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Chen Y, Meng X, Yang K, Wang H, Pei C, Song N. Association of physical activity and sitting time with femoral bone health among older cancer survivors. J Bone Miner Metab 2024:10.1007/s00774-024-01544-0. [PMID: 39127868 DOI: 10.1007/s00774-024-01544-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 07/23/2024] [Indexed: 08/12/2024]
Abstract
INTRODUCTION Our primary goal was to investigate the independent and combined associations of physical activity (PA) and sitting time (ST) with femoral bone health among cancer survivors aged 60 or older. MATERIALS AND METHODS This cross-sectional study included 1159 cancer survivors aged 60 years or older who underwent femur dual-energy X-ray absorptiometry (DXA) examination from continuous National Health and Nutrition Examination Survey data sets. PA and ST were assessed by self-report, and bone health included bone mineral density (BMD) at all femoral sub-regions, osteopenia/osteoporosis of femoral neck, and total fracture. The independent and combined associations of PA and ST with femoral bone health were determined using multivariable linear or logistic regression analyses. RESULTS More than 40% cancer survivors reported engaging in PA < 150 min/week with ST ≥ 6 h/d. PA solely showed no association with bone health at femur sites. Prolonged ST was associated with lower femur's BMD, higher prevalence of osteopenia/osteoporosis, and total fracture. Specifically, the negative association of prolonged ST and femur's BMD was shown in PA ≥ 150 min/week group, but not in PA < 150 min/week group. In combined analysis, prolonged ST with PA ≥ 150 min/week showed the strongest negative associations with femur's BMD. CONCLUSION PA appears not to be directly associated with femoral bone health. Higher ST is associated with lower BMD and a higher incidence of total fractures, regardless of PA level, among cancer survivors aged 60 or older.
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Affiliation(s)
- Ying Chen
- Department of Breast Surgery, Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Shushan District, Hefei, 230022, Anhui, People's Republic of China
| | - Xinmin Meng
- Department of Cardiology, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, 300052, People's Republic of China
| | - Kuan Yang
- Department of Cardiology, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, 300052, People's Republic of China
| | - Hanfei Wang
- Breast Cancer Center, Hefei Cancer Hospital, Chinese Academy of Sciences, 68 Yangqiao Road, Shushan District, Hefei, 230022, Anhui, People's Republic of China
| | - Chongzhe Pei
- Department of Cardiology, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, 300052, People's Republic of China.
| | - Ningning Song
- Department of Breast Surgery, Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Shushan District, Hefei, 230022, Anhui, People's Republic of China.
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Neville AR, Tabaczynski A, Whitehorn A, Bastas D, Trinh L. Sedentary time transitions and associations with quality of life in cancer survivors during the COVID-19 pandemic. J Psychosoc Oncol 2024:1-18. [PMID: 38693609 DOI: 10.1080/07347332.2024.2346560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
BACKGROUND Patterns in sedentary time (SED) and its impact on quality of life (QoL) in cancer survivors during the COVID-19 pandemic remains unknown. The purpose of this study was to 1) compare total and domain-specific SED before and during the pandemic; and 2) examine its association with QoL in a global sample of cancer survivors. METHODS In an online survey, cancer survivors retrospectively self-reported domain-specific SED (e.g. transportation, television) before and during the pandemic via the Domain-Specific Sitting Time Questionnaire. QoL was assessed via the Functional Assessment of Cancer Therapy (FACT)-General and FACT-Fatigue. Paired t-tests compared daily SED before and during the pandemic. Analysis of covariance compared QoL among: those who remained high (>8 h/day), remained low (<8 h/day), increased (<8 h/day to >8 h/day), or decreased (>8 h/day to <8 h/day) daily SED. RESULTS Among cancer survivors (N = 477, Mage=48.5 ± 15.4), 60.8% reported that their SED remained high, 19.7% remained low, 7.5% increased SED, and 11.9% decreased SED. Computer and television screen time significantly increased (p's<.001), while SED during transportation significantly decreased (p<.001). Sub-group analyses revealed that those who reduced SED who were normal or underweight (p=.042) or were meeting physical activity guidelines (p=.031) had significantly less fatigue than those who increased or remained high in SED, respectively. Those who remained high in SED with <3 comorbidities (p's =.005) had significantly better social well-being than those who increased SED. CONCLUSIONS As we transition to a post-pandemic era, behavioral strategies for cancer survivors should focus on reducing screen time to improve QoL and fatigue.
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Affiliation(s)
- Alyssa R Neville
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Allyson Tabaczynski
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Alexis Whitehorn
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Denise Bastas
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Linda Trinh
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
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Park JH, Lee JS, Nam HS, Kim YH. Factors associated with sedentary behavior among community-dwelling breast cancer survivors aged 50 years or older. Sci Rep 2024; 14:2396. [PMID: 38514659 PMCID: PMC10957892 DOI: 10.1038/s41598-024-51172-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 01/01/2024] [Indexed: 03/23/2024] Open
Abstract
Although increased sedentary behavior is associated with poor health outcomes among breast cancer survivors, the factors associated with high sedentary time in community-dwelling breast cancer survivors are unknown. This study aimed to identify factors associated with sedentary behavior in Korean community-dwelling breast cancer survivors aged ≥ 50 years. We included 205 breast cancer survivors from the Korea National Health and Nutrition Examination Survey. Total daily sedentary time was evaluated using questions from the Korean version of the Global Physical Activity Questionnaire. We used complex-sample multivariable-adjusted logistic regression analyses to analyze the associations between sociodemographic factors, medical factors, and health-related quality of life and high sedentary time (≥ 420 min/day). Among the Korean community-dwelling breast cancer survivors, 48.2% had a high daily sedentary time. Insufficient aerobic exercise (OR 2.29; 95% CI 1.12-4.69), diabetes (OR 3.37; 95% CI 1.22-9.33), and unemployed status (OR 2.29; 95% CI 1.05-5.02) were independently associated with high sedentary time after the adjustment for multiple sociodemographic and medical confounders. Participants with a low sedentary time (< 420 min/day) showed a significantly higher mean European Quality of Life 5-Dimensions (EQ-5D) index than those with a high sedentary time after adjusting for multiple confounders (0.89 ± 0.03 vs. 0.82 ± 0.04; P = 0.001). Among the EQ-5D dimensions, problems in mobility (OR 3.37; 95% CI 1.42-7.98) and pain/discomfort (OR 2.64; 95% CI 1.24-5.63) dimensions showed positive associations with high sedentary time. Middle- or older-aged breast cancer survivors with insufficient aerobic exercise, diabetes, unemployed status, and impaired quality of life are more likely to have a high sedentary time. Reducing sedentary behavior in this population requires a tailored approach that considers diverse sociodemographic, medical, and quality-of-life factors.
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Affiliation(s)
- Jae Hyeon Park
- Department of Rehabilitation Medicine, Hanyang University College of Medicine, Seoul, 04763, Republic of Korea
| | - Jung Soo Lee
- Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea
| | - Hyung Seok Nam
- Department of Rehabilitation Medicine, Sheikh Khalifa Specialty Hospital, Ras al Khaimah, United Arab Emirates
| | - Yeo Hyung Kim
- Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea.
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Côté A, Miquelon P, Trudel-Fitzgerald C. Physical Activity, Sedentary Time, and Psychosocial Functioning among Adults with Cancer: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:225. [PMID: 38397714 PMCID: PMC10888167 DOI: 10.3390/ijerph21020225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/07/2024] [Accepted: 02/11/2024] [Indexed: 02/25/2024]
Abstract
The post-treatment period (after the completion of primary cancer treatment) is a phase during which adults with cancer are particularly vulnerable to the physical and psychological side effects of treatment. Adopting healthy lifestyle habits during this time is essential to mitigate these effects. This scoping review investigated the associations of physical activity (PA) and sedentary time (ST) with two post-treatment psychosocial indicators among adults with cancer: psychological functioning and quality of life (QoL). An exhaustive search was performed in January 2023 across five databases, namely APA PsycInfo, MedLine, SPORTDiscuss, SCOPUS, and CINAHL, adhering to PRISMA guidelines for scoping reviews. Twenty articles met the inclusion criteria; 16 used a cross-sectional design, while 4 used a longitudinal one. PA and ST were assessed mainly with accelerometers (n = 17), and psychosocial indicators with self-reported questionnaires (n = 20). Most studies linked higher PA levels to reduced anxiety (n = 3) and depression (n = 4) symptoms, and elevated ST to higher psychological symptoms (n = 3). Opposite associations were observed for QoL (n = 5). Altogether, PA appeared to be more strongly related to psychological functioning and QoL than ST. This scoping review highlights associations of PA and ST with psychological functioning and QoL among adults with cancer in the post-treatment period. However, future studies must prioritize longitudinal designs to establish directionality.
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Affiliation(s)
- Arianne Côté
- Department of Psychology, Université du Québec à Trois-Rivières, Trois-Rivières, QC G8Z 4M3, Canada; (P.M.); (C.T.-F.)
- Research Center of Institut Universitaire en Santé Mentale de Montréal, Montréal, QC H1N 3V2, Canada
| | - Paule Miquelon
- Department of Psychology, Université du Québec à Trois-Rivières, Trois-Rivières, QC G8Z 4M3, Canada; (P.M.); (C.T.-F.)
| | - Claudia Trudel-Fitzgerald
- Department of Psychology, Université du Québec à Trois-Rivières, Trois-Rivières, QC G8Z 4M3, Canada; (P.M.); (C.T.-F.)
