impact of a physically active lifestyle on cancer risk and ... activity... · impact of a...
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Physical activity and cancer: impact of a physically active lifestyle on
cancer risk and recovery
John M SaxtonUniversity of East AngliaNorwich
Acute Lymphoblastic Leukemia, Adult
Acute Lymphoblastic Leukemia, Childhood Acute Myeloid Leukemia, Adult
Acute Myeloid Leukemia, Childhood Adrenocortical Carcinoma
Adrenocortical Carcinoma, Childhood AIDS-Related Cancers
AIDS-Related Lymphoma Anal Cancer
Astrocytoma, Childhood Cerebellar Astrocytoma, Childhood Cerebral
Bile Duct Cancer, Extrahepatic Bladder Cancer
Bladder Cancer, Childhood Bone Cancer, Osteosarcoma/Malignant Fibrous
Histiocytoma Brain Stem Glioma, Childhood
Brain Tumor, Adult Brain Tumor, Brain Stem Glioma, Childhood
Brain Tumor, Cerebellar Astrocytoma, Childhood Brain Tumor, Cerebral Astrocytoma/Malignant
Glioma, Childhood Brain Tumor, Ependymoma, Childhood
Brain Tumor, Medulloblastoma, Childhood Brain Tumor, Supratentorial Primitive Neuroectodermal Tumors, Childhood
Brain Tumor, Visual Pathway and Hypothalamic Glioma, Childhood
Brain Tumor, Childhood (Other) Breast Cancer
Breast Cancer and Pregnancy Breast Cancer, Childhood
Breast Cancer, Male Bronchial Adenomas/Carcinoids, Childhood
Carcinoid Tumor, Childhood Carcinoid Tumor,Gastrointestinal
Carcinoma, Adrenocortical Carcinoma, Islet Cell
Carcinoma of Unknown Primary Central Nervous System Lymphoma, Primary
Cerebellar Astrocytoma, Childhood Cerebral Astrocytoma/Malignant Glioma, Childhood
Cervical Cancer Childhood Cancers
Chronic Lymphocytic Leukemia Chronic Myelogenous Leukemia
Chronic Myeloproliferative Disorders Clear Cell Sarcoma of Tendon Sheaths
Colon Cancer Colorectal Cancer, Childhood Cutaneous T-Cell Lymphoma
Endometrial Cancer Ependymoma, Childhood Epithelial Cancer, Ovarian
Esophageal Cancer
Esophageal Cancer, Childhood Ewing's Family of Tumors
Extracranial Germ Cell Tumor, Childhood Extragonadal Germ Cell Tumor Extrahepatic Bile Duct Cancer
Eye Cancer, Intraocular Melanoma Eye Cancer, Retinoblastoma
Gallbladder Cancer Gastric (Stomach) Cancer
Gastric (Stomach) Cancer, Childhood Gastrointestinal Carcinoid Tumor
Germ Cell Tumor, Extracranial, Childhood Germ Cell Tumor, Extragonadal
Germ Cell Tumor, Ovarian Gestational Trophoblastic Tumor Glioma, Childhood Brain Stem
Glioma, Childhood Visual Pathway and Hypothalamic
Hairy Cell Leukemia Head and Neck Cancer
Hepatocellular (Liver) Cancer, Adult (Primary) Hepatocellular (Liver) Cancer, Childhood (Primary)
Hodgkin's Lymphoma, Adult Hodgkin's Lymphoma, Childhood
Hodgkin's Lymphoma During Pregnancy Hypopharyngeal Cancer
Hypothalamic and Visual Pathway Glioma, Childhood
Intraocular Melanoma Islet Cell Carcinoma (Endocrine Pancreas)
Kaposi's Sarcoma Kidney Cancer
Laryngeal Cancer Laryngeal Cancer, Childhood
Leukemia, Acute Lymphoblastic, Adult Leukemia, Acute Lymphoblastic, Childhood
Leukemia, Acute Myeloid, Adult Leukemia, Acute Myeloid, Childhood
Leukemia, Chronic Lymphocytic Leukemia, Chronic Myelogenous
Leukemia, Hairy Cell Lip and Oral Cavity Cancer
