1. “Living Your Best After Cancer: Being Physically Active as a Survivor.” Diane Baer Wilson, EdD, MS, RD Associate Professor & Co-director of Cancer Prevention & Control at VCU Massey Cancer Center Extensive research in cancer risk- reduction, with a focus on the roles of exercise and lifestyle modifications in cancer survivors Co-director of Cancer Survivors Symposia Series

2. Being Physically Active as a Cancer Survivor Dr. Diane Baer Wilson Associate Professor Department of Internal Medicine Program Leader Cancer Prevention and Control Massey Cancer Center Virginia Commonwealth University

3. Tonight Health benefits of being more physically active Research examining exercise and its impact on cancer survivorship How to start being more physically active

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

5. Preventable causes of death in the US

6. Regular exercise reaps more benefits than most other health habits because of its systemic effect on the human body.

7. Brain Muscles Bones Heart Physical, Physiologic, and Psychological Benefits of Exercise Blood Pressure Lower Cholesterol Improved immune response Better QOL Less depression Higher self- efficacy Higher Psych well- being People who exercise regularly are less likely to develop cancer and to survive longer after a cancer diagnosis

8. Why is it important to be physically active? Overall individuals who are more physically active: –are more likely to maintain a BMI >25 kg/m 2 –are less likely to develop chronic diseases, –are likely to recover faster from surgeries, –report a better daily quality of life –live longer

9. Percent Adults Engaging in Physical Activity, Virginia and US Virginia ranks 23 rd in the nation, Colorado ranks 1st

10. Exercise in cancer survivors: What the science says Limitations of the research: Few well-designed, long-term studies have been done to date Most studies are observational; cannot draw cause and effect conclusions Few studies have examined the effect on cancer outcomes Most studies conducted in one or two types of cancer

11. Exercise in women with breast cancer, Stage I, II, III, Holmes et al, 2006 Research to study the relationship between exercise and brca survival (stages I,II, and III) in 4400 women, Nurses Health Study (121,700) since 1976 Results-women in any category of activity higher than 1hr/wk, had better survival rates compared with those exercising less. Comparing the highest with lowest categories of PA, there was a 26- 40% lower relative risk of adverse outcomes in those in the highest category of PA. (Association particularly apparent in women with hormone (+) tumors, and those with Stage III cancer) 24 hr Tandem record Anna Schwartz, Betsy King, 436m

12. Research-Exercise in colon cancer survivors Meyerstadt, et al (2006)-2 studies in colon cancer survivors Examined association between PA after diagnosis and mortality (Nurses Health Study data). Results-significant reduction in cancer mortality for those exercising > 5-6 hours /week. (Independent of pre-dx PA)

13. Relevant issues remain: What dose is required for benefits? Is there benefit across types of cancer? What are the characteristics of individuals most likely to exercise? Is the positive effect of exercise exerted through weight control or some other molecular or metabolic mechanism?

14. Determinants of exercise in patients with multiple myeloma Jones et al. (2006) studied the determinants of intention to exercise in patients (n=77). In examining demographic, medical and social/cognitive factors results were: –Being more likely to see exercise as beneficial and –Perceiving exercise being easy rather than difficult were the strongest predictors Neither age, race, gender, nor stage of cancer was related.

15. 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

16. How to start being more physically active Make the decision Determine a schedule Use a calendar or a daytimer If you are currently sedentary, walking is a good choice Start with walking 15 minutes 3 days/week A pedometer is useful

17. Exercise Intervention To address energy balance in African American breast cancer survivors we developed a cognitive behavioral, theory based walking intervention, Walking Counts! (Wilson, et al). Study tested feasibility, recruitment/retention, use of pedometers, attending weekly classes, and impact of self-assessment, education, motivation. Test for effect on level of exercise, anthropometric, attitudinal and related measures in a group of African American breast cancer survivors recruited for the study in Richmond.

18. Walking Counts! Intervention Characteristics of the Sample Age (yrs) 55 (39 – 66) Weight (lbs)191 (142 – 271) BMI (kg/m 2 ) 32.7 (25.2 – 47.2) Education: (%) Post high school 91.0 Marital Status: (%) Married Single/Divorced/Widowed 50.0

19. Characteristics of the Sample Menopausal Status (%) Post 86.4 Time Since Diagnosis: (%) 1-6 years 7-10 years More than 10 years 59.1 13.6 27.3 Type of Treatment: (%) Chemotherapy Radiation therapy Both Neither 18.2 45.5 18.2 Tamoxifen: (%) No 77.3 Alcohol: (%) No 72.7 Smoking: (%) No 91.0

20. Study Results Baseline (N=22)Postp value* Exercise Measure Steps/day 4791 8297 <0.001* Anthropometric measures BMI (kg/m 2 ) 32.7* Weight (lb) 191.2* Body Fat (%) 40.1* Waist circumference (in.) 39.7* Hip circumference (in.) 47.2* Arm circumference (in.) 13.9* Systolic B/P (mm Hg) 140.9* Diastolic B/P(mm Hg) 80.1* Attitudinal measures: Exercise Attitude Total 66.2* Cancer Worry Total 6.8 * Paired “t-test” for difference in group means

21. Steps/day at Baseline,Post and 3 Month Post Intervention p<.001 B/P***, p=.001*** B/3mth

22. 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

23. Include daily exercise on your path to optimal health!

24. “Living Your Best After Cancer: You and Your Primary Care Doctor Working Together" Mary Helen Hackney, MD Associate Professor of Hematology/Oncology at VCU Massey Cancer Center Specialist in treatment for all stages of breast cancer Treats cancer of all types through Massey’s Rural Cancer Outreach Program Teaches residents and health professionals about prevention, long-term patient management and survivorship issues.