- Research Center of Institut Universitaire en Santé Mentale de Montréal, Montréal, QC H1N 3V2, Canada
- Lee Kum Sheung Center for Health and Happiness, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
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Dorfman CS, Fisher HM, Thomas S, Kelleher SA, Winger JG, Mitchell NS, Miller SN, Somers TJ. Breast cancer survivors with pain: an examination of the relationships between body mass index, physical activity, and symptom burden. Support Care Cancer 2023; 31:604. [PMID: 37782420 PMCID: PMC10721211 DOI: 10.1007/s00520-023-08064-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 09/22/2023] [Indexed: 10/03/2023]
Abstract
PURPOSE Overweight and obesity are common for breast cancer survivors and associated with high symptom burden (i.e., pain, fatigue, depressive symptoms). Physical activity may protect breast cancer survivors with higher body mass indexes (BMI) from increased symptoms. However, the role of physical activity in buffering the relationship between higher BMI and greater symptoms is unclear. METHODS Baseline data from a randomized trial investigating Pain Coping Skills Training among breast cancer survivors (N = 327) with pain were used to examine the relationship between self-reported BMI (kg/m2) and physical activity level (Rapid Assessment of Physical Activity; suboptimal vs. optimal) with pain (Brief Pain Inventory; severity and interference), fatigue (PROMIS-Fatigue short form), and depressive symptoms (Center for Epidemiological Studies Depression Scale). Analyses were conducted in SPSS. Hayes PROCESS macro (Model 1) assessed whether physical activity moderated the relationship between BMI and symptoms. RESULTS Lower BMI (B = .06, p < .01) and optimal physical activity (B = - .69, p < .01) were independently associated with lower pain interference. Lower BMI was also associated with lower pain severity (B = .04, p < .001). Neither BMI nor physical activity was associated with fatigue or depressive symptoms. Physical activity did not moderate the relationship between BMI and symptoms. CONCLUSIONS Among breast cancer survivors experiencing pain, higher BMI and being less physically active were related to greater pain (i.e., severity and/or interference). Physical activity did not buffer the relationships between BMI and pain, fatigue, and depressive symptoms, suggesting that physical activity alone may not be sufficient to influence the strength of the relationships between BMI and symptoms.
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Affiliation(s)
- Caroline S Dorfman
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA.
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA.
| | - Hannah M Fisher
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Samantha Thomas
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
- Department of Biostatistics & Bioinformatics, Duke University Medical Center, Durham, NC, USA
| | - Sarah A Kelleher
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
| | - Joseph G Winger
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
| | - Nia S Mitchell
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Shannon N Miller
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Tamara J Somers
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
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Lucas AR, Kim Y, Lanoye A, Franco RL, Sutton AL, LaRose JG, Ross M, Sheppard VB. Longitudinal associations among physical activity and sitting with endocrine symptoms and quality of life in breast cancer survivors: A latent growth curve analysis. Cancer Med 2023; 12:20094-20105. [PMID: 37768040 PMCID: PMC10587924 DOI: 10.1002/cam4.6581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 08/24/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023] Open
Abstract
PURPOSE Adjuvant endocrine therapy (AET) often causes debilitating endocrine symptoms that compromise quality of life (QOL) in women diagnosed with hormone receptor positive breast cancer (BC). We examined whether greater levels of physical activity (PA) or prolonged sitting were associated with reduced side effects or worse side effects of AET, respectively. METHODS We used parallel process latent growth curve models to examine longitudinal patterns in PA and sitting behaviors, and their association with endocrine symptoms and QOL over 3 years of follow-up in 554 female BC survivors undergoing AET. RESULTS At baseline, women were a mean age of 59 years, mostly white (72%), with overweight/obesity (67%), and approximately 50% were within 1 year of diagnosis. Unconditional models showed significant increases in PA (p < 0.01) over time but no change in sitting. Endocrine symptoms, general and BC-specific QOL all significantly worsened over time (p < 0.01). Parallel process models showed no cross-sectional or longitudinal associations between PA and endocrine symptoms. Higher levels of baseline PA were associated with higher baseline QOL scores (p = 0.01) but changes in PA were not associated with changes in QOL. Conversely, more sitting at baseline was associated with worse endocrine symptoms, general and BC specific QOL (ps <0.01). At baseline, having better QOL scores was associated with increases in sitting (ps <0.01), while having worse endocrine symptoms was associated with a slower rate of increase in sitting (p < 0.01). Increases in sitting time were also associated with a slower rate of increase in endocrine symptoms (p = 0.017). Model fit statistics (x2, CFI, TLI, SRMR) were acceptable. CONCLUSION Both PA and sitting behaviors are important for the management of symptoms and in maintaining QOL in BC survivors. Women with already high symptom burden do not increase sitting time further but having better general and BC specific QOL to begin with means a greater decline over time.
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Affiliation(s)
- Alexander R. Lucas
- Department of Health Behavior and PolicyVirginia Commonwealth UniversityRichmondVirginiaUSA
- Department of Internal Medicine – CardiologyVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Youngdeok Kim
- Department of Kinesiology and Health SciencesVirginia Commonwealth University College of Humanities and SciencesRichmondVirginiaUSA
| | - Autumn Lanoye
- Department of Health Behavior and PolicyVirginia Commonwealth UniversityRichmondVirginiaUSA
- Massey Cancer CenterVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - R. Lee Franco
- Department of Kinesiology and Health SciencesVirginia Commonwealth University College of Humanities and SciencesRichmondVirginiaUSA
| | - Arnethea L. Sutton
- Department of Health Behavior and PolicyVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Jessica G. LaRose
- Department of Health Behavior and PolicyVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Masey Ross
- Department of Internal Medicine‐ OncologyVirginia Commonwealth University Health SystemRichmondVirginiaUSA
| | - Vanessa B. Sheppard
- Department of Health Behavior and PolicyVirginia Commonwealth UniversityRichmondVirginiaUSA
- Office of Health Equity and Disparities Research, Massey Cancer CenterVirginia Commonwealth UniversityRichmondVirginiaUSA
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Lee JS, Park M, Kim YH. Sedentary Behavior and Physical Activity of Community-Dwelling Korean Breast Cancer Survivors: A Nationwide Study. Healthcare (Basel) 2023; 11:1974. [PMID: 37444808 DOI: 10.3390/healthcare11131974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 06/25/2023] [Accepted: 07/05/2023] [Indexed: 07/15/2023] Open
Abstract
This study aimed to investigate the contemporary characteristics of sedentary behavior and physical activity levels in breast cancer survivors. The cross-sectional data of 10,073 community-dwelling Korean women aged ≥50 years in the Korea National Health and Nutrition Examination Survey were analyzed. The differences in sedentary behavior, walking activity, and moderate-to-vigorous physical activity (MVPA) levels between breast cancer survivors, other cancer survivors, and women with no history of cancer were compared by complex-sample general linear models. Breast cancer survivors spent significantly less mean time in sedentary behavior than other cancer survivors and women with no history of cancer; however, among them, 48.34% spent a long sedentary time of ≥420 min/day. Breast cancer survivors had a significantly higher level of walking activity and similar total MVPA levels compared to women with no history of cancer. When comparing domain-specific MVPA levels, breast cancer survivors showed significantly lower work-related MVPA levels than women with no history of cancer. In recent years, community-dwelling Korean breast cancer survivors were less sedentary, walked more, and had equivalent MVPA levels compared with women with no history of cancer. Considering the growing emphasis on healthy lifestyles, our results may reflect more contemporary behavior trends of breast cancer survivors.
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Affiliation(s)
- Jung Soo Lee
- Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Mina Park
- Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Yeo Hyung Kim
- Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
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Welch WA, Solk P, Auster-Gussman L, Whitaker M, Siddique J, Fanning J, Mishory A, Khan S, Santa-Maria C, Kulkarni S, Phillips SM. Longitudinal Sedentary Time and Symptoms in Breast Cancer Patients during Chemotherapy Using Ecological Momentary Assessment. Med Sci Sports Exerc 2023; 55:966-974. [PMID: 36574735 PMCID: PMC10106380 DOI: 10.1249/mss.0000000000003115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE To examine the relationship between daily fluctuations in symptoms and sedentary behavior (SB) during chemotherapy (CT) for breast cancer. METHODS Breast cancer patients ( N = 68, M age = 48.5 ± 10.4 yr) undergoing CT wore an activity monitor on their hip to assess daily SB and completed prompts assessing symptoms (affect, anxiety, depression, fatigue, pain, and physical and cognitive functioning) for 10 consecutive days (3 d pre-CT, day of, and 6 d post-CT) at the beginning, middle and end cycles of CT. Mixed models assessed the bidirectional between-person (BP) and within-person (WP) associations of current day symptoms with minutes of SB measured on 1) the same day and 2) the next day, controlling for relevant covariates. RESULTS Within person same-day results revealed a significant association between affect, anxiety, fatigue, physical functioning, pain, and cognitive functioning and same-day SB. Worse than average symptom ratings on a given day were associated with more SB that day. There was a significant WP relationship between previous-day anxiety, depression, and physical function and next-day SB (i.e., worse than average symptom ratings the previous day were associated with more SB the next day). Within person same-day results revealed a significant association between same-day SB and affect, anxiety, fatigue, pain, physical functioning, and cognitive functioning. The WP relationships were significant for previous-day SB and next-day affect and pain (i.e., higher than average SB associated with lower ratings). Relationships persisted when controlling for moderate-to-vigorous physical activity. There were no significant BP results. CONCLUSIONS Higher symptom ratings were associated with increased SB and higher SB was associated with worse symptoms. Future work should identify SB reduction intervention approaches tailoring to daily symptom burden during CT for breast cancer.
