11/01/2022

The Foundations of Physical Activity and Health

SPSU8F4

Dr Jenni Connelly
Module Co-ordinator

SPSU8F4

Physical Activity and Health Benefits

Dr Jenni Connelly

Physical Activity and Cardiovascular Disease

Dr Jenni Connelly

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The Heart

The Heart- Basic Facts

•The average heart is the size of an adult fist.
•Your heart will beat about 115,000 times each day pumping about 2,000 gallons of blood.
•The beating sound your heart makes is caused by the opening and closing of its valves.
If you were to stretch out your blood vessel system, it would extend over 60,000 miles.
•The human heart weighs less than one pound, but a man’s heart is typically two ounces
heavier than a woman’s.
•A woman’s heart beats slightly faster than a man’s.
•There is such a thing as a broken heart. Symptoms are similar to a heart attack but the
cause is usually stress and not heart disease.
•Laughing is good for your heart. It reduces stress and gives a boost to your immune
system.

What is Cardiovascular Disease?

Cardiovascular disease (CVD) is an umbrella term that

describes all diseases of the heart and circulation. It
includes everything from conditions that are diagnosed at
birth, or inherited, to developed conditions such as
coronary heart disease, atrial fibrillation, heart failure,
and stroke. BHF 2018

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Prevalence

Prevalence

• There are an estimated 685,000 people living with cardiovascular disease

in Scotland.
• Coronary heart disease (CHD) is Scotland’s single biggest killer. It is also the
leading cause of death worldwide.
• In Scotland, 1 in 7 men and nearly 1 in 10 women die from coronary heart
disease.
• CHD is responsible for around 6,700 deaths in Scotland each year - that’s
around 18 deaths per day.
• Most deaths from coronary heart disease are caused by a heart attack.
• Over 4,600 people under the age of 75 in Scotland die from CVD each year

Prevalence

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How does PA protect us from CVD?

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1.2 Lifestyle modifications for the primary and secondary prevention of

CVD

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1949 & 1950 – London

CVD Incidence (per 1000)

Drivers Conductors

2.7 1.9

Civil Servants Postmen

2.4 1.8

Morris JN et al. 1953, 1980, 1990

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PA and CVD risk

• Negative relationship between PA and occurrence of CHD
(Reiner et al, 2013)

• Kyu et al (2016) dose-response meta-analysis

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PA and CVD risk

Kyu et al (2016) dose-response meta-analysis
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0.8
Risk

0.6

0.4

0.2

0
insufficiently active low active moderately active high active
ischemic heart disease 1 0.84 0.77 0.75
ischemic stroke 1 0.84 0.81 0.74

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Cholesterol: A simplified overview

• Cholesterol: A simplified overview

– Fatty substance
– Found in blood and almost every cell
– Has important role
– Made in liver
– Carried around body by proteins, hence
lipoproteins
– Two main types
• LDL – contributes to plaques
• HDL – removes excess cholesterol from the body

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PA and cholesterol
• Cross-sectional studies
– High active have higher HDL levels (Drygas et al 2000)
– Effects on LDL less consistent and may require
weight loss (Wang & Xu 2017)

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PA and cholesterol
• Meta-analysis RCT’s (Kodama et al 2007)
– Aerobic training for at least 8 weeks
– 25 studies
– Small (2.53 mg/dL) but significant increase in HDL
with exercise
– Translates to a decrease in CVD risk of 5.1% (men)
and 7.6% (women)
– Effects are lower in obese subjects
– Longer duration bouts of exercise

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High blood pressure

• Rarely noticeable
• Puts extra strain on blood
vessels, heart , brain,
kidneys and eyes
• If you have HBP reducing it
even a small amount is
helpful
• BP increases with age
– Inevitable?

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PA and blood pressure

Cornelissen & Smart 2013
• Meta-analysis of 93 RCTs, 5223
participants in total
• Aerobic exercise, dynamic
resistance training and isometric
resistance training all reduced SBP
and DBP
• Effects of aerobic exercise training
greatest in hypertensive
populations
• At least moderate intensity aerobic
exercise
• Isometric resistance exercise had
largest effects, but….

