1. By Janet Foote, PhD

2. Educational Objectives Discuss the role of movement in:  1. Prevention of breast cancer onset  2. Appropriateness for breast cancer survivors  3. Prevention of Breast Cancer recurrence

3. Physical Activity Anaerobic Aerobic - most prevention/survival research Bouts up to 2 mins, highest % effort, uses CP & ATP, & results in lactic acid build-up (burning) Bouts > 2 mins, sub-max effort, uses aerobic processes (O 2 ), w/ training - can sustain for longer periods

4. Types of Aerobic Activities walking, jogging, running cycling swimming skiing household: sweeping, vacuuming etc. recreational / occupational

5. Physical Activity & Breast Cancer Risk Recent comprehensive review - 2007 C M Friedenreich & A E Cust Br J Sports Medicine 42:636-647, 2008 1 1.5 2.0 0.50.25 increased riskreduced risk 50% less likely

6. 17 of 28 cohort studies Risk average 20% risk reduction Ref: Friedenreich CM & Cust AE, Br J Sports Med 42:636-647, 2008 Any type of Breast Cancer

7. 26 of 34 case-control studies average 30% risk reduction Ref: Friedenreich CM & Cust AE, Br J Sports Med 42:636-647, 2008 All Types of Breast Cancer Risk

8.  All studies - 25% reduction in breast cancer risk  Among only those studies finding that activity reduced breast cancer risk ◦ 36% reduction risk in active

9. Evidence for Aerobic Activity in Prevention of Breast Cancer Onset Differences by menopausal status WCRF AICR rating of benefits*: * Premenopausal: “limited suggestive” * Postmenopausal: “probable” Cohort & Case-control Studies WCRF-AICR Food,Nutrition, Physical Activity & the Prevention of Cancer: a Global Perspective, AICR Washington, DC, 2 nd edition 2007.

10. Breast Cancer Risk: Pre-menopausal Ref: Friedenreich CM & Cust AE, Br J Sports Med 42:636-647, 2008 Risk 5 signif. 14 n.s. 29 of 31 aver. 40%

11. Breast Cancer Risk: Post-menopausal Risk Ref: Friedenreich CM & Cust AE, Br J Sports Med 42:636-647, 2008 20 signif. 10 n.s. 30 of 35 aver. 33%

12. Recreational activity Lifetime, activity after age 50 Decreasing categories of BMI Asian, Black, Hispanic (50%, 40%, & 30%) Women with no family history Women - ER-/PR- ( 0.61) vs. ER+/PR+ (0.86) Parous women (28% vs. 22% reduction nulliparous) Effects were greater for:

13. Activity Responsive Pathways Immune function Growth factors, GF binding proteins Sex hormones & binding proteins Endogenous antioxidant enzyme systems Oxidative stress DNA repair Phase II xenobiotic system Good review: A. Rundle, Molecular epidemiology of physical activity and cancer, CEBP 14(1):227-236, 2005

14. Decreased lifetime exposure to estrogen Decreased % of body fat Increases immunity & antioxidant defense systems

15. Intervention Studies Majority among breast cancer Significant physiological benefits Significant psychological benefits Improved QOL, depression, anxiety Improved self-esteem Ref.: DA Galvao & RU Newton, Review of Intervention studies in cancer patients, J Clin Onc 23(4): 899-909, 2005

16. Intervention Studies Mostly aerobic activities Positive effects: resistance training - anaerobic Flexibility Do - able! Benefits!

17. Activity: Recurrence Prevention Minimize post-treatment weight gain Maintenance lean body mass (BMD) Enhance immunity/antioxidant systems Enhance QOL, fatigue and anxiety Enhance self-esteem & depression Advantages: aerobic & resistance tr. Enhance range of motion flexibility

18. Getting Started Bring up the subject! “Here are some things you can do as part of your treatment,…to help you live better and longer”. Be specific in advice Provide an exercise prescription

19. Exercise Prescription Elements 1. Frequency - how often 2. Intensity - % effort, 60 - 80% 3. Duration - how long each bout lasts Initial fitness level Type of exercise Additional considerations:

20. Exercise Prescription: Br CA Start slowly, but be specific “3 times during the next week, walk 2 blocks away from your house, turn & walk 2 more blocks & continue until you’ve walked back to your house” “keep 2 canned goods near your TV & every commercial alternate holding out front, to the side, overhead, curls” Watching 2 hrs TV nightly:

21. Physical Activity - Breast Cancer  decreases risk  enhances treatment  improves survival

22. Beneficial Physical Activity types aerobic (cardiovascular) anaerobic (resistance training) flexibility (range-of-motion)

23. Promoting regular activity among: women at risk women undergoing treatment survivors * Develop own hand-out: check boxes for prescription, diaries

24. Join: gym w/ set classes (like Curves  ) program/organization (Bone-builders, Walk Across Arizona, Better Than Ever, litter patrol, dog walkers, Masters Swim club, hiking club, dance classes, etc.) Enlist: friend, spouse, dog Pedometer: log steps / day on the calendar working to a 10,000 steps / day goal Activity Resources

25. Model it Make it happen