Make a Change, Live Well

1. Make a Change, Live Well With thanks to the Friends of the Royal Marsden-Chelsea and Macmillan Cancer Support

2. Programme of the day

3. What is in your pack Inside your packs for the day you should have items including: - Programme for the day - Macmillan 10 Top Tips - Walking for health, Macmillan and the Rambler - Diet and Breast Cancer Plus your personal goal programme

4. Setting the Scene… • The aim of today is to provide general advice about health and well being, and how you can make positive changes to your lifestyle.  • If it prompts any individual questions or concerns about your health or any aspect of your recovery from breast cancer please contact your Breast Care Specialist Nurse/ Keyworker at The Royal Marsden.  • If you are not a registered patient at The Royal Marsden you should contact your GP in the first instance.

5. The Recovery Package National Cancer Survivorship Initiative, April 2014

6. Physical activity:Overcoming the Hurdles Siobhan Cowan Dickie Clinical Specialist Physiotherapist Make a Change Physical activity 2015

7. Physical activity vs exercise:what’s the difference?

8. Physical activity vs exercise

9. Make a Change Physical activity 2015 What do we know about physical activity?

10. Make a Change Physical activity 2015 Question 1What are the current government guidelines for the amount of exercise or activity we should be doing on a weekly basis? • 30 minutes of moderate exercise, three times a week. • 15 minutes of moderate exercise, five times a week. • 30 minutes of moderate exercise, five times a week. • 10 minutes of moderate exercise, seven times a week.

11. Answer to Question 1: The correct answer: C Department of Health recommends: 30 minutes moderate exercise 5 x week 150 minutes moderate intensity exercise per week or (75 minutes vigorous intensity exercise per week) Question: How strongly should I exercise? Answer: Talk not sing! Make a Change Physical activity 2015

12. Together with…. • Some form of muscle strengthening activity 2 days per week i.e. lifting weights/shopping, resistance bands, heavy gardening, climbing stairs, yoga, Pilates And…. avoid sitting for too long!

13. Moderate intensity v Vigorous intensity • Brisk walking • Cycling – level ground • Aqua-aerobics • Doubles tennis • Pushing lawn mower • Hiking • Basketball/volleyball • Jogging/running • Cycling – hills • Fast swimming • Singles tennis • Aerobics • Football/rugby/hockey • Skipping

14. Make a Change Physical activity 2015 Question 2:How many people in the UK do enough physical activity to keep their heart healthy? • 3 out of 10 • 4 out of 10 • 5 out of 10 • 6 out of 10 • 7 out of 10

15. Make a Change Physical activity 2015 Answer to Question 2: Correct answer A: 3 out of 10 The most important thing is to make small changes to your level of physical activity. Gradually increasing the amount you are walking and putting more energy into your housework can really make a positive impact on the amount of physical activity you do.

16. Why be physically active? Keeps your heart healthy Reduces risk of other health problems Increases muscle bulk and tone Improves energy levels Boosts mood and self esteem Improves brain function Make a Change Physical activity 2015

17. Why is exercise so important after a cancer diagnosis? Make a Change Physical activity 2015

18. Why be physically active after a cancer diagnosis? Strong evidence that being active to current government recommended guidelines can reduce the risk of breast cancer recurrence Most of the evidence is in hormone positive breast cancers Research suggests that 25-50% of patients are less active after a breast cancer diagnosis It can also help with the side effects of treatment. Make a Change Physical activity 2015

19. So – if it is so easy and beneficial – why don’t we all do it? Some of the hurdles to exercise! Make a Change Physical activity 2015

20. HURDLE 1: Motivation Pros to exercise: Improving your health Sense of achievement Chance to discover something new Helping to control your weight Cons to exercise: I’ll start tomorrow How do I find the time I have never liked exercise Make a Change Physical activity 2015

21. HURDLE 2: Tiredness / fatigue Pros to exercise: The evidence suggests that exercise can help manage fatigue Setting healthy goals can be very motivating Cons to exercise: It’s all I can do to get out of bed in the morning I have so much else I want to be able to do in the day I went for a run yesterday and now I am exhausted! Make a Change Physical activity 2015

22. HURDLE 3: It all hurts! Pros to exercise: The evidence is strongly in favour of moderate, regular exercise for everyone, including people who have had treatment for cancer Starting slowly is the best way to avoid overdoing it If in doubt check with your GP before starting a new form of exercise Cons to exercise: Will it cause damage? What if I over do it? Make a Change Physical activity 2015

23. HURDLE 4: Weight Change/ Body Image Pros to exercise: You don’t have to join a gym in order to exercise 2. Regular exercise will help you control your weight if that is your goal 3. Improving your muscle strength will have a big impact on your body shape Cons to exercise: I’m embarrassed to go to the gym looking like this Make a Change Physical activity 2015

24. Question 3 To what extent is it true that exercise is an effective way to lose weight? Totally true – it is easy to lose weight with exercise Partly true – but only if you do very challenging exercises Not really true – it is difficult to lose weight through exercise alone Totally not true – exercise won’t help you lose weight None of the above – depends on the individual Make a Change Physical activity 2015

25. Answer to Question 3: The correct answer: C Unless you have only a few pounds to lose it’s quite hard to lose weight through exercise alone. Weight loss is all about burning more calories than you take in each day – and it's much easier to shave off 500 calories a day by cutting back on fatty foods in your diet, than it is to exercise to that level. Make a Change Physical activity 2015

26. The average person would have to run about five miles to burn the same number of calories. However, regular exercise combined with calorie reduction gives you the best chance of losing weight and keeping it off Make a Change Physical activity 2015