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PA and BP:
possible mechanisms

• Decreased systemic vascular resistance

• Structural changes in arteries and veins

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Readings in Sport and Exercise Science

SPSU9R7

Physical Activity and Health:

Prevention Management Cure

Dr Jenni Connelly

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Cardiac Rehabilitation

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Cardiac Rehab

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Cardiac Rehab
10 weeks of exercise for 1 hour per session

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Cardiac Rehab

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But Does Cardiac Rehab work?

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Health Risk

Cancer

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What is Cancer?

Cancer is a condition where cells in a specific part of the body

grow and reproduce uncontrollably. The cancerous cells can
invade and destroy surrounding healthy tissue, including organs.
Cancer sometimes begins in one part of the body before
spreading to other areas. This process is known as metastasis.

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What is Cancer?
1 in 2 people will develop some form of cancer during their
lifetime. In the UK, the 4 most common types of cancer are:
•breast cancer
•lung cancer
•prostate cancer
•bowel cancer

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What are the signs?

Changes to your body's normal processes or unusual,
unexplained symptoms can sometimes be an early sign of
cancer.
Symptoms that need to be checked by a doctor include:
•a lump that suddenly appears on your body
•unexplained bleeding
•changes to your bowel habits
But in many cases your symptoms will not be related to cancer
and will be caused by other, non-cancerous health conditions.

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Treatment
Surgery is the first treatment to try for most types of cancer,
as solid tumours can usually be surgically removed.
2 other commonly used treatment methods are:
•chemotherapy – powerful cancer-killing medicines
•radiotherapy – the controlled use of high-energy X-rays

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Costs
In 2008/09 the NHS spent £5.13 billion on cancer
treatment
The estimated cost of treatment for all
cancers was:
• £1.1 billion for surgery
• £900 million for drugs
• £250 million for radiotherapy

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Costs- Colorectal
• In 2007, total annual treatment costs for colorectal cancer in
England were approximately £1.1 billion
• The average cost per patient for colon and rectal cancer
treatment was estimated at £8,808 and £12,037, respectively
• In 2006/2007, colorectal cancer due to physical inactivity was
estimated to cost the NHS £65 million
• In the UK, if all inactive people were to become active, 18.7% of
all colon cancer cases could potentially be prevented

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Costs- Breast
• The average drug cost per cycle of chemotherapy for breast
cancer has been estimated to cost between £296 and £1,223
• In 2006/2007, breast cancer due to physical inactivity was
estimated to cost the NHS £54 million
• In the UK, if all inactive people were to become active, 17.9%
of all breast cancer cases could potentially be prevented

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Cancer in Scotland

• In 2014, 31,711 people were diagnosed with cancer in

Scotland (16,183 females and 15,528 males).
• The number of people diagnosed has increased over the last
ten years from 27,820.
• These figures do not include non-melanoma skin cancers
(NMSC), of which nearly 11,500 were diagnosed in 2014.

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Cancer in Scotland

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Cancer Patterns- Males

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Cancer Patterns- Females

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Cancer and Physical Activity

• Around 1% of cancers in the UK, around 3,400 cases every year, are linked to
people doing less than government guidelines for physical activity each week
(Parkin et al 2011)
• Evidence shows that people who do the most physical activity can cut their
risk of developing cancer of the large bowel (colon) by about a quarter (Wolin
et al 2009)
• Women who do the most activity have a 12% lower risk of developing breast
cancer compared with the least active women, the more activity a woman
does, the more she can reduce her risk of breast cancer. For example, for
every 2 hours a week a woman spends doing moderate to vigorous activity,
the risk of breast cancer falls by 5% (Wu et al 2013)

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Today we are going to discuss

Breast Cancer

Colorectal Cancer

Bladder Cancer

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PA and Other Cancer Risk

•Endometrial cancer: Physically active women had a 20% lower

risk
•Esophageal cancer: 21% lower risk
•Kidney cancer: 12% lower risk of renal cancer and 23% reduced
risk of kidney cancer.
•Stomach cancer: 19% lower risk of stomach cancer

