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Date Created: 11/01/15
KNH 188 Friday November 13 2009 CHAPTER 5 Diabetes Insulin resistance an type two diabetes Both types of diabetes include the impairment of glucose regulation About 80 of type 2 diabetes is obesity related Diabetes youtube video 0 O OO O O O O 0 type 2 issues with insulin not working well insulin hormone I made in pancreas I key to unlock the door to allow glucose in to the cell starch gets broken down into sugar important to regulate the sugar because high levels of sugar can cause problems I preventable issues I adult blindness I kidney disease I amputations I high rate of heart disease and stroke sugars will attach to proteins they become less exible and changes their function I blood vessels can become clogged from high sugar OR I leaky chages in eyes Diabetes Symptoms examples I thirsty urinate more frequently weight loss blurred vision fatigue gt Some people don t Show symptoms rate of diabetes going up so dramatically I we are becoming heavier I less physically active gt technology helps with this elevators cars video games TV gt exercise stimulate muscles to work these muscles deal with sugar better type one diabetes is pretty sudden body starts to fail to make insulin I usually brought on in children I but adults can get it too I body produces antibodies against the normal process attacks cells that make insulin type two patients may have very mild symptoms that becomes prominent later when blood sugar levels spike 0 Diabetes control and complications Trial 0 Lifestyle what to do Type 2 diabetes diet and exercise gt if you lose even 5 to 10 ofweight blood sugar may go down to normal gt modest exercise can make a difference 39239 preferably on a daily basis gt 2030 minutes of exercise gt check blood sugar at least lx per day 0 keep blood sugar as close to normal range as possible 0 INTRO 0 Diabetes is characterized by hyperglycemia and high NEFA concentration NEFA9 free fatty acids oating around in our system 0 Life expectancy is impaired by 5 to 10 years when not well controlled could be prevented or extremely well controlled 0 Type 1 involves autoimmune destruction immune system attacks beta cells of the pancreas 0 Type 2 shows up early in life pancreas beneath or behind stomach between stomach and the liver involves insensitivity to insulin resistance to the use of insulin possibly some impairment of insulin secretion obese or overweight you end up with more glucose in the blood than normal around 90 of diabetes is type 2 some people say that you can t be insulin resistant without being overweight 0 Defining Type 2 Diabetes 0 define by lab based techniques 0 mgdlAl normal fasting lt61 110 normal 120 minutes after 75mg glucose load lt78 140 Diabetes Fasting 370 126 Diabetes 2 hours after 75mg glucose 3 111 200 o CHART IN PF 0 Normal responses to insulin and the in uence of insulin resistance on these normally if glucose present liver muscle and adipocytes will take up glucose liver glycogen synthesis gluconeogenesis glycogenolysis 0 000 00 to take the glycogen and break that down glycogen is storage form ketones are not good when they build up glucose oxidiation burning of glucose to make ATP adipocytes fat cells will take up glucose hepatic means liver catabolism breaking down anabolism building up CHART IN PP 00000 0 copied chart he put up on screen check your notebook Monday November 16 2009 Chapter 5 Diabetes 0 about 80 can help or prevent their type 2 diabetes with life style modulation 0 relitevely inactive to active muscle becomes more effective 0 Major Complications of Diabetes 0 Brain and cerebral circulation cerebrovascular disease I stroke 0 Eyes Retinopathy I diabetes leading cause of blindness in the US 0 Heart and coronary circulation Coronary Heart Disease Kidney Nephropathy I kidney lters waste kidney has a network of small blood vessels that helps with the ltration Glucose affects the blood vessels supplying the kidney 0 Lower limbs peripheral vascular disease I similar process to hear build of atherosclorsis messes up supply to a limp amputation I gangrene could spread to other tissues Peripheral Nervous system Neuropathy I People w diabetes feel numb insensitive to pressure get ulcers and not know it disorder of the nerves 0 Diabetic Foot Ulceration and Amputation I blood ow off skin starts to ulcer could potentially require amputation o CHART IN PP O 0 Diabetes is the leading cause of amputations in the US 0 Prevalence of type 2 diabetes 0 prevalence tends to be higher in developed countries but the largest increases in prevalence are predicted to occur in developing countries 0 prevalence is probably increasing because of obesity I obesity tend to mirror