“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 risk-reduction, 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 WilsonAssociate Professor

Department of Internal MedicineProgram Leader Cancer Prevention and Control

Massey Cancer CenterVirginia 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 factorsNon-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.

Brain

Muscles

Bones

HeartPhysical, Physiologic, and Psychological Benefits of Exercise

Blood Pressure

Lower Cholesterol

Improved immune response

Better QOL

Less depression

Higher self- efficacy

Higher Psych well-being

People who exercise regularly are less likely to develop cancer and tosurvive 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

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No leisure timephysical activity

Moderate Vigorous

VirginiaUS

Percent Adults Engaging in Physical Activity, Virginia and US

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 26-40% 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! InterventionCharacteristics of the Sample

Age (yrs) 55 (39 – 66)

Weight (lbs) 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 SampleMenopausal 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 ResultsBaseline (N=22) Post p value*

Exercise Measure Steps/day 4791 8297 <0.001*

Anthropometric measures BMI (kg/m2) 32.7* Weight (lb) 191.2* Body Fat (%) 40.1* Waist circumference (in.) 39.7* Hip circumference (in.) 47.2* Arm circumference (in.) 13.9* Systolic B/P (mm Hg) 140.9* Diastolic B/P(mm Hg) 80.1* Attitudinal measures: Exercise Attitude Total 66.2* Cancer Worry Total 6.8 * Paired “t-test” for difference in group means

Steps/day at Baseline,Post and 3 Month Post Intervention

3 MonthsPostBaseline

Mea

n St

eps

Per

Day

9000

8000

7000

6000

5000

4000

3000

p<.001 B/P***, p=.001*** B/3mth

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.