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PA and Risk of Breast Cancer

• N: 25,624 women, 20 to 54 years of age

• Median follow-up of 13.7 years
• Adjustments for age, body-mass index, height, parity, and
county of residence

Physical Activity and the Risk of Breast Cancer

Inger Thune et al 1997

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PA and Risk of Breast Cancer

•

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PA and Risk of Breast Cancer

• N: 68 416 breast cancer cases
• PA type, the ORR for total activity was 0.87, for recreational
activity 0.88, for occupational activity 0.91, and for
nonoccupational activity 0.87.
• The risk of breast cancer was significantly lower in people with
exposure periods longer than 1 year and less than 5 years (ORR
0.62) , followed by those with lifetime activity (ORR 0.81)
• A linear relationship was found between breast cancer risk and PA
(recreational activity and total activity), and the ORR was reduced
by 3% for every 10 metabolic equivalent of energy hours per week
increment in recreational PA and by 2% for every 10 metabolic
equivalent of energy hours per week increment in total PA.

Physical Activity and Risk of Breast Cancer: A Meta-Analysis of 38 Cohort

Studies in 45 Study Reports. Chen et al 2019

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PA during treatment
• sixteen women diagnosed with breast cancer
• 16-week PA intervention during adjuvant chemotherapy
treatment
• qualitative approach included semi-structured individual and
focus group interviews
• The women in this study reported that PA had a positive
impact on their perceived health
• PA was perceived as a tool that supported health processes

Experiencing health – Physical activity during adjuvant chemotherapy

treatment for women with breast cancer Backman et al 2016

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HIIT?
• 240 women agreed to participate, and 182 participants completed the baseline and
follow-up testing

• CRF assessed by the Piper Fatigue Scale increased significantly in the UC group and
was significantly different from maintained levels found for RT–HIIT: total CRF
(ES = − 0.51), behaviour/daily life CRF (ES = − 0.62), and sensory/physical CRF
(ES = − 0.47)

• HRQoL measured by the EORTC-QLQ-C30 instrument showed a significant

difference in role functioning in favour of RT–HIIT (ES = 0.81) and AT–HIIT
(ES = 0.64) compared to declines for UC

• A significant difference was found for symptom burden as measured by the MSAS,
with RT–HIIT (ES = − 0.43) reporting a reduced symptom burden score and AT–HIIT
(ES = − 0.42) was unchanged compared to an increased score for UC.

Adding high-intensity interval training to conventional training modalities: optimizing health-related outcomes
during chemotherapy for breast cancer: the OptiTrain randomized controlled trial. Migwel et al 2017

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PA and breast cancer survivers

Schmitz et al 2009

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Take Home Message

Breast cancer survivors who were the

most physically active had a 42% lower
risk of death from any cause and a 40%
lower risk of death from breast cancer
than those who were the least physically
active

Spei et al (2019). Physical activity in breast cancer survivors:

A systematic review and meta-analysis on overall and breast
cancer survival

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PA and Risk of Colon Cancer

Liu et al 2016
• individuals who engaged in the highest level of physical activity had
a 19% lower risk of colon cancer than those who were the least
physically active (Liu et al 2016)

Gerhardsson et al 1988

• Swedish 14-year follow-up study of 16477 subjects

• RR of colon cancer in subjects with low physical activity was estimated at 3.6
• An association was observed for both men and women, and for low physical
activity during occupational hours (RR = 1.6) during recreational hours (RR=
1.6).
• A possible mechanism is that low physical activity could prolong the transit
time of the stool in the colon

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PA during Colon cancer

• 33 colon cancer patients undergoing chemotherapy (21 men and
12 women) were randomly assigned
• The primary outcome was fatigue.
• Secondary outcomes were quality of life, physical fitness, anxiety,
depression, body weight, and chemotherapy completion rate.
• Outcome assessment took place at baseline, postintervention (18 wk)
and at 36 wk.
• An 18-wk supervised exercise program in colon cancer patients during
chemotherapy is safe and feasible.
• The intervention significantly reduced physical fatigue at 18 wk and
general fatigue at 36 wk