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Affiliation(s)
- Whitney A. Welch
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Payton Solk
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Madelyn Whitaker
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Juned Siddique
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Abby Mishory
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Seema Khan
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Swati Kulkarni
- Northwestern University Feinberg School of Medicine, Chicago, IL
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Salerno EA, Saint-Maurice PF, Wan F, Peterson LL, Park Y, Cao Y, Duncan RP, Troiano RP, Matthews CE. Prospective associations between accelerometry-derived physical activity and sedentary behaviors and mortality among cancer survivors. JNCI Cancer Spectr 2023; 7:pkad007. [PMID: 36786414 PMCID: PMC10038185 DOI: 10.1093/jncics/pkad007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/20/2022] [Accepted: 01/21/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Survival benefits of self-reported recreational physical activity (PA) during cancer survivorship are well-documented in common cancer types, yet there are limited data on the associations between accelerometer-derived PA of all domains, sedentary behavior, and mortality in large, diverse cohorts of cancer survivors. METHODS Participants included adults who reported a cancer diagnosis in the National Health and Nutrition Examination Survey and wore an accelerometer for up to 7 days in 2003-2006. Participants were followed for subsequent mortality through 2015. We examined the association of light PA, moderate to vigorous PA, total PA, and sedentary behavior, with all-cause mortality. Cox proportional hazards models estimated hazard ratios (HRs) and 95% confidence intervals (CIs), adjusting for demographics and health indicators. RESULTS A total of 480 participants (mean age of 68.8 years [SD = 12.4] at the time of National Health and Nutrition Examination Survey assessment) reported a history of cancer. A total of 215 deaths occurred over the follow-up period. For every 1-h/d increase in light PA and moderate to vigorous PA (MVPA), cancer survivors had 49% (HR = 0.51, 95% CI = 0.34 to 0.76) and 37% (HR = 0.63 , 95% CI = 0.40 to 0.99) lower hazards of all-cause mortality, respectively. Total PA demonstrated similar associations with statistically significantly lower hazards of death for each additional hour per day (HR = 0.68, 95% CI = 0.54 to 0.85), as did every metabolic equivalents of task-hour per day increase in total PA estimations of energy expenditure (HR = 0.88, 95% CI = 0.82 to 0.95). Conversely, more sedentary time (1 h/d) was not associated with statistically significantly higher hazards (HR = 1.08, 95% CI = 0.94 to 1.23). CONCLUSIONS These findings reinforce the current recommendations for cancer survivors to be physically active and underscore the continued need for widespread PA promotion for long-term survival in older cancer survivors.
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Affiliation(s)
- Elizabeth A Salerno
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine in St. Louis, MO, USA
- Alvin J. Siteman Cancer Center, Washington University School of Medicine in St. Louis, MO, USA
| | - Pedro F Saint-Maurice
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Fei Wan
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine in St. Louis, MO, USA
- Alvin J. Siteman Cancer Center, Washington University School of Medicine in St. Louis, MO, USA
| | - Lindsay L Peterson
- Alvin J. Siteman Cancer Center, Washington University School of Medicine in St. Louis, MO, USA
- Division of Medical Oncology, Department of Medicine, Washington University School of Medicine in St. Louis, MO, USA
| | - Yikyung Park
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine in St. Louis, MO, USA
- Alvin J. Siteman Cancer Center, Washington University School of Medicine in St. Louis, MO, USA
| | - Yin Cao
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine in St. Louis, MO, USA
- Alvin J. Siteman Cancer Center, Washington University School of Medicine in St. Louis, MO, USA
- Division of Gastroenterology, Department of Medicine, Washington University School of Medicine in St. Louis, MO, USA
| | - Ryan P Duncan
- Program in Physical Therapy, Washington University School of Medicine in St. Louis, MO, USA
| | - Richard P Troiano
- Risk Factor Assessment Branch, Epidemiology and Genomics Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Charles E Matthews
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
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Trinh L, Sabiston CM, Alibhai SMH, Jones JM, Arbour-Nicitopoulos KP, Mina DS, Campbell K, Faulkner GE. A distance-based, randomized controlled trial for reducing sedentary behavior among prostate cancer survivors: a study protocol. BMC Public Health 2022; 22:855. [PMID: 35484523 PMCID: PMC9047476 DOI: 10.1186/s12889-022-13218-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 04/11/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Prostate cancer survivors (PCS) experience long-term side effects beyond treatment such as fatigue, depression and anxiety. Quality and engaging supportive care programs are needed to reduce these chronic and debilitating effects. Independent of physical activity (PA), high volumes of sedentary behavior (SB) are associated with chronic disease-related risk factors and poorer cancer-specific quality of life (QoL). Simultaneously increasing PA and decreasing SB may be an effective health promotion strategy. Given that PCS may face several barriers to engaging in supervised programs, there is a need to develop and assess the efficacy of interventions that employ distance-based approaches for behavior change. The primary aim of this study is to determine the effects of a 12-week intervention (Fitbit + behavioral counselling) vs. Fitbit-only control group in reducing SB among PCS. Secondary outcomes include light-intensity PA, QoL, motivational outcomes, and patient satisfaction. METHODS This two-armed, randomized controlled trial will recruit inactive PCS (stage I-IV) across Canada who self-report engaging in >8 hours/day of SB. Participants will be randomized to the intervention (n=60; Fitbit and behavioral support) or active control group (n=60; Fitbit-only). The intervention consists of the use of a Fitbit and a series of six behavioral support sessions (two group, four individual) to aid PCS in gradually replacing SB with light-intensity PA by increasing their daily step counts to 3,000 steps above their baseline values. The Fitbit-only control condition will receive a Fitbit and public health PA resources. The primary outcome is change in SB measured objectively using activPAL inclinometers. All secondary outcomes will be measured via self-report, except for PA which will be measuring using Fitbits. Data will be collected at baseline, post-intervention, and at 6-month post-intervention. DISCUSSION Reducing SB and increasing light-intensity PA plays an important, yet often undervalued role in the health and well-being of PCS. This study will create a unique distance-based platform that can be used by clinical and community-based organizations as a low-cost, supportive care tool to improve health outcomes for PCS. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT05214937 . Registered January 28, 2022 Protocol version: v.1.
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Affiliation(s)
- Linda Trinh
- Faculty of Kinesiology and Physical Education, University of Toronto, 55 Harbord Street, Toronto, Ontario, M5S 2W6, Canada.
| | - Catherine M Sabiston
- Faculty of Kinesiology and Physical Education, University of Toronto, 55 Harbord Street, Toronto, Ontario, M5S 2W6, Canada
| | - Shabbir M H Alibhai
- Faculty of Medicine, University of Toronto, 1 King's College Circle, Medical Sciences Building, Toronto, ON, M5S 1A8, Canada
- Toronto General Research Institute, Toronto General Hospital, 200 Elizabeth St, Toronto, ON, M5G 2C4, Canada
| | - Jennifer M Jones
- Department of Supportive Care, Princess Margaret Cancer Centre, 610 University Ave, Toronto, ON, M5G 2C1, Canada
| | - Kelly P Arbour-Nicitopoulos
- Faculty of Kinesiology and Physical Education, University of Toronto, 55 Harbord Street, Toronto, Ontario, M5S 2W6, Canada
| | - Daniel Santa Mina
- Faculty of Kinesiology and Physical Education, University of Toronto, 55 Harbord Street, Toronto, Ontario, M5S 2W6, Canada
| | - Kristin Campbell
- Department of Physical Therapy, University of British Columbia, 2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Guy E Faulkner
- School of Kinesiology, University of British Columbia, 210-6081 University Boulevard, Vancouver, BC, V6T 1Z1, Canada
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11
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Doré I, Plante A, Peck SS, Bedrossian N, Sabiston CM. Physical activity and sedentary time: associations with fatigue, pain, and depressive symptoms over 4 years post-treatment among breast cancer survivors. Support Care Cancer 2022. [PMID: 34387728 DOI: 10.1007/s00520-021-06469-2/tables/3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Despite the recommendations for cancer survivors to engage in physical activity (PA), little is known about the effects of both PA and sedentary time (ST) on key health symptoms. This study prospectively examined the lifestyle behaviors of moderate-to-vigorous PA (MVPA) and ST as predictors of depressive symptoms, pain, and fatigue in breast cancer survivors using longitudinal data from early post-treatment to 4-year survivorship. METHODS Breast cancer survivors (n = 199, mean(SD) age = 55.0(11.0) years) self-reported depressive symptoms, pain, and fatigue, and wore an accelerometer to measure MVPA and ST every 3 months during the first year (times 1 to 5) and 2 and 4 years (times 6 and 8) post-cancer treatment. Linear mixed models were adjusted for personal (e.g., age, BMI, education) and cancer (e.g., stage, time since treatment) variables. RESULTS MVPA and ST were independent predictors of depressive symptoms, but not fatigue, and only ST was associated with pain over 4 years post-treatment. Higher levels of MVPA were associated with lower scores of depressive symptoms ([Formula: see text] (95%CI): - 0.062 (- 0.092, - 0.031) p < .001), whereas higher levels of ST were associated with higher scores of depressive symptoms ([Formula: see text] (95%CI): 0.023 (0.017, 0.028) p < .001). Higher levels of ST were associated with increased pain level over time ([Formula: see text] (95%CI): 0.017 (0.007, 0.027) p = .001). CONCLUSIONS Rehabilitation interventions should aim to both increase MVPA and reduce ST to promote health and well-being among breast cancer survivors, in particular during the early post-treatment period.
