Changes in light-, moderate-, and vigorous-intensity physical activity and changes in depressive symptoms in breast cancer survivors: a prospective observational study

Exploration of helpful elements contributing to engage in physical activity in patients with cancer

PURPOSE

Although there are many reported benefits of physical activity for patients with cancer (e.g., improving quality of life), many patients with cancer do not meet the recommendations of physical activity guidelines. The amount of physical activity declines after diagnosis of cancer. This study aimed to clarify the elements that contribute engagement in regular moderate-or-higher-level intensity of physical activity (MHPA), based on the Health Action Process Approach (HAPA), among patients with cancer.

METHODS

Two web surveys were conducted among cancer outpatients, asking them to respond to a questionnaire. Participants provided information regarding their demographics, physical activity, purpose, advantages, disadvantages, barriers, triggers, and need for support for regular MHPA.

RESULTS

Categories were obtained for purposes, advantages, disadvantages, barriers, triggers, and support needs for regular MHPA. For example, the support they considered necessary to regularly engage in MHPA were developed 9 categories, such as Improving the environment, Support for the implementation of PA (interpersonal), and Reducing the burden. Women and younger patients provided more statements about reducing their burden; younger patients also mentioned on improving the environment more among those who did not engage in MHPA. Additionally, patients with cancer who provided statements about interpersonal support reported higher barriers to physical activity.

CONCLUSIONS

These findings will contribute to the development of a scale to measure the components of the HAPA on physical activity in patients with cancer. In addition, it will help develop a support system that promotes engagement in regular MHPA.

Psychological distress and health behaviours in people living with and beyond cancer: a cross-sectional study

This study aimed to examine whether psychological distress was cross-sectionally associated with meeting World Cancer Research Fund (WCRF) recommendations in people living with and beyond cancer. Participants were adults living with and beyond breast, prostate and colorectal cancer, participating in the baseline wave of the Advancing Survivorship after Cancer Outcomes Trial (ASCOT). Anxiety/depression was assessed using the EQ-5D-5L and dichotomised into any/no problems. WCRF recommendations were assessed via pedometers, 24-h dietary recalls, self-reported alcohol intake (AUDIT-C), and self-reported smoking status. Participants were categorised as meeting WCRF recommendations using the following cut-offs: average daily steps (≥ 10,000/day), average weekly aerobic steps (≥ 15,000/day), fruit and vegetables (≥ 400 g/day), fibre (≥ 30 g/day), red meat (< 500 g/week), processed meat (0 g/day), high calorie food (fat ≤ 33% of total daily energy intake and free sugar ≤ 5% of total daily energy intake), alcohol (≤ 14 units/week) and smoking (non-smoking). A composite health behaviour risk index (CHBRI) was calculated by summing the number of WCRF recommendations met (range: 0-9). Among 1348 participants (mean age = 64 years (SD = 11.4)), 41.5% reported anxiety/depression problems. The mean CHBRI score was 4.4 (SD = 1.4). Anxiety/depression problems were associated with lower odds of meeting WCRF recommendations for average daily steps (odds ratio (OR) = 0.73; 95% CI 0.55, 0.97), but not for any other health behaviour. Psychological distress is associated with lower adherence to WCRF recommendations for physical activity in people living with and beyond cancer. Physical activity may be a mechanism linking psychological distress and poorer outcomes among people living with and beyond cancer, and this should be explored in longitudinal studies.

An adaptive text message intervention to promote psychological well-being and reduce cardiac risk: The Text4Health controlled clinical pilot trial

OBJECTIVE

In a two-arm pilot trial, we examined the feasibility, acceptability, and preliminary efficacy of a 12-week, adaptive text message intervention (TMI) to promote health behaviors and psychological well-being in 60 individuals with multiple cardiac risk conditions (i.e., hypertension, hyperlipidemia, and/or type 2 diabetes) and suboptimal adherence to exercise or dietary guidance.

METHODS

Participants were allocated to receive the TMI or enhanced usual care (eUC). The TMI included daily adaptive text messages promoting health behaviors, twice-weekly messages to set goals and monitor progress, and monthly phone check-ins. Feasibility (primary outcome) and acceptability were measured by rates of successful text message delivery and daily participant ratings of message utility (0-10 Likert scale). We also assessed impact on health behavior adherence, psychological health, and functional outcomes.

