Move More to Reduce Your Cancer Risk

We can! Move More to Reduce Your Cancer Risk An initiative of the American Institute for Cancer Research.

AICR s Recommendations for Cancer Prevention Be as lean as possible without becoming underweight Be physically active for at least 30 minutes every day. Limit sedentary habits, like watching television. Avoid sugary drinks. Limit consumption of caloriedense foods (particularly processed foods high in added sugar, or low in fiber, or high in fat) Eat more of a variety of vegetables, fruits, whole grains and beans Limit consumption of red meats (such as beef, pork and lamb) and avoid processed meats If consumed at all, limit alcoholic drinks to 2 for men and 1 for women a day Limit consumption of salty foods and foods processed with salt (sodium) Don t use supplements to protect against cancer Special Population Recommendations It is best for mothers to breastfeed exclusively for up to 6 months and then add other liquids and foods After treatment, cancer survivors should follow the Recommendations for Cancer Prevention And, always remember do not smoke or chew tobacco

Move More to Reduce Your Cancer Risk Table of Contents Reduce your cancer risk.... 2 Make time for physical activity.... 4 What is physical activity?... 6 Healthy eating + physical activity = a healthy weight... 9 Get started... 10 Types of activity.... 12 How hard should you work?............. 17 Need more help?.... 19 About AICR... 20 Healthy Living for Cancer Prevention Series

We can! Reduce your cancer risk This booklet tells you how getting enough physical activity can lower cancer risk and simple ways you can become more active every day. More than 1 in 3 Americans will develop cancer at some point during their lives. Scientists estimate that about one-third of the most common cancers could be prevented if we ate a healthy diet, got at least 30 minutes of daily physical activity and maintained a healthy weight. Even more cancer cases could be prevented by not smoking. Although there are no guarantees when dealing with cancer, a growing amount of research links being more physically active with reduced cancer risk. It s never too late: Making healthy changes at any time in life can reduce your risk. So why wait? Start today! Start today! Why wait? It s never too late to make healthy changes and lower your cancer risk. 2 Move More to Reduce Your Cancer Risk

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We can! Make time for physical activity We now know that not getting enough physical activity increases risk for developing cancer and many other serious diseases, such as heart disease and diabetes. Based on AICR s reviews of the scientific evidence, you can begin to reduce your cancer risk by being moderately active for at least 30 minutes each day. And researchers are finding that even more health benefits come from getting at least 60 minutes of moderate activity every day or at least 30 minutes of daily vigorous activity. The health benefits are immediate. Yet fewer than half of all U.S. adults get the minimum 30 minutes recommended per day. And spending long hours being inactive watching TV, working on the computer or doing other seated activities like driving can also raise your cancer risk. This brochure gives you plenty of ideas for moving more each day. 4 Move More to Reduce Your Cancer Risk

What about cancer survivors? For cancer survivors, physical activity is helpful for everyday functioning and recovery. However, it s best to find an instructor or trainer who is certified to work with cancer patients and survivors. Studies are finding that regular physical activity helps cancer survivors: feel less fatigued boost muscle strength reduce stress possibly help prevent recurrence. To date, most of the research has focused on breast cancer survivors, but more studies are looking at survivors of prostate, colon and other types of cancer. Move More to Reduce Your Cancer Risk 5

We can! What is physical activity? Going to a gym isn t the only way to be physically active. Doing light activities during the day, like walking to the mailbox, vacuuming the house and raking the lawn, all count. Physical activity is any movement using skeletal muscles. Light physical activity includes standing, walking around an office or home and shopping. Recreation time may involve moderate physical activity, like a brisk walk, or vigorous physical activity, such as running. Exercise and other forms of physical training are types of recreational physical activity. Make Time for Break Time This graphic illustrates how different amounts of activity influence certain much-studied indicators of cancer risk. Other factors like eating smart, staying lean and not smoking also lower cancer risk. Ann Mike Kim Joe Types of activity: Moderate / Vigorous Br 6 Move More to Reduce Your Cancer Risk

Take Frequent Short Physical Activity Breaks Even if you have to sit for long periods of time, you don t have to sit still! Try walking down the hall to speak to an office mate instead of sending an email. Use hand-held weights to do strengthening exercises during TV commercials. Get up and stretch in place for a few minutes. Avoid inactivity Even if you do spend 30 minutes at the gym or doing other physical activity, recent research findings show too much sitting during the rest of the day still poses a health risk. This sedentary behavior may be associated with an increased risk of cancer. How? Not burning enough calories (energy) in the body affects your metabolism and may increase weight gain. Daily Activity Cancer Risk HIGHER ak Sedentary LOWER Move More to Reduce Your Cancer Risk 7