Liver Cancer, Adult (Primary) Liver Cancer, Childhood (Primary)
Lung Cancer, Non-Small Cell Lung Cancer, Small Cell
Lymphoblastic Leukemia, Adult Acute Lymphoblastic Leukemia, Childhood Acute
Lymphocytic Leukemia, Chronic Lymphoma, AIDS-Related
Lymphoma, Central Nervous System (Primary) Lymphoma, Cutaneous T-Cell Lymphoma, Hodgkin's, Adult
Lymphoma, Hodgkin's, Childhood Lymphoma, Hodgkin's During Pregnancy
Lymphoma, Non-Hodgkin's, Adult
Lymphoma, Non-Hodgkin's, Childhood Non-Hodgkin's During Pregnancy
Lymphoma, Primary Central Nervous System Macroglobulinemia, Waldenstr? m's
Male Breast Cancer Malignant Mesothelioma, Adult
Malignant Mesothelioma, Childhood Medulloblastoma, Childhood
Melanoma Melanoma, Intraocular Merkel Cell Carcinoma
Mesothelioma, Malignant Metastatic Squamous Neck Cancer with Occult
Primary Multiple Endocrine Neoplasia Syndrome, Childhood
Multiple Myeloma/Plasma Cell Neoplasm Mycosis Fungoides
Myelodysplastic Syndromes Myelodysplastic/Myeloproliferative Diseases
Myelogenous Leukemia, Chronic Myeloid Leukemia, Adult Acute
Myeloid Leukemia, Childhood Acute Myeloma, Multiple
Myeloproliferative Disorders, Chronic Nasal Cavity and Paranasal Sinus Cancer
Nasopharyngeal Cancer Nasopharyngeal Cancer, Childhood
Neuroblastoma Non-Hodgkin's Lymphoma, Adult
Non-Hodgkin's Lymphoma, Childhood Non-Hodgkin's Lymphoma During Pregnancy
Non-Small Cell Lung Cancer Oral Cancer, Childhood
Oral Cavity and Lip Cancer Oropharyngeal Cancer
Osteosarcoma/Malignant Fibrous Histiocytoma of Bone
Ovarian Cancer, Childhood Ovarian Epithelial Cancer Ovarian Germ Cell Tumor
Ovarian Low Malignant Potential Tumor Pancreatic Cancer
Pancreatic Cancer, Childhood Pancreatic Cancer, Islet Cell
Paranasal Sinus and Nasal Cavity Cancer Parathyroid Cancer
Penile Cancer Pheochromocytoma
Pineal and Supratentorial Primitive Neuroectodermal Tumors, Childhood
Pituitary Tumor Plasma Cell Neoplasm/Multiple Myeloma
Pleuropulmonary Blastoma Pregnancy and Breast Cancer
Pregnancy and Hodgkin's Lymphoma Pregnancy and Non-Hodgkin's Lymphoma
Primary Central Nervous System Lymphoma Primary Liver Cancer, Adult
Primary Liver Cancer, Childhood Prostate Cancer Rectal Cancer
Renal Cell (Kidney) Cancer Renal Cell Cancer, Childhood
Renal Pelvis and Ureter, Transitional Cell Cancer Retinoblastoma
Rhabdomyosarcoma, Childhood Salivary Gland Cancer
Salivary Gland Cancer, Childhood Sarcoma, Ewing's Family of Tumors
Sarcoma, Kaposi's Sarcoma (Osteosarcoma)/Malignant Fibrous
Histiocytoma of Bone Sarcoma, Rhabdomyosarcoma, Childhood
Sarcoma, Soft Tissue, Adult Sarcoma, Soft Tissue, Childhood
Sezary Syndrome Skin Cancer
Skin Cancer, Childhood Skin Cancer (Melanoma)
Skin Carcinoma, Merkel Cell Small Cell Lung Cancer Small Intestine Cancer
Soft Tissue Sarcoma, Adult Soft Tissue Sarcoma, Childhood
Squamous Neck Cancer with Occult Primary, Metastatic
Stomach (Gastric) Cancer Stomach (Gastric) Cancer, Childhood
Supratentorial Primitive Neuroectodermal Tumors, Childhood
T-Cell Lymphoma, Cutaneous Testicular Cancer
Thymoma, Childhood Thymoma and Thymic Carcinoma Thyroid Cancer
Thyroid Cancer, Childhood Transitional Cell Cancer of the Renal Pelvis and