RESULTS

The TMI was feasible (99.3% of messages successfully sent) and well-accepted (mean utility = 7.4/10 [SD 2.6]). At 12 weeks, the TMI led to small-sized greater improvements in moderate to vigorous physical activity (d = 0.37), overall physical activity (d = 0.23), optimism (d = 0.20), anxiety (d = -0.36), self-efficacy (d = 0.22), and physical function (d = 0.20), compared to eUC. It did not impact other outcomes substantially at this time point.

CONCLUSION

This 12-week, adaptive TMI was feasible, well-accepted, and associated with small-sized greater improvements in health behavior and psychological outcomes. Though larger studies are needed, it has the potential to be a scalable, low-intensity program that could be used in clinical practice.

CLINICALTRIALS

govregistration:NCT04382521.

Effects of Physical Activity on Quality of Life, Anxiety and Depression in Breast Cancer Survivors: A Systematic Review and Meta-analysis

PURPOSE

Anxiety, depression, and poor quality of life (QOL) were considered important concerns that hindered the rehabilitation of breast cancer survivors. A number of studies have investigated the effects of physical activity, but they have not reached the same conclusions. This review aimed to identify the effects of physical activity on QOL, anxiety, and depression in breast cancer survivors.

METHODS

PubMed, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, SinoMed, CNKI, Vip, and WanFang databases were searched for the time period between January 1, 2012, and April 30, 2022. Studies were included if they were randomized controlled trials of the effects of physical activity on QOL, anxiety, or depression in breast cancer survivors. The tools of the Joanna Briggs Institute were used to assess the quality of the included studies. R software version 4.3.1 was used for meta-analysis.

RESULTS

A total of 26 studies, involving 2105 participants, were included in the systematic review. Among these, 20 studies involving 1228 participants were included in the meta-analysis. Compared with the control group, the results indicated that physical activity can significantly improve QOL(Hedges' g = 0.67; 95% CI 0.41-0.92) and reduce anxiety (Hedges' g = -0.28; 95% CI -0.46 to -0.10) in breast cancer survivors. However, the effect of physical activity on depression (Hedges' g = -0.46; 95% CI -0.99 to 0.06) was not statistically significant.

CONCLUSIONS

Physical activity was an effective intervention to improve QOL and reduce anxiety in breast cancer survivors, as well as showed positive trends in depression, although without statistical significance. More well-designed studies are required to clarify the effects of different types of physical activities on the QOL, anxiety, and depression among breast cancer survivors.

REGISTERED NUMBER ON PROSPERO

CRD42022363094. https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=363094.

Breast cancer survivors with pain: an examination of the relationships between body mass index, physical activity, and symptom burden

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.

Feasibility of a positive psychology intervention (PATH) in allogeneic hematopoietic stem cell transplantation survivors: Randomized pilot trial design and methods

BACKGROUND

Although patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT) experience low levels of positive psychological well-being (PPWB), interventions that specifically boost PPWB in this population are lacking.

OBJECTIVE

To describe the methods of a randomized controlled trial (RCT) designed to assess the feasibility, acceptability, and preliminary efficacy of a positive psychology intervention (PATH) tailored to the unique needs of HSCT survivors and aimed to decrease anxiety and depression symptoms and boost quality of life (QOL).

METHODS

We will conduct a single-institution RCT of a novel nine-week phone-delivered manualized positive psychology intervention compared to usual transplant care in 70 HSCT survivors. Allogeneic HSCT survivors at 100 days post-HSCT are eligible for the study. The PATH intervention, tailored to the needs of HSCT survivors in the acute recovery phase, focuses on gratitude, strengths, and meaning. Our primary aims are to determine feasibility (e.g., session completion, rate of recruitment) and acceptability (e.g., weekly session ratings). Our secondary aim is to test the preliminary efficacy of the intervention on patient-reported outcomes (e.g., anxiety symptoms, QOL).

DISCUSSION

If the PATH intervention is feasible, a larger randomized, controlled efficacy trial will be indicated. Additionally, we anticipate that the results from this RCT will guide the development of other clinical trials and larger efficacy studies of positive psychology interventions in vulnerable oncological populations beyond HSCT.

