice generally appears to be beneficial Physical Activity and Cancer Treatment Rehabilitation Quality of life Inability to function at the same level as before disease and treatment Incorporation physical activity during cancer treatment rehabilitation can diminish side effects and improve quality of life Other effects Fatigue fitness mood body comp cancer biomarkers Study Anderson et al 2006 77 participants Cancer patients diagnosed in the last 1 month Received at least 1 cycle of chemotherapy 18 65 years of age Intervention lasted for 6 weeks 1 hr 30 min day 3 times per week Intervention Multi faceted Resistance Fitness training Relaxation techniques Balance and co ordination Change in 12 different side effects All symptoms decreased after 6 weeks Fatigue the most change Conclusions About 70 reported significant improvements in side effects Increased daily functional ability Greater adherence to intervention Livestrong Program and Cancer Survivors Created in 2008 largest scale program for PA and cancer Community based program for cancer survivors Free or low cost often families also given membership Served 37 000 12 week program Irwin 2016 Evaluation of LiveStrong Program Effectiveness safety Livestrong participants vs Waitlist 75 of people meet PA The program is efficacious in improving fitness Strength Training and Survivors Robust improvement in strength 20 50 increase Variety of different cancer types Improvements in functional tests I e up and go chair stand 6min walk No improvements in body comp No improvements in psychosocial outcomes 12 12 16 Cancer control and Survivorship Quiz on Moodle due Wednesday by 5pm PA and Breast Cancer Survivors 13 22 RCT s Randomized control trial show that exercise training during chemotherapy or radiation therapy is safe Aerobic and strength important for evaluation of mobility training show improvements in fitness and strength respectively Mixed results on decreases in body composition Mixed results on decreases