Ureter Trophoblastic Tumor, Gestational
Unknown Primary Site, Carcinoma of, Adult Unknown Primary Site, Cancer of, Childhood
Unusual Cancers of Childhood Ureter and Renal Pelvis, Transitional Cell Cancer
Urethral Cancer Uterine Cancer, Endometrial
Uterine Sarcoma Vaginal Cancer
Visual Pathway and Hypothalamic Glioma, Childhood
Vulvar Cancer Waldenstrom's Macroglobulinemia
Wilms' Tumor
• The four commonest cancers (breast, lung,
bowel and prostate) make up over half of all
cancer cases
• More than one in three of us will experience
a cancer diagnosis at some point in our lives
• Someone is diagnosed with cancer every
2 minutes (CRUK)
Introduction
• There are over 200 different types of cancer
WHAT IS CANCER?
• "Umbrella term" for group of diseases
• Uncontrolled cellular growth
• Results from DNA mutations which can be spontaneous or inherited
Female Cancer incidence - UK statistics (CRUK)
Female Cancer Mortality- UK statistics (CRUK)
Male Cancer incidence - UK statistics (CRUK)
Male Cancer Mortality - UK statistics (CRUK)
• Earlier detection and better treatments mean
that the 5-year survival rates in Europe for breast, prostate and colon cancer are now in
excess of 70%, 55% and 45%, respectively1.
• Worldwide, nearly 25 million people are alive
today after being diagnosed with cancer during the last five years.
• Currently 2 million cancer survivors in the UK,
a figure that is projected to double by 2030.
1 Coleman,M.P., Quaresma,M., Berrino,F. et al. (2008) Cancer survival in five continents:
a worldwide population-based study (CONCORD). Lancet Oncology 9, 730-756.
Cancer survivorship
How do lifestyle factors impact upon the risk of breast,
prostate and colon cancers?
International incidence
data
International comparisonsInternational variations in cancer incidence
Age-standardised incidence and mortality rates for female breast cancerin selected countries (2002 estimates). cancerresearchuk.org
Age-standardised incidence and mortality rates for prostate cancer in selected countries (2002 estimates). cancerresearchuk.org
International comparisonsInternational variations in cancer incidence
Age-standardised incidence rates for colorectal cancer by sex in selected countries (2002 estimates). cancerresearchuk.org
International comparisonsInternational variations in cancer incidence
Summary of international data
• Breast cancer incidence is ~ 5x higher in Western countries than in less developed countries and
Japan
• Prostate cancer incidence is ~10x higher in Europe
and North America than Asia
• Incidence of colorectal cancer in Africa and Asia
(with the exception of Japan) is considerably lower than Europe, North America and Australasia
• Exposure to Western lifestyles increases the risk of these cancers in Asians who migrate to the USA
and their descendents
Twin studies
Lichtenstein et al. (2000): Collected data
from 44,788 pairs of Scandinavian twins
Studies of monozygotic and dizygotic twins
Cancer concordance
Monozygotic > Dizygotic → genetic factors
Similar concordance → shared environmental
factors
Lichtenstein et al. (2000). NEJM 343, 78-85.
