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Physical Activity & Breast Cancer

Physical Activity & Breast Cancer. By Janet Foote, PhD. Educational Objectives. Discuss the role of movement in: 1. Prevention of breast cancer onset 2. Appropriateness for breast cancer survivors 3. Prevention of Breast Cancer recurrence.

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Physical Activity & Breast Cancer

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  1. Physical Activity & Breast Cancer By Janet Foote, PhD

  2. Educational Objectives Discuss the role of movement in: 1. Prevention of breast cancer onset 2. Appropriateness for breast cancer survivors 3. Prevention of Breast Cancer recurrence

  3. 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

  4. Types of Aerobic Activities walking, jogging, running cycling swimming skiing household: sweeping, vacuuming etc. recreational / occupational

  5. 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 increased risk 1 0.25 0.5 1.5 2.0 50% less likely

  6. Risk Any type of Breast Cancer 17 of 28 cohort studies average 20% risk reduction Ref: Friedenreich CM & Cust AE, Br J Sports Med 42:636-647, 2008

  7. Risk All Types of Breast Cancer 26 of 34 case-control studies average 30% risk reduction Ref: Friedenreich CM & Cust AE, Br J Sports Med 42:636-647, 2008

  8. Overall Findings • All studies - 25% reduction in breast cancer risk • Among only those studies finding that activity reduced breast cancer risk • 36% reduction risk in active

  9. 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.

  10. 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

  11. 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

  12. Additional Factors 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 (28% vs. 22% reduction nulliparous)

  13. 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

  14. Benefits: Mechanisms • Decreased lifetime exposure to estrogen • Decreased % of body fat • Increases immunity & antioxidant defense systems

  15. 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

  16. Intervention Studies • Mostly aerobic activities • Positive effects: resistance training • - anaerobic • Flexibility Do - able! Benefits!

  17. 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

  18. 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

  19. 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

  20. 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”

  21. Physical Activity - Breast Cancer • decreases risk • enhances treatment • improves survival

  22. Beneficial Physical Activity types aerobic (cardiovascular) anaerobic (resistance training) flexibility (range-of-motion)

  23. Challenge Promoting regular activity among: women at risk women undergoing treatment survivors * Develop own hand-out: check boxes for prescription, diaries

  24. 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

  25. Physical Activity Model it Make it happen Just do it!

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