27. Calorie-burning exercises • High calorie burning exercise – cycling/swimming/aerobics • Moderate calorie burning exercise – gardening/housework/Tai chi • Low calorie burning exercise – yoga/Pilates

28. HURDLE 5: Lymphoedema Pros to exercise: The evidence supports exercise to help lymphoedema – but remember to build it up gradually Cons to exercise: Will exercise make it worse? Make a Change Physical activity 2015

29. Bone and Joint health Once women have reached the menopause they are at risk of a bone thinning condition called osteoporosis This can also affect women who are receiving hormonal treatment for their breast cancer such as tamoxifen or letrozole Joint pain is a common side effect of some medications. Gentle exercise such as walking, swimming and joint stretches can be beneficial. Make a Change Physical activity 2015

30. Question 4.Which of these types of exercise is best at helping you maintain strong bones? Aerobic exercises Weight bearing exercises Resistance exercises All of the above Make a Change Physical activity 2015

31. Answer to Question 4: Correct answer: D All of these types of exercise will help to maintain strong bones. Exercises such as walking are often a good way to start as it is easier to fit it into your daily routine. Make a Change Physical activity 2015

32. How do I incorporate physical activity into my lifestyle. Talk to your GP if you have any concerns about your health before starting to exercise. Take up a new hobby Find an exercise partner to keep you motivated. If particular concerns book a session with a physio or ask for a referral to an exercise scheme Do something you enjoy! Make a Change Physical activity 2015

33. Spring into Action Spring Into Action is a one –off clinic at the Royal Marsden for people who have had or are having treatment for cancer to advise on making changes to diet or physical activity levels If you have specific questions regarding your own barriers please pick up a flyer in the break Make a Change Physical activity 2015

34. WHERE DO WE GO FROM HERE? To make sustained change I need to consider: The goals I would like to achieve How I am going to maintain this as part of a lifestyle change Where can I find information / support to get started Make a Change Physical activity 2015

35. Preautions and common sense advice • If you have any pre-existing conditions, speak to your GP before starting. • If you feel unwell or have any chest pain, unexplained swelling, sudden shortness of breath, stop and tell a healthcare professional • Wear good footwear and appropriate clothes • Don’t exercise if feeling unwell • Stay hydrated • Don’t exercise after a heavy meal • If balance an issue be cautious on uneven surfaces • Start gradually and build up

36. Other resources/ information • Macmillan Move More Pack • Walking for health- local health walks • Park Run • Apps: Couch to 5k Active10 • Local exercise on referral schemes.

37. What should we eat & drink to be healthy? Penelope Mctaggart Specialist Oncology Dietician Make a Change, Live Well 30.09.2013 37

38. Make a Change Physical activity 2015Make a Change, Live Well 30.09.2013

39. Food Glorious Food... All things in moderation......... 39 39 Make a Change, Live Well 30.09.2013 Make a Change, Live Well

40. World Cancer Research Fund UK Recommendations Be as lean as possible without becoming underweight Be physically active for at least 30minutes every day Avoid sugary drinks and limit the consumption of high calorie foods Eat more of a variety of vegetables, fruits, whole grains and pulses Limit intake of red meat and avoid processed meat Limit alcoholic drinks to 2 a day for men and 1 a day for women Limit consumption of salty foods Do not use nutritional supplements to protect against cancer After treatment, cancer survivors should follow the recommendations for cancer prevention 40 40

41. WCRF guidance for Breast Cancer Survivors October 2014 41 Evidence is not strong but there are indications of links between better survival and • A healthy body weight • Eating foods containing fibre • Eating foods containing soy • A lower intake of total fat & saturated fat To follow the 8 key recommendations for all survivors

42. Aim to be a healthy weight Aim for a healthy weight for your height BMI 20 – 25 Aim for a healthy waist measurement Less than 31 ½ inches / 80cm for women Less than 37 inches / 94cm for men 42 42

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44. Q1. Which is highest in calories/energy? A slice of wholemeal bread 1 tablespoon olive oil 1 medium (grande) latte 4 oz cooked pasta 44

45. Top tips Correct answer is a Latte Use a smaller plate Eat regularly Eat more slowly Avoid distractions Have a drink Keep healthy snacks around 45 45

46. A word about sugar… Sugary drinks have been shown to contribute to weight gain Choose sugar free versions, no added sugar versions, water, unsweetened tea or coffee Natural fruit juice counts as a piece of fruit but limit to one glass per day 46 46

47. Q2. How big is a healthy portion of meat? Size of a cheque book Size of a matchbox Size of a pack of playing cards Size of a box of tissues 47

48. Fats Correct answer is: A pack of playing cards for meat & oily fish A cheque book for white fish 48 48

49. Fats Small amount of fat - essential for health and to make foods more pleasant to eat. However large amounts can lead to excessive weight gain. Two main types of fat: Saturated fats: animal fat: meat, butter, cheese, pastries and cakes. Unsaturated fats: vegetable oils, such as sunflower, soya, olive and corn, in nuts and oily fish, such as mackerel, tuna and pilchards. All fats contain the same amount of energy (calories). 49 49 Make a Change, Live Well 30.09.2013

50. How to eat less fat Choose a low or reduced fat spread and use sparingly. Use semi-skimmed or skimmed milk rather than whole milk. Try using low fat yoghurt . Try half-fat hard cheese or cottage cheese. Cut down on crisps, chocolate, cakes, pastries and biscuits. Try microwaving, steaming, poaching, boiling or grilling. Remove skin off poultry and visible fat from the meat before you start cooking. 50 50