1

運動對癌症的預防與恢復效果

2

Total PA and risk for colorectal cancer -cohort studies

WCRF & AICR, 2007

3Occupational PA and risk for colorectal cancer

WCRF & AICR, 2007

Colorectal cancer Rectal cancer

4Recreational PA and risk for colorectal cancer

WCRF & AICR, 2007

5

PA and proximal colon cancer

Boyle et al, JNCI, 104: 1548-1561, 2012

6

PA and distal colon cancer

Boyle et al, JNCI, 104: 1548-1561, 2012

7

PA and risk for colorectal cancerJapan Public Health Center prospective study (M)

Lee et al, Cancer Causes Control, 18, 199-209, 2007

8

PA and risk for colorectal cancerJapan Public Health Center prospective study (F)

Lee et al, Cancer Causes Control, 18, 199-209, 2007

9

Commuting PA and colon cancer, case-control study in Shanghi, male

0

1

2

3

4

5

6

7

Q1 Q2 Q3 Q4 Q5

BMI Quintile

RR

High

Medium

Low

*

*

Hou et al, Am J Epidemiol 160: 860-867, 2004

10Recreational PA and risk for postmenopausal breast cancer

Cohort studies Case-control studies

WCRF & AICR, 2007

11Occupational and recreational PA and risk for endometrial cancer

WCRF & AICR, 2007

12

PA and prostate cancer: total45997 men, 10-yr follow-up

↓7% (95% CI: 1–12%) for every 30 min/d incrementOrsini et al, Br J Cancer 101: 132-1938, 2009

13

PA and prostate cancer: advanced45997 men, 10-yr follow-up

↓12% (95% CI: 2-20%) for every 30 min/d increment

Orsini et al, Br J Cancer 101: 132-1938, 2009

14PA and renal cancer riskcase-control studies

Behrens & Leitzmann, BJC, 108: 798-811, 2013

15PA and renal cancer riskcohort studies

Behrens & Leitzmann, BJC, 108: 798-811, 2013

16

PA and risk for lung cancerHarvard Alumni Health Study, 13905 men, 1977-93

Lee et al, Int J Epidemiol 28: 620-625, 1999

走路

爬樓梯

PA > 4.5 MET

17PA in different life stages and stomach cancer: case-control study

Strenuous PA, 3+time/week vs <1 time/month

Mid-teens: OR=0.73 (0.54–0.99) Early-30s: OR=0.63 (0.46–0.86) Early-50s: OR=0.80 (0.56–1.15) Average lifetime: OR=0.58 (0.41–0.83) Moderate PA not significant

Campbell & McTiernan, J Nutr 137: 161S-169S, 2007

18

World Cancer Research Fund/ American Institute for Cancer Research conclusions, 2007

PA could reduce the risk for colorectal cancer

PA could reduce the risk for breast cancer in postmenopausal women

PA may reduce the risk for endometrial cancer

PA and risk for other sites require further investigation

19Epidemiological evidence on PA and cancer prevention in Europe: Men

Convincing: colon cancer, RR=0.76 52 studies

Possibly: lung cancer, RR=0.70 9 studies

Possibly: prostate cancer, RR=0.80 27 studies

Friedenreich et al Eur J Cancer, 46: 2593-2604, 2010

20

Epidemiological evidence on PA and cancer prevention in Europe: Women

Convincing: colon cancer, RR=0.75 62 studies

Probably: breast cancer, RR=0.70 9 studies

Probably: endometrial cancer, RR=0.70 18 studies

Possibly: ovarian cancer, RR=0.81 12 studies

Probably: lung cancer, RR=0.70 9 studies

165,000-330,000 cases of the six major cancers could have been prevented in 2008 in Europe if sufficient PA Friedenreich et al Eur J Cancer, 46: 2593-2604, 2010

21

World Cancer Research Fund/ American Institute for Cancer Research recommendations

Be physically active as part of your everyday life >60 min moderate or > 30 min vigorous PA per day

European Prospective Investigation into Nutrition and Cancer score 0: < 15 min/d of cycling/sports 0.5: 15-30 min/d of cycling/sports 1: >30 min/d of cycling/sports, or 2 hr/wk vigorous PA 378,384 participants in 9 European countries

HR for cancer mortality per 1-unit increase in Score 0.93 (0.87-0.99) for men 0.86 (0.81-0.92) for women

Vergnaud et al, AJCN 97: 1107-1120, 2013

22Physical Activity Guidelines for Americans

Aerobic exercise : 150 min/week moderate intensity, or 75 min/week vigorous intensity

Resistance exercise : moderate intensity at least 2 days/week for each major muscle group

Flexibility: Stretch major muscle groups and tendons on days other activities are performed

American College of Sports Medicine, Exercise Guidelines for Cancer Survivors modification: additional care/supervision for obese or post-surgery

Wolin et al, J Support Oncol 10: 171-177, 2012

23

Potential mechanisms

PA reduces circulating estrogen and testosterone by reducing body weight and/or body fat

PA improves insulin sensitivity/metabolic syndrome Direct effect Indirect effect, through reducing body weight

and/or body fat PA reduces DNA methylation

24

Association of BMI and PA with estrogen levels in post-menopausal women

McTieman, 2006

PA cut-off point

6.5 MET-hr/wk

25Change in estradiol by change in body fat after 1-yr intervention

Campbell, 2007

26Change in testosterone by change in body fat after 1-yr intervention

Campbell, 2007

27

Bed rest changes DNA methylation promoter of PPAR- coactivator-1 in muscle

□: before BR; gray: post BR; ■: retrainingAlibegovic, 2010

286-mo interval walking reduces methylation in ASC gene in elderly

Nakajima, 2010

296-mo interval walking reduces methylation in ASC gene in elderly

Nakajima, 2010

30

PA and breast cancer survivor

Ballard-Barbash et al, JNCI, 104: 815-840, 2012

31

PA and non-breast cancer survivor

Ballard-Barbash et al, JNCI, 104: 815-840, 2012