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 ½ 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