Physical Activity & Breast Cancer By Janet Foote, Ph. D
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
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 (O 2), 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
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
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, 2 nd 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
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 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
Benefits: Mechanisms 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 q decreases risk q enhances treatment q improves survival
Beneficial Physical Activity types aerobic (cardiovascular) anaerobic (resistance training) flexibility (range-of-motion)
Challenge 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
Physical Activity Model it Make it happen
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