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Affiliation(s)
- Isabelle Doré
- Scool of Komnesiology and Physical Activity Sciences, Faculty of Medicine, Université de Montréal, 2100, boulevard Édouard-Montpetit, Montreal, Québec, H3T 1J4, Canada.
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, (CRCHUM), Montreal, Canada.
- School of Public Health, Université de Montréal, Montreal, Canada.
| | - Audrey Plante
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, (CRCHUM), Montreal, Canada
- School of Public Health, Université de Montréal, Montreal, Canada
| | - Serena S Peck
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada
| | - Nathalie Bedrossian
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, (CRCHUM), Montreal, Canada
- School of Public Health, Université de Montréal, Montreal, Canada
| | - Catherine M Sabiston
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada
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12
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Lambert M, Sabiston CM, Wrosch C, Brunet J. Behavioural, physical, and psychological predictors of cortisol and C-reactive protein in breast cancer survivors: A longitudinal study. Brain Behav Immun Health 2021; 10:100180. [PMID: 34589720 PMCID: PMC8474539 DOI: 10.1016/j.bbih.2020.100180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/26/2020] [Accepted: 11/28/2020] [Indexed: 12/05/2022] Open
Abstract
Background Breast cancer survivors (BCS) can exhibit a dysregulation of cortisol and elevated C-reactive protein (CRP) levels post-treatment, which increase the risk of diverse health outcomes. Certain behavioural, physical, and psychological variables may help to predict cortisol and CRP levels post-treatment. The aims of this study were to: (1) describe naturally occurring changes in absolute diurnal cortisol and CRP levels over a period of 1.5 years post-treatment among BCS, (2) assess if absolute diurnal cortisol and CRP levels change in tandem, and (3) assess behavioural, physical, and psychological variables as predictors of absolute diurnal cortisol levels and CRP levels. Methods Capillary blood and saliva samples were collected from 201 BCS, on average, 3.5 months post-treatment (T1) and again 3, 6, 9, and 12 months later (T2−T5). At each time point, five saliva samples were collected on two nonconsecutive days: at awakening, 30 min after awakening, 2:00 p.m., 4:00 p.m., and at bedtime. At each time point, participants also completed self-report questionnaires and wore an accelerometer for seven consecutive days. Data were analyzed using multilevel modeling. Results Absolute diurnal cortisol levels did not change significantly over time. CRP levels decreased across time points (Blinear = −0.31, p = .01), though the rate of decrease slowed over time (Bquadratic = 0.05, p = .03). Generally, greater sedentary time predicted higher overall absolute diurnal cortisol levels (B < 0.01, p = .01); whereas higher physical activity (B = −0.004, p < .01), lower body mass index (B = 0.10, p < .01), and lower health- and cancer-related stress (B = 0.24, p = .04) predicted lower overall CRP levels. Also, lower absolute diurnal cortisol levels were evident when participants engaged in more sedentary time, as compared to their own average sedentary time (B = −0.01, p < .01). Conclusions Results offer insight into the nature of change in diurnal cortisol and CRP levels among BCS from treatment completion onwards and offer clinical implications. Helping BCS manage their weight, reduce stress, increase physical activity participation, and decrease sedentary time as soon as possible after treatment may help to reduce physiological dysregulations, thereby lowering the risk of adverse health outcomes in this population. Further research investigating specific intervention parameters such as type, context, frequency, and intensity are warranted for the development of the most optimal interventions.
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Affiliation(s)
- M Lambert
- School of Psychology, University of Ottawa, ON, Canada
| | - C M Sabiston
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada
| | - C Wrosch
- Department of Psychology, Concordia University, Montreal, Canada
| | - J Brunet
- School of Human Kinetics, University of Ottawa, Montpetit Hall, Room 339, Ottawa, ON K1N 6N5, Canada
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13
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Doré I, Plante A, Peck SS, Bedrossian N, Sabiston CM. Physical activity and sedentary time: associations with fatigue, pain, and depressive symptoms over 4 years post-treatment among breast cancer survivors. Support Care Cancer 2021; 30:785-792. [PMID: 34387728 DOI: 10.1007/s00520-021-06469-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 07/25/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Despite the recommendations for cancer survivors to engage in physical activity (PA), little is known about the effects of both PA and sedentary time (ST) on key health symptoms. This study prospectively examined the lifestyle behaviors of moderate-to-vigorous PA (MVPA) and ST as predictors of depressive symptoms, pain, and fatigue in breast cancer survivors using longitudinal data from early post-treatment to 4-year survivorship. METHODS Breast cancer survivors (n = 199, mean(SD) age = 55.0(11.0) years) self-reported depressive symptoms, pain, and fatigue, and wore an accelerometer to measure MVPA and ST every 3 months during the first year (times 1 to 5) and 2 and 4 years (times 6 and 8) post-cancer treatment. Linear mixed models were adjusted for personal (e.g., age, BMI, education) and cancer (e.g., stage, time since treatment) variables. RESULTS MVPA and ST were independent predictors of depressive symptoms, but not fatigue, and only ST was associated with pain over 4 years post-treatment. Higher levels of MVPA were associated with lower scores of depressive symptoms ([Formula: see text] (95%CI): - 0.062 (- 0.092, - 0.031) p < .001), whereas higher levels of ST were associated with higher scores of depressive symptoms ([Formula: see text] (95%CI): 0.023 (0.017, 0.028) p < .001). Higher levels of ST were associated with increased pain level over time ([Formula: see text] (95%CI): 0.017 (0.007, 0.027) p = .001). CONCLUSIONS Rehabilitation interventions should aim to both increase MVPA and reduce ST to promote health and well-being among breast cancer survivors, in particular during the early post-treatment period.
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Affiliation(s)
- Isabelle Doré
- Scool of Komnesiology and Physical Activity Sciences, Faculty of Medicine, Université de Montréal, 2100, boulevard Édouard-Montpetit, Montreal, Québec, H3T 1J4, Canada. .,Centre de Recherche du Centre Hospitalier de l'Université de Montréal, (CRCHUM), Montreal, Canada. .,School of Public Health, Université de Montréal, Montreal, Canada.
| | - Audrey Plante
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, (CRCHUM), Montreal, Canada.,School of Public Health, Université de Montréal, Montreal, Canada
| | - Serena S Peck
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada
| | - Nathalie Bedrossian
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, (CRCHUM), Montreal, Canada.,School of Public Health, Université de Montréal, Montreal, Canada
| | - Catherine M Sabiston
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada
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14
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van Cappellen-van Maldegem SJM, Mols F, Horevoorts N, de Kruif A, Buffart LM, Schoormans D, Trompetter H, Beijer S, Ezendam NPM, de Boer M, Winkels R, Kampman E, Schuit J, van de Poll-Franse L, Seidell JC, Hoedjes M. Towards OPtimal TIming and Method for promoting sUstained adherence to lifestyle and body weight recommendations in postMenopausal breast cancer survivors (the OPTIMUM-study): protocol for a longitudinal mixed-method study. BMC WOMENS HEALTH 2021; 21:268. [PMID: 34229690 PMCID: PMC8258491 DOI: 10.1186/s12905-021-01406-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 06/30/2021] [Indexed: 11/10/2022]
Abstract
Background The majority of postmenopausal breast cancer (PMBC) survivors do not adhere to lifestyle recommendations and have excess body weight. In this group, this is associated with poorer health-related quality of life and an increased risk of type II diabetes mellitus, cardiovascular disease, second primary cancers, cancer recurrences, and mortality. Gaining and maintaining a healthy lifestyle and body composition is therefore important. It is unknown when and how sustained adherence to these recommendations can be promoted optimally in PMBC survivors. Therefore, the OPTIMUM study aims to identify the optimal timing and method for promoting sustained adherence to lifestyle and body weight recommendations in PMBC survivors.
Methods The OPTIMUM-study has a mixed-methods design. To assess optimal timing, a longitudinal observational study will be conducted among approximately 1000 PMBC survivors. The primary outcomes are adherence to lifestyle and body weight recommendations, readiness for change, and need for support. Questionnaires will be administered at 4–6 months after cancer diagnosis (wave 1: during treatment and retrospectively before diagnosis), 1 year after diagnosis (wave 2: after completion of initial treatment), and 1.5 years after diagnosis (wave 3: during follow-up). Wave 2 and 3 include blood sampling, and either wearing an accelerometer for 7 days or completing a 3-day online food diary (randomly assigned at hospital level). To assess the optimal method, behavioural determinants of the primary outcomes will be matched with Behavior Change Techniques using the Behaviour Change Technique Taxonomy. Qualitative research methods will be used to explore perceptions, needs and preferences of PMBC survivors (semi-structured interviews, focus groups) and health care providers (Delphi study). Topics include perceptions on optimal timing to promote adherence; facilitators and motivators of, and barriers towards (sustained) adherence to recommendations; and acceptability of the selected methods. Discussion The OPTIMUM study aims to gain scientific knowledge on when and how to promote sustained adherence to lifestyle and body weight recommendations among PBMC survivors. This knowledge can be incorporated into guidelines for tailored promotion in clinical practice to improve health outcomes.
