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Scottish Cancer Prevention Network | Putting Prevention First

#SitLessMoveMore

Are you sitting standing comfortably? Then we can begin…

A basic definition of sedentary behaviour is any waking activity performed while sitting or reclining which involves no noticeable effort. This means your heart and breathing rates are not raised above a resting level. There is a body of research to suggest that sedentary behaviour increases the risk of cancer-the World Cancer Research Fund report states that long periods of uninterrupted sitting increases the risk of weight gain, and so cancer risk. They argue that sedentary behaviour may contribute to a cellular micro-environment that’s conducive to cancer development. Continue reading “#SitLessMoveMore”

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Top 10 tips to #SitLessMoveMore at work

We all know we should try to be active regularly to stay healthy – it is recommended we do at least 150 minutes of moderate intensity activity each week. We can do this by walking, going to a gym class or taking part in a team sport. It is also recommended we try to reduce and break up our sitting time. It is important to think about physical activity and sitting separately to maximise the benefits for our health. People fall into four categories when it comes to their physical activity and sedentary behaviours:

  1. People who don’t meet the physical activity guidelines and have a lot of sedentary time in their day
  2. People who don’t meet physical activity guidelines but don’t spend much time sedentary
  3. People who achieve the recommended amount of physical activity but spend a lot of time sedentary 
  4. People who achieve the recommended amount of physical activity AND don’t spend much time sedentary

For maximum health benefit number 4 is best, but even small changes throughout the day are beneficial.

The amount of time we spend sedentary has increased in recent years, particularly in our workplaces. Long uninterrupted periods of sedentary behaviours during the day are thought to slow down how we process the food we eat. This affects our ability to break down fats and to regulate our blood sugars and blood pressure. We know that breaking up sitting every half an hour, even just for a few minutes, uses our muscles and gives our bodies and brains a boost. Regularly moving throughout the day also help to ease aches, pains and stiffness from sitting at a desk all day.

Ten top tips to help break up sedentary time at work are:

  1. Stand during meetings – or try ‘Share a Chair’ meeting with a colleague if you don’t want to stand for an entire meeting.
  2. Have ‘Walk and Talk’ meetings with colleagues – this works well for smaller meetings with one or two colleagues.
  3. Stand up while talking on the phone.
  4. Set up a reminder on your computer or phone to move regularly – try to move every 30 minutes for a couple of minutes if you can.
  5. Drink more water (and consider if you can use a bathroom that is further away!) and refill your water bottle at a water fountain that is up a flight of stairs.
  6. Use communal printers/photocopiers/bins which you have to walk to.
  7. Move away from your desk at lunchtime, eat in a communal recreational area with colleagues, and go for a walk outside – take your dog to work if you can!
  8. Talk to colleagues in your building rather than emailing or phoning.
  9. Try a standing desk if this is option in your workplace – Get Britain Standing gives a good overview of the options currently available http://www.getbritainstanding.org/
  10. If you really can’t get away from your desk, could you do some simple stretches at your desk?

For top tips on how to reduce and break up your sedentary behaviours at home see here – https://www.pathsforall.org.uk/pfa/news/new-research-aims-to-get-older-adults-sitting-less-and-moving-more.html

Claire Fitzsimons, Paul Kelly, Cindy Gray, Victoria Palmer, Nanette Mutrie

#CutSittingTime – NOW!

Sedentary behaviour is defined as ‘any waking behaviour characterised by an energy expenditure less than or equal to 1.5 METs while in a sitting or reclining posture’. 

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Sometimes I just call this sitting behaviour and when we stop to think there are lots of places we sit for prolonged periods. Travelling by car, bus, train, sitting at computers in our working days and sitting in our leisure time whether in front of the tv, in pubs or just lounging around. 

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There is now a growing evidence about sedentary behaviour as a risk factor to health which is independent of physical activity. In other words, the athlete who spends his evenings training but his days in front of a computer still has increased risks. Many people find this difficult to follow and assume that messages to break up sitting time are about getting more steps or stretching muscles – these things are important but the main message to move and BREAK up prolonged sitting. Personally, when I break sitting time I also do something – a bit of kettlecise, walk across the room,  move to the mirror to comb my hair, or pop my head into the next room. Any wee movements away from my sitting computer pose is a relief for my neck – but best of all is when I can access my standing desk!