Sale
s
27-42% of risk due
to heritable factors
TIME
0 20Y
DAMAGEDDNA + CANCER
NORMAL DNA
DAMAGEDDNA ++
DAMAGED
DNA +++
DAMAGED
DNA ++++
REPAIR CELL DEATH
REPAIRCELL DEATH
CELL DEATH
SMOKING
RADIATION
EG X-RAYS
SALTED/
PRESERVED FOODS
OBESITY
INSULIN RESISTANCE HORMONES
ALCOHOL
Environmental factors and cancer risk
SEDENTARY
LIFESTYLE
Can a physically active lifestyle help to reduce the risk of cancer?
...what is the evidence?
AICR/WCRF Expert Report 2007Food, Nutrition, Physical Activity and the
Prevention of Cancer: a Global Perspective
•Six year project involving expert review of
>7000 rigorously selected studies
•Expert Panel of 21 world-renowned scientists
judged the accumulated evidence
•10 Recommendations for Cancer Prevention
Biological mechanisms?
• Promotes negative energy balance and reduces general/
central adiposity
� Effect on circulating sex steroid hormones and adipokines
• Improves insulin sensitivity, which could underpin any positive
changes in sex steroid hormones and growth factor peptides
� Reduces exposure to growth factor peptides (e.g. IGF axis
peptides) implicated in breast, prostate and colon cancer
• Possibly reduces gastro-intestinal transit time so that the GI
tract has lower exposure to cancer-causing agents
• Possibly improves the anti-tumour defence system (immune
system changes)
• Possibly enhances anti-oxidant defences and DNA repair
mechanisms
How much physical activity is associated with
reduced risk of these cancers?
MET.hours.week-1
MET.hours.day-1
Hours.week-1
Energy expenditure.week-1
Frequency of sessions.week-1
Frequency of sessions.month-1
"Very active"
"Moderately active"
"Quite inactive"Methods used to grade
physical activity
AICR & WCRF Expert Panel Report (2007)
• Be moderately physically active, equivalent to
brisk walking, for at least 30 min every day
• As fitness improves, aim for 60 min or more of
moderate, or for 30 min or more of vigorous
physical activity every day
• Limit sedentary habits such as watching television
Cancer Research UK
30 min per day is the minimum recommended level
Breast and bowel cancer risk can be further reduced
by exercising:
• more frequently
• more intensely
• for longer periods of time
• throughout your lifetime
Physical activity and cancer survivorship
1. Long-term prognosis / survival
9080706050403020100
Holmes et al. (2005)
(Overall mortality)
9-14.9 MET-h/week moderate intensity PA
Pierce et al. (2007)
(Overall mortality)
25 MET-h/week total recreational PA
Holick et al. (2008)
(Overall mortality)
4-10.2 MET-h/week moderate intensity PA
Irwin et al. (2008)
(Overall mortality)
150 min per week moderate intensity PA
Meyerhardt et al. (2006a)
(Disease recurrence or death)
18-26.9 MET-h/week total recreational PA
Holmes et al. (2005)
(Breast cancer mortality)
9-14.9 MET-h/week moderate intensity PA
Holick et al. (2008)
(Breast cancer mortality)
4-10.2 MET-h/week moderate intensity PA
Meyerhardt et al. (2006b)
(Colorectal cancer mortality)
≥≥≥≥18 MET-h/week total recreational PA
% Risk reduction
Bre
ast
ca
nce
r stu
die
sC
olo
recta
l ca
nce
r stu
die
s
9080706050403020100
Kenfield et al. (2011)
(Overall mortality)
≥ 90 min/week normal/brisk pace walking
Richman et al. (2011)
(Prostate cancer progression)
≥ 3 h/week brisk walking
Kenfield et al. (2011)
(Prostate cancer mortality)
≥ 3 h/week vigorous activity
% Risk reduction
Pro
sta
te c
an
ce
r stu
die
s
2. Quality of cancer survivorship
More people than ever are surviving for
longer after a cancer diagnosis but the
impact of cancer does not suddenly stop
when treatment is over.