SCIENCE What are the benefits of physical activity? AICR s expert report and its updates found strong evidence that physical activity plays a direct role in reducing your risk for: colon cancer postmenopausal breast cancer endometrial cancer Some cancer-prevention effects include: Reducing body fat. Extra fat can raise levels of estrogen and other hormones in the blood, increasing risk for cancer. Fat cells also prompt more production of proteins that can cause inflammation, another factor in cancer risk. Speeding up food transit time in the gut. Faster digestion reduces the time cells in your gut are exposed to cancercausing substances possibly lowering cancer risk. Among the other diseases that become less likely once you get and stay active are: heart disease depression stroke cognitive decline and osteoporosis dementia Type 2 diabetes obesity You can improve your health in a number of ways by being more physically active to: Lower blood pressure Increase bone density Raise levels of good cholesterol and lower levels of bad cholesterol Control blood sugar Improve mood Maintain functional health and improve balance for day-to-day activities Increase brain function Ease arthritis symptoms 8 Move More to Reduce Your Cancer Risk

We can! Healthy eating + physical activity = a healthy weight Physical activity alone can help reduce your cancer risk directly. Combining healthy eating with physical activity to maintain a weight that is right for you can also lower your cancer risk. How? If the amount of calories you burn through physical activity during the day is balanced with the amount of calories you eat and drink, then you can maintain a healthy weight. According to the federal Centers for Disease Control, on average, males consume 2,475 calories daily and females consume 1,833 calories. But because many people get little activity and watch an average of 4 hours of television a day they do not burn enough calories, which instead turn into extra body fat. To maintain a healthy weight, AICR suggests eating mostly plant-based foods vegetables, fruits, whole grains and beans that are minimally processed. These foods are naturally low in calories and high in water and fiber, so they fill you up with fewer calories than high-calorie foods like chips, sweets, baked goods and fried foods. Plant foods also contain natural compounds that may help protect against cancer. For more information about eating to maintain your healthy weight, www.aicr.org. Move More to Reduce Your Cancer Risk 9

We can! Get started 1) Start at your current ability level. Go at your own pace and be active at a time of day that suits your schedule. You can be active by yourself or with others. Adding 5, 10 or 15 minutes of activity like walking a couple of times a day is a good start if you haven t been active until now. 2) Do more than you re doing now. Gradually increase the 5 minutes to 10 every day for a week or two; then make it 15 minutes, adding more time over a few weeks until you are getting at least 30 minutes of moderate activity each day. 3) Remember: Some physical activity is better than none. Even if you have to sit for long periods of time, get up every hour and move around or try not to sit still. Schedule it in! Treat your physical activity sessions like appointments. Schedule them in your calendar just like you would a visit to the doctor. You will be more likely to keep up with your program if you see it on your planner. 10 Move More to Reduce Your Cancer Risk

We can! Types of activity The three basic types of physical activity are: aerobic, strengthening and flexibility/balance. Each helps your body in a different way. Doing all three kinds during the week varies your activity and benefits different muscles. 1. Aerobic activity helps your heart and lungs get stronger and work more efficiently by raising your heart rate to an elevated but safe level for a period of time. How it helps Aerobic activity burns calories. This type of activity is known to lower cancer risk by controlling your weight and hormone levels. Aerobic activity can: improve your heart (cardio) fitness improve levels of good cholesterol lower blood pressure reduce risk for bone loss (osteoporosis) increase brain function reduce stress Examples of aerobic activities include: brisk walking biking hiking jogging dancing vacuuming sweeping 12 Move More to Reduce Your Cancer Risk

for aerobic activity Break it up One 30-minute walk is equal to three 10-minute walks. What matters most is the total amount you accumulate throughout the day. Seize opportunities Take the stairs instead of the escalator, park in the farthest spot and walk to your destination or get off the bus two stops early. You can fit in more physical activity just by making a few small adjustments to your daily routine. Make it fun mix it up Choose activities that you like and look for ways to spice them up when you get bored like inviting a friend along. The more you enjoy your routine, the more likely you are to stick with it. For aerobic activity: Start with a 5 10 minute warm-up. Start slowly and give your body a chance to get used to the new activity. Listen to your body. Continue your activity at a pace that feels comfortable. Allow time for a 5- to 10-minute cool-down at the end. Push yourself. When you can complete your routine with ease, start to boost its intensity by increasing the speed, the distance or the difficulty (e.g., adding a hill to your walking route). Move More to Reduce Your Cancer Risk 13

