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Evidence of reduced risk from physical activity Convincing Probable Limited but suggestive Colon Breast (post-menopausal) Endometrium Lung Pancreas Breast (pre-menopausal) Conclusions of World Cancer Research Fund (WCRF) expert report (2007) and continuous update project (CUP)

Pre-diagnosis (prevention) Pre-treatment (prehabilitation) Survivorship (health promotion) End of life (palliation) Treatment (symptom control) Post-treatment (rehabilitation)

Physical activity and survival Emerging evidence of physical activity post-diagnosis as an independent predictor of survival time/disease progression Cancer Studies Risk reduction Breast 4 >20% cancer mortality/progression Colorectal 6 >30% cancer mortality/progression Prostate 2 >50% cancer mortality/progression Lung 1 >30% total mortality Brain 1 >30% total mortality

Exercise is safe both during and after most cancer treatments Patients are advised to avoid inactivity and return to normal daily activities as soon as possible after surgery, and during adjuvant cancer treatments The standard age appropriate guidelines are also appropriate for cancer patients

Safety considerations Potential risk Precaution Exacerbate symptoms Avoid high intensity; modify based on site of treatment Immune suppression Avoid high intensity/volume & public places while white blood cell counts are low Bone fractures Avoid high impact/contact with bone metastases/osteoporosis risk Falls Avoid activities needing balance with dizziness/frailty/peripheral neuropathy

50 45 40 35 30 Active enough 25 Some Actviity 20 Inactive 15 10 5 0 % Department of Health. Improving Outcomes. (2102). A Strategy for Cancer. Second Annual Report. London: Stationery Office.

Macmillan Cancer Support/ICM. (2011). Online survey of 400 health professionals who deal with cancer patients (100 GPs, 100 practice nurses, 100 oncologists, and 100 oncology nurses, of whom 52 were oncology nurse specalists). Fieldwork conducted 23 May-12 June 2011. Survey results are unweighted.

Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Patticrew M. Developing and evaluating complex interventions: new guidance. Medical Research Council; 2008 Sep pp. 1 – 39.

Michie S, van Stralen MM, West R. The behaviour change wheel: A new method for characterising and designing behaviour change interventions. Implementation Science. Bio. Med Central Ltd; 2011 Apr 23; 6(1): 42.

Michie S, van Stralen MM, West R. The behaviour change wheel: A new method for characterising and designing behaviour change interventions. Implementation Science. Bio. Med Central Ltd; 2011 Apr 23; 6(1): 42.

Michie S, van Stralen MM, West R. The behaviour change wheel: A new method for characterising and designing behaviour change interventions. Implementation Science. Bio. Med Central Ltd; 2011 Apr 23; 6(1): 42.

Michie S, Richardson M, Johnston M, Abraham C, Francis J, Hardeman W, et al. The Behavior Change Technique Taxonomy (v 1) of 93 Hierarchically Clustered Techniques: Building an International Consensus for the Reporting of Behavior Change Interventions. ann behav med. Springer US; 2013 Mar 20; 46(1): 81– 95.

Health care professional responsibilities: if you have only 60 seconds ASK about current physical activity levels and if they are aware of the benefits of moving more ADVISE of the benefits of physical activity to people living with and beyond cancer ACT signpost on for more help and support

Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Patticrew M. Developing and evaluating complex interventions: new guidance. Medical Research Council; 2008 Sep pp. 1 – 39.

Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Patticrew M. Developing and evaluating complex interventions: new guidance. Medical Research Council; 2008 Sep pp. 1 – 39.

Site 1 3 month Time Period 6 months time period 9 month time period 12 month time period 15 month time period Site 2 Site 3 Site 4 Site 5

“To ensure everyone living with and beyond cancer is aware of the benefits of physical activity and enabled to choose to become and to stay active at a level that is right for them. ”

Physical activity the underrated wonderdrug ‘Keeping active has helped me, and my family, through a really difficult time. It’s helped me return to a more normal way of life and has given me a real sense of achievement’. Ted Poulter,

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