Pet ownership and lifestyle behaviours of immunosuppressed individuals and their relatives in the context of COVID-19 pandemic

The COVID-19 pandemic and containment measures will likely have a detrimental impact on immunosuppressed individuals' lifestyle behaviours. Increasing evidence suggests that pet ownership is positively associated with healthier lifestyle. Yet, no study has investigated the potential benefits of pet ownership on lifestyle behaviours of immunosuppressed individuals, a population at increased risk of COVID-19 complications. This study aims to examine 1) changes in light, moderate and vigorous intensity physical activity (LPA, MPA, VPA), sedentary time (SED), and sleep duration, assessed by comparing "before COVID-19 pandemic" and "past 7 days" (i.e., current, during pandemic) self-reported behaviours in immunosuppressed individuals and their relatives; 2) to assess if changes in lifestyle behaviours are associated with pet ownership status and whether age is a moderator of these associations. A convenience sample of 132 participants (65.2% female, 41.3% ≥55 years of age) provided self-reported LPA, MPA, VPA (days/week), SED and sleep (min/day) and pet ownership status using an online questionnaire (May-August 2020). Descriptive analyses, paired T-tests, Cohen's d effect size and linear regressions were conducted. Results show that participants reported a decrease in VPA (-0.56 days/week, d = 0.34; p < 0.01) and an increase in SED (106.79 min/day, d = -0.81; p < 0.01). Stratified analysis revealed that having at least one dog, compared to not owning pets, is associated with a reduced decline in LPA, MPA and VPA and an increase in sleep in participants aged < 55 years old only. Having a dog appears to be positively associated with healthy lifestyle behaviours in younger and middle age immunosuppressed individuals.

Reallocating sedentary time to physical activity: effects on fatigue and quality of life in patients with breast cancer in the Phys-Can project

PURPOSE

We aimed to investigate the effects of reallocating sedentary time to an equal amount of light (LPA) or moderate-to-vigorous intensity physical activity (MVPA) on cancer-related fatigue and health-related quality of life (HRQoL) in patients with breast cancer. We also aimed to determine the daily amount of sedentary time needed to be reallocated to LPA or MVPA to produce minimal clinically important changes in these outcomes.

METHODS

Pooled baseline data from three studies were used, including women with breast cancer who participated in the Phys-Can project. Fatigue was assessed with the Multidimensional Fatigue Inventory questionnaire (MFI; five dimensions, 4-20 scale) and HRQoL with the European Organisation for Research and Treatment of Cancer quality of life questionnaire (EORTC QLQ-C30; 0-100 scale). Sedentary time and physical activity were measured with accelerometry. Isotemporal substitution modelling was used for the analyses.

RESULTS

Overall, 436 participants (mean age 56 years, fatigue 11 [MFI], HRQoL 66 [EORTC QLQ-C30], LPA 254 min/day, MVPA 71 min/day) were included. Fatigue significantly decreased in two MFI dimensions when reallocating 30 min/day of sedentary time to LPA: reduced motivation and reduced activity (β =  - 0.21). Fatigue significantly decreased in three MFI dimensions when reallocating 30 min/day of sedentary time to MVPA: general fatigue (β =  - 0.34), physical fatigue (β =  - 0.47) and reduced activity (β =  - 0.48). To produce minimal clinically important changes in fatigue (- 2 points on MFI), the amount of sedentary time needed to be reallocated to LPA was ≈290 min/day and to MVPA was ≥ 125 min/day. No significant effects were observed on HRQoL when reallocating sedentary time to LPA or MVPA.

CONCLUSIONS

Our results suggest that reallocating sedentary time to LPA or MVPA has beneficial effects on cancer-related fatigue in patients with breast cancer, with MVPA having the greatest impact. In relatively healthy and physically active breast cancer populations, a large amount of time reallocation is needed to produce clinically important changes. Future studies are warranted to evaluate such effects in broader cancer populations.

TRIAL REGISTRATION

NCT02473003 (10/10/2014) and NCT04586517 (14/10/2020).

Interactive Compensation Effects of Physical Activity and Sleep on Mental Health: A Longitudinal Panel Study among Chinese College Students during the COVID-19 Pandemic

Physical activity (PA) and sleep are both important to mental health. However, their joint effects on mental distress have not been well explored. The aim of this study was to investigate the joint effects of PA and sleep on mental health, as well as the dose-response relationships between PA and mental health under different sleep health statuses. A longitudinal panel study was adopted to evaluate the relationship between PA, sleep, and mental health among 66 healthy Chinese college students with four online questionnaire surveys. A mixed-effect model with individual-level random effect was used to analyze the interactive regulation effect of PA and sleep on mental health, and a generalized additive model with splines was further fitted to analyze dose-response relationships between variables. When sleep was at a healthy level, no significant difference in mental health was observed between different levels of PA (p > 0.05). However, poor sleepers with moderate and high PA levels indicated significantly fewer negative emotions than those with low PA levels (p = 0.001, p = 0.004). Likewise, poor sleepers who engaged in more moderate intensity PA could significantly reduce negative emotions (β = -0.470, p = 0.011) in a near-linear trend. In summary, both sleep and PA benefit mental health, and they probably regulate mental health through an interactive compensation mode. For good and poor sleepers, PA plays a different role in maintaining and improving mental health. Increasing moderate intensity PA up to moderate-and-high levels is recommended for those who simultaneously suffer from sleep and psychological health problems.

