Active Living After Cancer program improves physical functioning of breast cancer survivors

Breast cancer survivors who participated in Active Living After Cancer, an evidence-based 12-week group program, markedly increased their physical activity and ability to accomplish the basic pursuits of daily life, researchers from The University of Texas MD Anderson Cancer Center reported today in Cancer.

The results show the program could serve as a model to deliver a community-based physical activity program to minority and medically underserved cancer survivors.

“After a cancer diagnosis, survivors’ physical functioning declines much faster than their peers of the same age and gender who don’t have cancer, which can ultimately affect their ability to remain independent and mobile,” said Karen Basen-Engquist, Ph.D., professor of Behavioural Science and senior author of the paper.

“We’ve shown this evidence-based program can be successfully implemented through a community model to help diverse populations of cancer survivors improve physical functioning after completing cancer treatment.”

The program measured changes in participants’ six-minute walk and 30-second sit-to-stand test results from baseline to completion of the program. These physical functioning tests measure activities essential to daily life.

Mean sit-to-stand repetitions increased 19%, from 12.5 to 14.9; and mean six-minute walk distance increased 10%, from 428 meters to 470 meters. Self-reported physical activity nearly doubled, from a mean of 172.8 minutes of moderate to vigorous physical activity per week at baseline to 344.6 minutes at the 12-week follow-up.

Participants also reported an 8% increase in physical quality of life and a 6% improvement in mental health, as measured by a health-related quality of life outcomes questionnaire.

Active Living After Cancer is not a supervised exercise program.

Facilitators from community organisations follow a 12-week curriculum that introduces a different low-impact exercise, cognitive/behavioural skill and survivorship resource each week to help participants increase their physical activity at home, learn how to build healthier habits and cope with the challenges of survivorship.

“One reason this model is successful is that we focus on meeting people where they are, teaching them the skills to develop their own goals and allowing them to go at their own pace,” Basen-Engquist said. “We know that not everyone is ready for or interested in going to a gym.

We need models to deliver these services to all cancer survivors, especially to people with less access. Active Living After Cancer provides a soft start to get people thinking about how active living benefits them and incorporating physical activity into their everyday lives.”

The findings reported in Cancer were based on 127 breast cancer survivors who completed the program between 2014 and 2017. During this time, 34 Active Living After Cancer groups (12-week sessions with the same cohort) were completed at health care organisations, community organisations and churches across the greater Houston area.

The research team focused on recruiting minority and medically underserved cancer survivors because these populations tend to exercise less and have less access to physical activity resources. The program is free and was offered to breast cancer survivors who had completed primary cancer treatment.

The recruitment rate for the program was 45%, similar to other exercise programs for cancer survivors. Of the 187 participants who enrolled in the program, 74% completed at least half the sessions. The 68% who completed the 12-week intervention were included in the outcome analysis.

Participants were all women, with a mean age of 59.6 years, and 65% were minority and/or medically underserved breast cancer survivors. Participants were 30.6% white, 31.2% Black, 26.9% Hispanic and 11.1% other.

Some classes were held in Spanish to accommodate the 15.5% of Spanish-speaking participants. Nearly half had private insurance, while 51% were covered by Medicare, Medicaid, Harris County’s Gold Card health care financial assistance program or were uninsured.

Researchers from MD Anderson developed the curriculum, trained facilitators from community organisations to lead the sessions and measured program results.

“It was important to work with community partners to provide a way to disseminate the program more broadly,” Basen-Engquist said. “We try to work with organisations that have a track record of working within that community and can make it relevant to the people they serve.”

The program builds on a lifestyle physical activity intervention that the team previously tested in a randomised study. Since 2017, Active Living After Cancer has expanded to include survivors of all cancer types and broadened to serve the El Paso, Beaumont and Tyler, Texas communities.

Due to the COVID-19 pandemic, Active Living After Cancer has been delivered virtually since March 2020, and more than 1,000 cancer survivors have now completed the program.

“We’ve learned a lot about exercise and benefits for cancer survivors over the past 20 years, and now our job is to implement that knowledge,” Basen-Engquist said. “We hope that Active Living After Cancer will be a model to deliver these services to all cancer survivors, especially to people with less access to resources for healthy living.”

Source: The University of Texas MD Anderson Cancer Center

Too much belly fat, even for people with a healthy BMI, raises heart risks

People with too much fat around their midsections and vital organs are at increased risk for heart disease, even if their body mass index falls within what is considered a healthy range, according to a new scientific report.

The statement from the American Heart Association, published Thursday in its journal Circulation, summarizes research on the ways in which belly fat and other measures of obesity affect heart health. Belly fat also is referred to as abdominal fat and visceral adipose tissue, or VAT.

