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

3 Occupational PA and risk for colorectal cancer WCRF & AICR, 2007 Colorectal cancerRectal cancer

4 Recreational PA and risk for colorectal cancer WCRF & AICR, 2007

5 PA and proximal colon cancer Boyle et al, JNCI, 104: , 2012

6 PA and distal colon cancer Boyle et al, JNCI, 104: , 2012

7 PA and risk for colorectal cancer Japan Public Health Center prospective study (M) Lee et al, Cancer Causes Control, 18, , 2007

8 PA and risk for colorectal cancer Japan Public Health Center prospective study (F) Lee et al, Cancer Causes Control, 18, , 2007

9 Commuting PA and colon cancer, case-control study in Shanghi, male Hou et al, Am J Epidemiol 160: , 2004

10 Recreational PA and risk for postmenopausal breast cancer Cohort studiesCase-control studies WCRF & AICR, 2007

11 Occupational and recreational PA and risk for endometrial cancer WCRF & AICR, 2007

12 PA and prostate cancer: total men, 10-yr follow-up ↓7% (95% CI: 1–12%) for every 30 min/d increment Orsini et al, Br J Cancer 101: , 2009

13 PA and prostate cancer: advanced men, 10-yr follow-up ↓12% (95% CI: 2-20%) for every 30 min/d increment Orsini et al, Br J Cancer 101: , 2009

14 PA and renal cancer risk case-control studies Behrens & Leitzmann, BJC, 108: , 2013

15 PA and renal cancer risk cohort studies Behrens & Leitzmann, BJC, 108: , 2013

16 PA and risk for lung cancer Harvard Alumni Health Study, men, Lee et al, Int J Epidemiol 28: , 1999 走路 爬樓梯 PA > 4.5 MET

17 PA 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

19 Epidemiological evidence on PA and cancer prevention in Europe: Men Convincing: colon cancer, RR= studies Possibly: lung cancer, RR= studies Possibly: prostate cancer, RR= studies Friedenreich et al Eur J Cancer, 46: , 2010

20 Epidemiological evidence on PA and cancer prevention in Europe: Women Convincing: colon cancer, RR= studies Probably: breast cancer, RR= studies Probably: endometrial cancer, RR= studies Possibly: ovarian cancer, RR= studies Probably: lung cancer, RR= studies 165, ,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: , 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: 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 ( ) for men 0.86 ( ) for women Vergnaud et al, AJCN 97: , 2013

22 Physical 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: , 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

25 Change in estradiol by change in body fat after 1-yr intervention Campbell, 2007

26 Change 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; ■ : retraining Alibegovic, 2010

28 6-mo interval walking reduces methylation in ASC gene in elderly Nakajima, 2010

29 6-mo interval walking reduces methylation in ASC gene in elderly Nakajima, 2010

30 PA and breast cancer survivor Ballard-Barbash et al, JNCI, 104: , 2012

31 PA and non-breast cancer survivor Ballard-Barbash et al, JNCI, 104: , 2012