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Affiliation(s)
- Sandra J M van Cappellen-van Maldegem
- CoRPS - Center of Research On Psychological and Somatic Disorders, Department of Medical and Clinical Psychology, Tilburg University, PO Box 90153, 5000 LE, Tilburg, the Netherlands
| | - Floortje Mols
- CoRPS - Center of Research On Psychological and Somatic Disorders, Department of Medical and Clinical Psychology, Tilburg University, PO Box 90153, 5000 LE, Tilburg, the Netherlands.,Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| | - Nicole Horevoorts
- CoRPS - Center of Research On Psychological and Somatic Disorders, Department of Medical and Clinical Psychology, Tilburg University, PO Box 90153, 5000 LE, Tilburg, the Netherlands.,Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| | - Anja de Kruif
- Department of Epidemiology and Biostatistics, Amsterdam Public Health (APH), VUmc, Amsterdam, the Netherlands.,Department of Nutrition, Dietetics and Lifestyle, School of Allied Health, HAN University of Applied Sciences, Nijmegen, the Netherlands
| | - Laurien M Buffart
- Radboudumc, Department of Physiology, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Dounya Schoormans
- CoRPS - Center of Research On Psychological and Somatic Disorders, Department of Medical and Clinical Psychology, Tilburg University, PO Box 90153, 5000 LE, Tilburg, the Netherlands
| | - Hester Trompetter
- CoRPS - Center of Research On Psychological and Somatic Disorders, Department of Medical and Clinical Psychology, Tilburg University, PO Box 90153, 5000 LE, Tilburg, the Netherlands
| | - Sandra Beijer
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| | - Nicole P M Ezendam
- CoRPS - Center of Research On Psychological and Somatic Disorders, Department of Medical and Clinical Psychology, Tilburg University, PO Box 90153, 5000 LE, Tilburg, the Netherlands.,Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| | - Michiel de Boer
- Department of Health Sciences and the Amsterdam Public Health Research Institute, VU University Amsterdam, Amsterdam, the Netherlands.,Department of General Practice and Elderly Care Medicine, UMCG, Groningen, the Netherlands
| | - Renate Winkels
- Division of Human Nutrition and Health, Wageningen University, Wageningen, the Netherlands
| | - Ellen Kampman
- Division of Human Nutrition and Health, Wageningen University, Wageningen, the Netherlands
| | - Jantine Schuit
- CoRPS - Center of Research On Psychological and Somatic Disorders, Department of Medical and Clinical Psychology, Tilburg University, PO Box 90153, 5000 LE, Tilburg, the Netherlands
| | - Lonneke van de Poll-Franse
- CoRPS - Center of Research On Psychological and Somatic Disorders, Department of Medical and Clinical Psychology, Tilburg University, PO Box 90153, 5000 LE, Tilburg, the Netherlands.,Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands.,Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Jacob C Seidell
- Department of Health Sciences and the Amsterdam Public Health Research Institute, VU University Amsterdam, Amsterdam, the Netherlands
| | - Meeke Hoedjes
- CoRPS - Center of Research On Psychological and Somatic Disorders, Department of Medical and Clinical Psychology, Tilburg University, PO Box 90153, 5000 LE, Tilburg, the Netherlands.
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Natalucci V, Villarini M, Emili R, Acito M, Vallorani L, Barbieri E, Villarini A. Special Attention to Physical Activity in Breast Cancer Patients during the First Wave of COVID-19 Pandemic in Italy: The DianaWeb Cohort. J Pers Med 2021; 11:jpm11050381. [PMID: 34066580 PMCID: PMC8148515 DOI: 10.3390/jpm11050381] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 04/30/2021] [Accepted: 05/04/2021] [Indexed: 12/17/2022] Open
Abstract
Recent evidence highlights that physical activity (PA) is associated with decreased recurrence risk, improved survival and quality of life for breast cancer (BC) patients. Our study aimed to explore patterns of increased/decreased PA, and sedentary behaviors among BC women of the DianaWeb cohort during the first wave of COVID-19 pandemic, and examined the association with residential locations, work changes, different modality used to increase PA, and quality of life. The study analyzed the questionnaires completed by the 781 BC women (age 54.68 ± 8.75 years on both December 2019 and June 2020. Results showed a decrease of 22%, 57%, and 26% for walking activity, vigorous activity, and total PA, respectively. Sitting/lying time increased up to 54.2% of the subjects recruited. High quality of life was associated with lower odds of being sedentary (p = 0.003). Our findings suggest that innovative health management fostering compliance with current guidelines for PA and active behavior should be implemented, especially in unpredictable emergency conditions.
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Affiliation(s)
- Valentina Natalucci
- Department of Biomolecular Sciences, University of Urbino Carlo Bo, 61029 Urbino, Italy; (V.N.); (L.V.)
| | - Milena Villarini
- Department of Pharmaceutical Sciences, University of Perugia, 06122 Perugia, Italy;
- Correspondence: (M.V.); (E.B.); Tel.: +39-075-5857419 (M.V.); +39-0722-303417 (E.B.)
| | - Rita Emili
- U.O.C. Oncologia Medica, ASUR Area Vasta 1, Ospedale Santa Maria della Misericordia di Urbino, 61029 Urbino, Italy;
| | - Mattia Acito
- Department of Pharmaceutical Sciences, University of Perugia, 06122 Perugia, Italy;
| | - Luciana Vallorani
- Department of Biomolecular Sciences, University of Urbino Carlo Bo, 61029 Urbino, Italy; (V.N.); (L.V.)
| | - Elena Barbieri
- Department of Biomolecular Sciences, University of Urbino Carlo Bo, 61029 Urbino, Italy; (V.N.); (L.V.)
- Correspondence: (M.V.); (E.B.); Tel.: +39-075-5857419 (M.V.); +39-0722-303417 (E.B.)
| | - Anna Villarini
- Department of Research, Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milano, Italy;
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16
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Álvarez-Bustos A, de Pedro CG, Romero-Elías M, Ramos J, Osorio P, Cantos B, Maximiano C, Méndez M, Fiuza-Luces C, Méndez-Otero M, Martín S, Cebolla H, Ruiz-Casado A. Prevalence and correlates of cancer-related fatigue in breast cancer survivors. Support Care Cancer 2021; 29:6523-6534. [PMID: 33909147 DOI: 10.1007/s00520-021-06218-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 04/09/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE To identify potential correlates of cancer-related fatigue (CRF) after curative breast cancer (BC) treatment. The hypothesis was that fatigue would be more severe among women treated with cardiotoxic drugs, with poor physical condition and those who exercised less. METHODS Observational cross-sectional design. Fatigue was evaluated through PERFORM Questionnaire (multi-item, multi-dimensional). Patient-reported assessments and objective information regarding clinical data, physical activity (PA) and physical condition were analysed as potential correlates of CRF. RESULTS One hundred eighty women who remained free of disease were recruited. The prevalence of fatigue interfering with quality of life was 43%. Weight, resting and recovery heart rate were positively associated with fatigue. Age and time from diagnosis were negatively associated. Previous therapies, objectively assessed weekly PA, cardiorespiratory condition, muscular strength and adherence to Mediterranean diet were not associated with CRF. CONCLUSIONS CRF is a prevalent problem after BC treatment. Objectively assessed PA, cardiorespiratory fitness and muscular strength did not predict CRF. The association of heart rate and fatigue deserves a further insight. Future research should include longitudinal studies and determination of biomarkers. IMPLICATIONS FOR CANCER SURVIVORS BC survivors, especially younger and overweight women, should be informed about fatigue as a potential persistent symptom through all stages of the cancer trajectory and into survivorship. They also should be routinely screened for CRF.
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Affiliation(s)
- Alejandro Álvarez-Bustos
- Department of Medical Oncology, Hospital Universitario Puerta de Hierro-Majadahonda, 28220, Madrid, Spain
| | - Cristina G de Pedro
- Department of Medical Oncology, Hospital Universitario Puerta de Hierro-Majadahonda, 28220, Madrid, Spain
| | - María Romero-Elías
- Department of Sports Sciences, Universidad Miguel Hernández de Elche, Av. De la Universidad s/n, 03202 Elche, Alicante, Spain
| | - Javier Ramos
- Department of Medical Oncology, Hospital Universitario Puerta de Hierro-Majadahonda, 28220, Madrid, Spain
| | - Pablo Osorio
- Department of Medical Oncology, Hospital Universitario Puerta de Hierro-Majadahonda, 28220, Madrid, Spain
| | - Blanca Cantos
- Department of Medical Oncology, Hospital Universitario Puerta de Hierro-Majadahonda, 28220, Madrid, Spain
| | - Constanza Maximiano
- Department of Medical Oncology, Hospital Universitario Puerta de Hierro-Majadahonda, 28220, Madrid, Spain
| | - Miriam Méndez
- Department of Medical Oncology, Hospital Universitario Puerta de Hierro-Majadahonda, 28220, Madrid, Spain
| | - Carmen Fiuza-Luces
- Instituto de Investigación Doce de Octubre, Avda Cordoba sn, 28041, Madrid, Spain
| | - Marta Méndez-Otero
- Department of Medical Oncology, Hospital Universitario Puerta de Hierro-Majadahonda, 28220, Madrid, Spain
| | - Silvia Martín
- Department of Medical Oncology, Hospital Universitario Puerta de Hierro-Majadahonda, 28220, Madrid, Spain
| | - Héctor Cebolla
- Universidad Nacional Española a Distancia, Madrid, Spain
| | - Ana Ruiz-Casado
- Department of Medical Oncology, Hospital Universitario Puerta de Hierro-Majadahonda, 28220, Madrid, Spain.
