Chapter 3: Energy balance, body comp & PA

Question 1

% of adults & % of children considered overweight or obese

Answer 1

70%, 17%

Question 2

Physical activity lowers the risk for ________# cancers regardless of weight status

Answer 2

13

Question 2

A wt gain of only ______ lbs/kg beginning in early adulthood can increase the risk for cancers related to overweight/obesity

Answer 2

11 (5 kg)

*Note wt gain is most concerning in adult life, especially post menopause, for breast cancer risk

Question 3

Intentional weight loss helps to reduce cancer risk for these 2 cancers especially

Answer 3

Breast & endometrial

mechanisms: reduced insulin & IGF1, estradiol & inflammation

Question 4

_________ leads to the largest & most sustained weight reduction

Answer 4

Bariatric surgery. This reduces cancer risk, especially in women.

Question 5

Define Calorie Restriction

Answer 5

A chronic reduction of energy intake by ~30% without incurrence of malnutrition

Question 6

Research of calorie restriction on cancer

Answer 6

Decreases glucose levels & factors stimulating cell division. Promotes autophagy-mediated recycling of cell components & clearence from damaging factors that influence tissue homeostasis from tumorigenesis

*most research done in prevention on animals. human studies yet to reflect whether CR affects cancer rates

Question 7

Higher level of physical activity is associated with decrease cancer risk, especially these 3 cancers

Answer 7

Breast, endometrium, colon

Question 8

PA recommendations for cancer prevention

Answer 8

American Cancer Society: 150-300 minutes of moderate exercise or 75-100 minutes of vigorous intensity (or combination). 60 mins of mod/vig for children.

WCRS/AICR: Be active DAILY. At least 150 minutes of moderate PA or 75 minutes of vigorous intensity weekly.

American College of Sports Medicine: At least 30 mins of mod-vigorous 5x/week (2.5 hours). Muscle strengthening at least 2 days/weel (8-12 reps, 1-3 sets)

National Comprehensive Cancer Network: none

Question 9

Moderate versus vigorous exercise

Answer 9

Moderate - can talk but not sing (water aerobics, tennis doubles, brisk walking)

Vigorous - requires too much effort to talk (running, walking uphill, swimming laps, heavy gardening, tennis singles)

Question 10

PA recommendations during cancer treatment

Answer 10

ACS: Individualize. Return to baseline activity ASAP after diagnosis and avoid being sedentary.

WCRI/AICS: Daily PA

ACSM: Avoid inactivity. Return to normal PA ASAP. Conduct pre-exercise assessment and tumor site-specific assessment as needed

NCCN: Follow ACS & ACSM guidelines

Question 11

Special consideration for PA with severe anemia

Answer 11

Delay exercise other than ADLs until anemia improves

Question 12

Avoid these areas of exercise w/ compromised immune function

Answer 12

Public gyms/pools until WBC return to safe levels. Avoid for 1 year after bone marrow transplant

Question 13

Survivors experiencing severe fatigue are encouraged to do ______ minutes of light exercise daily

Answer 13

10 minutes

Question 14

Survivors undergoing radiation should avoid exposing irradiated skin to ______

Answer 14

Chlorine

Question 15

Survivors with ______________ or _____________ should avoid pool, lake, ocean water, or other microbial exposures that may/ result in infection.

Avoid resistance training of muscles in the area to avoid dislodgement.

Answer 15

Indwelling catheters or feeding tubes

Question 16

Survivors with multiple comorbidities should ________

Answer 16

Consider program modifications in consultation with physician

Question 17

Survivors with significant peripheral neuropathies or ataxia may do better with _______________ than treadmills

Answer 17

Stationary bikes

Question 18

Long term cancer survivor recommendations for physical activity

Answer 18

ACS: at least 150 mins/week + strength training at least days/week

WCRF/AICR: Same as prevention

ACSM:
-ages18-64, 150 mins/week of moderate-intensity PA or 75 mins/week of vigorous. Muscle strengthening at least 3 days/week for each major muscle group. Stretch major muscle groups & tendons.

NCCN: 150 mins moderate-intensity PA or 75 mins/week vigorous. Strength training 2-3/week including major muscle groups. Stretch at least 2x/week. Avoid prolonged sedentary behavior. Resistance training as prescribed
-Frequency: 2-3x/week, wait 48 hours between sessions
-Intensity: 2-3 sets of 10-15 reps/set, increase weight as this becomes easy
-Time: 20 minutes per session
-Rest: 2-3 minutes between sets & exercises

Question 19

BMI formula

Answer 19

weight (kg)/height (meters sq)

*most common too for determining obesity but poorly reflects body composition

Esp w/ cancer, body composition is more important

*waist/hip ratio may be a better option

Question 20

Best direct measurement tool for quantifying skeletal muscle

Answer 20

CT - standard of care, non-invasive & precise. Third lumbar vertabra cross-sectional is the area chosen to best correlate with body composition.