increases in diabetes 0 each year approx 7 million people develop diabetes and 6 of total global mortality is attributable to this disease 0 people die from complications not necessarily from too much glucose in the blood 0 prevalence increases with age I people are less physically active I obesity goes up with age fat goes up with years 0 in the UK since 1991 prevalence has more than doubled for men and increased by 80 0 Type 2 diabetes is associated with obesity particulary abdominal obesity 0 destructive obesity 0 gets Has right into liver which helps stimulate gluconeogenesis 0 Relative Risk of Developing diabetes according to indices of fatness at baseline 0 waist to hip ratio is an okay way of seeing fat obesity 0 Prevalence of Obesity and diabetes in US adults 1991 2001 o GRAPH o obesity values and diabetes values look pretty similar in 9l and 10 years later 0 increases in obesity seem related to increases in diabetes obesity makes cells more resistant to glucose insulin resistant more glucose in blood 0 Relative risk of diabetes during a l3yr followup in overweight men and women who intentionally lost weight 0 losing weight drops the risk of diabetes 0 if you aren t as insulin resistant you aren t at risk for diabetes 0 20 drop in risk of diabetes just from losing weight 0 GRAPH 0 Elevated Nefas 0 reduce glucose uptake by adipocytes and muscle 0 promote hepatic glucose production I liver starts pumping out glucose 0 lead to accumulation of intracellular fatty acid metabolites 0 reduce beta cell insulin secretion I produce insulin within the pancreas hyperinsulinemia over time body becomes resistant to insulin beta cells get a feedback mechanism here reduce insulin secretion diabetes meds help promote sensitivity to insulin for type 2 O o Obesity 0 is associated with elevated concentrations of cytokines markers for in ammation I associated w complications O O O 0 causes in ammation which may be associated with endothelial dysfunction compromising vasodilation and blood ow through suppression of nitric oxide production causes increase in the amount of visceral adipocytes which are particularly resistant to the antilipolytic effects of insulin with concomitant effects on hepatic fat metabolism I increases in size of cell we can get more cells with OBESITY visceral adipocytes are the bad ones subcutaneous are okay antilipolytic resistant to the breakdown of fat insulin can t break down fat 0 Enviromental in uences textbook does well I migrant studies show strong effect of lifestyle on diabetes prevalence 0 people migrate from rural to urban area rising rates of diabetes 0 people from foreign countries rapidly gain weight when coming to US strong temporal changes in prevalence occur within one society when there is rapid economic development which shows importance of environmental factors eg singapore Changing prevalence of diabetes in the adult population of Singapore between 1975 and 1998 o CHART Physical activity associated with low risk for type 2 diabetes 0 sentence on pp I typed it below relative risk for developing diabetes according to level of physical activity 0 relative risk on y axis 0 MET hours for total physical activity on x axis 0 doesn t matter whether you have it in your family or not as you engage in more exercise you have higher levels of MET hours we don t know from graph how much PA a person got lSt is lowest level group and 5Lh is highest level group it makes no difference whether or not you have a genetic predisposition but your risk does DROP significantly RT 0 O 0 November 18 2009 Dropping weight definitely makes an improvement with diabetes Biggest risk factor OBESITY Physical activity associated w low risk for type 2 diabetes 0 overall epidemiological evidence suggests that physically active individuals have a 3050 lower risk of developing type 2 diabetes than their sedentary counterparts Relative risk for diabetes in women according to energy expenditure and BMI 0 Relative risk vertical axis with BMI on x o more BMI translates to greater risk 0 exercise drops the risk of diabetes 0 Lifestyle intervention 0 losing weight by diet I changing eating behaviors limiting saturated fat balance between protein and carbs I big meals with lots of carbs tend to drive up insulin I blunting the response a little bit helps Life style to pharmacy drug metformin I it sensitizes insulin to becoming more effective I w diabetes makes insulin more effective 0 incidence is number of new cases measured per 100 person years on this 0 graph diet and lifestyle and exercise are the biggest things that will make an impact especially in this study there was a drug 0 randomized controlled trial high form of evidence 0 CHART Fitness and Risk of developing type 