**2. Our point of view with regard to an ideal physical activity in oncological patients to survive**

The development of exercise in cancer rehabilitation context has as its primary goal the promotion of a better quality of life, especially in terms of individual perception.

The rehabilitation outcome has to be measured in terms of an individual perception of wellbeing, and it is also expressed in a collective form, involving all the interested subjects to this topic in its definition.

The outcome, in general, has to do with the return to society of people who experienced the disease, as it happens for other important but not lethal diseases.

After having expressed, in the international review, what is believed to induce positive effects in the body system which survived cancer, through the use of physical exercise, we find useful to propose a rehabilitative treatment which is not limited to recommend regular metabolic activity but aims to recover the remaining capacity of the subject, through a specific approach to the patient and the pathology but, at the same time, it aims to increase his/her residual performance with progressive metabolic load by METs .

Therefore, we divided our therapeutic intervention in 3 phases:

Phase 1 Recovery of Residual Capacity.

184 Topics in Cancer Survivorship

Physical activity, before the diagnosis, indirectly correlates with the reduced incidence

The amount of physical activity, before the diagnosis, does not affect mortality

The amount of physical activity after diagnosis reduces the risk of recurrence and

many studies have shown a relationship between BMI and risk of colorectal cancer

 Fat has an important role, especially in its topographic distribution (Giovannucci 1995). High levels of visceral adiposity are related to high levels of insulin on an empty

 The Health Professionals Follow-up Cohort Study conducted on a population of 31.400 men, highlighted that waist-thigh circumference ratio, which is a surrogate of the visceral fat measure, correlated with the risk of colon cancer in the rectum; individuals with the highest quartile showed a 3.4 RR, compared with the ones who had the lowest

 The insulin and the Insulin Like Growth Factor 1 (IGF-1) have a mitogenic activity and induce cell proliferation of colon mucosa cells, in vivo and in vitro (Giovannucci 1995,

Patients with type 2 diabetes have a high incidence of colon adenomas (Hu 1999, Will

High levels of plasma insulin have been linked to higher risk of colon cancer

 The observational Cardiovascular Health Study showed the onset of the colorectal cancer in 102 subjects. It was carried out in 5.849 subjects, who were monitored for 3 years. The relative risk was twice for those who belonged to the quartile with the highest glucose on an empty stomach (also insulin on an empty stomach should be tested), compared with the ones with the lowest quartile of blood glucose levels. High levels of plasma glucose and insulin, after the glucose tolerance test were related to a

High plasma levels of C-peptide in patients with colorectal cancer are related to an

 High IGF-1 levels in non-cancer subjects have been associated with high risk of colorectal cancer in two important, prospective studies, the Nurses Health Study and the Physicians Health Study. This association was not confirmed by the European prospective study, EPIC (European Prospective Investigation into Cancer) (Giovannucci

Two meta-analyses did not confirm the relationship between risk and pre-disease IGF-1

**1.8 As regards risk factors for colon cancer it should be noted that** 

stomach (kissenbach 1982; Bjorntorp 1990; Krotkiewsky 1983).

(McKeown-Eyssen 1994, Shoen 1999, Yamada 1998).

colorectal cancer risk of 2.4. (Shoen 1999).

2000; McPollack 1999, Rinaldi 2010)

levels (Rinaldi, 2010; Renehan 2004).

unfavorable prognosis for survival (Wolpin 2009).

mortality.

of recurrence (Haydon 2006).

(Meyerhardt in 2006, 2009).

quartile, (Giovannucci 1995).

Singh 1993, Tran 1996).

1998, Nishi 2001).

mortality (Meyerhardt 2006a, 2006 b).

(Potter, 1993, Manson 1995, Murphy 1998).

week energy expenditure, the index of mortality risk to 0.39 compared with women with <3 MET activity. Mortality in 5 years gave the following percentages: 14.1% for patients with <3 MET activity, 14.4% for those whose activity was between 3 and 17.9 MET hours per week, 62% for the > 18 MET group. Those women who increased their physical activity compared with the pre diagnosis period reduced by 50% their risk of

Phase 2 Recovery sensory-motor and functional capacity.

Phase 3 Recovery of the quality of Life.