(MRI is great but mostly reserved for research setting)

Question 21

Obesity-related mechanisms in cancer occurrance

Answer 21

Visceral fat is metabolically active and plays a large role
-increase insulin resistance & IGF1
-increased inflammation
-leptin at higher levels
-decreased adiponectin
-increased estrogen (produced mostly through adipose post-menopause, ovaries pre-menopause)

Question 22

Physical activity related mechanisms related to cancer

Answer 22

Not fully understood

-Indirect by reducing obesity
-Lowering chronic inflammation
-Improving immune function
-Activating peristalsis (colon ca)

Question 23

Define cachexia

Answer 23

A metabolic syndrome driven by inflammation and characterized by muscle loss, with or without the loss of fat mass

Multi-factorial and cannot be fully reversed by conventional nutrition support

Leads to progressive functional impairment

Question 24

Cancer cachexia is most prevalent in these 7 cancer types

Answer 24

1. lung
2. pancreatic
3. H&N
4. prostate
5. esophageal
6. colorectal
7. gastric

Question 25

A diagnosis of cancer cachexia is made using one of the following 3 criteria

Answer 25

1. Weight loss of > 5% over the past 6 months in the absence of starvation
2. BMI of <20 and any degree of weight loss >2%
3. Appendicular skeletal muscle index indicative of sarcopenia <7.26 for men, <5.45 for women AND weight loss of >2%

Question 26

3 stages of cancer cachexia

Answer 26

1. Precachexia - weight loss, anorexia. Progression depends on cancer type, inflammation, PO intake, lack of response to cancer therapy
2. Cachexia - one of the 3 definitions + reduced food intake & presence of systemic inflammation
3. Refractory “resistant” cachexia - active catabolism, management of weight loss not possible, very advanced or rapidly progressive cancer, unresponsive to therapy
   (typically last 3 months of life)

Question 27

Define sarcopenia

Answer 27

Severe muscle depletion. First described as “frailty syndrome.”

Occurs 15% in healthy people, 40-50% in cancer patients. Used as a prognostic factor

Associated w/ poor performance and chemo toxicity

Question 28

Sarcopenic obesity

Answer 28

Combination of low muscle mass & high adipose tissue. Often overlooked at being at-risk for malnutrition.

Question 29

Define intermittent fasting

Answer 29

A type of calorie restriction in which pts go 16-48 hours with little to no energy, followed by periods of normal food intake, occurring on a recurring basis.

In cancer patients, this may improve metabolism & reduce inflammation with fewer negative effects

(i.e. complete fasting every other day, 70% energy restriction every other day)

Question 30

Define periodic fasting

Answer 30

Fasting or fasting-mimicking diet for 2-21 days

Question 31

Potential benefits of fasting

Answer 31

-May improve chemotherapy treatment, partially d/t impact on circadian rhythm
-May improve radiosensitivity of mammory tumors
-May reduce side effects

*more human studies needed

Question 32

Define Time-Restricted Feeding

Answer 32

Food intake restricted to 8 hours/day or less

Question 33

Obesity paradox with cancer

Answer 33

Emerging studies have found that elevated BMI is associated with improved survival compared with normal weight patients

This is only found with overweight & mild obesity (class I) having a protective effect. Class 2 & 3 are associated with worse outcomes.

Question 34

Ideal weight loss programs should include

Answer 34

-at least 6 months including diet, PA, and behavior modification
-ideally on-site & frequent sessions
-Group or individual by a trained interventionalist

Question 35

Define medically-based weight loss program

Answer 35

Includes an oncology dietitian or weight-loss clinic (may be covered by certain insurance yet not usual specific for cancer)

Highly personalized yet limited access d/t costs & lack of coverage. Some cancer centers may offer free of charge

Question 36

Define community-based weight-loss programs

Answer 36

1. Not for profit - cancer specific, typically with an RDN or other health specialist. Typically low cost or free of charge, i.e. LIVESTRONG
2. Work-site - employers may include programs for their cancer survivors as part of their health & wellness plan but this isn’t widely available or known. Likely no-cost to the participants
3. Commercial - convenient, usually participant pays, may be costly and not cancer specific (i.e. weight watchers)

Question 37

Define home-based weight loss programs

Answer 37

1. Cancer-specific programs - only available through research studies. Effective & convenient but limited.
2. Non-cancer specific - websites, apps, print materials. Convenient but minimal cancer-specific information. May or may not be free.

Question 38

T/F: PA may counteract changes in body composition associated with hormone therapy

Answer 38

True

Studies have shown benefits of resistance training for breast & prostate cancers

Question 39

FITT principle for exercise prescription

Answer 39

Frequency
Intensity
Type
Time (duration)

*should also involve a plan for advancement as fitness levels improve