Transcript Physical activity during and after breast cancer treatment

Mike Grisenthwaite
Director and Founder
About me…..
 Diagnosed 2000 – Lymphatic
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Cancer NHL
Ironman Triathlon 2001
Numerous other endurance events
Relapse 2005
Donor stem cell transplant or BMT.
2007 Tour de France 2200 miles in
19 days
Personal Trainer and Certified
Cancer Exercise Specialist –
Northern Colorado University
Overall Cancer Risk
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Involvement in occupational or leisure-time activity
or being physically fit is associated with a reduced
risk of cancer
Typical risk reduction of 20-30%
Independent of other lifestyle
factors
Risk reduction is dose-related
Physical Activity and Cancer Prevention:
Possible Mechanisms
 Sex steroid hormones: oestrogen, testosterone
 Energy balance & fat distribution
 Growth factors: Insulin/ IGF-1/IGF-BP3
 Anti-inflammatory system – C reactive Protein, interleukins
 Immune defence system: NK cells
 Antioxidant defence system/DNA damage/ apoptosis
Cancer Survivorship
Cancer Statistics - 2002
 Cancer incidence:
 One in three people in UK will develop some form of cancer in
their lifetime.
 Cancer survival rates have increased:
 43% of men and 54% of women survived to five years after
diagnosis (prostate has improved to 60% and breast to 77%)
 Number of survivors:
 2% of men and 2.7% of women in Scotland are living with
cancer (1.2% of women in Scotland are living with breast
cancer).
Exercise and Activity for Children
and TYA’s - Evidence
 The few childhood studies
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are far more neutral.
Restricted by numbers of
participants
Access to facilities
Measurement comparisons age
Activity motivation
Research evidence
Beneficial effects of exercise interventions
Exercise during
treatment
Exercise after treatment
Functional capacity
Exercise capacity
Body weight &
composition
Natural killer (NK) cell activity
Fatigue
Nausea
Flexibility
Mood
Self-esteem
Lean body mass & body fat %
Physical well-being
Decreased levels of depression &
anxiety
Satisfaction with life
Quality of life
Quality of life
No adverse effect on Lymphoedema
Exercise After Diagnosis & Association with Recurrence &
Mortality
Data from Cohort of 2987 Breast Cancer Survivors in Nurse’s Health Study
1
0.9
0.8
Relative Risk
0.7
0.6
0.5
recurrence
breast cancer mortality
0.4
0.3
all cause mortality
0.2
0.1
<3
3-8.9
9-14.9
15-23.9
24+
0
Level of Exercise (MET hrs/week)
Holmes et al. JCO 20:2479-86, 2005
The Rehabilitation Exercise for Health
After Breast Cancer (REHAB) Trial
 RCT comparing aerobic
exercise to control in 53
postmenopausal BC
survivors post therapy.
 Primary endpoints were
QOL, fitness, biomarkers.
Peak Oxygen Consumption
(ml/kg/min)
Peak Oxygen Consumption
22
Exercise
Control
21
20
Baseline (p=.807)
Change (p<.001)
3.3 (18%)
19
18
17
Baseline
Posttest
(Courneya et al. JCO 2003;21:1660-8)
Overall Quality of Life
(FACT-B: 0-140)
Overall Quality of Life
122
Exercise
Control
120
118
116
Baseline (p=.286)
Change (p=.001)
8.8 (3.6 to 14.0)
114
112
110
108
Baseline
Posttest
(Courneya et al. JCO 2003;21:1660-8)
IGF-1/IGFBP-3 Molar Ratio
IGF-1/IGFBP-3 Molar Ratio
0.04
Exercise
Control
0.038
0.036
0.034
0.032
Baseline (p=.518)
Change (p=.017)
-0.006 (-0.01 to -0.001)
0.03
0.028
0.026
0.024
Baseline
Posttest
(Fairey et al. CEBP 2003;12:721-7)
Natural Killer Cell Cytotoxic
Activity (E:T = 3:1)
15
Exercise
Control
14
% Specific Lysis
13
12
11
10
9
Baseline (p=.307)
Change (p<.001)
6.0 (2.8 to 9.1)
8
7
6
5
4
3
Baseline
Posttest
(Fairey et al., submitted)
Activity Levels for Patients and
Survivors What is recommended?
 30 minutes
 5 days a week
 To a moderate intensity i.e.
60 – 70% of Maximum Heart
 Can be accumulative.
 This applies to everyone here!
VERY IMPORTANT – Practical note
 Carers need to buy in to this
Nacer – Wish list
To get exercise based rehabilitation results into practice via;
 Integrating physical activity with other supportive care
interventions:
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Physiotherapy.
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Psychosocial interventions.
Complementary Therapies etc.
 Training of primary, secondary and tertiary health
professionals and community based exercise instructors.
 Provision of information through various existing media
channels
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Future Projects - Nacer
Participation in TYA Cancer Survivorship programme at the
Christie Hospital.
More user friendly Website Focused on Patients and
Support Networks
Supplying information on
 local initiatives
 Cancer Exercise Specialists
 One to one consultation
 Latest proven research, downloads etc.
Cyclists Fighting Cancer
in 2CFC award new bikes, tandems and specially adapted trikes to children and
young people who have been affected by cancer throughout the UK and
Northern Ireland.
 We encourage cycling as the best form of exercise based rehabilitation for
those children undergoing and recovering from cancer treatments.
 To encourage them further CFC also give bikes to their siblings and in many
cases their parents in order that they can take part in an activity as a family
once again after what can be years of hospitalisation and disruption.
 Awarded over 300 bikes so far.
Bike Awards
 Referrals via Clic Sargent
and other social workers,
Physios, Consultants,
Support groups etc.
 0-18 years
 Siblings Included
 Can include parents
 No Cost whatsoever
 UK and Northern Ireland
The Benefits
 Moment of delight
 Assists mobility
 Gives back choice
 Family Activity
 Reintegration/normality
 Reconditioning of Muscles
 Help with side affects of
treatment
Future Projects - CFC
 Pilot Scheme at the John
Radcliffe Hospital Oxford.
 CFC has provided 2 static
exercise bikes in junior
and Adult size. 5’ 2”
upwards
 Currently undergoing
evaluation by physio’s on
site.
 We hope to identify 2
further hospitals in 2009.
Get Set, Ready, Go!
 Contact details
 email: [email protected]
 Web:
www.cyclistsfc.org.uk
www.nacer.org.uk
Thank you.