2 diabetes in women 0 PA anything that uses energy to engage our muscles in movement 0 Physical fitness people can engage in PA at higher levels higher V02 max Mechanisms 0 why does Physical Activity impact diabetes I we maintain glucose tolerance maintaining glucose through improved insulin sensitivity I glucose transport into muscle is improved as is glycogen synthesis 0 more efficient at extracting and using glucose 0 glycogen synthesis improved as well glucose can be turned into glycogen and used as a storage form I improved capillarization o w exercise we improve blood ow more metabolic exchange between tissues 0 insulin resistance should improve and we should better be able to transport glucose I more mitochondria o metabolic machinery 0 better metabolism I increased activity of oxidative enzymes 0 Skeletal muscle is the body s largest insulinsensitive tissue 0 physical activity using skeletal muscle 0 0 Improve glucose transport into muscle an glycogen synthesis after one exercise session and after six weeks of training 0 with FA training ability to improve glycogen synthesis increases 0 glucose6 phosphate is an enzyme in glycolysis 0 Exercise as therapy in People with Type 2 diabetes wwwcdcgovdia39 etes faa 39 h you need at least 6090 minutes of exercise every day to lose weight strength or cardio vascular 30 minutes 5 days a week lower risk for diabetes cvd all cause mortality really glycosylated hemoglobin is a marker that can be tested in the blood I found on red blood cells I red blood cells last about 120 to 180 days then broken down by spleen I reduced by exercise training indicating improved glucose control and reduced risk for complications I glucose binds to the hemoglobin and the red blood cell is there like 120 to 180 days so it can be used as amarker 0 Summary is on the PF 0 insulin resistantce precursor to diabeters TYPE 2 0 not producing insulin TYPE 1 o glycemic control refers to glucose control tm O O O O O 0 November 20 2009 CANCER ch 8 0 number 2 killer in our society 0 Nature of cancer 0 people can live with cancer in remission or show no signs after treatment 0 the incidence of cancer is really high 0 2007 to 2008 cancer rates on the decline prevention and treatment 0 involves problems with genes genetic disease I not always passed downs genetic in the respect that it affects genes 0 the body usually has an effective way to deal with mutations but when it gets overwhelmed that is when we start to see cancer 0 genetic code corrupted accumulation of mutations 0 cancer video from cancerquest 0 www org imagesFLVfullDocumentarvEnglishfullDocInterf aceEngswf 0 group of misbehaving cells cause problems in body like a bad part in a machine 0 mitosis divide cells I cancer cells do not obey and will divide with out being told o nucleus blueprint for us I genes in chromomsomes in nucleus I all cancers a thought to result from changes to DNA which alters critical genes I mutation alteration in a gene 0 proto oncogenes o oncogenes I these genes might divide without signals 0 tumor suppressors I stops abnormal behavior 0 angiogenesis cells being provided with nutrients o metastisis movement of tumor cells to other parts of the body to form tumors at new locations 0 Apoptosis breakdown of key cell parts and death of cell I cancer cells don t have this ability 0 drug resistance because cancer cells are all slightly different they may have different drug tolerances many cells with corrupt DNA don t usually survive that long insidecancer org metastisis spread of cancer cancer group of diseases characterized by uncontrolled growth and spread of abnormal cells tumor a new growthmass 0 does not have to be cancerous o benign tumors noncancerous new tissue that is not growing out of control sometimes they can compress organs and need removed 0 malignant tumor cancerous dysplasiaichange in size shape uniformity arrangement structure of cell 0 precursor to cancer DNA genetic substance of which genes are made molecule that contains cell s genetic code RNA genetic material that guides the formation of cell proteins you need DNA to make RNA RNA to form proteins oncogenes genes that initiate cell dividion suppressor genes genes that deactivate the process of cell division angiogenesis formation of blood capillaries metastasis the movement of cells from one part of the body to another Cancer development 0 anything that promotes growth for example estrogen could relate to cancer cancer development 0 a hallmark of cancer cells is their immortality unlimited life spani continue to divide for years 0 cancerous cells seem to be able to divide indefinitely and normal cells have stopping mechanisms that stop unlimited replication 0 apoptosis cell death O O 0 one major