Wolin opac2013

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Wolin opac2013

  1. 1. physical activity andcancer:appraising the evidenceKate Wolin, ScD, FACSMLoyola University Chicago
  2. 2. conflict of interest disclosure:Theraband research supportUp to Date publishing royaltyDr. Oz Show travel expensesAICR travel expenses
  3. 3. where have we been
  4. 4. Wolin et al 2010
  5. 5. where we areSecond Expert Report 2007
  6. 6. why what we don’t knowmatters
  7. 7. polypsWolin et al 2010I–V overall (I 2= 46.2%, P = 0.005)Shinchi et al, 1994Tiemersma et al, 2003Larsen et al, 2006D+L overallRosenberg et al, 2006Neugut, 1996Kahn et al, 1998Hauret et al, 2004Tiemersma et al, 2003Kono et al, 1991Kono et al, 1999Wallace et al, 2005Lubin et al, 1997Neugut, 1996LabelLieberman et al, 2003Enger et al, 1997Sandler, 1995Little et al, 1993Boutron-Ruault et al, 2001Boutron-Ruault et al, 2001Giovannucci et al, 1996Colbert et al, 2002Kahn et al, 1998Hermann et al, 2009Wallace et al, 2005Sandler, 1995Larsen et al, 2006Giovannucci et al, 19950.87 (0.83, 0.91.20 (0.80, 1.80.69 (0.43, 1.10.96 (0.74, 1.20.84 (0.77, 0.90.72 (0.57, 0.91.30 (0.70, 2.40.83 (0.76, 0.90.63 (0.34, 1.11.05 (0.72, 1.50.44 (0.22, 0.80.60 (0.30, 1.21.21 (0.36, 4.00.60 (0.30, 1.20.60 (0.40, 0.9ES (95% CI)0.94 (0.86, 1.01.00 (0.70, 1.40.64 (0.35, 1.10.46 (0.17, 1.20.80 (0.40, 1.61.30 (0.70, 2.40.58 (0.40, 0.81.20 (0.90, 1.60.90 (0.78, 1.01.02 (0.74, 1.40.35 (0.17, 0.70.92 (0.36, 2.30.56 (0.34, 0.90.79 (0.57, 1.010.2 5
  8. 8. lifetime activity & breastDallal et al 2007RELATIVERISKHOURS/WEEK P FOR TRENDSTRENUOUS = 0.02MODERATE = 0.290.5$0.6$0.7$0.8$0.9$1$1.1$0*0.5$ 0.51*2.0$ 2.01*3.5$ 3.51*5.00$ >$5.0$
  9. 9. what we think we know
  10. 10. just 30 minutes/day ofwalking is enough
  11. 11. colon cancerWolin et al 2007RELATIVERISKMET HRS/WEEK0.75%0.8%0.85%0.9%0.95%1%1.05%<2% 2.1+4.5% 4.6+10.3% 10.4+21.4% 21.5+%
  12. 12. walking & colonWolin et al 20070.5$0.6$0.7$0.8$0.9$1$1.1$0$ <1$ 1+1.9$ 2+3.9$ 4+$RELATIVERISKHOURS/WEEK
  13. 13. colon cancer survivalMeyerhardt et al 2006
  14. 14. Measurement
  15. 15. breast cancer survivalIbrahim et al 2010
  16. 16. breast cancer survivalHolmes et al 2005ll num-catego-ses wasMET-no sub-usal sta-neficialboth es-ors (RR,not tod hor-5% CI,ing wasaths.icial toase, butcial towomenngagedweek ofessthanwas 0.36hese re-men andwas noercise in categories of MET-hours perweek (TABLE 5). Both walking and vig-CI, 0.38-0.95) for 24 or more MET-hours per week.Figure. Kaplan-Meier Survival Curves0.250.100.05Physical Activity, MET-h/wkNo. at Risk0.150.2000 2 6 8 10 12 14 16 184<3 959 957 573 407 286 222 83 438093-8.9 862 862 569 489 372 184 84 31767≥9 1166 1166 773 692 449 290 164 861066Follow-up, yProbabilityofMortalityMET-h/wk≥93-8.9<3MET indicates metabolic equivalent task.
  17. 17. colon cancer survivalMeyerhardt et al 2006
  18. 18. resistance training & colonBoyle et al 2012RELATIVERISK0.4$0.5$0.6$0.7$0.8$0.9$1$1.1$1.2$never$ definite$ possible$ definite$or$possible$
  19. 19. physical activity mattersfor everyone
  20. 20. breast by BMIFriedenreich & Cust 2008RELATIVERISK0.7$0.8$0.9$1$1.1$<22$ 22*25$ >=25$ >=30$
  21. 21. lifetime activity & endometrialPatel et al 2008MULTIVARIABLE MULTIVARIABLE WITH BMI***RELATIVERISK0.5$0.6$0.7$0.8$0.9$1$1.1$None/Low$Low$1982,$High$1992$High$1982,$Low$1992$High$
  22. 22. endometrial by bmiPatel et al 2008** SIGNIFICANT** TREND**RELATIVERISK0.5$0.6$0.7$0.8$0.9$1$1.1$BMI<%25%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%BMI%25+%none$>0$.$<7$7$.$<17.5$17.5+$
  23. 23. anything is better thannothing
