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SURVIVORSHIP – PHYSICAL ACTIVITY
EMER GUINAN MISCP
Supporting People with Breast Cancer Irish Cancer Society Annual Patient Conference 29.09.2012
Physical Activity Workshop
Role of modifiable risk factors in breast cancer Physical activity Body composition
Practical activities Body mass index Waist circumference Exercise prescription
Who am I??
Emer GuinanChartered physiotherapist, MISCP.
Main interests: The role of physical activity in chronic disease, in particular
cancer Exercise testing and prescription.
“The Metabolic Profile and Physical Activity Levels of Breast Cancer Survivors and BRCA Mutation Carriers”
Dr. Juliette Hussey, Discipline of Physiotherapy, TCD.Ms. Elizabeth Connolly, Consultant Surgeon, St. James’s Hospital.
Breast Cancer Risk Factors
Risk Age Family History
Prognosis Characteristics of
the breast tumour
Obesity Physical inactivity Alcohol
consumption HRT
Non-Modifiable Modifiable
Obesity, physical activity and cancer
Obesity and Breast Cancer
Obesity and Cancer Risk
Overweight and Obesity
Increases Risk
Total Body Fatness• Oesophagus• Pancreas• Colorectal• Postmenopausal
breast• Endometrium• KidneyAbdominal Fatness• Colorectal• Pancreas• Postmenopausal
breast • Endometrium
Obesity and Cancer
Metabolically Active• Insulin• Inflammation• Cholesterol• Glucose• Blood pressure
Ideal environm
ent for tumour growth
and progressi
on
Abdominal Fat(visceral fat)
Obesity
Obesity
Poorer breast cancer
prognosis
Increases breast cancer
risk
Weight Gain during Treatment Treatments
Chemotherapy Hormonal therapy (Tamoxifen)
Who? Premenopausal women
Why? Decreased physical activity levels Changes in diet Lower metabolism Side effects
Recommendations
Aim to be a healthy weight for your height
Body Mass Index (BMI)
Do not let fat accumulate on your tummy
Waist circumference
During breast cancer treatment do not either gain or lose weight
Some important measurements…. Body Mass Index Waist Circumference
Body Mass Index (BMI)
BMI is a measure of body fat based on height and weight
Waist Circumference
Measuring Waist Circumference Find the top of the hip bone
Find the last rib
Estimate the mid-point between the hip bone and the
last rib
Place the tip of the measuring tape at this point
Your partner should hold the tape in place as you spin
around, allowing the tape to wrap around you
Remember: relax the tummy! Do not hold your breath!!!
Waist Circumference
Increased Risk
Substantially Higher Risk
Men 94 cm 102 cm
Women 80 cm 88 cm
Physical Activity and Breast Cancer
Physical Activity and Cancer Risk
Physical ActivityDecreases Risk
Convincing Evidence• Colon
Probable Evidence• Postmenopausal
breast • Endometrium• Lung • Pancreas• Premenopausal
breast
Physical Activity throughout the cancer experience
Breast Cancer Prevention
During Treatment Breast Cancer Survivorship
Breast Cancer Prevention
Women who are physically active throughout their live have a 25%
reduced risk of developing breast cancer after the menopause
During Breast Cancer Treatment
Breast Cancer Survivorship
Being physically active after a breast cancer diagnosis…..
2-3 hours of brisk walking per week
26% reduced risk of breast cancer recurrence
30-40% reduced risk of death from any cause
Physical Activity and Obesity
Metabolically Active• Insulin• Inflammation• Cholesterol• Glucose• Blood pressure
Ideal environm
ent for tumour growth
and progressi
on
Abdominal Fat(visceral fat)
Physical A
ctivity
Breast cancer survivors…
Reduction in physical activity levels at breast cancer diagnosis.
Rarely return to “normal” physical activity levels when treatment is complete.