block to unlimited cell division is the size of the telomere protective cap of chromosome normal cell division reduces the telomeres and when small enough the chromosomes become unstable and die stem cells and cancer celss activate telomerases which resotres and maintains telomeres class I missed Video library website digital Video collection what is cancer cancer development slide November 30 CANCER 2009 0 Article Cancer is a preventable disease that requires major lifestyle changes 0 O 0 Video 0 OO O O O O OO 0 only 5 to 10 of all cancer cases can be attributed to genetic defects every cancer has to do with genes so what is the article saying I you can overcome it if you lead a healthy lifestyle I they are saying that what we inherit from mom and dad is only 5 to 10 and that it is lifestyle that induces mutation second half Surgery Radiation Therapy Chemotherapy treatment options I but many people have a combination Chemotherapy anti cancer drug can cause cancer cells to die often used along with surgery Radiation kills cancer cells while sparing healthy ones apoptosis cell death cellular suicide I p53 tumor repressor gene Cancer cells have lost the ability for apoptosis cell death Scrotum cancer in chimney sweeps tar I people realized different lifestyle choices affected the risk of getting cancer carcinogen increases the risk of developing cancer act to promote cancer through cell proliferation and irritation of tissue I damage dna and cause cancer I or promote cancer to formipromoters mutagens damage dna I smokinghard alcohol 13 of cancer deaths due to smoking most cancers are not hereditary but genetic predisposition is definitely possible angiogenesis growth of new blood vessesls I antiangiogenesis treatment to prevent this 0 Powerpoint 0 Cancer development 0 once cancer cells metastasize treatment becomes more difficult 0 some are treatment resistant 0 normal cells 0 reproduce themselves exactly 0 stop reproducing at the right time 0 stick together in the righ place 0 apoptosis if damaged 0 become specialized or mature o Hallmarks of Cancer 0 Growth factor independence I they can continue to replicate with appropriate nutrition and signals 0 insensitivity to anti growth signals 0 avoidance of programmed cell death apoptosis I telomerase protects telomeres and allows for continued replication 0 recruit a dedicated blood supply I necessary for mestastasis o immortalization by reactivation of telomerase I more telomerase avoids death 0 ability to invade adjacent normal tissues and metastasize to distant sites 0 Risk Factors 0 ageimost important factor I something about telomerase and losing the ability for normal replication genes that increase susceptibility heredity two genes are known to increase risk for breast cancer impaired immune function AIDS I when the immune system is down cancer has a better chance to survive diets high in fat meat salt or alcohol increase risk for some cancers red meat I approx 13 of cancer deaths that we see I preventable agents in the environment eg tobacco somke sun radiation workplace hazards asbestos I these things seem to induce mutations in our genes viruses can cause genetic changes in cells that make them more likely to become cancerous eg hepatitis B increases risk factor for liver cancer I cause mutations in cells they then replicate copious amounts of the mutated viral cells 0 O O O 0 December 2 2009 0 Cancer Epidemiology 0 notes in PF 0 10 million people worldwide will be diagnosed with cancer this year O O 0 only 510 of all cancer causes can be attributed to genetic defects heredity the rest has it s roots in lifestyle factors 2530 of cancer deaths are due to tobacco 30 to 35 are linked to diet and 15 to 20 are due to infections the rest are due to other factors like radiation stress physical activity environmental pollutants etc I all of these things place stresses and demands on the body which lead to abnormal mutations 0 Physical Activity and Cancer 0 0 there are not evidence based cancerspecific guidelines for exercise inactivity during and following caner treatment leads to decreased cardiorespiratory fitness bone loss muscle atrophy declines in glucose metabolism insulin sensitivity digestive function immune function and increased cardiovascular risk I muscles are some of the most metabolic tissues in our body they need to be used I a healthy body is best to fight foreign invaders 0 Physical Activity and Cancer Big Picture 0 O O O 25 of cancer cases globally are due to excess weight and a sedentary lifestyle various mechanism may be operative in cancer inhibition with increased physical activity prognosis what s the expected outcome the level of physical activity might also be associated with prognosis among