Survivorship, physical activity ms. emer guinan

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: fitness@irishcancer.ie 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: info@plurabellepaddlers.com 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?????