Cramp, Anita G.

Fitzgeorge, L.

Prapavessis, H.

English

Scholarship@Western

Western University Scholarship@Western Paediatrics Publications Paediatrics Department 1-1-2011 Cancer risk: Are we well behaved? Anita G. Cramp Western University L. Fitzgeorge Western University H. Prapavessis Western University Follow this and additional works at: https://ir.lib.uwo.ca/paedpub Citation of this paper: Cramp, Anita G.; Fitzgeorge, L.; and Prapavessis, H., "Cancer risk: Are we well behaved?" (2011). Paediatrics Publications. 1645. https://ir.lib.uwo.ca/paedpub/1645 CANCER RISK259Current OnCOlOgy—VOlume 18, number 6Copyright © 2011 Multimed Inc. Following publication in Current Oncology, the full text of each article is available immediately and archived in PubMed Central (PMC).G U E S T  E D I T O R I A LCancer risk: are we well behaved?A.G. Cramp phd,* L. Fitzgeorge phd,*  and H. Prapavessis phd*†a minimum of 45 minutes of moderate-to-vigorous physical activity 5 days per week—may help to reduce the risk of cancer development 15. Although these guidelines are based on scientific evidence, the American Cancer Society cautions that the evidence used to create this general guideline is not definitive because the research is unclear with respect to the minimum intensity, duration, frequency, and type of physical activity needed to reduce cancer risk 15. In addition, most data are limited to aerobic activity; very few studies have been published on the preven-tive effects of other forms of activity—for example, weight training, yoga, or tai chi 10. Future research is needed to determine the minimum dose and optimal type or types of physical activity needed to yield site-specific cancer prevention effects 16.Despite knowledge of physical activity’s protec-tive effects with regard to cancer, and a host of other chronic illness such as heart disease and diabetes, half of all Canadian adults are insufficiently active 17. Engaging in regular physical activity is a complex behaviour that is influenced by factors such as per-sonal motivation, health and mobility issues, and the social and physical environments in which people live 18. At present, given the low percentages of regular exercisers in the population, physical activity as a cancer prevention strategy is underperforming. So here are several recommendations for increasing physical activity.First, from both a cancer prevention and a be-havioral standpoint, efforts need to be focused on increasing activity levels among children and youth. The 2010 annual report card from Active Healthy Kids Canada found that 87% of children and youth are not engaging in the recommended minimum of 90 minutes of physical activity daily 19. As people age, the statistics do not get better. In fact, epidemiology data show a significant trend of decreasing physical activity levels during the transition from adolescence to adulthood 20. Sedentary lifestyles are therefore be-ing established in childhood and being maintained into adulthood. This situation is problematic, because Cancer contributes to approximately 13% (7.4 mil-lion) of all deaths worldwide 1, making cancer the leading cause of death across the globe. Based on Canadian data, 29% of deaths each year are estimated to be related to cancer 2. Unfortunately, cancer deaths are projected to continue rising 1. Preventing cancer is therefore a major worldwide public health concern.Lifestyle factors such as tobacco use, unhealthy diet, physical inactivity, excess body weight, and alcohol consumption are well-documented modifi-able cancer risk factors 3. In North America, evidence suggests that 50%–75% of cancer deaths are caused by modifiable lifestyle behaviours 4. Moreover, when smoking behaviour is removed, one third of cancer deaths are estimated to be attributable to poor nutri-tion, physical inactivity, and overweight or obesity 5–7.Epidemiology studies reveal that people who are more physically active have a lower risk of certain cancers than do those who are sedentary 8. For ex-ample, prospective cohort studies in postmenopausal women reveal a 10%–20% reduced risk of breast cancer in women who engage in a minimum of 3 hours of moderate-level physical activity weekly 9,10. Two reviews summarizing the association between physical activity and colorectal cancer concluded that there is convincing evidence of a causal relationship between physical activity and colon cancer 11,12. In addition, cohort studies have found that high levels of physical activity are associated with reduced