individuals with cancer 0 PA and Cancer Big Picture 0 O O 0 PP notes when people engage in physical activity certain biomarkers change in a positive light and increased chance in survival occurs reduced cancer risk MVPA moderate to vigorous physical activity the more exercise you get the better off you ll be and this is true for cancer why would understanding the mechanisms that link physical activity with cancer be useful I we could hopefully change things I but we seem to know what contributes to obesity and our obesity rate continues to rise I are we going to be able to change WHY people get cancer 0 Slide with a chart about REGULAR PHYSICAL ACTIVITY 0 O O O with reg physical activity you get a drop in sex hormones I in increase in sex hormones is a risk for cancer grth factorsiinsulin growth factor I increases in the presence of inactivity and is an indicator towards cancer exercise seems to improve the repair of our genetic material antioxidants O O O O O O O O O O O SEX H O O OO 0 o Decrea o Insulin o O Mechanisms that link cancer with PA reducing sex steroid hormone levels decrease in body weight adiposity changes in levels of insulin like growth factors and their binding proteins decrease in intestinal transit time enhanced immune function Reducing sex steroid hormone levels estrogen promotes the growth of many tissues bone being one of them these hormones help to proliferate cells and therefore an proliferate cancer especially reproductive cancers women with increased levels of estrogens and androgens have an increased risk of developing breast cancer and those with increased estrogen concentrations are at an increased risk for endometrial cancer in men having a lot of circulating androgens like testosterone seems to be related to prostate cancer I antiandrogen therapy improves prostate cancer survival soy has antiandrogenic effects ORMONES PA can decrease time exposure to endogenous sex hormones by delay of menarche reduce the number of ovulatory cycles reduce ovarian estrogen generation and therefore reduce cancers I hormone replacement therapy was a risk for breast cancer because estrogen is a risk factor obesity is one of the strongest determinants of increased endogenous sex hormones concentrations in women after menopause and is considered a very important risk factor for the development of cancers among postmenopausal women I obesity has a lot of baggage increases level of some of these hormones did not get to copy everything down excess levels of some androgens testosterone have been postulated to increase risk for prostate cancer did not copy everything down se in body weightadiposity PP like growth factors insulin like growth factors IGFs are multifunctional peptides that regulate cell differentiation proliferation and apoptosis IGFs actions and their binding proteins are important in tumorigenesis High concentrations of circuating IGFl are associated with an increased risk of lung prostate premenopausal breast and colorectal cancers dietary energy restriction may reduce levels of circulating insulin like growth factors as may exercise December 4 2009 0 Reducing sex steroid hormone levels 0 O reducing amounts can make a difference in reducing cancer excess levels of some androgens eg testosterone have been postulated to increase risk for prostate cancer I lower testosterone in athletes o Insulin like growth factors 0 O reducing energy input can reduce levels of Insulin like growth factor 1 IGFl o Decrease in intestinal transit time 0 0 physical activity affects colon motility leading to decreased transit time and perhaps reduced carcinogen exposure in the colon makes it faster so the stuff is not hanging around in your colon for as long 0 Enhanced Immunity O O 0 exercise can weaken immunity at first because body has to recover but later it can be beneficial moderate physical activity may enhance immune function by increasing number and activity of macrophages killer cells and their regulating cytokines in turn strenuous exercise has been shown to suppress the function of the human immune system as recognized by a reduction in leucocytosis and an impaired functioning of the system PA can also improve antioxidant property of defense systems moderate physical activity enhances the ability to scavenge reactive oxygen species ROS for example oxygen free radicals 0 NOT IN NOTES 0 Free Radicals O O O 0 000 O 0 Picture II39 A during combines with hydrogen to produce H20 Normally electron leakage along the ETS allows 25 of oxygen to form oxygen free radicals such as OH A free radical is a highly chemically reactive atom molecule or molecule fragment that contains at least 1 unpaired electron in its outer orbital shell or valence shell an accumulation