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
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.
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