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There is now growing evidence about prolonged sedentary behavior and cancer risk. As you might expect the association is strongest for the same cancer sites as low physical activity, namely breast, colon and endometrium. A meta-analysis of 14 observational studies showed that high versus low levels of time spent sitting are related to 13% higher risk of cancer incidence (after adjustment for physical activity) and another meta analysis reported  2% of cancer mortality was related to TV viewing.  The World Cancer Research Fund Third Expert Report reported weaker relationships overall but more notable in endometrial cancer. 

Reducing sedentary time is related to a whole host of other health outcomes including cardiovascular disease and type 2 diabetes. Psychologically it can be very good for patients in recovery – something is better than nothing and getting moving can mean moving towards health.

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Are you reading this whilst sitting down ? Think again …

Professor Annie S. Anderson

How young adults can #BeFree and achieve more…

Our co-director Professor Annie S Anderson writes….at age 15 I thought smoking was the coolest thing ever. I dared to be different (along with my small band of pals). Opportunities to smoke were limited – the school bus, at the back of the bike sheds and out on those “healthy” walks. My parents didn’t smoke but they also didn’t mind that I smoked as long as I didn’t set the house on fire. I guess they thought it was a sign of maturity. Smoking started with packets of 10 then progressed to packs of 20 when I started my first job and then roll ups when I became a student.  I remember smoking in my hospital based office in my first NHS post and feeling only slightly embarrassed when any consultants walked in. By the age of 25 I had been through several quit attempts and found new health conscious friends that clearly didn’t think much of smoking and then I found the will power to stop. I kidded on that I wasn’t addicted but for the next 20 years and I still had dreams in which I was smoking and I’d wake worried that I harboured that addictive tendency.

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With that background I was delighted to hear that ASH Scotland is preparing to launch a new campaign highlighting how not smoking leaves young adults happier, better off and achieving more. Development Lead from ASH (Emma Papakyriakou), explains more…

The tobacco industry deliberately built up smoking as a lifestyle choice promising to help young adults find their identity at a time when they are still learning about themselves, their potential and where they fit in. Where they can they still do this, so we feel it’s time to reclaim the aspirations of young adults.

The reality is that a pack a day habit will cost £250 a month of their limited finances, immediately impact on their energy levels and fitness and dictate their daily schedules as they socialise, train, learn or work around smoking breaks – while developing unhelpful coping mechanisms that can be hard to break.  

The factors which push people to smoke, and the protective factors which discourage it, are closely linked to social and economic circumstances and as such it looks less and less like a lifestyle choice and more like part of the problems facing disadvantaged young adults. So we can understand why smoking rates are four times higher in the most deprived communities, even though these groups are just as likely to say they want to stop.

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This means that young adults growing up in these communities are more likely to have parents or families who smoke. They will live in areas where cigarettes are more widely sold and where smoking is more commonly accepted as a normal part of daily life. And while most schools and families today are conscious about creating a smoke-free environment for children, young adults often arrive into a culture where smoking breaks are the norm, where doorways and entrances are visible gathering points for smoking breaks and where smoking is an expected part of the social scene. 

Yet smoking need not be inevitable for these young adults. They have more to gain by being smoke-free and we know young adults want better for themselves and their families regardless of their postcode. We’ve been out speaking to young adults, who have told us some of their goals for the next 12 months – passing exams, getting a job, saving for their driver’s license, buying a car, being a good parent and going to college, to name a few.

Our #befree campaign will be clear and simple and link to these aspirations, complementing existing efforts to help young adults achieve more. The first phase of the campaign will use a new set of posters to promote the key message that not smoking means being happier, fitter and better off, and we aim to get these out to colleges, employability services and other venues where young adults spend their time.

If you can help with this then please contact Emma Papakyriakou on epapakyriakou@ashscotland.org.uk

 

 

Breast feeding ABC – Action, Best practice, Cancer risk reduction

If asked if there is a single nutritional intervention that would make a difference in the health of a life time, in a population, in people from any background then my nomination would be breast feeding.   

Several weeks of my life have been spent on the Scientific Advisory Committee on Nutrition (SACN) subgroup on maternal and child nutrition reviewing and discussing the evidence on breast feeding as part of a report (now published) on feeding in the first year of life. 

The evidence is clear – Breast feeding trumps all the fancy formula milks, bottles and paraphernalia. Breast fed babies grow in ways that are healthier and are less prone to infections. The SACN recommends retaining existing advice for women to exclusively breastfeed for around the first 6 months and to continue breastfeeding for at least the first year of life once solid foods have been introduced. SACN recommends that infants are not introduced to solid foods until around 6 months of age.