of free radicals increases the epotential for cell ular damageithis is known as oxidative stress J ial energy outer orbital of oxygen has a free electron normally our body can handle free radicals OXIDATIVE STRESS9 lots of free radicals build up and cause oxidative stress I lots of free radicals involve oxygen there are diseases associated with free radical damage o If they attact DNA free radicals can lead to mutations mutations lead to cancer 0 Picture 0 free radical has an unpaired electron gets paired up it becomes neutralized it probably won t attack cell now 0 parkinsons disease 0 alzheimers I might account for neurologic issues 0 heart disease is now linked to free radicals I damaged lipid layer can t exchange substances in and out 0 Picture Where do free radicals come from 0 smoking infections UV rays 0 alcohol promotes free radicals cancer 0 burns o stresses on body promotes production of free radicals o antioxident protection 0 oxygen free radicals substances fromed during metabolism that attack and damage structures in the body and can lead to various chronic diseases 0 antioxidants compounds that prevent oxygen from combining with other substances in the body to form harmful compuounds 0 Sources of natural antioxidants o fruits o nutsipolyunsaturated fats fairly stable double bonds within organic compounds can donate unpaired electrons to oxygen rich free radicals vegetables grains leaves 0 spicesicurcuminiturmericiantioxidant ability 0 slide with a diagram 0 how we can prevent and treat cancer with positive effects through cellular targets during the process of cell division we can have mutations our body usually takes care of this mutated cells often times don t survive anti initiation strategies I alter carcinogen metabolism I enhance carcinogen detoxification 0 find ways that could remove the toxic components 0 antioxidants I scavenge electrophilesreactive oxygen species I enhance DNA repair preneoplastic right before getting to cancer step antipromotionprogression stragegies I scavenge reactive oxygen species I decrease in ammation I suppress proliferationenhance apoptosis I enhance immunity 000 O O OO I discourage angio genesis 0 Physical activity and cancer 0 0 000 00 0 regular exercise at least every other day resistancei2 to 3 times a week moderate intensity but there is some evidence that if you can engage in vigerous activity that can be helpful multiple typesmodes of exercise 210420 minutes per week 150 minutes a week does not appear to provide a major bene t you almost need to do it every day for a substantial period of time longer life better quality of life 0 Cancer Stats 0 0 cancer is second leading cause of death in the US 23 of all yearly deaths are caused by cancer 0 Death rates for major cancer sites 0 O O O O graph in PP IN WOMEN Lung cancer is number 1 then breastI then colon rectum 0 Cancer death rates for men 0 O O O lung prostate colonrectum close between prostate and colonrectum December 7 2009 0 Slide with a chart most common cancers in the US men and women 0 Cancer in Racial and Ethnic Minorities O O O O 0 Overall African Americans are more likely to develop and die from cancer than any other racial or ethnic population Death rate from cancer among African American males is 40 higher than that among white males 18 higher for African American females WHY Equal access to prevention early detection quality treatment insurance inner city communities low incomes language barriers racial bias stereotyping 8 whites 24 African Americans 22 Hispanics Latinos live below poverty line 20 African Americans 32 Hispanics Latinos ll whites are uninsured Cultural In uences Genetics Diet Stressors Exercise Work Enviomment o Mamograms not till 50 every other year 0 Self breast exams don t necessarily work 0 Chart on powerpoint Incidence and Mortality Rates by Site Race and Ethnicity US 19982000 0 incidence new cases 0 American Indian and Alaska Natives have much lower numbers for cancer incidence than any other group Cancer Chapter part 3 o Colon Cancer 0 forms in the tissures of the colon the longest part of the large intestine most colon cancers are adenocarcinomas cancers that begin in cells that make and release mucus and other uids 0 colon allows you to excrete feces through the rectum o somewhat square shaped 0 food and stuff can get caught tin pockets of the colon and start to grow in terms of the amount of food collecting o more responsive to physical activity 0 Rectal Cancer 0 forms in the tissues of the rectum the last several inches of large intestine closest to anus 0 very end very end of colon o affect last several inches of the colon o difficult to treat 0 Colon Cancer 0 physically active people have lower risk of developing