Survivorship, physical activity ms. emer guinan


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Survivorship, physical activity ms. emer guinan

  1. 1. SURVIVORSHIP – PHYSICAL ACTIVITY EMER GUINAN MISCPSupporting People with Breast CancerIrish Cancer Society Annual Patient Conference29.09.2012
  2. 2. Physical Activity Workshop Role of modifiable risk factors in breast cancer  Physical activity  Body composition Practical activities  Body mass index  Waist circumference  Exercise prescription
  3. 3. 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 Levelsof Breast Cancer Survivors and BRCA MutationCarriers” Dr. Juliette Hussey, Discipline of Physiotherapy, TCD. Ms. Elizabeth Connolly, Consultant Surgeon, St. James’s
  4. 4. Breast Cancer Risk FactorsNon-Modifiable ModifiableRisk  Obesity Age  Physical inactivity Family History  Alcohol consumptionPrognosis  HRT Characteristics of the breast tumour
  5. 5. Obesity, physical activity andcancer
  6. 6. Obesity and Breast Cancer
  7. 7. Obesity and Cancer Risk Total Body Fatness • Oesophagus • Pancreas • Colorectal • PostmenopausalOverweight breast and • Endometrium • Kidney Obesity Abdominal Fatness Increases • Colorectal Risk • Pancreas • Postmenopausal breast
  8. 8. Obesity and Cancer Abdominal Fat (visceral fat) Metabolically Ideal Active environme • Insulin nt for • Inflammation tumour • Cholesterol growth and • Glucose • Blood pressure progressio n
  9. 9. Obesity Obesity Increases Poorer breast breast cancer cancer risk prognosis
  10. 10. Weight Gain during Treatment Treatments  Chemotherapy  Hormonal therapy (Tamoxifen) Who?  Premenopausal women Why?  Decreased physical activity levels  Changes in diet  Lower metabolism  Side effects
  11. 11. 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
  12. 12. Some important measurements…. Body Mass Index Waist Circumference
  13. 13. Body Mass Index (BMI) BMI is a measure of body fat based on height and weight
  14. 14. Waist Circumference
  15. 15. 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
  16. 16. Waist Circumference Increased Substantially Risk Higher Risk Men 94 cm 102 cmWomen 80 cm 88 cm
  17. 17. Physical Activity and BreastCancer
  18. 18. Physical Activity and CancerRisk Convincing Physical Evidence • Colon Activity Probable EvidenceDecreases • Postmenopausal Risk breast • Endometrium • Lung • Pancreas • Premenopausal breast
  19. 19. Physical Activity throughout the cancer experienceBreast Cancer During Breast Cancer Prevention Treatment Survivorship
  20. 20. Breast Cancer Prevention Women who are physically active throughout their live have a 25% reduced risk of developing breast cancer after the menopause
  21. 21. During Breast CancerTreatment
  22. 22. Breast Cancer SurvivorshipBeing physically active after a breast cancerdiagnosis….. 26% reduced risk of breast cancer recurrence 30-40% reduced risk of death from any cause 2-3 hours of brisk walking per week
  23. 23. Physical Activity and Obesity Abdominal Fat (visceral fat) Metabolically Ideal Active environme • Insulin nt for • Inflammation tumour • Cholesterol growth and • Glucose • Blood pressure progressio n
  24. 24. 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
  25. 25. Physical Activity Guidelines 30 Minutes of Moderate Intensity Physical Activity x5 Days per Week Avoid Inactivity
  26. 26. The 10 minute rule 10 Minute Bouts10 minute walk to 10 minute the shop / work household chore 10 minute walk/jog/stair climbing during lunch
  27. 27. Physical Activity “Any body movement, produced by skeletal muscles and resulting in energy expenditure that exceeds resting levels” Recreation al Occupation al Transport Househol d
  28. 28. 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
  29. 29. Types of Exercise • Walking • Weights • Aerobics • “Curves” • Swimming Aerobic Strength Flexibilit Core y • Yoga • Pilates
  30. 30. Types of Exercise • Walking • Weights • Aerobics • “Curves” • Swimming Aerobic Strength Flexibilit Core y • Yoga • Pilates
  31. 31. 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
  32. 32. Borg Rate ofPerceivedExertion Moderate intensity exerciseYou can talk but you can’t sing!
  33. 33. Heart Rate Monitor Moderate intensity = 64-76% Maximum Heart Rate Maximum Heart Rate = 220 - ageExample: 50 year old womanMaximum heart rate = 220 – 50 = 170 beats per minModerate intensity exercise = 64-76% (170) = 108.8 – 129.2 = 108 – 129 beats permin
  34. 34. 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”
  35. 35. 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: Contact: Telephone: 01 2316624
  36. 36. 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: Contact: Telephone: 0872806048
  37. 37. “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
  38. 38. Exercise after Breast Cancer Arm and shoulder  Pain  Reduced range of movement (stiffness) Lymphoedema Bone health  Hormone therapy  Arimidex  Femara
  39. 39. Exercise and Bone Health Weight-bearing exercise  Walking  Running  Step aerobics Muscle Strengthening Exercises that don’t improve bone health  Cycling  Swimming  Aqua aerobics
  40. 40. Side-Effects of Exercise Muscle soreness  Warm-up / Cool-down  Stretching  Proper footwear  Warm bath Dehydration / cramp  Drink lots of fluids while exercising
  41. 41. Medical Clearance to Exercise If 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?
  42. 42. 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
  43. 43. Acknowledgements
  44. 44. Questions?????