Living Your Best After Cancer: Being Physically Active as a Survivor' Diane Baer Wilson, EdD, MS, RD

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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

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Being Physically Active as a Cancer Survivor

• Dr. Diane Baer Wilson
• Associate Professor
• Department of Internal Medicine
• Program Leader Cancer Prevention and Control
• Massey Cancer Center
• Virginia Commonwealth University

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Tonight

• Health benefits of being more physically active
• Research examining exercise and its impact on
  cancer survivorship
• How to start being more physically active

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Cancer risk factors
Non-modifiable Family History Age
Gender
Modifiable Tobacco use
Diet/exercise-Energy Balance Alcohol
over-consumption Other
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Preventable causes of death in the US
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• Regular exercise reaps more benefits than most
  other health habits because of its systemic
  effect on the human body.

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Higher self- efficacy Higher Psych well-being
Better QOL Less depression
Brain
Physical, Physiologic, and Psychological Benefits
of Exercise
Heart
Blood Pressure
Improved immune response
Bones
Muscles
Lower Cholesterol
People who exercise regularly are less likely to
develop cancer and to survive longer after a
cancer diagnosis
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Why is it important to be physically active?

• Overall individuals who are more physically
  active
• are more likely to maintain a BMI gt25 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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Percent Adults Engaging in Physical Activity,
Virginia and US
Virginia ranks 23rd in the nation, Colorado
ranks 1st
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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

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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
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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 gt 5-6 hours /week.
  (Independent of pre-dx PA)

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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?

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Determinants of exercise in patients with
multiple myeloma

• Jones et al. (2006) studied the determinants of
  intention to exercise in patients (n77).
• 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.

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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

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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

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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.

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Walking Counts! Intervention
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Characteristics of the Sample
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Study Results

• Baseline (N22) Post p value
• Exercise Measure
• Steps/day 4791 8297
  lt0.001
• 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

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

plt.001 B/P, p.001 B/3mth
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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

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Include daily exercise on your path to optimal
health!
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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 Masseys Rural
  Cancer Outreach Program
• Teaches residents and health professionals about
  prevention, long-term patient management and
  survivorship issues.