colon cancer 0 relative risk of 7 for physically active men and 6 for women 0 3040 minutes per day of MVPA is necessary moderate to vigerous physical activity 0 Rectal cancer 0 no difference in rates of cancer among physically fit vs not physically fit 0 Breast Cancer 0 cancer that forms in tissues of the breast usually the ducts tubes that ca1ry milk to the nipple and lobules glands that make milk 0 It occurs in both men and women although male breast cancer is rare 0 Studies indicate women who ar ephysically active have half or less than half the inidence rates of breast cancer 0 active women have 20 lower risk 0 median relative risk is 8 for premenopausal 7 for post menopausal women 0 a recent study found a 6 decrease in breast cancer risk for each additional hour of physical activity per week assuming that the level of activity would be sustained 0 why wouldn t we screen earlier than 50 when the risk is higher 0 47 hours of MVPA seems required to produce the benefits figure 133 0 o Prostate cancer cancer that forms in tissues of the prostate no strong support for inverse relationship between physical activity and prostate cancer risk 00 o a few studies have shown higher rates of prosate cancer with physical activity 0 median relative risk is about 09 for most active compared to least active men 0 physical activity no strong data 0 CHART Epidemiological studies on the effect of exercise on reduction in prostate cancer risk 0 No of studies 27 o No of positive studies reduced risk in most active 16 0 Max risk reduction 50 0 Avg Risk reduction December 9 2009 0 Lung Cancer 0 those who are physically active have a 20 lower risk of developing lung cancer compared to sedentary 0 studies suggest an inverse relationship 0 the more of one the less of another 0 confounding by cigarettes o CHART o equivocal don t know some evidence for some against 0 Evidence linking physical activity with cancer risk 0 coloniseveral hypothesesievidence convincing o Breastiseveral 1 quot c vidcnw r convincingprobable premenopausal limited 0 EndometriumiA few hypothesesiEvidence probable o Prostateisome hy o Amore on chart Preventive potential 0 populationattributable risk estimates from international agency for research on cancer 2002 I estrogen is not playing a significant role in postmenopausal breast cancer Critical thinking Cancer Causing Factors 0 as much as 90 of all human cancer is related to lifestyle or environmental factors I diet I obesity I more on slide 0 Guidelines for Preventing Cancer 0 proper nutrition I anti in amitoryibeta carotenes I fruits and vegetables I eating lots of red meat increase incidence of breastcolon cancer abstain from tobacco avoid excessive sun exposure I issue body makes vitamin D from sun so you don t want to be vitamin D de cient so you have to nd that balance 0 monitor estrogen radiation exposure and potential occupational hazards o engage in physical activity 0 maintain recommended body weight 0 Weird article thing 0 vitamin D we need sun 0 o Vit D horomone critically important for regulation of many of our genes over 200 0 help prevent common cold 0 vit d might be related to cancer anti cancer effects I 1 it reduces the proliferation of cells 0 cancer is abnormal proliferation of cells with no ability to stop I 2 it helps reduce angiogenesis new growth of blood vessels I 3 helps induce apoptosis 0 cancer bypasses cellular death I 4 induces differentiation of cells 0 vit D causes this to happen takes a stem cell and makes it go down the pathway of a speci c cell 0 cancer does the opposite proliferation without differentiation 0 milk and OJ are supplemented with Vitamin D or you could get it from the sun 0 Dietary Guidelines 0 predominately a vegetarian diet high in ber and low in fat I high ber important gets rid of stuff from colon reduces transit time and gets the stuff out of the crevices in the colon 0 should include a variety of fruits and vegetables in particular cruciferous vegetables I broccolicauli ower o the use of tea soy products calcium and omega3 fats is encouraged I green white black 0 adequate intake of ber is recommended 25 to 38 grday 0 protein intake should be kept within the recommended guidelines I 8 grams per kilogram body mass 0 avoid saltcured smoked and nitritecured foods nitrite and nitrates are used to prevent the growth of harmful bacteria in processed meats but lead 00 to the formation of nitrosamines which cause stomach and esophageal cancers I sometimes appealing meats have nitrates added to them I vasodialaters eat processed foods headache later 0 Alcohol if used at all should be consumed in moderation 1 women to 2 men servings per day 0 grilling of meats at high temps is discouraged o consume ample amounts of