The neighbourhood built environment can support the physical activity of adults regardless of their individual-level socioeconomic status. However, physical activity supportive (walkable) ...neighbourhoods may not be accessible to those with lower incomes if homes in walkable neighbourhoods are too expensive. The objectives of this study were: 1) to estimate the associations between neighbourhood walkability and home values in Canadian cities, and 2) to test whether these associations differ by city size and residential property type composition within neighbourhoods. We linked built environment data from the 2016 Canadian Active Living Environments (Can-ALE) index with neighbourhood-level structural home characteristics and sociodemographic data from the 2016 Canadian census for 33,026 neighbourhoods across 31 Census Metropolitan Areas. We used multilevel linear regression models to estimate covariate-adjusted associations between neighbourhood walkability and natural-log median home values and tested city size and neighbourhood property type composition as moderators. There were no statistically significant associations between walkability and home values overall. The associations between neighbourhood walkability and home values were jointly moderated by city size and property type composition. For small and medium sized cities, within neighbourhoods containing a high proportion of detached homes, walkability was negatively associated with home values (b = -0.05, 95% CI: -0.10, -0.01; and, b = -0.04, 95% CI: -0.06, -0.02, for small and medium cities, respectively). However, for extra-large cities, within neighbourhoods containing a high proportion of detached homes, walkability was positively associated with home values (b = 0.06, 95% CI: 0.01, 0.10). Our findings suggest that, based on housing affordability, higher walkable neighbourhoods are likely accessible to lower income households that are situated in small and medium Canadian cities. In larger cities, however, municipal interventions (e.g., inclusionary zoning or targeted development of subsidized or social housing) may be needed to ensure equitable access to walkable neighbourhoods for lower income households.
This scoping review aims to synthesize the current landscape of physical activity in cancer prehabilitation and identify knowledge gaps. We searched MEDLINE, EMBASE, SCOPUS and WEB OF SCIENCE for ...exercise interventions and observational studies that measured exercise or physical activity before cancer treatment from inception to January 20, 2023. Fifty-one articles from 44 unique studies were reviewed, including 32 intervention and 12 observational studies. Surgery is the only treatment modality that has been investigated. Included studies used heterogeneous exercise interventions and measures for physical activity. Colorectal and other gastrointestinal, lung, and urologic cancers are the most studied cancer types. Exercise intervention in cancer prehabilitation is highly feasible. The evidence for improved fitness, functional, psychosocial, and clinical outcomes is promising yet limited. Although research has increased recently, prehabilitation exercise remains a relatively under-investigated area in oncology. We have provided research directions towards an ideal cancer prehabilitation design in the real-world setting.
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Scientific evidence is accumulating on physical activity as a means for the primary prevention of cancer. Nearly 170 observational epidemiologic studies of physical activity and cancer risk at a ...number of specific cancer sites have been conducted. The evidence for decreased risk with increased physical activity is classified as convincing for breast and colon cancers, probable for prostate cancer, possible for lung and endometrial cancers and insufficient for cancers at all other sites. Despite the large number of studies conducted on physical activity and cancer, most have been hampered by incomplete assessment of physical activity and a lack of full examination of effect modification and confounding. Several plausible hypothesized biological mechanisms exist for the association between physical activity and cancer, including changes in endogenous sexual and metabolic hormone levels and growth factors, decreased obesity and central adiposity and possibly changes in immune function. Weight control may play a particularly important role because links between excess weight and increased cancer risk have been established for several sites, and central adiposity has been particularly implicated in promoting metabolic conditions amenable to carcinogenesis. Based on existing evidence, some public health organizations have issued physical activity guidelines for cancer prevention, generally recommending at least 30 min of moderate-to-vigorous intensity physical activity on ≥5 d/wk. Although most research has focused on the efficacy of physical activity in cancer prevention, evidence is increasing that exercise also influences other aspects of the cancer experience, including cancer detection, coping, rehabilitation and survival after diagnosis.
