Be active against cancer! Tuesday, 4th of February 2014 (World Cancer Day)

Be Active – Why and How? Professor Nanette Mutrie Physical Activity for Health Research Centre University of Edinburgh

• Physical inactivity has reached ‘Pandemic’ proportions

• Interventions are needed!

• July 2012

"Everything that gets worse when you grow older gets better when you exercise."

Regular physical activity reduces risk of:

• All-cause mortality • Coronary heart

disease • High blood

pressure • Stroke • Falling

• Metabolic syndrome

• Type 2 diabetes • Breast cancer • Colon cancer • Depression

Lee et al. , Lancet, July 2012

Strong evidence of the following benefits for adults:

– Increased cardiorespiratory and muscular fitness

– Healthier body mass and composition – Improved bone health – Increased functional health – Improved cognitive function

Lee et al. , Lancet, July 2012

How does the risk of inactivity compare with smoking?

0123456789

10

PAF% deaths caused in millions

smoking

smoking

Lee et al. , Lancet, July 2012

How does the risk of inactivity compare with smoking?

0123456789

10

PAF% deaths caused in millions

smokinginactivity

Lee et al. , Lancet, July 2012

Percentage of worldwide burden of disease caused by

inactivity

0 1 2 3 4 5 6 7 8 9 10

CHD

Breast cancer

Type 2 Diabetes

Colon Cancer

Prem mortality

Percentage

Lee et al. , Lancet, July 2012

Public health guidelines on Physical Activity

CMOs 2011 ‘start active stay active’ 150 mins of moderate activity/week – or 75 mins vigorous intensity per week – or combination

Strength exercise at least two days/week Older adults all of above plus – balance and co-ordination 2/days/week

Limit sedentary behaviour

Percentage adults achieving Scottish strategy1 recommendations

[SHeS,2012]

39 37

39 39 38

0

10

20

30

40

50

strategy recommendations [5x30]

20082009201020112012

1. Let’s make Scotland more active. 2003

Percentage adults achieving Scottish strategy recommendations and ‘new’

recommendations [SHeS,2012]

0

10

20

30

40

50

60

70

strategy recommendations [5x30] new recommendations [150 mins]

20082009201020112012

Odds of Metabolic Syndrome in Women – TV Viewing and Physical Activity

Physical activity time (hrs/wk)

TV viewing time

(hrs/wk)

*

* *

* P < 0.05 vs ref.

Courtesy Neville Owen

Dunstan et al. (2005). Diabetologia 48, 2254-2261.

Independent of level of moderate to vigourous activity, greater sitting time was associated with increased endometrial cancer risk

Physical Activity and Cancer Preventability estimates (PAF%) (UK) (WCRF, 2013)

Site PAF% accounted for by low physical activity

Breast 12

Colorectum 12

Endometrium 10 http://www.wcrf.org/cancer_statistics/preventability_estimates/preventability_estimates_food.ph

Low physical activity will also influence obesity and increased risk for the following cancer sites Oesphagus Breast Pancreas Colorectum Gallbladder Endometrium Kidney

American Cancer Society Guidelines on Nutrition and Physical Activity for

Cancer Prevention 2012

Physical activity may reduce the risk of several types of cancer, including cancers of the breast, colon, and endo- metrium, as well as advanced prostate cancer, and possibly, pancreatic cancer.

American Cancer Society Guidelines on Nutrition and Physical Activity for

Cancer Prevention 2012

• Physical activity may help to prevent certain cancers via: • regulating sex hormones • insulin • prostaglandins • various beneficial effects on the immune

system.

Be Active – Why and How?

The HOW part

The ABC of Physical Activity for Health: A consensus statement from the

British Association of Sport and Exercise Sciences BASES Journal of Sport Sciences 2010

• A- all adults; B- beginners; C-conditioned • Beginners

– Something is better than nothing – Set achievable goals – Find enjoyment – Seek support

7 Investments that work for physical activity

1. ‘Whole-of-school’ programs

2. Transport policies and systems that prioritise walking, cycling and public transport

3. Urban design regulations and infrastructure that provides for equitable and safe access for recreational physical activity, and recreational and transport-related walking and cycling across the life course

4. Physical activity and NCD prevention integrated into primary health care systems

5. Public education, including mass media to raise awareness and change social norms on physical activity

6. Community-wide programs involving multiple settings and sectors & that mobilize and integrate community engagement and resources

7. Sports systems and programs that promote ‘sport for all’ and encourage participation across the life span

For almost everyone the best place to start is to increase walking

1) Walking is the easiest mode of activity

for inactive people : to get started with to sustain

1) Confers all the major benefits of

activity

Why Walking for Health?

Social

Least affected by SIMD

Low to no expense TRANSFORMATIVE

Habit/ routine

Non age dependent

1st pathway for the least active/sedentary

WHY?

Walking + pedometers?

• Pedometers have been identified as the single most effective method of physical activity promotion (Heath et al., 2012).

Understanding behaviour change techniques [BCTs] in relation to walking

and cycling

• From studies with sig. intervention effects (n=21) the most frequently coded BCTs were: – “Prompt self-monitoring of behavior” – “Prompt intention formation”

• In terms of walking – the pedometer offers a perfect tool

• Bird EL, Baker G, Mutrie N, Ogilvie D, Sahlqvist S, Powell J. Behavior Change

Techniques Used to Promote Walking and Cycling: A Systematic Review. Health Psychol. 2013 Mar 11. PubMed PMID: 23477577.

Pedometers make use of several behaviour change techniques:

goal-setting (individuals can set daily step goals) self-monitoring (check out daily steps) self-efficacy (improve confidence in walking

ability) problem-solving (adapt walking behaviour to suit

weather and setting) motivation (provide instant feedback to

individuals on goals) social support (a visual prompt for friends and

family)

• Week 1 and 2: – an additional 1,500 steps at least 3 days/week

• Week 3 and 4: – increase to 5 days/week

• Week 5 and 6: – an additional 3,000 steps on at least 3

days/week • Week 7:

– increase to 5 days/week • Week 8-12:

– maintain week 7

WWW Walking Goals

12-week Results step-counts

02000

40006000

8000

10000

Baseline Week 12Time-point

Mean daily step-counts

Intervention Control

Ste

ps/d

ay

• 65% of intervention group achieved an increase of 15,000 steps/week

154 steps/day

*3,175 steps/day

• * indicates significant difference between baseline and week 12 at p < .001

Step counts

02000400060008000

1000012000

baseline 12 weeks 24 weeks 48 weeks

Time point

Steps

MAX

MIN

Cost effectiveness • Shaw, et al. (2011).

'Pedometers cost buttons': Bmc Public Health, 11(1), 200.

• Under £100/person to achieve recommended levels of PA

Find out more: www.pathsforall.org.uk Find a Health Walk near you: www.pathsforall.org.uk/findahealthwalk

Community Pedometer Pack

Paths for All Strength & Balance Programme

10 simple exercises that will improve strength and balance and reduce the risk of falls in older adults