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Breast feeding isn’t just about nutrition …. The SACN report also highlights  that breastfeeding is associated with improved health in mothers including  lower risk of breast cancer and endometriosis, and greater postpartum weight loss and lower body mass index (BMI) in the longer term. The cancer issues are also highlighted in the latest World Cancer Research Fund report The science is interesting – and suggests that because breast feeding decreases the number of menstrual cycles lifetime exposure to some cancer-related hormones in the body (specifically, androgens) are reduced. In addition the process of lactation helps to remove cells that may have DNA damage and mutations.

In this country, the marketing of breast feeding is pitiful – something talked about under the wraps of antenatal care, maternal support and midwifery. Breast feeding should be praised, celebrated and supported across our society – from worksites to churches to retail to catering we need breast feeding to be seen and valued as part of everyday life. When was the last time you saw a women breast feeding? When was the last time you talked about breast feeding with your male partners/colleagues/friends/brothers?

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Across the world, breast feeding remains a crucial part of promoting infant life. Whilst there are many attempts to protect existing cultural practices these are too often eroded. In recent work published by my colleague Dr Linda Shaker in Lebanon (working within the refugee crisis) we can see that policies are in place to protect infant and young child feeding but implementation is not fully operationalised across all sectors. There is much need to walk the talk across all cultures and society.

Prof Annie Anderson, SCPN Co-Director

 

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Leadership, Culture and Eating

Food is so very embedded within our working lives, leisure activities, our daily journeys and our hospitality. Our cultural norms about eating have stretched beyond any boundaries that I may have learnt as a child. Not that I can recall ever being “taught” what was right and wrong but the learning was by example from elders including older siblings, parents and family, people you met on holiday and then others like work colleagues and friends. Even now it doesn’t feel right to eat in the street, or eat more than one biscuit at a time, keep confectionary in the house or reward children with sweeties.

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I remain convinced that our food habits are strongly influenced by what we see around us and are re-enforced as culture norms which we certainly won’t change by education or training. We need to be “Be the change we want to see” and that needs leaders who a) don’t perpetuate food habits that need to be broken and b) are prepared to lead by example. Incidentally… that doesn’t mean targeting NHS leaders personal habits but supporting the changes they can initiate and lead on within the NHS.

Quite by co-incidence in the week the Scottish Government launched the Healthy Weight Delivery Plan I heard several quips about how the odd caloric “treat” isn’t a problem. The most public of this was the unfortunate action by Maree Todd MSP sharing her recipe for tablet (which she hand makes for children as a treat). The issue here isn’t calories it’s about perpetuating the concept of treats that need to come in the form of sugary, fatty forms. Then a note from some of NHS colleagues about the annual NHS showcase event that turns a blind eye to the sweeties and confectionary offered by exhibitors. Finally an email about an NHS training event that provides pastries, croissants and chocolate tea cakes at start and break time.

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When we launched our healthy meetings score card we did it to help change the norms of what might be expected in a healthy working day. We have had hundreds of comments back and people who have tried to ask for changes but leadership is missing ….. this is where we need the NHS to lead by example.

And a final word. Inevitably when the NHS celebrated its big birthday this week… it did it with cake (sticky and icy variety) …. !

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Looking for non food and drink gift ideas? Have a look at our blog ideas here.

Getting to know your neighbours

Ireland and Scotland are neighbours who have many cultural and population similarities: native Celtic language, the unique similar national sports of hurling and shinty, the need to always pack an umbrella and a battle to reduce rising cancer incidence due to modifiable risk factors. 

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The Irish Cancer Society (ICS) have long standing links with the Scottish Cancer Prevention Network (SCPN) and introduced the Irish National Cancer Control Programme (NCCP) to the SCPN, growing a cancer risk reduction neighbourhood.  The NCCP and the SCPN are neighbours getting to know each other which can provide immense benefits to reducing cancer risk for both our nations. 

      Learning from each other

The SCPN recently travelled to Dublin to meet stakeholders with an interest in cancer prevention in Ireland.  Learning from the actions undertaken by the SCPN a similar approach could meet the aims of the NCCP by bringing a collaborative and focused approach to cancer prevention in Ireland, facilitating peer learning and supporting national and local cancer risk reduction initiatives.  Likewise a workshop held after the presentation stimulated new ideas for the SCPN. 

      Resources

Ireland’s cancer risk reduction function won’t be borrowing a cup of sugar from the SCPN but may borrow “Dougal the dog” for a walk to promote physical activity to reduce cancer risk in Ireland. 

