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