Health-related
Quality of life&
Disease-free survival
Morphological(Body
composition)
Cardio-respiratory
Metabolic
Motor
Immunological
Molecular
Muscular
Physiological
Depression
Anxiety
Stress
Self-esteem
Cognitive function
Mood states
Sense of control
Perceived fatigue
Perceived ability to cope
PerceivedPhysical
attractiveness
Social integration
Enjoyment of life
Psychosocial
The feasibility and impact of pragmatic lifestyle interventions in cancer patients
Lifestyle intervention in men with
advanced prostate cancer receiving
androgen suppression therapy: a
feasibility study.
Bourke L, Doll H, Crank H, Daley A, Rosario DJ, Saxton JM. (2011). Cancer Epidemiol Biomarkers Prev. 20(4):647-57.
Men with locally advanced disease receiving Androgen deprivation therapy
ADT is associated with physical /mental side effects:
• Fatigue
• Reduced bone mineral density and increased fracture risk
• Decrease in skeletal muscle mass
• Negative impact on QoL
• Associated with the development of insulin resistance syndrome and adverse cardiovascular events
Purpose of the study
•to investigate the feasibility of a pragmatic lifestyle intervention aimed at increasing exercise participation and
improving dietary behaviour
•to obtain preliminary data on the impact of the lifestyle
intervention on key health outcomes
• Exercise and dietary behaviour
• Fatigue • Health-related quality of life
• Aerobic exercise tolerance
• Functional capacity • Muscle strength
• Anthropometry
13
24
Time-line (weeks)
0
Assessments
2 home & 1 supervised
2 supervised & 1 home
0 1 2 3 4 5 6 7 8 9 10 11 12 13 24
Weeks of the study
Supervised exercise•30 min aerobic exercise at 55-85% age-predicted HR max or 11-15 on Borg Scale
•2-4 sets of 8-12 repetitions of resistance exercises (quadriceps, deltoids, pectorals,
latissimus dorsi, hamstrings) using body weight resistance and free weights
•Self-directed exercise (e.g. brisk walking, cycling, gym exercise) for at least one 30 min
session per week during the initial six weeks and at least two sessions per week for the
final six weeks using a log book to record activity
Dietary advice•A nutrition advice pack encouraging reduction of saturated fat and refined
carbohydrate and increase of dietary fibre intake with moderation of alcohol, was
provided and small group healthy eating seminars lasting approximately fifteen to thirty
minutes were carried out fortnightly throughout the twelve week intervention.
• 95 % compliance to the supervised exercise sessions
• 87% self-reported compliance to the home exercise sessions (patients reporting engagement in brisk walking/cycling/gym exercise for ≥ 30 min,1-2 sessions per week)
Compliance to the exercise
sessions
Intervention
Control
Exercise tolerance Sit-to-standMaximum voluntary quadriceps torque
Me
an
diffe
ren
ce
(s)
Me
an
diffe
ren
ce
(re
pe
titio
ns)
Me
an
diffe
ren
ce
(N
m)
12 24 12 24 12 24
Weeks of the study Weeks of the study Weeks of the study
**
**
****
*
*
Weeks of the study
Weeks of the study
12 24
12 24
FACT-P
FACT-F
Me
an
diffe
ren
ce
(p
oin
ts)
Me
an
diffe
ren
ce
(p
oin
ts)
**
**
(n) Usual care Mean (SD)
Intervention Mean (SD)
Usual care Mean (SD)
Intervention Mean (SD)
Group mean difference in ∆ (95% CI)
P
Insulin (mU.L-1)
42 10.8 (12.7) 10.4 (13.2) 11.7 (14.2) 8.91 (8.4)
-2.3 (-12.5, 7.8)
0.46
IGFBP3 (ng.ml-1)
42 3052.5 (750.7) 3098.1 (738.2) 2964.7 (796.2) 2875.7 (827.3)
-134.6 (-503.9, 234.6)
0.49
IGF-1 (ng.ml-1)
42 77.6 (25.8) 74.5 (21.5) 79.4 (27.2) 78.3 (22.6)
1.9 (-6.9, 10.8)
0.72
IGFBP-1 (ng.ml-1)
42 34.5 (24.4) 32.6 (25.9) 38.4 (26.2) 36.4 (26.4)
-0.18 (-12.1, 11.7)
0.91
PSA (ng.ml-1)
50 5.02 (10.2) 3.32 (6.83) 6.24 (13.6) 4.55 (8.74)
0.01 (-2.2, 2.2)
0.61
Serum Testosterone
(nmol.L-1)
40 3.19 (6.97) 4.12 (8.69) 3.85 (8.67) 4.50 (8.01) -0.28
(-1.8, 1.2) 0.68
Free Androgen Index
39 8.52 (19.4) 12.4 (24.3) 9.44 (21.5) 13.5 (22.8)
0.22 (-3.3, 3.8)
0.87
SHBG (nmol.L-1) 40 45.1 (13.6) 41.6 (13.2) 46.8 (14.0) 40.8 (11.8) -2.5
(-6.4, 1.5) 0.13
Baseline End-point
Blood biomarkers at baseline and after 12 weeks
Summary and Conclusions
•The lifestyle group demonstrated improvements in exercise behaviour, total energy intake, dietary fat
intake, fatigue, aerobic exercise tolerance and muscle strength compared to the standard care controls.