      Support

The actions to reduce cancer risk for individuals, such as eating a diet rich in fruit, vegetables and wholegrains requires support from your neighbour.  If you are trying to eat healthy and your neighbour calls over with freshly picked strawberries or a box of chocolate, which is the support you are looking for?  Creating the link between the SCPN and the NCCP provides a platform to support each other in our endeavours to support and empower cancer risk reduction for our populations.

Over the coming time we hope the link between Ireland and Scotland cancer risk reduction endeavours are strengthened, to learn and support each other.  The Irish cancer risk reduction neighbourhood is strengthening, the SCPN were welcomed to the NCCP by the Irish Cancer Society, Marie Keating and Breakthrough Cancer Research, a community coming together.

Take care of your neighbours and the world will look after itself” is an age old saying that has a depth that extends to world of cancer risk reduction.

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Be active in everyday life – evidence, actions and communications

The third expert report on Diet, Nutrition, Physical Activity and Cancer provides the most comprehensive review on the topic ever published. There is strong evidence that physical activity affect the risk of cancer of the colon, breast and endometrium. The mechanisms involved include reductions in circulating oestrogen levels, immunomodulatory effects, enhancing innate and acquired immunity, and promoting tumour surveillance insulin resistance and inflammation. Physical activity also reduces body fatness, in particular visceral fat, and therefore may have an additional indirect impact on cancer risk. There is more, much more to read on the evidence about Physical activity and cancer in the report.

Key message – we recommend being physically active as part of everyday life – walk more and sit less

But having evidence alone is not enough to change behaviour. A point well made by Professor Mike Kelly in the Guardian, with heart felt words he says… getting people more active is more than drip feeding information and evidence, it requires increasing people’s opportunities to be able to be physically active. It also means helping people to develop motivation and acquire the skills to do the activities. It is about opportunities to be active.

There is a role for information, it’s part of the portfolio to assist change but let us communicate in ways that are remembered, that help sign post, that help motivate and help to make people feel they are engaging in one of lifes great pleasures.

WE asked four UK physical activity communicators to provide us with communications beyond words and you will see below what they sent us. Please share those messages about being active and being alive and help to create the demand for pavements beyond the city boundary green space we can play on and paths we can cycle on. Please share these images widely…. its more than evidence and it’s a contribution to motivating change.

Ann Gates Founder and CEO, Exercise Works!

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Credit: World Health Organization

Dr Paul Kelly Lecturer for Physical Education and Health Sciences, The University of Edinburgh

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Credit: Healthier Scotland Scottish Government

 

Dr Andrew Murray Sport and Exercise Medical Team, The University of Edinburgh

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Credit: Himself

Mary Colvin Senior Health Improvement practitioner, NHS Tayside

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Credit: http://www.everybodywalk.org

Prostate Screening – to screen or not to screen with PSA alone?

The recently published CAP study (1) has a stark message – screening for prostate cancer using a single PSA test doesn’t work – it has no effect on mortality from the disease. This reinforces what we already know from previous trials. True, there is one European trial of repeated PSA testing that has shown a reduction in prostate cancer deaths, but at the cost of having to treat 28 men to prevent one death. As the treatment for prostate cancer causes significant morbidity in the form of urinary and sexual dysfunction, the UK National Screening Committee along with all other competent international organisations, do not recommend PSA screening for prostate cancer. 

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The problem is that, although PSA testing detects cancer, most cases do not progress and are therefore not destined to cause death. Indeed, aggressive prostate cancer often presents in the face of a normal PSA. To compound the problem, symptoms are a very poor indicator of cancer – most men with frequency, urgency and poor stream have benign prostatic enlargement. Of course, some will have cancer as well, picked up by well-meaning PSA testing and subsequent biopsy, and these men will go on to have radical treatment despite the fact that few will benefit.

So what can we do? The message cannot be “don’t screen”, it must be “don’t offer screening with PSA alone”. Given that, in the absence of PSA testing, most aggressive cancer presents with metastatic disease, we need something else that can pick up early significant disease without exposing many men to unnecessary morbidity. Where this will come from is not yet clear, but there is promising ongoing work looking at the value of different levels of PSA, specific age ranges and combining PSA testing with advanced MRI scanning.

  1. Effect of a Low-Intensity PSA-Based Screening Intervention on Prostate Cancer Mortality: The CAP Randomized Clinical Trial (2018) JAMA Mar 6;319(9):883-895 https://www.ncbi.nlm.nih.gov/pubmed/29509864

 

RSteele

Prof. Bob Steele

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