Understanding the basis of major depressive disorder in oncological patients: Biological links, clinical management, challenges, and lifestyle medicine

In recent years, the incidence of different types of cancer and patient survival have been rising, as well as their prevalence. The increase in survival in recent years exposes the patients to a set of stressful factors such as more rigorous follow-up and more aggressive therapeutic regimens that, added to the diagnosis of the disease itself, cause an increase in the incidence of depressive disorders. These alterations have important consequences for the patients, reducing their average survival and quality of life, and for these reasons, special emphasis has been placed on developing numerous screening tests and early recognition of depressive symptoms. Despite that cancer and major depressive disorder are complex and heterogeneous entities, they also share many critical pathophysiological mechanisms, aiding to explain this complex relationship from a biological perspective. Moreover, a growing body of evidence is supporting the relevant role of lifestyle habits in the prevention and management of both depression and cancer. Therefore, the present study aims to perform a thorough review of the intricate relationship between depression and cancer, with a special focus on its biological links, clinical management, challenges, and the central role of lifestyle medicine as adjunctive and preventive approaches to improve the quality of life of these patients.

Study design exploring Qigong and Tai Chi Easy (QTC) on cardiometabolic risk factors

BACKGROUND

Cardiovascular disease is the leading cause of death in the United States paralleled with several cardiometabolic risk factors that are on the rise such as obesity, hypertension, and diabetes. Many of these cardiometabolic risk factors are preventable by lifestyle changes in physical activity and dietary patterns. Qigong and Tai Chi Easy (QTC) exercises are considered meditative movement practices that have been shown to reduce cardiometabolic risk factors such as psychosocial stress, poor sleep quality and weight gain and is particularly suitable for older adults. Heart rate variability (HRV) is a common factor known to be related to reduction of these risks and may be enhanced using HRV biofeedback to specifically optimize effects of QTC.

METHODS

The protocol presented describes a two-group parallel randomized controlled trial testing effects of QTC vs QTC plus HRV biofeedback "priming" on HRV parameters (primary), and cardiometabolic risk factors and sequelae (secondary) (e.g., waist circumference/percent body fat, sleep quality, stress, anxiety/depression, emotional regulation, eating behaviors, and cognitive performance). We will enroll 50 adults aged 55-85 years old to participate in an 8-week intervention. Self-reported body measurements, psychosocial and behavioral questionnaires, and cognitive performance assessments will be conducted before and after the intervention.

CONCLUSIONS

Findings from this study are expected to assess effects of QTC and elucidate the potential role of HRV in QTC relative to cardiometabolic risk factors and sequelae. Implications for how HRV may play a central role and be optimized in a meditative movement practice are discussed.

Association between behavioral patterns and mortality among US adults: National Health and Nutrition Examination Survey, 2007–2014

Few large-scale studies have been conducted to show the joint effects of mortality associated with physical activity and sedentarism. Therefore, we examined the relationship between all-cause mortality and behavioral patterns among adults in the United States. Data of 17,730 non-institutionalized US civilians aged ≥20 years were extracted from the 2007–2014 National Health and Nutrition Examination Survey. We set the criteria for metabolic equivalents as 600 according to the WHO guideline, and sedentary time as 300 min/day according to the median. The Cox proportional hazards model was adjusted for demographic and lifestyle characteristics. During the 58.54±28.18 months follow-up, all-cause mortality rate was 4% and heart-related and cancer mortality rate was 1%. Participants in the high metabolic equivalents and low sedentary time group had a lower risk of all-cause (hazard ratio = 0.41, 95% confidence interval = 0.34–0.50), cardiovascular (hazard ratio = 0.36; 95% confidence interval = 0.23–0.55), and cancer (hazard ratio = 0.55; 95% confidence interval = 0.37–0.83) mortality, compared to those in the low metabolic equivalents and high sedentary time group. Sufficient physical activity and less sedentary behavior reduce all-cause and cause-specific mortality in adults in the United States, especially cardiovascular mortality among the elderly. Additional nationwide policies to improve behavioral patterns among adults need to be implemented in the United States.