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Tabaczynski A, Whitehorn A, McAuley E, Trinh L. A comparison of total and domain-specific sedentary time in breast cancer survivors and age-matched healthy controls. J Behav Med 2020; 44:277-283. [PMID: 33185782 DOI: 10.1007/s10865-020-00195-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 11/03/2020] [Indexed: 12/30/2022]
Abstract
Breast cancer survivors (BCS) engage in more sedentary behavior (SED) than those without cancer. However, the context in which SED is accrued is unknown. The purpose of this study is to examine differences in total and domain-specific SED of BCS and healthy controls. 20 BCS and 20 age-matched, healthy controls wore ActiGraph GT3X + accelerometers to measure SED and activity. Participants self-reported SED for transportation, occupational, screen time and leisure purposes. Multiple linear regressions were used to estimate differences in SED between BCS and controls. BCS spent significantly more time watching TV (152.4 vs. 60.3; p < 0.01) and less time in total SED (490.8 vs. 587.4; p = 0.046) and other leisure activities (57.6 vs. 106.9; p < 0.01) than healthy controls. BCS engage in more TV watching and less time in other leisure activities than controls, thus interventions should focus on reducing TV time. Understanding facilitators of TV viewing is needed to determine specific intervention targets.
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Affiliation(s)
- Allyson Tabaczynski
- Faculty of Kinesiology and Physical Education, University of Toronto, 55 Harbord Street, Toronto, ON, M5S 2W6, Canada
| | - Alexis Whitehorn
- Faculty of Kinesiology and Physical Education, University of Toronto, 55 Harbord Street, Toronto, ON, M5S 2W6, Canada
| | - Edward McAuley
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Linda Trinh
- Faculty of Kinesiology and Physical Education, University of Toronto, 55 Harbord Street, Toronto, ON, M5S 2W6, Canada.
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18
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Ruiz-Casado A, Álvarez-Bustos A, de Pedro CG, Méndez-Otero M, Romero-Elías M. Cancer-related Fatigue in Breast Cancer Survivors: A Review. Clin Breast Cancer 2020; 21:10-25. [PMID: 32819836 DOI: 10.1016/j.clbc.2020.07.011] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/12/2020] [Accepted: 07/21/2020] [Indexed: 02/06/2023]
Abstract
Fatigue has been the most distressing and frequent symptom in breast cancer (BC) survivors after treatment. Although fatigue can occur in other cancer survivors, women with a history of BC might share some distinctive features. The present study aimed to recapitulate the knowledge about risk factors and correlates of cancer-related fatigue (CRF) in BC survivors after oncologic therapy. An electronic data search was conducted in PubMed using the terms "fatigue," "breast," "cancer," and "survivors." Records were included if they were original articles, available in English, had used a quantitative scale, had > 100 participants, and had excluded women with BC relapse. BC survivors were required to have finished their treatments ≥ 2 months before, except for hormonal therapy. The physiopathology and other interventions were considered beyond the scope of our review. The correlates were subsequently classified into 7 main categories: (1) sociodemographic data, (2) physical variables, (3) tumor- and treatment-related variables, (4) comorbidities, (5) other symptoms, (6) psychological issues, and (7) lifestyle factors. Fatigue was consistently greater in younger, obese, and diabetic women. Women reporting fatigue often communicated symptoms such as pain, depression, insomnia, and cognitive dysfunction. Coping strategies such as catastrophizing could play an important role in the persistence of fatigue. However, tumor characteristics, previous treatments received, and physical activity were not consistently reported. CRF was a strong predictor of the quality of life of BC survivors after treatment. In conclusion, we found CRF was a frequent and serious symptom that severely affects the quality of life of BC survivors after treatment. Health practitioners require more awareness and information about CRF.
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Affiliation(s)
- Ana Ruiz-Casado
- Department of Medical Oncology, University Hospital Puerta de Hierro-Majadahonda, Madrid, Spain.
| | | | - Cristina G de Pedro
- Department of Medical Oncology, University Hospital Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Marta Méndez-Otero
- Department of Medical Oncology, University Hospital Puerta de Hierro-Majadahonda, Madrid, Spain
| | - María Romero-Elías
- Department of Sport Sciences, Sport Research Centre, Miguel Hernandez University of Elche, Alicante, Spain
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Depression and Objectively Measured Physical Activity: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103738. [PMID: 32466242 PMCID: PMC7277615 DOI: 10.3390/ijerph17103738] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 05/13/2020] [Accepted: 05/15/2020] [Indexed: 12/20/2022]
Abstract
Depression is a major contributor to the overall global burden of disease, with high prevalence and relapse rate. Several factors have been considered in order to reduce the depression burden. Among them, physical activity (PA) showed a potential protective role. However, evidence is contrasting probably because of the differences in PA measurement. The aim of this systematic review with meta-analysis is to assess the association between objectively measured PA and incident and prevalent depression. The systematic review was conducted according to methods recommended by the Cochrane Collaboration and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Relevant papers published through 31 August 2019 were identified searching through the electronic databases PubMed/MEDLINE, Excerpta Medica dataBASE (Embase), PsycINFO, Scopus, Web of Science (WoS), and the Cochrane Library. All analyses were conducted using ProMeta3. Finally, 42 studies met inclusion criteria. The overall Effect size (ES) of depression for the highest vs. the lowest level of PA was −1.16 [(95% CI = −1.41; −0.91), p-value < 0.001] based on 37,408 participants. The results of the meta-analysis showed a potential protective effect of PA on prevalent and incident depression.
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20
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Ehlers DK, Fanning J, Sunderlage A, Severson J, Kramer AF, McAuley E. Influence of sitting behaviors on sleep disturbance and memory impairment in breast cancer survivors. Cancer Med 2020; 9:3417-3424. [PMID: 32202706 PMCID: PMC7221435 DOI: 10.1002/cam4.3008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 02/25/2020] [Indexed: 01/09/2023] Open
Abstract
Background The purpose was to prospectively examine the effects of sedentary behaviors on subjective memory impairment in breast cancer survivors (BCS) and the extent to which sleep disturbances mediated this pathway. Methods BCS (N = 380; Mage = 57.38 ± 9.25 years) completed questionnaires assessing demographics, health history, sitting behaviors, sleep disturbance, subjective memory impairment, and moderate‐to‐vigorous physical activity (MVPA) at baseline and 6‐month follow‐up. A subsample (N = 300) wore an accelerometer to objectively estimate sedentary time and MVPA. Structural equation modeling was used to test direct and indirect effects of self‐reported and objectively estimated sedentary behaviors on memory impairment (through sleep disturbance) across time. Models were adjusted for demographic, clinical, and MVPA covariates. Results At baseline, more total daily sitting (γ = 0.23), occupational sitting (γ = 0.11), television viewing (γ = 0.15), and computer use (γ = 0.22) were associated with greater sleep disturbance, which was associated with greater memory impairment (γ = −0.22). Indirect effects of self‐reported sitting on memory were significant. At follow‐up, increased total daily sitting (γ = 0.08) and computer use (γ = 0.14) predicted increased sleep disturbance, which predicted increased memory impairment (γ = −0.09). The indirect path from increased computer use to memory impairment was significant (β = −0.01). In the accelerometer subsample, greater daily sedentary time at baseline was associated with less sleep disturbance (γ = −0.14) and memory impairment (indirect effect: β = 0.03). Conclusions Findings provide early evidence that sedentary contexts may differentially influence sleep disturbance and memory impairment in BCS. Computer use and television viewing may pose the strongest risks to cognitive health. Disparate findings between objective and subjective sedentary measures warrant further research.
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Affiliation(s)
| | | | | | | | - Arthur F Kramer
- University of Illinois at Urbana-Champaign, Urbana, IL, USA.,Northeastern University, Boston, MA, USA
| | - Edward McAuley
- University of Illinois at Urbana-Champaign, Urbana, IL, USA
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21
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Low CA, Danko M, Durica KC, Kunta AR, Mulukutla R, Ren Y, Bartlett DL, Bovbjerg DH, Dey AK, Jakicic JM. A Real-Time Mobile Intervention to Reduce Sedentary Behavior Before and After Cancer Surgery: Usability and Feasibility Study. JMIR Perioper Med 2020; 3:e17292. [PMID: 33393915 PMCID: PMC7709849 DOI: 10.2196/17292] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 01/13/2020] [Accepted: 01/27/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Sedentary behavior (SB) is common after cancer surgery and may negatively affect recovery and quality of life, but postoperative symptoms such as pain can be a significant barrier to patients achieving recommended physical activity levels. We conducted a single-arm pilot trial evaluating the usability and acceptability of a real-time mobile intervention that detects prolonged SB in the perioperative period and delivers prompts to walk that are tailored to daily self-reported symptom burden. OBJECTIVE The aim of this study is to develop and test a mobile technology-supported intervention to reduce SB before and after cancer surgery, and to evaluate the usability and feasibility of the intervention. METHODS A total of 15 patients scheduled for abdominal cancer surgery consented to the study, which involved using a Fitbit smartwatch with a companion smartphone app across the perioperative period (from a minimum of 2 weeks before surgery to 30 days postdischarge). Participants received prompts to walk after any SB that exceeded a prespecified threshold, which varied from day to day based on patient-reported symptom severity. Participants also completed weekly semistructured interviews to collect information on usability, acceptability, and experience using the app and smartphone; in addition, smartwatch logs were examined to assess participant study compliance. RESULTS Of eligible patients approached, 79% (15/19) agreed to participate. Attrition was low (1/15, 7%) and due to poor health and prolonged hospitalization. Participants rated (0-100) the smartphone and smartwatch apps as very easy (mean 92.3 and 93.2, respectively) and pleasant to use (mean 93.0 and 93.2, respectively). Overall satisfaction with the whole system was 89.9, and the mean System Usability Scale score was 83.8 out of 100. Overall compliance with symptom reporting was 51% (469/927 days), decreasing significantly from before surgery (264/364, 73%) to inpatient recovery (32/143, 22%) and postdischarge (173/420, 41%). Overall Fitbit compliance was 70% (653/927 days) but also declined from before surgery (330/364, 91%) to inpatient (51/143, 36%) and postdischarge (272/420, 65%). CONCLUSIONS Perioperative patients with cancer were willing to use a smartwatch- and smartphone-based real-time intervention to reduce SB, and they rated the apps as very easy and pleasant to use. Compliance with the intervention declined significantly after surgery. The effects of the intervention on postoperative activity patterns, recovery, and quality of life will be evaluated in an ongoing randomized trial.
