Preventable causes of death in the US Cancer

Preventable causes of death in the US

Cancer risk factors Non-modifiable Family History Age Gender Modifiable Tobacco use Diet/exercise-Energy Balance Alcohol over-consumption Other

General Guidelines Cancer dx affects all aspects of physical functioning Unique manifestations - Tumor - Treatment - Side effects - Demographic profile ACSM guidelines (3 -5 d/wk, 30 -60 mins, moderate intensity) Optimal guidelines – not yet established

Prescription Guidelines Mode Walking / cycle ergometry natural choice Account for specific impairments (e. g. , colorectal, breast cancer) Resistance/upper body – lymphedema concerns - unfounded Combined program optimal

Prescription Guidelines Frequency & Intensity At least 3 -5 d/wk Daily for deconditioned patients Moderate Intensity 50 -70% VO 2 max 60 -80% HRmax RPE 11 -14

Prescription Guidelines Duration & Progression 20 -30 mins (continuous) Intermittment bouts (5 -10 mins) Initially in frequency & duration - then intensity Progression slower for deconditioned pts & those suffering severe side effects

Recommended Exercise prescription for people with cancer Exercise Frequency type Aerobic 3 -5 days/week Intensity Time Low-moderate 20 -60 minute 40 -60% Heart sessions Rate Reserve (HRR) Resistance 3 days/week with 48 hours between sessions that use the same muscle groups Flexibility 5 -7 days/week Low intensity to start, then progress intensity level 1 -3 sets of 1012 repetitions involving 8 -10 muscle groups To level of tension, stop before discomfort 10 -30 seconds/stretc h

Common side effects of cancer treatment l Post-treatment fatigue l Depression l Bone loss l Decreased level of muscular strength l Decreased aerobic capacity l Increased weight gain l Impaired quality of life l Disturbed body image

Research evidence indicates that regular participation in physical activity after cancer diagnosis might mitigate some of the common side effects of cancer treatment: • Fatigue • Depression • Impaired quality of life • Decreased muscular strength • Decreased aerobic capacity • Weight gain

Special Precautions Complication • • Precaution Hemoglobin <8. 0 g/dl Avoid high intensity exercise Absolute neutrophil count Avoid exercises that may increase chance of infection (swimming) Fever > 38 o. C Avoid exercise Ataxia/dizziness Avoid exercises that require significant balance & coordination (treadmill) Severe cachexia Loss of muscle mass limits exercise intensity - modify program accordingly Bone pain Avoid high impact exercises Extreme fatigue Exercise at lower power output, avoid maximal tests

Absolute Contraindication of physical activity in individuals with cancer · Symptomatic heart failure · Inflammation of the heart (myocarditis) · Recent heart attack (Myocardial infarction) · Acute infection · Thyroid problems · Psychosis · Intravenous chemotherapy within previous 24 hours · Severe anaemia (Haemoglobin < 8 g/dl) · Acute onset of nausea during exercise Beware: · Indwelling catheters: risk of dislodgement Peripheral neuropathy: Loss of balance

Impact of a Pre-Operative Exercise Intervention on Breast Cancer Proliferation and Gene Expression: Results from the Pre-Operative Health and Body (Pre. HAB) Study Inactive women with newly diagnosed breast cancer were randomized to an exercise intervention or mind–body control group, and participated in the study between enrollment and surgery (mean 29. 3 days). 49 women (27 exercise, 22 control) with mean age 52. 6 y, BMI 30. 2 kg/m 2, exercise for 49 min/week. Exercise participants significantly increased exercise versus controls (203 vs. 23 minutes/week, P < 0. 0001). KEGG pathway analysis demonstrated significant upregulation of 18 unique pathways (q < 0. 1) which are implicated in immunity and inflammation Clinical Cancer Research doi: 10. 1158/1078 -0432. CCR-18 -3143

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

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