The document provides information from a workshop on physical activity for breast cancer survivors. It discusses the role of modifiable risk factors like physical inactivity and obesity in breast cancer. It outlines recommendations for exercise during and after cancer, including aiming for a healthy weight and waist circumference. Types of exercises are described, along with programs for cancer survivors. Benefits of physical activity for cancer prevention, treatment and survivorship are summarized.

1. SURVIVORSHIP –
PHYSICAL
ACTIVITY
EMER GUINAN
MISCP
Supporting People with Breast Cancer
Irish Cancer Society Annual Patient Conference
29.09.2012

2. Physical Activity Workshop
 Role of modifiable risk factors in breast cancer
 Physical
activity
 Body composition
 Practical activities
 Body mass index
 Waist circumference
 Exercise prescription

3. Who am I??
Emer Guinan
Chartered physiotherapist, MISCP.
Main interests:
 The role of physical activity in chronic disease, in particular
cancer
 Exercise testing and prescription.
“The Metabolic Profile and Physical Activity Levels
of Breast Cancer Survivors and BRCA Mutation
Carriers”
Dr. Juliette Hussey, Discipline of Physiotherapy, TCD.
Ms. Elizabeth Connolly, Consultant Surgeon, St. James’s

4. Breast Cancer Risk Factors
Non-Modifiable Modifiable
Risk  Obesity
 Age  Physical inactivity
 Family History
 Alcohol
consumption
Prognosis  HRT
 Characteristics of
the breast tumour

5. Obesity, physical activity and
cancer

6. Obesity and Breast Cancer

7. Obesity and Cancer Risk
Total Body Fatness
• Oesophagus
• Pancreas
• Colorectal
• Postmenopausal
Overweight breast
and • Endometrium
• Kidney
Obesity Abdominal Fatness
Increases • Colorectal
Risk • Pancreas
• Postmenopausal
breast

8. Obesity and Cancer
Abdominal Fat
(visceral fat)
Metabolically Ideal
Active environme
• Insulin nt for
• Inflammation tumour
• Cholesterol
growth and
• Glucose
• Blood pressure
progressio
n

9. Obesity
Obesity
Increases Poorer breast
breast cancer cancer
risk prognosis

10. Weight Gain during Treatment
 Treatments
 Chemotherapy
 Hormonal therapy (Tamoxifen)
 Who?
 Premenopausal women
 Why?
 Decreased physical activity levels
 Changes in diet
 Lower metabolism
 Side effects

11. Recommendations
Aim to be a healthy weight for your height
Body Mass Index (BMI)
Do not let fat accumulate on your tummy
Waist circumference
During breast cancer treatment do not
either gain or lose weight

12. Some important measurements….
 Body Mass Index
 Waist Circumference

13. Body Mass Index (BMI)
 BMI is a measure of body fat based on height and
weight

15. Waist Circumference

16. Measuring Waist Circumference
 Find the top of the hip bone
 Find the last rib
 Estimate the mid-point between the hip bone and
the last rib
 Place the tip of the measuring tape at this point
 Your partner should hold the tape in place as you
spin around, allowing the tape to wrap around you
 Remember: relax the tummy! Do not hold your

17. Waist Circumference
Increased Substantially
Risk Higher Risk
Men 94 cm 102 cm
Women 80 cm 88 cm

19. Physical Activity and Breast
Cancer

20. Physical Activity and Cancer
Risk
Convincing
Physical Evidence
• Colon
Activity
Probable Evidence
Decreases • Postmenopausal
Risk breast
• Endometrium
• Lung
• Pancreas
• Premenopausal
breast

21. Physical Activity throughout the
cancer experience
Breast Cancer During Breast Cancer
Prevention Treatment Survivorship

22. Breast Cancer Prevention
Women who are physically active
throughout their live have a 25% reduced
risk of developing breast cancer after the
menopause

23. During Breast Cancer
Treatment

24. Breast Cancer Survivorship
Being physically active after a breast cancer
diagnosis…..
26% reduced risk of breast cancer
recurrence
30-40% reduced risk of death from
any cause
2-3 hours of brisk walking per
week

25. Physical Activity and Obesity
Abdominal Fat
(visceral fat)
Metabolically Ideal
Active environme
• Insulin nt for
• Inflammation tumour
• Cholesterol
growth and
• Glucose
• Blood pressure
progressio
n

26. Breast cancer survivors…
 Reduction in physical activity levels at breast
cancer diagnosis.
 Rarely return to “normal” physical activity
levels when treatment is complete.
 66% of waking hours spent sedentary /
inactive
 Poor adherence to physical activity guidelines