fruits and vegetables which are high in antioxidants and phytochemicals I antioxidants seem to o absorb free radicals before they can cause damage 0 interrupt the sequence of reactions once damage has begun I phytochemicals plant chemicals seem to prevent cancer by blocking the formation of cancerous tumors and disrupting the process at almost every step of the way 0 Abstain from Tobacco use 0 the biggest carcinogenic exposure in the workplace is cigarette smoke o of all cancers at least 30 are tied to smoking and 87 of lung cancers are linked to smoking 0 agnosiamidon t discuss anymore 0 use of smokeless tobacco increases the risk for mouth larynx throat and esophageal cancers 0 Avoiding Excessive sun 0 excessive exposure to ultra violet radiation both UVB and UVA rays contributes to skin cancer 0 l in every 6 americans will develop some type of skin cancer 0 the most common sites of skin cancer are those areas exposed to the sun most often face neck and back of the hands 0 nearly 90 ofthe almost 1 million yearly cases ofbasal cell or squamous cell skin cnacers in the Us could be prevented by protecting the skin from the sun 0 Melanoma is the most deadly form of skin cancer causing 7600 yearly deaths 0 Summary 1 0 cancer is major source of morbidity and mortality 0 risk factors vary by tumor site 0 carcinogenesis disrupts the orderly fashion in which normal body cells grow divide and die 0 PA is associated with reductions in the risk of several site specific cancers many top killers o evidence is the strongest for cancers of the colon and beast Decemberll 2009 0 Behavior modi cation 0 research has convincingly documented the bene ts of physical activity and healthy lifestyles 0 most Americans accept this notion 0 people are still unable to adhere to a healty lifestyle program Behavior modi cation 0 convincing research is not enough to cause change in people 0 the science of behavioral therapy has shown that most behaviors are learned from the environment ExerciseExercise dropout cycle 0 97 of Americans see a need to incorporate exercise into their lives 0 70 of new and returning exercisers are at risk for early dropout 0 cycle is on the powerpoint Factors Affecting Behavior 0 family friends peers homes schools workplaces TV Eating with TV radio movies communities country cultures various cultures may promote physical activity more than others I Greek culture embraced physical activity 0 The Toxic Social environment 0 environment that doesn t promote physical activity 0 choice to take stairs or an escalator 0 at airports speed lanes to save walking time o behaviors of our peer or social group eating or drinking a lot Barriers to Change 0 procrastination preconditioned cultural beliefs grati cation risk complacency o complexity indifference and helplessness Barriers to Change 0 Procrastination I tomorrow is a better time to change I ask why not change today 0 Preconditioned cultural beliefs I I am a product of my environment I improve the environment 0 Grati cation I today s pain isn t worth later bene t I is the bene t really worth it 0 Risk Complacency I Maybe I m an exeption I I won t be the exception my whole life 0 Complexity I I cannot do all the right things I Can t Itake them one at a time o Indifference and Helplessness 20 I my genetics are against me I more than 80 of the risk is lifestyle 0 Rationalization I I m not as bad as him I Do the problems of other help me o Illusions of Invincibility I I can handle anything I Will this continue when I am older 0 Behavior Modi cation 0 the process to permanently change negative behaviors in favor of positive behaviors that will lead to better health and well being 0 The Process of Change 0 Behavior Change is typically viewed as a process that unfolds over time and occurs through a series of stages 0 Transtheoretical Model I stages of change 0 processes of change 0 techniques of change 0 Changing Behavior 0 Recognize that there is a problem 0 Work on a particular type of change I stopping a negative behavior I preventing negative behavior relapse I developing a positive behavior I strengthening a positive behavior I maintaining a positive behavior 0 Make one change at a time 0 Behavior Change Theories o The transtheoretical Model I change is gradual I change involves 6 stages 0 6 stages I precontemplation Do not wish to change contemplation contemplating change over next 6 months preparation looking to change in the next month action implementing change for 6 months maintenance maintaining change for 5 years terminationadoption change has been maintained for more than 5 years 0 Definitions of the 6 stages are online in the powerpoint EXAM 40 to 50 questions 21
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