Observational studies may play an important role in evaluating physical activity (PA) as a cancer treatment; however, few studies have been designed, analyzed, or interpreted from a clinical oncology ...perspective. The purpose of the present paper is to apply the Exercise as Cancer Treatment (EXACT) Framework to assess current observational studies of PA and cancer outcomes from a clinical oncology perspective and provide recommendations to improve their clinical utility. Recent systematic reviews and meta-analyses of over 130 observational studies have concluded that higher prediagnosis and postdiagnosis PA are associated with lower risks of cancer-specific and all-cause mortality. Most of these studies, however, have: (a) included cancer patients receiving heterogeneous treatment protocols, (b) provided minimal details about those cancer treatments, (c) assessed PA prediagnosis and/or postdiagnosis without reference to those cancer treatments, (d) reported mainly mortality outcomes, and (e) examined subgroups based on demographic and disease variables but not cancer treatments. As a result, current observational studies on PA and cancer outcomes have played a modest role in informing clinical exercise trials and clinical oncology practice. To improve their clinical utility, we recommend that future observational studies of PA and cancer outcomes: (a) recruit cancer patients receiving the same or similar first-line treatment protocols, (b) collect detailed data on all planned and unplanned cancer treatments beyond whether or not cancer treatments were received, (c) assess PA in relation to cancer treatments (i.e., before, during, between, after) rather than in relation to the cancer diagnosis (i.e., various time periods before and after diagnosis), (d) collect data on cancer-specific outcomes (e.g., disease response, progression, recurrence) in addition to mortality, (e) conduct subgroup analyses based on cancer treatments received in addition to demographic and disease variables, and (f) interpret mechanisms for any associations between PA and cancer-specific outcomes based on the clinical oncology scenario that is recapitulated rather than referencing generic mechanisms or discordant preclinical models. In conclusion, observational studies are well-suited to contribute important knowledge regarding the role of PA as a cancer treatment; however, modifications to study design and analysis are necessary if they are to inform clinical research and practice.
Physical activity is emerging from epidemiologic research as a lifestyle factor that may improve survival from colorectal, breast, and prostate cancers. However, there is considerably less evidence ...relating physical activity to cancer recurrence and the biologic mechanisms underlying this association remain unclear. Cancer patients are surviving longer than ever before, and fear of cancer recurrence is an important concern. Herein, we provide an overview of the current epidemiologic evidence relating physical activity to cancer recurrence. We review the biologic mechanisms most commonly researched in the context of physical activity and cancer outcomes, and, using the example of colorectal cancer, we explore hypothesized mechanisms through which physical activity might intervene in the colorectal recurrence pathway. Our review highlights the importance of considering pre-diagnosis and post-diagnosis activity, as well as cancer stage and timing of recurrence, in epidemiologic studies. In addition, more epidemiologic research is needed with cancer recurrence as a consistently defined outcome studied separately from survival. Future mechanistic research using randomized controlled trials, specifically those demonstrating the exercise responsiveness of hypothesized mechanisms in early stages of carcinogenesis, are needed to inform recommendations about when to exercise and to anticipate additive or synergistic effects with other preventive behaviors or treatments.
Purpose
Alcohol consumption and cigarette smoking increase the risk of developing several cancers. We examined the individual and synergistic effects of these modifiable lifestyle factors on overall ...and site-specific cancer risk.
Methods
Baseline participant data were acquired from Alberta’s Tomorrow Project (ATP). Adults 35–69 years old who consented to data linkage and completed relevant questionnaires were included (
n
= 26,607). Incident cases of cancer up to December 2017 were identified via linkage to the Alberta Cancer Registry. Associations between alcohol consumption, cigarette smoking, and cancer risk were examined using adjusted Cox proportional hazard models. Non-linear effects were estimated using restricted cubic splines. Interactions between alcohol and tobacco were examined through stratified analyses and inclusion of interaction terms in relevant models.
Results
A total of 2,370 participants developed cancer during the study follow-up period. Cox proportional hazard models found no statistically significant associations between alcohol consumption and incidence of all cancers among males (hazard ratio HR 1.14, 95% confidence interval CI 0.93–1.40) and females (HR 0.89, 95% confidence interval CI 0.73–1.10), though a modest and positive association was observed in both males and the entire cohort using cubic splines. Smokers were at an increased risk of developing all cancers (female current smokers: HR 1.72, 95% CI 1.49–1.99, male current smokers: HR 1.24, 95% CI 1.03–1.49) with the strongest association observed between current smokers and lung cancer (males: HR 11.33, 95% CI 4.70–27.30, females: HR 23.51, 95% CI 12.70–43.60). A 3-way interaction model showed an additive effect between alcohol as a continuous variable (g/day) and pack-years (PYs) consumed for all, colon, and prostate cancers. A “U-shaped” multiplicative interaction was observed for breast cancer (
p
= 0.05).
Conclusions
Alcohol consumption was minimally associated with all-cancer risk. Cigarette smoking clearly increased all-cancer risk, with females being more affected than males. Combined use of alcohol and tobacco increased the risk of developing all, colon, and prostate cancers. A “U-shaped” multiplicative interaction was observed for breast cancer when alcohol and tobacco were used in combination.
Background
The benefits of an active lifestyle after a breast cancer diagnosis are well recognized, but the majority of survivors are insufficiently active. The ACTIVATE Trial examined the efficacy ...of an intervention (use of the Garmin Vivofit 2 activity monitor coupled with a behavioral feedback and goal‐setting session and 5 telephone‐delivered health coaching sessions) to increase moderate to vigorous physical activity (MVPA) and reduce sedentary behavior in breast cancer survivors.