2. Strength training works your muscles against weight or resistance to increase strength. Starting around age 30, muscle strength decreases by a small amount every year. That s why strengthening exercises are important for everyone, especially older adults. Strength training increases and maintains muscle mass. It can also build bone density. How it helps Weight training can: improve blood sugar control for people with diabetes build bone density to stave off osteoporosis strengthen core muscles to alleviate back pain For strength training, use inexpensive free weights (i.e., dumbbells), weight machines or resistance bands. Cans of food or your own body weight work, too. For strength training: Start with a warm-up. To avoid injury from straining inert muscles with sudden weight resistance, go for a 5 10 minute brisk walk or do a short routine of jumping jacks and marching in place before you begin your routine. Listen to your body. Do at least one exercise for each major muscle group: abdominals, arms, back, chest, legs and shoulders. Avoid working the same muscles two days in a row because they need a day in between to recover and grow stronger. 14 Move More to Reduce Your Cancer Risk

for strength training Learn the technique To avoid injury, become familiar with the proper technique for each exercise. There are books and websites that can guide you through a strength-training program (see page 19). You could also work with an instructor for a few sessions to be sure you have it right. Make it challenging Moderate-to-vigorous intensity means completing 8 12 repetitions. If you can t complete at least 8 repetitions, then the weight is too heavy. If you can complete more than 12 15 repetitions, then the weight is too light. Write down the amount of weight and repetitions in a diary so you know when to increase them. Pay attention to how each exercise feels. Strength training should challenge your muscles but should never be painful. If an exercise doesn t feel comfortable, remove it from your routine. However, you will get the most benefit by building up to a moderate-to-vigorous intensity strength training routine 2 3 times each week. 3. Flexibility and balance become especially important as you get older. A regular series of flexibility and balance exercises that works your joints through their full range of motion can help you stay physically active for lower cancer risk. Simply bending and touching your toes from a standing or seated position, reaching high above your head and alternating reaches (as if you were climbing a ladder) will help strengthen your muscles. Although these movements are considered light and not intense enough to count toward the 30 minutes of moderate activity needed daily for cancer prevention they are still important. Move More to Reduce Your Cancer Risk 15

For flexibility and balance: A class or home routine should include at least one exercise for each major muscle group of the body: abdominals, arms, back, chest, legs and shoulders. Hold each flexibility pose 10 30 seconds. Try to do some every day. for flexibility and balance Start with a warm-up because working cold muscles may cause injury. Stretch between sets during weighttraining or at the end of your workout. Check out books and websites that can show you some effective flexibility and balance exercises; for example, go4life.nia.nih.gov/exercises Try a yoga, tai chi or Pilates class. 16 Move More to Reduce Your Cancer Risk

We can! How hard should you work? Intensity can be light, moderate or vigorous. It is based on your current fitness level. When you begin an exercise program, a 3-mile-per-hour (mph) walk may be vigorous activity. As you become more fit, the walk will become easier to complete in less time and may be considered a moderate activity. Light intensity activities: walking slowly (2 mph) golfing, using powered cart gardening or pruning bicycling, leisurely dusting or vacuuming light stretching or warming up Moderate intensity activities: walking briskly (3.5 mph) swimming, recreational raking the lawn tennis, doubles golfing, pulling or carrying clubs bicycling (5 9 mph) on level terrain scrubbing floors or washing windows weight lifting machines, free weights or resistance bands Vigorous intensity activities: jogging or running (5 mph) swimming laps mowing lawn, hand mower tennis, singles bicycling more than 10 mph or on steep uphill terrain dancing at a fast pace circuit training with weight machines team sports like soccer or basketball Move More to Reduce Your Cancer Risk 17