66% of waking hours spent sedentary / inactive
Poor adherence to physical activity guidelines
Physical Activity Guidelines
30 Minutes of Moderate Intensity Physical Activity x5 Days per Week
Avoid Inactivity
The 10 minute rule
10 Minute Bouts
10 minute walk to the shop /
work
10 minute household
chore10 minute
walk/jog/stair climbing during
lunch
Physical Activity
“Any body movement, produced by skeletal muscles and resulting in energy expenditure that exceeds resting levels”
Recreational
Transport Househo
ld
Occupational
Benefits of Physical Activity
Improves cardiovascular fitness Improves bone quality Reduces blood pressure Reduces cholesterol Reduces insulin resistance and the risk of diabetes Improves body composition Reduces low-grade inflammation Improves quality of life Improves symptoms of depression Reduces the risk of chronic diseases (heart disease,
stroke) Reduces cancer related fatigue Improves breast cancer prognosis
Types of Exercise
• Walking• Aerobics• Swimming
• Weights• “Curves”
• Pilates• Yoga
Aerobic Strength
CoreFlexibilit
y
Types of Exercise
• Walking• Aerobics• Swimming
• Weights• “Curves”
• Pilates• Yoga
Aerobic Strength
CoreFlexibilit
y
What is aerobic exercise?
Exercise that increases your heart rate and where you sweat but you can still hold a conversation.
Moderate intensity
Methods to measure exercise intensity Rate of perceived exertion The “Talk Test” Heart rate monitor
Borg Rate of Perceived Exertion
Moderate
intensity exercise
You can talk but you can’t sing!
Heart Rate Monitor
Moderate intensity = 64-76% Maximum Heart Rate
Maximum Heart Rate = 220 - age
Example: 50 year old woman
Maximum heart rate = 220 – 50 = 170 beats per min
Moderate intensity exercise = 64-76% (170)
= 108.8 – 129.2= 108 – 129 beats
per min
Ideas for Exercise
Walking!!!!
Take up a sport
Join a class Aerobics
Exercise groups for women following breast cancer Irish Cancer Society Exercise programme Plurabelle Paddlers “Move On”
Irish Cancer Society
Free exercise programmes for people following breast and colon cancer
30 weeks Walking programme
9 MET-hours.weekˉ¹ 2-3 hours of brisk walking
Light weights programme Supervised by exercise specialists
Website: www.cancer.ie Contact: [email protected] Telephone: 01 2316624
Plurabelle Paddlers
First dragon boat team in Ireland 60+ active members (aged 30-70+) 2 boats Train March to November on Wednesday
evenings and Saturday mornings Fitness classes during the winter The repetitive movement strengthens the arms
and reduces lymphedema
Website: www.plurabellepaddlers.com Contact: [email protected] Telephone: 0872806048
“Move On”
A medically supervised exercise programme for breast and colon cancer survivors.
Only for patients of Beaumont or the Mater Hospitals
3 month exercise programme Three classes per week Home exercise programme DCU Sport Ask your doctor for a referral
Exercise after Breast Cancer
Arm and shoulder Pain Reduced range of movement (stiffness)
Lymphoedema
Bone health Hormone therapy
Arimidex Femara
Exercise and Bone Health
Weight-bearing exercise Walking Running Step aerobics
Muscle Strengthening
Exercises that don’t improve bone health Cycling Swimming Aqua aerobics
Side-Effects of Exercise
Muscle soreness Warm-up / Cool-down Stretching Proper footwear Warm bath
Dehydration / cramp Drink lots of fluids while exercising
Medical Clearance to ExerciseIf you answer yes to any of the following questions consult with your doctor before starting any new exercise programme.
1. Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?
2. Do you feel pain in your chest when you do physical activity?
3. In the past month, have you had chest pain when you were not doing physical activity?
4. Do you lose your balance because of dizziness or do you ever lose consciousness?
5. Do you have a bone or joint problem (for example back, knee or hip) that could be made worse by a change in physical activity?
6. Is your doctor currently prescribing drugs (for examples water pills) for your blood pressure or heart condition.
7. Do you know of any other reason why you should not do physical activity?
Take Home Message
Being physically active after breast cancer has a wide range of health
benefits and is one of the things that you can do to reduce your risk of
breast cancer recurrence.
Aim for 30 minutes of moderate intensity activity 5 days per week
Acknowledgements
Questions?????