“Studies that have examined the relationship between abdominal fat and cardiovascular outcomes confirm that visceral fat is a clear health hazard,” writing committee chair Dr. Tiffany Powell-Wiley said in a news release. Powell-Wiley is chief of the Social Determinants of Obesity and Cardiovascular Risk Laboratory at the National Heart, Lung, and Blood Institute in Bethesda, Maryland.

Whether a person has too much belly fat is typically determined using the ratio of waist circumference to height (taking body size into account) or waist-to-hip ratio. This measurement has been shown to predict cardiovascular death independent of BMI, a measure of obesity that is based on height and weight.

Experts recommend both abdominal measurement and BMI be considered during regular health care visits because even in healthy weight individuals, it could mean an increased heart disease risk. Abdominal obesity is also linked to fat accumulation around the liver. That often leads to non-alcoholic fatty liver disease, which adds to cardiovascular disease risk.

Worldwide, around 3 billion people are overweight or have obesity. The “obesity epidemic contributes significantly” to many chronic health conditions and cardiovascular disease cases around the world, Powell-Wiley said. Specifically, obesity is associated with a higher risk of coronary artery disease and death from cardiovascular disease. It contributes to high cholesterol, Type 2 diabetes, high blood pressure and sleep disorders.

Yet some people whose BMI classifies them as obese, but who have low levels of abdominal fat, are at lower risk for heart problems, the analysis showed.

Meeting federal guidelines for 150 minutes of physical activity per week may be sufficient to reduce abdominal fat, the analysis found, with no additional loss from longer activity times. Exercise alone or in combination with diet changes have been shown in some instances to reduce abdominal obesity even without weight loss.

Also, weight loss from lifestyle changes improves blood sugar, blood pressure, and triglyceride and cholesterol levels – a cluster of factors referred to as metabolic syndrome, according to the new statement. It also reduces inflammation, improves blood vessel function and helps non-alcoholic fatty liver disease.

In addition, intense weight loss may help curb atrial fibrillation, a quivering or irregular heartbeat, according to the report. Estimates suggest obesity may account for one-fifth of all cases.

The new scientific statement evaluated research on managing and treating obesity, particularly abdominal obesity. Experts concluded that reducing calories and aerobic exercise were the most beneficial.

Bariatric weight loss surgery has been shown to reduce the risk for coronary artery disease better than weight loss achieved without surgery. This may be due to the larger amount of weight loss achieved with surgery and the resultant changes in metabolism that are typical after bariatric surgery.

The statement also addresses what’s known as the “obesity paradox.” That is, even though overweight and obesity are strong risk factors for cardiovascular disease, in the short-term, they don’t always mean patients have worse survival outcomes. The analysis concludes this may be because people classified as overweight or obese are often screened earlier for cardiovascular disease than people with healthy weight, so they are diagnosed and treated earlier.

“The underlying mechanisms for the obesity paradox remain unclear,” Powell-Wiley said. “Despite the existence of the paradox for short-term cardiovascular disease outcomes, the data show that patients with overweight or obesity suffer from cardiovascular disease events at an earlier age, live with cardiovascular disease for more of their lives and have a shorter average lifespan than patients with normal weight.”

Article published courtesy of American Heart Association News

Following healthy lifestyle habits at middle age may increase years lived free of chronic diseases

A senior African American Man jogging

Maintaining five healthy habits—eating a healthy diet, exercising regularly, keeping a healthy body weight, not drinking too much alcohol, and not smoking—at middle-age may increase years lived free of type 2 diabetes, cardiovascular disease, and cancer, according to a new study led by Harvard T.H. Chan School of Public Health.

The study was published online January 8, 2020 in BMJ. It is a follow-up and extension of a 2018 study, which found that following these habits increased overall life expectancy.

“Previous studies have found that following a healthy lifestyle improves overall life expectancy and reduces risk of chronic diseases such as diabetes, cardiovascular disease, and cancer, but few studies have looked at the effects of lifestyle factors on life expectancy free from such diseases,” said first author Yanping Li, senior research scientist in the Department of Nutrition. “This study provides strong evidence that following a healthy lifestyle can substantially extend the years a person lives disease-free.”

The researchers looked at 34 years of data from 73,196 women and 28 years of data from 38,366 men participating in, respectively, the Nurses’ Health Study and the Health Professionals Follow-up Study. Healthy diet was defined as a high score on the Alternate Healthy Eating Index; regular exercise as at least 30 minutes per day of moderate to vigorous activity; healthy weight as a body mass index of 18.5-24.9 kg/m2; and moderate alcohol intake as up to one serving per day for women and up to two for men.

They found that women who practiced four or five of the healthy habits at age 50 lived an average of 34.4 more years free of diabetes, cardiovascular diseases, and cancer, compared to 23.7 healthy years among women who practiced none of these healthy habits. Men practicing four or five healthy habits at age 50 lived 31.1 years free of chronic disease, compared to 23.5 years among men who practiced none. Men who were current heavy smokers, and men and women with obesity, had the lowest disease-free life expectancy.