  24. 24. mortalityWijndaele et al 2011diabete(Modelafter fuA 1-h/dan incrfrom a(2% mteriallyshown)excludi2 yearsTablederivedcation,tion anConsisttermsamongwere nsignifictotal P(P ¼ 0.4the simtweenTo exmediatBMI anThe incresultsP ¼ 0.0395% CItality:Addingthe effCI ¼ 0.9(HR ¼ 1ally noHR ¼ 1.No ev0501001502002503000 - 0.99 1 - 1.99 2 - 2.99 3 - 3.99 4 - 4.99 5 - 5.99TV time (h/day)All-cause mortality0204060801001201400 - 0.99 1 - 1.99 2 - 2.99 3 - 3.99 4 - 4.99 5 - 5.99TV time (h/day)Cardiovascular mortality0204060801001201400 - 0.99 1 - 1.99 2 - 2.99 3 - 3.99 4 - 4.99 5 - 5.99TV time (h/day)Cancer mortalityMortalityrateper10000person-yearsMortalityrateper10000person-yearsMortalityrateper10000person-yearsFigure 1 Unadjusted all-cause, cardiovascular and cancerTV TIMMVAR HR: 1.04 (0.98-1.10)MVAR HR: 1.08 (1.01-1.16)MVAR HR: 1.05 (1.01-1.09)
  25. 25. mortalityDunstan et al 20100510152025All−causemortalityrate0− 1− 2− 3− 4− 5− 6−TV viewing time (hours/day)A0510152025CVDmortalityrate0− 1− 2− 3− 4− 5− 6−TV viewing time (hours/day)B0510152025Cancermortalityrate0− 1− 2− 3− 4− 5− 6−TV viewing time (hours/day)C0510152025Non−CVD/non−cancermortalityrate0− 1− 2− 3− 4− 5− 6−TV viewing time (hours/day)DFigure. Unadjusted all-cause (A), CVD (B), cancer (C), and non-CVD/noncancer (D) mortality rates per 1000 person-years according totelevision (TV) viewing time (h/d). Dashed line presents the linear relationship between increments of television viewing time and all-cause, CVD, cancer, and non-CVD/noncancer mortality rates. Number of people in each television viewing category was as follows: 0h/d, 2442; Ն1 h/d, 2528; Ն2 h/d, 2138; Ն3 h/d, 1020; Ն4 h/d, 407; Ն5 h/d, 155; and Ն6 h/d, 108.Dunstan et al Television Viewing Time and Mortality 387CANCERALLCAUSECVDNON-CVD/NON-CANCER
  26. 26. colorectalHoward et al 20080.9$1$1.1$1.2$1.3$1.4$1.5$<3$3+4$5+6$7+8$9+$RELATIVERISKH/DMEN WOMENTV SITTING TV SITTING* SIGNIFICANT*** **
  27. 27. breastLynch et al 2013H/W/Y**** SIGNIFICANTRELATIVERISK0.5$0.6$0.7$0.8$0.9$1$1.1$Premenopausal,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,Postmenopausal,0$0.1$*$<2.2$2.2$*$<7.3$7.3+$
  28. 28. breastDallal et al 2012COUNTSRELATIVERISK** SIGNIFICANT**1"1.5"2"2.5"3"3.5"4"mvar" mvar"+"PA"<396.6"396.612457.74"457.752524.1"524.11+"
  29. 29. breastGeorge et al 20100.9$1$1.1$1.2$1.3$1.4$1.5$1.6$1.7$1.8$<3$3.4$5.6$7.8$9+$H/DTV SITTING
  30. 30. endometrialArem et al 2011** SIGNIFICANTRELATIVERISK0.8$0.9$1$1.1$1.2$1.3$1.4$1.5$1.6$0$ 4$to$<6$ 6$to$<8$ 8+$HR/DAY
  31. 31. endometrialMoore et al 2010RELATIVERISK* SIGNIFICANT* HRS/DAYSITTING****1"1.1"1.2"1.3"1.4"1.5"1.6"1.7"Ac,ve" Inac,ve" Inac,ve"+BMI"<3"3to4"5to6"7to8"9+"
  32. 32. mechanismsLynch 2010Sixty-two studies that met review criteria addressed theassociation between sedentary behavior and adiposity(see Table 2). The randomized controlled trial assessedthe effect of a 3-week television-viewing-reduction inter-of sedentary behavior at follow-up (93). A second pro-spective study found that baseline sedentary behavior(assessed by individually calibrated heart rate monitor-ing) did not predict fat mass, BMI, or waist circumferenceFigure 2. Biological model of hypothesized pathways from sedentary behavior to cancer. TNF-α, tumor necrosis factor-α; IL-6, interleukin-6; CRP, C-reactive protein.
  33. 33. mechanismsCancerObesityInsulin ↑(insulinresistance)IGFBP-1 ↓IGFBP-2 ↓IGF-I ↑ExerciseVitamin DAdipokinesInflammationOxidative stressImmune functionHormones
  34. 34. future directions

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