risk for advanced prostate cancer and lung cancer when ad-justed for smoking behaviour 13. Furthermore, a recent meta-analysis that included prospective studies found that, compared with inactive women, physically active women had a reduced risk of endometrial cancer 14.Taken together, the evidence to date reveals a clear and consistent message: engaging in regular physical activity has protective effects with respect to cancers of the colon and breast. Furthermore, evi-dence of protective effects for physical activity in the case of other cancers is building.The American Cancer Society suggests that par-ticipating in regular physical activity—for example, CRAMP et al.260Current OnCOlOgy—VOlume 18, number 6Copyright © 2011 Multimed Inc. Following publication in Current Oncology, the full text of each article is available immediately and archived in PubMed Central (PMC).the cancer risk–reduction effects of physical activity are thought to accumulate over the course of a life-time 11. Thus, starting a pattern of regular physical activity early in life is likely to have the biggest effect in preventing cancer.Second, it must be conveyed to adults who are not active that some physical activity is better than none. They can start by walking for 10 minutes, and then gradually increase that time up to 45 or more minutes most days of the week. They can walk with a friend or partner and can try new physical activities—for example, cycling, swimming, strength training—to promote enjoyment and prevent boredom.In addition to engaging in structured or planned physical activity, people should be encouraged to be more active throughout the day. A study by Tremblay and colleagues 21 demonstrates that thermogenesis outside of exercise activity (for example, incidental movement such as walking up stairs) has health ben-efits and that people should be encouraged to move throughout the day. This simply means move more: for example, park the car farther away or take breaks from sedentary activities such as screen use to walk.Finally, to improve physical activity levels, it is important to indentify individual and environ-mental factors associated with physical activity. For example, at the individual level, barriers to physical activity include lack of time and motivation and a lack of confidence in the ability to engage in physical activity. One way to help people overcome these barriers is to teach them the self-regulatory skills needed to adhere to physical activity: for example, self-monitoring, goal-setting, scheduling, and brainstorming barrier solutions. Substantial environmental barriers may also exist. Common environmental barriers include a lack of facilities and resources such as sidewalks and bicycle trails, or safe and convenient places to exercise. To help overcome such barriers, it is important that com-munities support healthy lifestyle choices by pro-viding safe environments in which people have the opportunity to be physically active.The protective effects for physical activity with respect to cancer are convincing. Moreover, the sig-nificance of physical activity in cancer prevention is multi-dimensional, in that leading a physically active lifestyle may have a domino effect on other modifi-able factors related to cancer. For example, becoming more physically active can lead to weight loss and healthier eating habits. Recent evidence suggests that exercise may help to reduce or even eliminate smoking behaviour 22. However, most of the popula-tion forgoes this benefit because they chose to lead a sedentary lifestyle. A few strategies for increasing physical activity have been highlighted: encourage young people to become more active, understand that some activity is better than none, teach and practice self-regulatory skills, and support an environment that promotes active lifestyle choices.CONFLICT OF INTEREST DISCLOSURESThere are no conflicts of interest.REFERENCES 1. World Health Organization (who). Cancer [Web resource]. Fact sheet 297. Geneva, Switzerland: who; 2011. [Available online at: http://www.who.int/mediacentre/factsheets/fs297/en/index.html; cited November 19, 2010] 2. Canadian Cancer Society’s Steering Committee. Canadian Cancer Statistics 2010. Toronto: Canadian Cancer Society; 2010. 3. Canadian Cancer Society and the National Cancer Institute of Canada. Canadian Cancer Statistics 2005. Toronto: Canadian Cancer Society; 2005. 