“Given the high cost of chronic disease treatment, public policies to promote a healthy lifestyle by improving food and physical environments would help to reduce health care costs and improve quality of life,” said senior author Frank Hu, Fredrick J. Stare Professor of Nutrition and Epidemiology and chair, Department of Nutrition.

Other Harvard Chan School study authors included Dong Wang, Klodian Dhana, Xiaoran Liu, Mingyang Song, Gang Liu, Qi Sun, Laila Al-Shaar, Molin Wang, Eric B. Rimm, Ellen Hertzmark, Meir J. Stampfer, and Walter C. Willett.

To grow up healthy, children need to sit less and play more

Children under five must spend less time sitting watching screens, or restrained in prams and seats, get better quality sleep and have more time for active play if they are to grow up healthy, according to new guidelines issued by the World Health Organization (WHO).

“Achieving health for all means doing what is best for health right from the beginning of people’s lives,” says WHO Director-General Dr Tedros Adhanom Ghebreyesus. “Early childhood is a period of rapid development and a time when family lifestyle patterns can be adapted to boost health gains.”

The new guidelines on physical activity, sedentary behaviour and sleep for children under 5 years of age were developed by a WHO panel of experts. They assessed the effects on young children of inadequate sleep, and time spent sitting watching screens or restrained in chairs and prams. They also reviewed evidence around the benefits of increased activity levels.

Children playing at Boboh Beach in Sierra Leone. Photo credit: ABC

“Improving physical activity, reducing sedentary time and ensuring quality sleep in young children will improve their physical, mental health and wellbeing, and help prevent childhood obesity and associated diseases later in life,” says Dr Fiona Bull, programme manager for surveillance and population-based prevention of noncommunicable diseases, at WHO.

Failure to meet current physical activity recommendations is responsible for more than 5 million deaths globally each year across all age groups.  Currently, over 23% of adults and 80% of adolescents are not sufficiently physically active. If healthy physical activity, sedentary behaviour and sleep habits are established early in life, this helps shape habits through childhood, adolescence and into adulthood.

“What we really need to do is bring back play for children,” says Dr Juana Willumsen, WHO focal point for childhood obesity and physical activity. “This is about making the shift from sedentary time to playtime, while protecting sleep. “

The pattern of overall 24-hour activity is key: replacing prolonged restrained or sedentary screen time with more active play, while making sure young children get enough good-quality sleep. Quality sedentary time spent in interactive non-screen-based activities with a caregiver, such as reading, storytelling, singing and puzzles, is very important for child development.

The important interactions between physical activity, sedentary behaviour and adequate sleep time, and their impact on physical and mental health and wellbeing, were recognized by the Commission on Ending Childhood Obesity, which called for clear guidance on physical activity, sedentary behaviour and sleep in young children.

Applying the recommendations in these guidelines during the first five years of life will contribute to children’s motor and cognitive development and lifelong health

NIAID Scientists Investigate How Exercise Exacerbates Symptoms of Rare Disease

People with a rare disease called mastocytosis must do their cardio with caution.

NIAID staff do a warm-up before taking a run or brisk walk.

Mastocytosis occurs when a person has too many mast cells(link is external), a type of white blood cell. Mast cells normally play a healthy role by releasing granules filled with chemicals that cause inflammation, which allows immune cells and other helpful particles in the blood to reach a site of infection or injury more easily. However, having too many mast cells can lead to the release of too much of these inflammatory chemicals, causing symptoms such as flushing, severe itching, abdominal pain, diarrhea, and fainting due to a sudden drop in blood pressure.

Scientists have reported that physical factors including exercise can worsen mastocytosis-related symptoms. To better understand the relationship between exercise and these symptoms, scientists led by NIAID researcher Hirsh Komarow, M.D., explored whether physical exercise triggers the release of mast-cell chemicals in people with mastocytosis. Dr. Komarow is a staff clinician in the NIAID Laboratory of Allergic Diseases.

Dr. Komarow and colleagues focused on two chemicals released by mast cells, histamine and tryptase. In people with mastocytosis, blood-serum levels of these chemicals rose significantly after physical exercise, supporting the hypothesis that physical activity can induce mast cells to release inflammatory chemicals. The increase in histamine and tryptase levels after exercise was significantly greater in people with mastocytosis than in healthy individuals. The scientists also found that the post-exercise increase in blood levels of these chemicals was associated with a worsening of mastocytosis-related symptoms.

Dr. Komarow advises that people with mastocytosis consult their physicians about how to manage any worsening of symptoms during and after exercise, noting that medication such as an antihistamine could potentially help. In addition, Dr. Komarow recommends that people with mastocytosis know how to self-administer epinephrine to treat anaphylaxis, should it occur.

The results of this study were recently published in The Journal of Allergy and Clinical Immunology: In Practice