•Improvements in physical and functional fitness and
fatigue were maintained for at least 3 months in the absence of patient contact.
Breast cancer study
Randomised controlled trial:
The effects of a combined Diet and
Exercise intervention on Biomarkers
associated with disease Recurrence
After breast cancer treatment:
The Sheffield DEBRA trial.
Weight gain is a problem for breast cancer patients
The majority of women gain weight and % body fat between 1-3 years post-diagnosis (Irwin et al. 2005; JCO 23, 774-782)
Mechanisms of weight gain?
• Chemotherapy / endocrine therapy
• Reduction in lean body mass and resting
energy expenditure
• Reduction in physical activity due to fatigue
• Increased food ingestion – linked to coping mechanisms / treatment-related appetite
• Being overweight or obese is negatively
associated with postmenopausal breast cancer
risk and survival
• Obesity is associated with later stage at
diagnosis
• Regardless of weight at diagnosis, evidence
that every 5 kg increase in body weight confers a 14% increased risk of all cause mortality(Reviewed in Hede et al. 2008; JNCI 100, 298-299)
• 24% improvement in relapse-free survival evoked by diet-induced weight loss within a year
of diagnosis vs controls who gained weight (Chlebowski et al. 2006; JNCI 98, 1767-1776)
Study design:
Randomised controlled trial: women randomised to a combined exercise and diet intervention or standard care
control group.
Primary aims:
• To examine the effects of a 24 week exercise and dietary intervention on body weight/body composition in
overweight/obese post-menopausal women who have undergone breast cancer treatment
• To examine the effects of the intervention on biomarkers
associated with disease recurrence
• To examine the effects of the intervention on quality of life
and indices of psychological health status
Patients
• Post-menopausal women with a BMI > 25 kg.m-2
who completed their breast cancer treatment 3-18
months previous
Intervention
• 3 supervised exercise sessions per week
comprising 30 min of moderate intensity aerobic
exercise (treadmill walking, stepping, cycling)
• Individualised healthy eating plan with the aim of
inducing a steady weight loss of up to 0.5 kg each
week
Outcome measures
Body weight
Body composition
Cardio-pulmonary
fitnessCirculating biomarkers
Sex Steroid Hormones
IGF axis peptides/binding
proteins
Adipokines
Salivary cortisol
Immune function
Quality of life
Psychological stress
Depression
Results:
90 women recruited
Excellent compliance > 80%
Low attrition ~12% drop-out
VariableIntervention Group
(n = 47)Control Group
(n = 43)P
Age (years)56 ± 1.5