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Affiliation(s)
- Carissa A Low
- University of Pittsburgh, Pittsburgh, PA, United States
| | | | | | | | | | - Yiyi Ren
- Carnegie Mellon University, Pittsburgh, PA, United States
| | | | | | - Anind K Dey
- University of Washington, Seattle, WA, United States
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22
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Swain CTV, Nguyen NH, Eagles T, Vallance JK, Boyle T, Lahart IM, Lynch BM. Postdiagnosis sedentary behavior and health outcomes in cancer survivors: A systematic review and meta‐analysis. Cancer 2019; 126:861-869. [DOI: 10.1002/cncr.32578] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 08/22/2019] [Accepted: 09/09/2019] [Indexed: 01/08/2023]
Affiliation(s)
| | - Nga H. Nguyen
- Cancer Epidemiology Division Cancer Council Victoria Melbourne Victoria Australia
| | - Tobyn Eagles
- Cancer Epidemiology Division Cancer Council Victoria Melbourne Victoria Australia
| | - Jeff K. Vallance
- Faculty of Health Disciplines Athabasca University Athabasca Alberta Canada
| | - Terry Boyle
- School of Health Sciences University of South Australia Adelaide South Australia Australia
| | - Ian M. Lahart
- Faculty of Education Health and Wellbeing University of Wolverhampton Wolverhampton United Kingdom
| | - Brigid M. Lynch
- Cancer Epidemiology Division Cancer Council Victoria Melbourne Victoria Australia
- Melbourne School of Population and Global Health University of Melbourne Melbourne Victoria Australia
- Physical Activity Laboratory Baker Heart and Diabetes Institute Melbourne Victoria Australia
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Trinh L, Motl RW, Roberts SA, Gibbons T, McAuley E. Estimation of physical activity intensity cut-points using accelerometry in breast cancer survivors and age-matched controls. Eur J Cancer Care (Engl) 2019; 28:e13090. [PMID: 31106924 DOI: 10.1111/ecc.13090] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 02/13/2019] [Accepted: 04/17/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To examine the association between accelerometer activity counts and energy expenditure during walking in breast cancer survivors (BCS) compared with age-matched healthy controls, and differences in moderate-to-vigorous physical activity (MVPA) cut-points. METHODS Using a case-control design, 19 BCS and 19 age-matched women completed 6 min of resting energy expenditure and 6-min periods of treadmill walking in Midwestern United States. Accelerometers and an open-circuit spirometry system were used to measure activity counts and energy expenditure (VO2 ). A mixed-factor analysis of variance was conducted on activity counts and VO2 . Independent samples t tests compared the magnitude of associations between groups. RESULTS There were group by speed interactions on energy expenditure (p < 0.001) and counts (p < 0.001). The linear association did not differ between BCS and controls for the R2 (p = 0.62) nor the slope (p = 0.43), but there was a difference in the intercept (p = 0.01). This resulted in different MVPA cut-points between groups: 1,439 ± 761 counts·min-1 in BCS and 1,937 ± 639 counts·min-1 in controls. CONCLUSION The findings support the use of different cut-points to quantify time spent in MVPA for BCS. Application of these cut-points is warranted to accurately assess physical activity (PA) patterns for better prescription and health outcomes in PA programmes for BCS.
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Affiliation(s)
- Linda Trinh
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON
| | - Robert W Motl
- Department of Physical Therapy, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Sarah A Roberts
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - Trisha Gibbons
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - Edward McAuley
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois
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24
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MCNEIL JESSICA, BRENNER DARRENR, STONE CHELSEAR, O’REILLY RACHEL, RUAN YIBING, VALLANCE JEFFK, COURNEYA KERRYS, THORPE KEVINE, KLEIN DOUGJ, FRIEDENREICH CHRISTINEM. Activity Tracker to Prescribe Various Exercise Intensities in Breast Cancer Survivors. Med Sci Sports Exerc 2019; 51:930-940. [DOI: 10.1249/mss.0000000000001890] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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25
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Abrahams H, Gielissen M, Verhagen C, Knoop H. The relationship of fatigue in breast cancer survivors with quality of life and factors to address in psychological interventions: A systematic review. Clin Psychol Rev 2018; 63:1-11. [DOI: 10.1016/j.cpr.2018.05.004] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 05/15/2018] [Accepted: 05/15/2018] [Indexed: 12/24/2022]
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26
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Ehlers DK, Fanning J, Salerno EA, Aguiñaga S, Cosman J, Severson J, Kramer AF, McAuley E. Replacing sedentary time with physical activity or sleep: effects on cancer-related cognitive impairment in breast cancer survivors. BMC Cancer 2018; 18:685. [PMID: 29940894 PMCID: PMC6019533 DOI: 10.1186/s12885-018-4603-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 06/18/2018] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Evidence suggests reallocating daily sedentary time to physical activity or sleep confers important health benefits in cancer survivors. Despite emerging research suggesting physical activity as a treatment for cancer-related cognitive impairment (CRCI), little is known about the interactive effects of behaviors across the 24-h period. The present purpose was to examine the cognitive effects of reallocating sedentary time to light-intensity physical activity, moderate-to-vigorous physical activity (MVPA), or sleep in breast cancer survivors. METHODS Breast cancer survivors (N = 271, Mage = 57.81 ± 9.50 years) completed iPad-based questionnaires and cognitive tasks assessing demographics, health history, executive function, and processing speed (Task-Switch, Trail Making). Participants wore an accelerometer for seven consecutive days to measure their sedentary, physical activity, and sleep behaviors. Single effects (each behavior individually) and partition (controlling for other behaviors) models were used to examine associations among behaviors and cognitive performance. Isotemporal substitution models were used to test the cognitive effects of substituting 30 min of sedentary time with 30 min of light-intensity activity, MVPA, and sleep. RESULTS MVPA was associated with faster Task-switch reaction time in the partition models (stay: B = - 35.31, p = 0.02; switch: B = - 48.24, p = 0.004). Replacing 30 min of sedentary time with 30 min of MVPA yielded faster reaction times on Task-Switch stay (B = - 29.37, p = 0.04) and switch (B = - 39.49, p = 0.02) trials. In Trails A single effects models, sedentary behavior was associated with faster completion (B = - 0.97, p = 0.03) and light-intensity activity with slower completion (B = 1.25, p = 0.006). No single effects were observed relative to Trails B completion (all p > 0.05). Only the effect of MVPA was significant in the partition models (Trails A: B = - 3.55, p = 0.03; Trails B: B = - 4.46, p = 0.049). Replacing sedentary time with light-intensity activity was associated with slower Trails A (B = 1.55 p = 0.002) and Trails B (B = 1.69, p = 0.02) completion. Replacing light activity with MVPA yielded faster Trails A (B = - 4.35, p = 0.02) and Trails B (B = - 5.23, p = 0.03) completion. CONCLUSIONS Findings support previous research suggesting MVPA may be needed to improve cognitive function in breast cancer survivors. Trails findings underscore the need to dissect sedentary contexts to better understand the impact of daily behavioral patterns on CRCI. Additional research investigating the cognitive impacts of behaviors across the 24-h period is warranted. TRIAL REGISTRATION This study is registered with United States ClinicalTrials.gov ( NCT02523677 ; 8/14/2015).
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Affiliation(s)
| | - Jason Fanning
- Wake Forest School of Medicine, Winston-Salem, NC USA
| | | | - Susan Aguiñaga
- University of Illinois at Urbana-Champaign, Urbana, IL USA
| | | | | | - Arthur F. Kramer
- University of Illinois at Urbana-Champaign, Urbana, IL USA
- Northeastern University, Boston, MA USA
| | - Edward McAuley
- University of Illinois at Urbana-Champaign, Urbana, IL USA
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27
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Wolvers MDJ, Bussmann JBJ, Bruggeman-Everts FZ, Boerema ST, van de Schoot R, Vollenbroek-Hutten MMR. Physical Behavior Profiles in Chronic Cancer-Related Fatigue. Int J Behav Med 2018; 25:30-37. [PMID: 28699090 PMCID: PMC5803288 DOI: 10.1007/s12529-017-9670-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Increasing physical activity level is a generally effective intervention goal for patients who suffer from chronic cancer-related fatigue (CCRF). However, patients are unlikely to benefit equally from these interventions, as their behavioral starting points might vary substantially. Therefore, we explored patterns of physical behavior of participants who suffer from CCRF. METHODS Baseline data of a randomized controlled trial were used for a latent profile analysis on nine accelerometer-derived physical behavior measures, describing levels and patterns of physical activity, moderate-to-vigorous intensity physical activity (MVPA), and sedentary behavior. The relation between participant characteristics and the latent profiles was analyzed. RESULTS Accelerometer data of 172 participants from the Netherlands was analyzed. Three latent profiles were distinguished that differed most on physical activity level and total time spent in MVPA. Eighty-eight percent of all participants were assigned to a profile with a probability higher than 8. Age and perceiving limitations by comorbid conditions and pain were significant covariates of profile membership. CONCLUSIONS We distinguished three physical behavior profiles. The differences between the patterns indicate that the heterogeneity of this sample requires patients to have substantially different treatment goals. Further research should test the applicability of these profiles in clinical practice.