27. Physical Activity Guidelines
30 Minutes of Moderate
Intensity Physical Activity
x5 Days per Week
Avoid Inactivity

28. The 10 minute rule
10 Minute Bouts
10 minute walk to 10 minute
the shop / work household chore
10 minute
walk/jog/stair
climbing during
lunch

29. Physical Activity
 “Any body movement, produced by skeletal
muscles and resulting in energy expenditure
that exceeds resting levels”
Recreation
al
Occupation
al
Transport
Househol
d

30. Benefits of Physical Activity
 Improves cardiovascular fitness
 Improves bone quality
 Reduces blood pressure
 Reduces cholesterol
 Reduces insulin resistance and the risk of diabetes
 Improves body composition
 Reduces low-grade inflammation
 Improves quality of life
 Improves symptoms of depression
 Reduces the risk of chronic diseases (heart disease, stroke)
 Reduces cancer related fatigue
 Improves breast cancer prognosis

31. Types of Exercise
• Walking • Weights
• Aerobics • “Curves”
• Swimming
Aerobic Strength
Flexibilit
Core
y
• Yoga • Pilates

32. Types of Exercise
• Walking • Weights
• Aerobics • “Curves”
• Swimming
Aerobic Strength
Flexibilit
Core
y
• Yoga • Pilates

33. What is aerobic exercise?
 Exercise that increases your heart rate and
where you sweat but you can still hold a
conversation.
 Moderate intensity
 Methods to measure exercise intensity
 Rate of perceived exertion
 The “Talk Test”
 Heart rate monitor

34. Borg Rate of
Perceived
Exertion
Moderate
intensity
exercise
You can talk but you can’t
sing!

35. Heart Rate Monitor
Moderate intensity = 64-76% Maximum Heart
Rate
Maximum Heart Rate = 220 -
age
Example: 50 year old woman
Maximum heart rate = 220 – 50
= 170 beats per min
Moderate intensity exercise = 64-76% (170)
= 108.8 – 129.2
= 108 – 129 beats per
min

37. Ideas for Exercise
 Walking!!!!
 Take up a sport
 Join a class
 Aerobics
 Exercise groups for women following breast
cancer
 Irish Cancer Society Exercise programme
 Plurabelle Paddlers
 “Move On”

38. Irish Cancer Society
 Free exercise programmes for people following
breast and colon cancer
 30 weeks
 Walking programme
 9 MET-hours.weekˉ¹
 2-3 hours of brisk walking
 Light weights programme
 Supervised by exercise specialists
 Website: www.cancer.ie
 Contact: fitness@irishcancer.ie
 Telephone: 01 2316624

39. Plurabelle Paddlers
 First dragon boat team in Ireland
 60+ active members (aged 30-70+)
 2 boats
 Train March to November on Wednesday
evenings and Saturday mornings
 Fitness classes during the winter
 The repetitive movement strengthens the arms
and reduces lymphedema
 Website: www.plurabellepaddlers.com
 Contact: info@plurabellepaddlers.com
 Telephone: 0872806048

40. “Move On”
 A medically supervised exercise programme for
breast and colon cancer survivors.
 Only for patients of Beaumont or the Mater
Hospitals
 3 month exercise programme
 Three classes per week
 Home exercise programme
 DCU Sport
 Ask your doctor for a referral

41. Exercise after Breast Cancer
 Arm and shoulder
 Pain
 Reduced range of movement (stiffness)
 Lymphoedema
 Bone health
 Hormone therapy
 Arimidex
 Femara

42. Exercise and Bone Health
 Weight-bearing exercise
 Walking
 Running
 Step aerobics
 Muscle Strengthening
 Exercises that don’t improve bone health
 Cycling
 Swimming
 Aqua aerobics

43. Side-Effects of Exercise
 Muscle soreness
 Warm-up / Cool-down
 Stretching
 Proper footwear
 Warm bath
 Dehydration / cramp
 Drink lots of fluids while exercising

44. Medical Clearance to Exercise
If you answer yes to any of the following questions consult
with your doctor before starting any new exercise
programme.
1. Has your doctor ever said that you have a heart condition and that
you should only do physical activity recommended by a doctor?
2. Do you feel pain in your chest when you do physical activity?
3. In the past month, have you had chest pain when you were not
doing physical activity?
4. Do you lose your balance because of dizziness or do you ever lose
consciousness?
5. Do you have a bone or joint problem (for example back, knee or hip)
that could be made worse by a change in physical activity?
6. Is your doctor currently prescribing drugs (for examples water pills)
for your blood pressure or heart condition.
7. Do you know of any other reason why you should not do physical
activity?

45. Take Home Message
Being physically active after breast cancer
has a wide range of health benefits and is
one of the things that you can do to reduce
your risk of breast cancer recurrence.
Aim for 30 minutes of moderate intensity
activity 5 days per week

46. Acknowledgements

47. Questions?????