(36-77)
56 ± 1.4
(36-76).87
Height (cm)162.3 ± 0.9
(149.5-173.5)
163.2 ± 0.9
(148.0-174.0).46
Weight (kg)78.0 ± 1.5
(62.2-105.1)
83.2 ± 2.6
(56.9-142.9).08
Body Mass Index (kg.m-2)29.6 ± 0.5
(25.1-39.3)
31.1 ± 0.9
(25.1-54.5).13
Waist circumference (cm)92.7 ± 2.4
(70.0-178.8)
94.6 ± 2.1
(73.0-136.0).55
Waist:Hip ratio0.84 ± 0.02
(0.65-1.66)
0.83 ± 0.01
(0.69-0.99).55
Systolic blood pressure (mm Hg)138 ± 3
(99-183)
136 ± 3
(96-183).61
Diastolic blood pressure(mm Hg)
90 ± 2
(51-113)
88 ± 2
(61-120.49
Predicted VO2 max23.6 ± 0.6
(14.8-37.8)
23.7 ± 0.8
(14.8-35.2).94
Perceived Stress Scale22.6 ± 1.1
(6-36)
21.3 ± 0.9
(7-30).36
Beck Depression Inventory11.2 ± 1.1
(0-29)
10.1 ± 0.8
(2-26).47
FACT-Total105.7 ± 2.6
(67.0-139.5)
108.9 ± 2.2
(70.0-136.0).35
Intervention group Control group
Baseline 24 weeks Baseline 24 weeks
Total energy intake (kCal) 1679 ± 63 1575 ± 45 1740 ± 57 1685 ± 53
Total fat intake (g) 61.6 ± 3.6 51.3 ± 2.7* 64.3 ± 3.2 62.2 ± 3.2
Saturated fat intake (g) 21.5 ± 1.4 16.9 ± 1.0** 21.8 ± 1.3 21.8 ± 1.3
Carbohydrate intake (g) 202.9 ± 8.1 203.0 ± 6.8 206.9 ± 7.8 203.2 ± 8.1
Protein intake (g) 72.0 ± 2.3 73.5 ± 2.1 78.9 ± 2.6 78.1 ± 2.4
N=47
N=43
Interventiongroup
Controlgroup
Changes in aerobic fitness
ml·kg
-1·m
in-1
**
-2.50
-2.00
-1.50
-1.00
-0.50
0.00
0.50
-1.20
-1.00
-0.80
-0.60
-0.40
-0.20
0.00
0.20
-6.0
-5.0
-4.0
-3.0
-2.0
-1.0
0.0
-0.050
-0.045
-0.040
-0.035
-0.030
-0.025
-0.020
-0.015
-0.010
-0.005
0.000
Body mass BMI
Waist circumference WHR
Me
an
dif
fere
nce
(k
g)
Me
an
dif
fere
nce
(cm
)
Me
an
dif
fere
nce
(k
g/m
2)
Me
an
dif
fere
nce
Outliers included
Outliers removed
** **
***
** **
Depression and quality of life
Intervention Group
Control Group
Pre Post Pre Post
Pre Post Pre Post
**
**
Characteristic TimeIntervention Group
(n = 47)
Control Group
(n = 43)P value
IGF-1 Baseline 60.0 (51.3,87.6) 65.1 (48.2,82.6)
25 weeks 57.2 (47.1,80.7) 61.1 (50.8,69.9)
Change -1.70 (-11.2,5.87) -1.26 (-11.7,6.67) 0.85
IGFBP-1 Baseline 48.4 (22.8,59.9) 29.1 (17.6,49.4)
25 weeks 45.9 (22.3,67.0) 32.0 (22.9,51.6)
Change 5.67 (-9.42,16.1) 1.53 (-4.54,9.82) 0.33
IGFBP-3 Baseline 2457 (2025,3070) 2445 (1851,2956)
25 weeks 2326 (1894,2887) 2359 (2011,2796)0
Change -166 (-323,86.0) -65.9 (-344,403) 0.059
Leptin Baseline 28114 (22549,42008) 27264 (16911,47177)
25 weeks 26019 (16489,40530) 30853 (22360,43096)
Change -3351 (-9088,2057) 4553 (-4342,10085) <0.001
Hs-CRP Baseline 1.37 (0.64,2.53) 2.12 (0.67,5.22)
25 weeks 1.52 (0.78,3.37) 2.18 (0.82,6.17)
Change 0.10 (-0.36,0.63) 0.03 (-0.43,0.70) 0.82
Total cholesterol Baseline 5.70 (4.90, 6.50 5.00 (4.10,6.15)