Popular Physical Activities and Calories Burned Calorie expenditures listed below are approximate for a 160 lb. person doing the activity at moderate intensity or speed for 30 minutes. Activity Cycling at 10 miles per hour Walking at 3.5 miles per hour Rowing Swimming laps Aerobics, high impact or step Weight lifting, vigorous Hiking with backpack Expenditure 138 calories 200 calories 210 calories 210 calories 272 calories 280 calories 364 calories By comparison, here are examples of sedentary activities and calories burned: Sleeping Watching TV, sitting or lying Sitting, playing cards or in meetings Sitting, typing or writing Standing 33 calories 47 calories 57 calories 69 calories 69 calories Source: Ainsworth, BE et. al., 2011 Compendium of Physical Activities, Med Sci Sports Exerc. 2011 Aug;43(8):1575-81. Stay active throughout life Older adults are urged to follow our recommendation of at least 30 minutes of daily moderate activity. If you have a health condition that may prevent you from being physically active, check with your health care provider. Otherwise, being older is no reason to be inactive, says the National Institute on Aging. 18 Move More to Reduce Your Cancer Risk

Need more help? The information in this booklet is about becoming physically active for cancer prevention. Eating a healthy diet, staying in shape and not smoking play a big part, too. Find out more in our booklet, 10 Ways to Reduce Your Cancer Risk, and other free AICR brochures. Visit www.aicr.org to download brochures or contact AICR to order up to 3 individual titles for free: Eat Well Reach Your Healthy Weight Simple Steps: Start Where You Are Simple Steps: Mix It Up Simple Steps: Keep It Up The New American Plate Contact us at: American Institute for Cancer Research 1759 R Street, NW, P.O. Box 97167 Washington, DC 20090-7167 or call: 1-800-843-8114 or 202-328-7744 The following websites have more information: America on the Move www.americaonthemove.org American Council on Exercise Get Fit workouts and videos www.acefitness.org/getfit Go4Life National Institute on Aging Exercises for adults and related information. Go4life.nia.nih.gov 1-800-222-2225 Growing Stronger: Strength Training for Older Adults growingstronger.nutrition.tufts.edu/ Developed by Tufts University and the Centers for Disease Control and Prevention, this exercise program focuses on older adults. The Walking Site www.thewalkingsite.com Tells how to use a pedometer and calculate your steps. Contact your cancer center, yoga center with certified instructors, tai chi center, YMCA or county department of recreation. Move More to Reduce Your Cancer Risk 19

About AICR OUR VISION: We want to live in a world where no one develops a preventable cancer. OUR MISSION: We champion the latest and most authoritative scientific research from around the world on cancer prevention and survival through diet, weight and physical activity, so that we can help people make informed lifestyle choices to reduce their cancer risk. We have contributed over $105 million for innovative research conducted at universities, hospitals and research centers across the country. Find evidence-based tools and information for lowering cancer risk, including AICR s Recommendations for Cancer Prevention, at www.aicr.org. About the Continuous Update Project As the U.S. charity in the World Cancer Research Fund network, we contribute to the Continuous Update Project (CUP), an ongoing analysis of global scientific research into the link between diet, physical activity, weight and cancer. The CUP produces periodic reports on the state of the evidence linking various lifestyle factors to risk of specific cancers. These reports will inform a major update of our Recommendations for Cancer Prevention scheduled for 2017. Visit our website for the complete list of CUP reports including: 2015 Gallbladder Cancer 2015 Liver Cancer 2014 Prostate Cancer 2014 Breast Cancer Survivors 2014 Ovarian Cancer 2013 Endometrial Cancer 2012 Pancreatic Cancer 2011 Colorectal Cancer Analyzing the research on cancer prevention and survival 2010 Breast Cancer You can support AICR s life-saving research and education in a variety of ways: make a donation online at www.aicr.org; write to AICR, 1759 R Street, NW, P.O. Box 97167, Washington, DC 20090-7167; or include a bequest in your will. For more information, contact our Gift Planning Department at 1-800-843-8114 or gifts@aicr.org. 2008 AICR Latest revision, February 2015 20 Move More to Reduce Your Cancer Risk

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CancerPrevention Together We Can is an initiative of the American Institute for Cancer Research. The website, www.aicr.org/can-prevent is dedicated to presenting evidence-based, user-friendly and interactive tools that educate and empower people to reduce cancer risk. AICR Guidelines for Cancer Prevention The choices you make about food, physical activity and weight management can reduce your chances of developing cancer. Choose mostly plant foods, limit red meat and avoid processed meat. Be physically active every day in any way for 30 minutes or more. Limit sedentary habits, like watching television. Aim to be a healthy weight throughout life. And always remember do not smoke or chew tobacco. www.aicr.org Follow us on AICRBlog Facebook Twitter E51-MM