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Affiliation(s)
- M D J Wolvers
- Telemedicine Group, Roessingh Research and Development, Enschede, the Netherlands.
- Telemedicine Group, Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, Enschede, the Netherlands.
| | - J B J Bussmann
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - F Z Bruggeman-Everts
- Telemedicine Group, Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, Enschede, the Netherlands
- Scientific Research Department, Helen Dowling Institute, Bilthoven, the Netherlands
| | - S T Boerema
- Telemedicine Group, Roessingh Research and Development, Enschede, the Netherlands
- Telemedicine Group, Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, Enschede, the Netherlands
| | - R van de Schoot
- Department of Methods and Statistics, Utrecht University, Utrecht, the Netherlands
- Optentia Research Program, Faculty of Humanities, North-West University, Vanderbijlpark, South Africa
| | - M M R Vollenbroek-Hutten
- Telemedicine Group, Roessingh Research and Development, Enschede, the Netherlands
- Telemedicine Group, Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, Enschede, the Netherlands
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28
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Gal R, Monninkhof EM, Groenwold RHH, van Gils CH, van den Bongard DHJG, Peeters PHM, Verkooijen HM, May AM. The effects of exercise on the quality of life of patients with breast cancer (the UMBRELLA Fit study): study protocol for a randomized controlled trial. Trials 2017; 18:504. [PMID: 29078800 PMCID: PMC5659016 DOI: 10.1186/s13063-017-2252-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 10/11/2017] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Meta-analyses of randomized controlled trials (RCTs) have shown that exercise has beneficial effects on quality of life (QoL) in patients with breast cancer. However, these effects were often small. Blinding in an exercise trial is not possible, which has the possible disadvantage of difficult accrual, drop-out after randomization to control and contamination between study groups (controls adopting the behaviour of the intervention group). The cohort multiple randomized controlled trial (cmRCT) is an alternative for conventional RCTs and has the potential to overcome these disadvantages. METHODS This cmRCT will be performed within the Utrecht cohort for Multiple BREast cancer intervention studies and Long-term evaLuAtion (UMBRELLA). Patients with breast cancer who visit the radiotherapy department of the University Medical Center Utrecht are asked to participate in UMBRELLA. Patients give consent for collection of medical information, providing patient-reported outcomes through regular questionnaires and randomization into future intervention studies. Patients who fulfill the UMBRELLA Fit study eligibility criteria (12 to 18 months post inclusion in UMBRELLA, low physical activity level) will be randomly allocated to the intervention or control group (1:1 ratio). Patients randomized to the intervention group will be offered a 12-week exercise programme. The control group will not be informed. Regular cohort measurements will be used for outcome assessment. Feasiblity (including participation, contamination, generalizability and retention) of the cmRCT design and effects of the intervention on QoL will be evaluated. DISCUSSION We will examine the feasibility of the cmRCT design in exercise-oncology research and compare this with conventional RCTs. Furthermore, the effectiveness of an exercise intervention on the QoL of patients with breast cancer in the short term (6 months) and long term (24 months) will be studied. TRIAL REGISTRATION Netherlands Trial Register, NTR5482/NL.52062.041.15 . Retrospectively registered on 7 December 2015.
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Affiliation(s)
- Roxanne Gal
- Department of Clinical Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Evelyn M. Monninkhof
- Department of Clinical Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Rolf H. H. Groenwold
- Department of Clinical Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Carla H. van Gils
- Department of Clinical Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Petra H. M. Peeters
- Department of Clinical Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Anne M. May
- Department of Clinical Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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Sabiston CM, Lacombe J, Faulkner G, Jones J, Trinh L. Profiling sedentary behavior in breast cancer survivors: Links with depression symptoms during the early survivorship period. Psychooncology 2017; 27:569-575. [PMID: 28763129 DOI: 10.1002/pon.4520] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 06/11/2017] [Accepted: 07/26/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Depression symptoms are prevalent among breast cancer survivors (BCS). Reducing sedentary behavior (SED) may be a non-pharmaceutical strategy for alleviating depression symptoms. However, little is known about SED among BCS. The present study aimed to: (i) describe SED behaviors among BCS and identify unique SED groups based on different SED dimensions; (ii) identify personal and cancer-specific factors that discriminate SED clusters; and (iii) examine the association between SED clusters and depression symptoms. METHODS Baseline self-report demographic and medical information was collected from 187 BCS. SED and physical activity were assessed over seven days using an accelerometer. Self-reported depression symptoms were reported three months later. Multiple dimensions of SED were identified and examined in cluster analysis. The clusters were examined for differences using multivariate analysis of variance and chi-square analyses. The difference in depression symptoms among SED groups was assessed using an analysis of covariance. RESULTS High and low SED groups were identified. Survivors in the high SED cluster were significantly older, heavier, less physically active, reported less education, and were more likely to have undergone lymph/axial node dissection. Women in the high SED cluster reported significantly higher depression symptoms prospectively (M = 9.50, SD = 6.07) compared to women in the low SED group (M = 6.89, SD = 5.18), F(8,179) = 4.97, p = 0.03, R2 = 0.34. CONCLUSIONS The importance of understanding multiple dimensions of SED among BCS was highlighted. Reducing SED during the early survivorship period may alleviate depression symptoms.
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Affiliation(s)
- Catherine M Sabiston
- Faculty of Kinesiology and Physical Education, University of Toronto, Ontario, Canada
| | - Jason Lacombe
- Faculty of Kinesiology and Physical Education, University of Toronto, Ontario, Canada
| | - Guy Faulkner
- School of Kinesiology, University of British Columbia, British Columbia, Canada
| | - Jennifer Jones
- Director, Cancer Rehabilitation and Survivorship, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Linda Trinh
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, USA
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30
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Objectively measured sedentary behavior and quality of life among survivors of early stage breast cancer. Support Care Cancer 2017; 25:2495-2503. [PMID: 28326507 DOI: 10.1007/s00520-017-3657-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 02/27/2017] [Indexed: 02/06/2023]
Abstract
PURPOSE This study examined relationships between sedentary behavior accumulated in different bout durations and quality of life (QoL) among breast cancer survivors. METHODS Postmenopausal breast cancer survivors completed the Short Form Health Survey to assess QoL and wore an accelerometer to measure sedentary behavior and physical activity between August 2011 and May 2013. RESULTS Participants (n = 134) averaged 509.7 min/day in sedentary time with 285.2 min/day in short bouts (<20 min) and 224.5 min/day long bouts (≥20 min). Linear regression models indicated that greater total sedentary time was significantly associated with worse physical QoL (b = -0.70, p = 0.02) but not mental QoL (p = 0.92). Models that examined the accumulation of sedentary time in short bouts and long bouts together showed that time in long sedentary bouts was significantly related to physical QoL (b = -0.72, p = 0.02), while time in short bouts was not (p = 0.63). Moderate-to-vigorous intensity physical activity (MVPA) was a significant effect modifier of the relation between time spent in long sedentary bouts and physical QoL (p = 0.028) such that greater time in long bouts was associated with worse physical QoL only among women with lower levels of MVPA. CONCLUSIONS Findings indicate that time spent in long sedentary bouts is associated with worse physical QoL among breast cancer survivors who do not engage in high levels of MVPA. Future research should examine reducing sedentary time as a potential strategy to improve physical QoL.
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Dunn J, Adams C, Holland J, Watson M. Reinforcing the role of psycho-social oncology in global cancer prevention: applying psycho-oncology research in programmes and practice. Psychooncology 2015; 24:1217-1221. [PMID: 29978931 DOI: 10.1002/pon.3923] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 07/07/2015] [Indexed: 01/06/2023]
Abstract
Over the past decade, global action to address the emerging crisis in non-communicable diseases (NCDs) has escalated. Central to these efforts has been the support and influence of the World Health Organisation and the United Nations with the 2000 civil societies represented by the Non-Communicable Disease Alliance. In particular this reached expression in the world's first High Level Meeting on NCDs by the United Nations leading to the 2011 Political Declaration urging a coordinated global response to NCDs. Where then does psycho-oncology sit in this global context? Psycho-oncology practitioners and their collective, the International Psycho-Oncology Society (IPOS), have traditionally been situated within a patient focus and context. However, through linkages with community-based and non-government cancer organisations' agencies, psycho-oncology research and practice has played a key role in reducing cancer risk, improving cancer survivorship, and influencing social and cultural change to eliminate disease-related stigma. As a discipline, psycho-oncology has contributed to widespread recognition of patient-centred care in cancer and along with a broad acceptance and endorsement of the IPOS International Standard. However psycho-oncology is less well accepted in nation-state cancer plans and herein lies opportunity. This special issue includes research across the illness continuum from cancer prevention to screening and early detection, and then to tertiary prevention with lifestyle considerations for cancer survivors. Importantly this demonstrates the capacity within psycho-oncology to develop new understandings of cancer as not only a disease but also a context linked to individual, community, and society health and well-being. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Jeff Dunn
- Cancer Council Queensland, Brisbane, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Queensland, Australia.,School of Social Science, University of Queensland, St. Lucia, Queensland, Australia.,International Union Against Cancer, Geneva, Switzerland
| | - Cary Adams
- International Union Against Cancer, Geneva, Switzerland
| | - Jimmie Holland
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Maggie Watson
- Pastoral and Psychological Care, Royal Marsden Hospital, Sutton, Surrey, UK.,Research Department of Clinical, Health and Educational Psychology, University College London, UK
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