25 weeks 5.50 (4.70, 6.40) 5.15 (4.53,5.95)
Change -0.20 (-0.50 0.10) 0.10 (-0.30,0.58) 0.71
HDL Baseline 1.60 (1.36,1.80) 1.47 (1.19,1.74)
25 weeks 1.60 (1.33,1.78) 1.48 (1.29,1.80)
Change 0.00 (-1.0,1.0) 0.09 (-0.03,0.22) 0.28
N=42
N=48
Weight loss ≥1kg versus <1kg
Characteristic TimeWeight loss ≥≥≥≥1kg
(n = 42)
Weight loss <1kg
(n = 48)P value
IGF-1 Baseline 62.6 (48.1,85.8) 58.8 (49.5,83.9)
25 weeks 57.3 (48.6,84.1) 60.3 (47.6,74.6)
Change -0.79 (-10.7,4.59) -3.56 (-11.6,7.85) 0.52
IGFBP-1 Baseline 29.3 (16.5,59.5) 40.8 (22.8,56.1)
25 weeks 29.0 (22.2,63.9) 40.0 (24.8,62.6)
Change 5.00 (-8.92,12.2) 2.93 (-10.7,13.9) 0.68
IGFBP-3 Baseline 2583 (2020,3015) 2303 (1928,2959)
25 weeks 2315 (1881,2783) 2379 (2007,2873)
Change -206 (-446,109) 29.2 (-280,309) 0.008
Leptin Baseline 27871 (21455,46595) 27224 (18937,41472)
25 weeks 23977 (16433,41350) 30172 (22019,42286)
Change -5449 (-11411,3659) 1163 (-3412,9243) 0.028
Hs-CRP Baseline 1.44 (0.71,4.97) 1.87 (0.64,3.44)
25 weeks 1.36 (0.76,4.81) 2.26 (0.92,5.11)
Change 0.00 (-0.58,0.20) 0.26 (-0.16,1.07) 0.019
Total cholesterol Baseline 4.90 (4.20, 6.10) 5.70 (4.80,6.50)
25 weeks 4.90 (4.00, 5.74) 5.50 (4.90,6.53)
Change -0.20 (-0.50 0.11) 0.10 (-0.30,0.51) <0.001
HDL Baseline 1.45 (1.30,1.73) 1.58 (1.34,1.82)
25 weeks 1.45 (1.30,1.73) 1.60 (1.37,1.80)
Change 0.00 (-0.11,0.11) 0.05 (-0.06,0.10) 0.021
Summary and Conclusions
•The lifestyle group demonstrated modest changes in body mass and body composition variables, reduced
depression score and improved QoL.
•Reductions in body mass appeared to have the
greatest impact on circulating levels of biological risk
markers.
Summary
Pre-diagnosisTreatment / surveillance
Recovery / rehabilitation
End of life
Lifestyle behaviours influencing QoL / disease-free survival
Cancer survivorship
Lifestyle behaviours influencing risk
Lifestyle behaviours influencing QoL
Cancer diagnosis
Time-line
Disease
recurrence /
Second primary
tumour
Lifestyle behaviours influencing treatment outcome / QoL
Stages of the cancer
experience
Treatment cycle
Future research
• Dose-response – how much exercise is needed to
evoke tangible effects in key health outcomes in those at elevated risk of cancer and those recovering from
cancer treatments?
• How can behavioural strategies be used to ensure that
physical activity is engaged in at the right levels to
evoke tangible health benefits?
• Biomarker studies – biomarkers that can be shown to be
on the "causal pathway" used as intermediate end-points to assess the effectiveness of lifestyle
interventions.
• Develop standardised approaches for physical activity
assessment.
The End