4. United States, National Institutes of Health, National Cancer Institute (nci). Cancer Trends Progress Report—2009/2010 Update [Web page]. Bethesda, MD: nci; 2010. [Available at: http://progressreport.cancer.gov/trends-glance.asp; cited November 10, 2010] 5. Krauss RM, Eckel RH, Howard B, et al. American Heart As-sociation Dietary Guidelines Revision 2000: a statement for healthcare professionals from the Nutrition Committee of the American Heart Association. Circulation 2000;102:2284–99. 6. United States, Department of Health and Human Services and Department of Agriculture (usda). USDA Dietary Guidelines for Americans. 5th ed. Washington, DC: usda; 2000. 7. McGinnis JM, Foege WH. Actual causes of death in the United States. JAMA 1993;270:2207–12. 8. United States, National Institutes of Health, National Cancer Institute (nci). Physician Data Query database: Cancer Prevention Overview [Web resource]. Bethesda, MD: nci; 2010. [Avail-able at: http://www.cancer.gov/cancertopics/pdq/prevention/overview/HealthProfessional; cited November 10, 2010] 9. United States, Department of Health and Human Services (dhhs), Physical Activity Guidelines Advisory Committee. Physical Activity Guidelines Advisory Committee report, 2008. Washington, DC: dhhs; 2008. 10. McTiernan A, Irwin M, Vongruenigen V. Weight, physical activity, diet, and prognosis in breast and gynecologic cancers. J Clin Oncol 2010;28:4074–80. 11. Friedenreich CM, Thune I. Review of physical activity and prostate cancer risk. Cancer Causes Control 2001;12:461–75. 12. Slattery ML. Physical activity and colorectal cancer. Sports Med 2004;34:239–52. 13. World Cancer Research Fund and American Institute for Cancer Research. Food, Nutrition, Physical Activity, and the Prevention of Cancer: A Global Perspective. Washington, DC: American Institute for Cancer Research; 2007. 14. Renehan AG, Tyson M, Egger M, Heller RF, Zwahlen M. Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies. Lancet 2008;371:569–78. 15. Byers T, Nestle M, McTiernan A, et al. on behalf of the American Cancer Society 2001 Nutrition and Physical Activ-ity Guidelines Advisory Committee. American Cancer Society Guidelines on nutrition and physical activity for cancer preven-tion: reducing the risk of cancer with healthy food choices and physical activity. CA Cancer J Clin 2002;52;92–119.CANCER RISK261Current OnCOlOgy—VOlume 18, number 6Copyright © 2011 Multimed Inc. Following publication in Current Oncology, the full text of each article is available immediately and archived in PubMed Central (PMC). 16. Rogers CJ, Colbert LH, Greiner JW, Perkins SN, Hursting SD. Physical activity and cancer prevention pathways and targets for intervention. Sports Med 2008;38:271–96. 17. Canadian Fitness and Lifestyle Research Institute. Physical Activity Monitor: Facts and Figures. Bulletin 2. Physical Activity Levels of Canadians. Ottawa, ON: Canadian Fitness and Lifestyle Research Institute; 2009. [Available online at: http://72.10.49.94/media/node/82/files/PAM2008FactsFigures_Bulletin02_PA_among_CanadiansEN.pdf; cited October 25, 2010] 18. Katzmarzyk PT. Physical activity, sedentary behavior, and health: paradigm paralysis or paradigm shift? Diabetes 2010;59:2717–25. 19. Active Healthy Kids Canada. Health Habits Start Earlier Than You Think: The Active Healthy Kids Canada Report Card on Physical Activity for Children and Youth. Toronto, ON: Active Healthy Kids Canada; 2010. [Available online at: http://www.activehealthykids.ca/ecms.ashx/2010ActiveHealthyKidsCanadaReportCard-shortform.pdf; cited November 25, 2010] 20. Gilmour H. Physically active Canadians. Health Rep 2007;18:45–65. 21. Tremblay MS, Esliger DW, Tremblay A, Colley R. Inciden-tal movement, lifestyle-embedded activity and sleep: new frontiers in physical activity assessment. Can J Public Health 2007;98(suppl 2):S208–17. 22. Taylor AH, Ussher MH, Faulkner G. The acute effects of exercise on cigarette cravings, withdrawal symptoms, af-fect and smoking behaviour: a systematic review. Addiction 2007;102:534–43.Correspondence to: Anita G. Cramp, Exercise and Health Psychology Laboratory, Room 408, Arthur and Sonia Labatt Health Science Building, The University of Western Ontario, London, Ontario  N6A 5B9.E-mail: acramp2@uwo.ca*  Exercise and Health Psychology Laboratory, The University of Western Ontario, London, ON.†  School of Kinesiology and Division of Clinical Oncology, Department of Oncology, The University of Western Ontario, London, ON.

Cancer risk: Are we well behaved?

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Cancer risk: Are we well behaved?

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