Methods
This randomized controlled trial recruited 83 inactive, postmenopausal women diagnosed with stage I‐III breast cancer who had completed primary treatment. Participants were randomly assigned to the intervention group or to the control group, and the intervention was delivered over a 12‐week period. MVPA and sedentary behavior were measured with Actigraph and activPAL accelerometers at baseline (T1) and at the end of the intervention (T2).
Results
Retention in the trial was high, with 80 (96%) of participants completing T2 data collection. At T2, there was a significant between‐group difference in MVPA (69 min/wk; 95% CI = 22‐116) favoring the intervention group. The trial resulted in a statistically significant decrease in both total sitting time and prolonged bouts (≥20 min) of sitting, with between‐group reductions of 37 min/d (95% CI = −72 to −2) and 42 min/d (95% CI = −83 to −2), respectively, favoring the intervention group.
Conclusion
Results from the ACTIVATE Trial suggest that the use of wearable technology presents an inexpensive and scalable opportunity to facilitate more active lifestyles for cancer survivors. Whether or not such wearable technology‐based interventions can create sustainable behavioral change should be the subject of future research.
A randomized controlled trial evaluated a 12‐week wearable technology‐based intervention to increase moderate to vigorous physical activity (MVPA) and reduce sitting time in breast cancer survivors. The intervention increased total MVPA (between‐group change = 69 min/week, 95% CI = 22‐116) and decreased total sitting time (−37 min/d; 95% CI = −72 to −2).
Highlights • Physical activity was associated with reduced lung cancer risk among current and former smokers. • Effects were consistent across, histology groups and geographic location of studies. • ...The method and duration of physical activity assessment impacted the heterogeneity of effects observed across studies. • Additional research is needed among never smokers to further evaluate the potential for confounding in this association.
Exercise is one of the most widely used non‐pharmacological strategies to prevent bone resorption during menopause. Given the detrimental consequences of bone demineralization, the purpose of this ...study was to examine the effects of prescribing different exercise volumes on bone mineral density and content in previously inactive, post‐menopausal women during a 12‐month intervention and 1 year after intervention completion. Four hundred post‐menopausal women were randomized to either 150 min/wk (MODERATE dose group) or 300 min/wk (HIGH dose group) of aerobic exercise. Total bone mineral density (g/cm2) and bone mineral content (g) were assessed at baseline, 12 months (end of the intervention) and 24 months (follow‐up) using whole body dual‐energy X‐ray absorptiometry. At 12 months, mean bone mineral density among women in the HIGH dose group was estimated to be 0.006 g/cm2 (95% CI: 0.001‐0.010; P = 0.02) higher than that of women randomized to the MODERATE dose group. At 24 months, the mean difference between groups remained statistically significant, indicating higher mean bone mineral density among women in the HIGH dose group (0.007 g/cm2; 0.001‐0.001; P = 0.04). No significant differences between groups were found at any time point for bone mineral content. In an exploratory analysis, women who completed more min/wk of impact exercises had significantly higher mean levels of bone mineral density at 12 months compared to baseline (0.006 g/cm2, 95% CI: 0.006‐0.012; P = 0.03). These findings suggest that higher volumes of exercise, especially impact exercise, lead to a smaller decline in total bone mineral density, which may remain following intervention completion.
Lymphoma patients commonly experience declines in physical functioning and quality of life (QoL) that may be reversed with exercise training.
We conducted a randomized controlled trial in Edmonton, ...Alberta, Canada, between 2005 and 2008 that stratified 122 lymphoma patients by major disease type and current treatment status and randomly assigned them to usual care (UC; n = 62) or 12 weeks of supervised aerobic exercise training (AET; n = 60). Our primary end point was patient-rated physical functioning assessed by the Trial Outcome Index-Anemia. Secondary end points were overall QoL, psychosocial functioning, cardiovascular fitness, and body composition.
Follow-up assessment for our primary end point was 96% (117 of 122) at postintervention and 90% (110 of 122) at 6-month follow-up. Median adherence to the supervised exercise program was 92%. At postintervention, AET was superior to UC for patient-rated physical functioning (mean group difference, +9.0; 95% CI, 2.0 to 16.0; P = .012), overall QoL (P = .021), fatigue (P = .013), happiness (P = .004), depression (P = .005), general health (P < .001), cardiovascular fitness (P < .001), and lean body mass (P = .008). Change in peak cardiovascular fitness mediated the change in patient-rated physical functioning. AET did not interfere with chemotherapy completion rate or treatment response. At 6-month follow-up, AET was still borderline or significantly superior to UC for overall QoL (P = .054), happiness (P = .034), and depression (P = .009) without an increased risk of disease recurrence/progression.
AET significantly improved important patient-rated outcomes and objective physical functioning in lymphoma patients without interfering with medical treatments or response. Exercise training to improve cardiovascular fitness should be considered in the management of lymphoma patients.
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