Exercise: A Way to Outdistance Breast Cancer?
Hi. This is Dr. Kathy Miller from Indiana University with another Medscape Oncology video blog. Today I would like to talk to you about exercise and the risk for recurrence of breast cancer. Several studies have suggested that women who exercise more have lower risk for recurrence. These studies looked at self-reports of exercise and typically found that women who exercised more throughout their lives tended to do better. This finding has led to many questions: Can we actually get women who have been sedentary to exercise regularly, and would changing those habits after a diagnosis change a woman's prognosis? I would like to make sure that you see a recent study from our colleagues in Alberta, Canada, who addressed the first question: Can you get women who have been sedentary to start exercising, and might you see some physiologic changes from exercise that could be helpful?
It was a randomized trial with 320 postmenopausal women ages 50-74 who admitted that they had a sedentary lifestyle. They were randomly assigned to an aerobic exercise intervention or a control group. The goal of the aerobic exercise intervention was that women would exercise for 45 minutes 5 days a week; 225 minutes per week was the goal. They had a very detailed intervention, support groups, one-on-one meetings with physical trainers, group exercise sessions 3 times a week, reminders, and a variety of incentives for reaching different milestones -- intensive support geared towards getting these women to make these lifestyle changes. The good news is they could and they did.
They assessed the women at baseline, 6 months, and 12 months. At the end of the year, women in the exercise group were exercising an average of 3.5 days per week, totaling approximately 178 minutes of aerobic exercise. They were not quite at their goal, but they had substantially more exercise than women in the control group. They enjoyed many of the fitness benefits that you would expect them to enjoy, but this study took it a step further. The investigators also measured hormone levels to see whether it was possible to identify changes in estrogen levels and sex hormone binding globulin (SHBG) levels in the women who exercised compared with those who didn't. They found reductions in estradiol levels and increases in SHBG, the hormone parameters associated with an improved prognosis in postmenopausal women. So if you just looked at those levels at baseline, the women with lower estradiol levels and higher SHBG levels tend to do better.
A question that remains unanswered by this study is, does changing these values (with exercise or anything else) after diagnosis change their prognosis, or is prognosis largely set by the hormonal milieu at the time the breast cancer is diagnosed? This study really can't address that, but it does lend credence to the importance of exercise and the potential for lifestyle modifications to have an impact on the physiology of our patients in ways that could be helpful for the breast cancer, not just for cardiovascular health, blood pressure, weight control, and diabetes management. It behooves us to continue to study this. These findings tell us that it is possible, although not easy. Getting sedentary women to exercise regularly and keep them going and develop the habit takes commitment and resources, but it is possible and that should give hope to all of us.
It is springtime, so get out there and enjoy it. Get moving and bring your patients with you. Thank you again for joining me on this Medscape video blog, and I hope to have your comments and see you again soon.
Hi. This is Dr. Kathy Miller from Indiana University with another Medscape Oncology video blog. Today I would like to talk to you about exercise and the risk for recurrence of breast cancer. Several studies have suggested that women who exercise more have lower risk for recurrence. These studies looked at self-reports of exercise and typically found that women who exercised more throughout their lives tended to do better. This finding has led to many questions: Can we actually get women who have been sedentary to exercise regularly, and would changing those habits after a diagnosis change a woman's prognosis? I would like to make sure that you see a recent study from our colleagues in Alberta, Canada, who addressed the first question: Can you get women who have been sedentary to start exercising, and might you see some physiologic changes from exercise that could be helpful?
It was a randomized trial with 320 postmenopausal women ages 50-74 who admitted that they had a sedentary lifestyle. They were randomly assigned to an aerobic exercise intervention or a control group. The goal of the aerobic exercise intervention was that women would exercise for 45 minutes 5 days a week; 225 minutes per week was the goal. They had a very detailed intervention, support groups, one-on-one meetings with physical trainers, group exercise sessions 3 times a week, reminders, and a variety of incentives for reaching different milestones -- intensive support geared towards getting these women to make these lifestyle changes. The good news is they could and they did.
They assessed the women at baseline, 6 months, and 12 months. At the end of the year, women in the exercise group were exercising an average of 3.5 days per week, totaling approximately 178 minutes of aerobic exercise. They were not quite at their goal, but they had substantially more exercise than women in the control group. They enjoyed many of the fitness benefits that you would expect them to enjoy, but this study took it a step further. The investigators also measured hormone levels to see whether it was possible to identify changes in estrogen levels and sex hormone binding globulin (SHBG) levels in the women who exercised compared with those who didn't. They found reductions in estradiol levels and increases in SHBG, the hormone parameters associated with an improved prognosis in postmenopausal women. So if you just looked at those levels at baseline, the women with lower estradiol levels and higher SHBG levels tend to do better.
A question that remains unanswered by this study is, does changing these values (with exercise or anything else) after diagnosis change their prognosis, or is prognosis largely set by the hormonal milieu at the time the breast cancer is diagnosed? This study really can't address that, but it does lend credence to the importance of exercise and the potential for lifestyle modifications to have an impact on the physiology of our patients in ways that could be helpful for the breast cancer, not just for cardiovascular health, blood pressure, weight control, and diabetes management. It behooves us to continue to study this. These findings tell us that it is possible, although not easy. Getting sedentary women to exercise regularly and keep them going and develop the habit takes commitment and resources, but it is possible and that should give hope to all of us.
It is springtime, so get out there and enjoy it. Get moving and bring your patients with you. Thank you again for joining me on this Medscape video blog, and I hope to have your comments and see you again soon.
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