Transcript Session 10 Provider Presentation

By
Janet Foote, PhD
Discuss the role of movement in:
1. Prevention of breast cancer onset
 2. Appropriateness for breast cancer
survivors
 3. Prevention of Breast Cancer
recurrence

Physical Activity
Anaerobic
Bouts up to 2 mins, highest % effort,
uses CP & ATP, & results in lactic
acid build-up (burning)
Aerobic - most prevention/survival research
Bouts > 2 mins, sub-max effort, uses
aerobic processes (O2), w/ training can sustain for longer periods
Types of Aerobic Activities
walking, jogging, running
cycling
swimming
skiing
household: sweeping, vacuuming etc.
recreational / occupational
Physical Activity & Breast
Cancer Risk
Recent comprehensive review - 2007
C M Friedenreich & A E Cust
Br J Sports Medicine 42:636-647, 2008
reduced risk
0.25
0.5
increased risk
1
1.5
50% less likely
2.0
Any type of
Breast Cancer
17 of 28
cohort studies
Risk
average
20%
risk
reduction
Ref: Friedenreich CM & Cust AE,
Br J Sports Med 42:636-647, 2008
All Types of
Breast Cancer
26 of 34
case-control
studies
Risk
average
30%
risk
reduction
Ref: Friedenreich CM & Cust AE, Br J Sports Med 42:636-647, 2008
 All
studies
- 25% reduction in breast cancer risk
 Among
only those studies finding
that activity reduced breast cancer
risk
◦ 36% reduction risk in active
Evidence for Aerobic Activity in
Prevention of Breast Cancer Onset
Cohort & Case-control Studies
Differences by menopausal status
WCRF AICR rating of benefits*:
* Premenopausal: “limited suggestive”
* Postmenopausal: “probable”
•
WCRF-AICR Food,Nutrition, Physical Activity & the
Prevention of Cancer: a Global Perspective,
AICR Washington, DC, 2nd edition 2007.
Breast Cancer Risk: Pre-menopausal
5 signif.
14 n.s.
29 of 31
aver.
40%
Risk
Ref: Friedenreich CM & Cust AE, Br J Sports Med 42:636-647, 2008
Breast Cancer Risk: Post-menopausal
20 signif.
10 n.s.
30 of 35
aver. 33%
Risk
Ref: Friedenreich CM & Cust AE, Br J Sports Med 42:636-647, 2008
Effects were greater for:
Recreational activity
Lifetime, activity after age 50
Decreasing categories of BMI
Asian, Black, Hispanic (50%, 40%, & 30%)
Women with no family history
Women - ER-/PR- (0.61) vs. ER+/PR+
(0.86)
Parous women
nulliparous)
(28%
vs.
22% reduction
Activity Responsive Pathways
Immune function
Growth factors, GF binding proteins
Sex hormones & binding proteins
Endogenous antioxidant enzyme systems
Oxidative stress DNA repair
Phase II xenobiotic system
Good review: A. Rundle, Molecular epidemiology of physical
activity and cancer, CEBP 14(1):227-236, 2005
Decreased lifetime exposure to
estrogen
Decreased % of body fat
Increases immunity & antioxidant
defense systems
Intervention Studies
Majority among breast cancer
Significant physiological benefits
Significant psychological benefits
Improved QOL, depression, anxiety
Improved self-esteem
Ref.: DA Galvao & RU Newton, Review of Intervention studies in
cancer patients, J Clin Onc 23(4): 899-909, 2005
Intervention Studies
Mostly aerobic activities
Positive effects: resistance training
- anaerobic
Flexibility
Do - able! Benefits!
Activity: Recurrence Prevention
Minimize post-treatment weight gain
Maintenance lean body mass (BMD)
Enhance immunity/antioxidant systems
Enhance QOL, fatigue and anxiety
Enhance self-esteem & depression
Advantages: aerobic & resistance tr.
Enhance range of motion flexibility
Getting Started
Bring up the subject!
“Here are some things you can do
as part of your treatment,…to help
you live better and longer”.
Be specific in advice
Provide an exercise prescription
Exercise Prescription Elements
1. Frequency - how often
2. Intensity - % effort, 60 - 80%
3. Duration - how long each bout lasts
Additional considerations:
Initial fitness level
Type of exercise
Exercise Prescription: Br CA
Start slowly, but be specific
“3 times during the next week, walk 2
blocks away from your house, turn &
walk 2 more blocks & continue until
you’ve walked back to your house”
Watching 2 hrs TV nightly:
“keep 2 canned goods near your TV &
every commercial alternate holding out
front, to the side, overhead, curls”
Physical Activity - Breast Cancer
 decreases risk
 enhances treatment
 improves survival
Beneficial Physical
Activity types
aerobic (cardiovascular)
anaerobic (resistance training)
flexibility (range-of-motion)
Promoting regular activity among:
women at risk
women undergoing treatment
survivors
* Develop own hand-out:
check boxes for prescription, diaries
Activity Resources
Join: gym w/ set classes (like Curves)
program/organization
(Bone-builders, Walk Across Arizona, Better
Than Ever, litter patrol, dog walkers,
Masters Swim club, hiking club, dance
classes, etc.)
Enlist: friend, spouse, dog
Pedometer: log steps / day on the calendar
working to a 10,000 steps / day goal
Model it
Make it happen