Effects of an Exercise Program in Colon Cancer Patients

undergoing Chemotherapy VULPEN et al 2016

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PA post Colon cancer

• Eighteen colon cancer survivors (mean age:69y; range, 52–80y)
• Participants were randomized 6 to 24 months postoperatively to either a 12-
week program of combined exercise and dietary advice or standard treatment.
• Exercise and dietary behaviour, fatigue, health-related quality of life (QOL),
aerobic exercise tolerance, functional capacity, muscle strength, and
anthropometery were assessed at baseline and immediately after the
intervention
• Adherences to supervised and independent exercise during the intervention
were 90% and 94%, respectively, and there was low attrition (6%).
• The lifestyle intervention elicited improvements in exercise behaviour, fatigue,
aerobic exercise tolerance, chair sit-to-stand performance, and waist-to-hip
ratio.
• A positive change in dietary fiber intake was also observed in the intervention
group.

Pragmatic Lifestyle Intervention in Patients Recovering From Colon

Cancer: A Randomized Controlled Pilot Study. Bourke et al 2011

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Take Home Message

Evidence from multiple epidemiologic

studies suggests that physical activity
after a colorectal cancer diagnosis is
associated with a 30% lower risk of
death from colorectal cancer and a
38% lower risk of death from any cause

Patel et al (2019) American College of Sports Medicine

Roundtable Report on physical activity, sedentary behavior,
and cancer prevention and control

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PA and Bladder Cancer Risk

• A total of 15 studies with 5, 402, 369 subjects and 27, 784 bladder
cancer cases were included
• The risk of bladder cancer was 15% lower for individuals with the
highest level of recreational or occupational physical activity than in
those with the lowest level
• Further studies are required to assess the relations of intensity,
frequency, duration, and timing in life of physical activity to bladder
cancer risk.

Keimling M, Behrens G, Schmid D, Jochem C, Leitzmann MF. The

association between physical activity and bladder cancer: systematic
review and meta-analysis. British Journal of Cancer 2014; 110(7):1862-1870

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PA and Bladder cancer

• 60 patients were randomised to an exercise or control group with 55
providing follow up data
• The exercise group was offered twice-weekly pre-operative supervised
vigorous intensity aerobic interval exercise in addition to standard
treatment, whilst the controls received standard treatment only.
• Patients attended an average of 8 exercise sessions over a pre-
operative period of 3-6 weeks.
• Improvements in peak values of oxygen pulse, minute ventilation and
power output
• Vigorous intensity aerobic interval exercise could be an effective
strategy.
• Bladder cancer patients respond well to pre-surgical interval exercise
and the improvements in cardiopulmonary fitness variables could have
important implications for post-operative recuperation after RC

Vigorous intensity aerobic interval exercise in bladder cancer patients prior to radical
cystectomy: a randomized controlled feasibility study. Banerjee et al 2017

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Possible Mechanisms
•Lowering the levels of sex hormones
•Preventing high blood levels of insulin
•Reducing inflammation
•Improving immune system function
•Altering the metabolism of bile acids
•Reducing the time it takes for food to travel through
the digestive system
•Helping to prevent obesity

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How it can help

•reduce anxiety
•improve depression
•reduce fatigue
•improve quality of life
•prevent or improve lymphoedema
•improve general physical functioning

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Dangers

• Cancer affecting your bones

• Low immunity
• Peripheral neuropathy
• After certain types of surgery

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Still to be answered?

•What are the mechanisms?

•What is the optimal time in life, intensity, duration,
and/or frequency of physical activity needed?
•Impact of sedentary time?
•Does the association between physical activity and
cancer differ in different demographics?
•Does physical activity outrun genetics?

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CanRehab

https://www.youtube.com/watch?time_contin
ue=14&v=ZRP_hiwVflc&feature=emb_logo

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In summary

What is a successful intervention in cancer

care?

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