Exercise to prevent shoulder problems after breast cancer surgery: the PROSPER RCT

BACKGROUND

Upper limb problems are common after breast cancer treatment.

OBJECTIVES

To investigate the clinical effectiveness and cost-effectiveness of a structured exercise programme compared with usual care on upper limb function, health-related outcomes and costs in women undergoing breast cancer surgery.

DESIGN

This was a two-arm, pragmatic, randomised controlled trial with embedded qualitative research, process evaluation and parallel economic analysis; the unit of randomisation was the individual (allocated ratio 1 : 1).

SETTING

Breast cancer centres, secondary care.

PARTICIPANTS

Women aged ≥ 18 years who had been diagnosed with breast cancer and were at higher risk of developing shoulder problems. Women were screened to identify their risk status.

INTERVENTIONS

All participants received usual-care information leaflets. Those randomised to exercise were referred to physiotherapy for an early, structured exercise programme (three to six face-to-face appointments that included strengthening, physical activity and behavioural change strategies).

MAIN OUTCOME MEASURES

The primary outcome was upper limb function at 12 months as assessed using the Disabilities of Arm, Hand and Shoulder questionnaire. Secondary outcomes were function (Disabilities of Arm, Hand and Shoulder questionnaire subscales), pain, complications (e.g. wound-related complications, lymphoedema), health-related quality of life (e.g. EuroQol-5 Dimensions, five-level version; Short Form questionnaire-12 items), physical activity and health service resource use. The economic evaluation was expressed in terms of incremental cost per quality-adjusted life-year and incremental net monetary benefit gained from an NHS and Personal Social Services perspective. Participants and physiotherapists were not blinded to group assignment, but data collectors were blinded.

RESULTS

Between 2016 and 2017, we randomised 392 participants from 17 breast cancer centres across England: 196 (50%) to the usual-care group and 196 (50%) to the exercise group. Ten participants (10/392; 3%) were withdrawn at randomisation and 32 (8%) did not provide complete baseline data. A total of 175 participants (89%) from each treatment group provided baseline data. Participants' mean age was 58.1 years (standard deviation 12.1 years; range 28-88 years). Most participants had undergone axillary node clearance surgery (327/392; 83%) and 317 (81%) had received radiotherapy. Uptake of the exercise treatment was high, with 181 out of 196 (92%) participants attending at least one physiotherapy appointment. Compliance with exercise was good: 143 out of 196 (73%) participants completed three or more physiotherapy sessions. At 12 months, 274 out of 392 (70%) participants returned questionnaires. Improvement in arm function was greater in the exercise group [mean Disabilities of Arm, Hand and Shoulder questionnaire score of 16.3 (standard deviation 17.6)] than in the usual-care group [mean Disabilities of Arm, Hand and Shoulder questionnaire score of 23.7 (standard deviation 22.9)] at 12 months for intention-to-treat (adjusted mean difference Disabilities of Arm, Hand and Shoulder questionnaire score of -7.81, 95% confidence interval -12.44 to -3.17; p = 0.001) and complier-average causal effect analyses (adjusted mean difference -8.74, 95% confidence interval -13.71 to -3.77; p ≤ 0.001). At 12 months, pain scores were lower and physical health-related quality of life was higher in the exercise group than in the usual-care group (Short Form questionnaire-12 items, mean difference 4.39, 95% confidence interval 1.74 to 7.04; p = 0.001). We found no differences in the rate of adverse events or lymphoedema over 12 months. The qualitative findings suggested that women found the exercise programme beneficial and enjoyable. Exercise accrued lower costs (-£387, 95% CI -£2491 to £1718) and generated more quality-adjusted life years (0.029, 95% CI 0.001 to 0.056) than usual care over 12 months. The cost-effectiveness analysis indicated that exercise was more cost-effective and that the results were robust to sensitivity analyses. Exercise was relatively cheap to implement (£129 per participant) and associated with lower health-care costs than usual care and improved health-related quality of life. Benefits may accrue beyond the end of the trial.

LIMITATIONS

Postal follow-up was lower than estimated; however, the study was adequately powered. No serious adverse events directly related to the intervention were reported.

CONCLUSIONS

This trial provided robust evidence that referral for early, supported exercise after breast cancer surgery improved shoulder function in those at risk of shoulder problems and was associated with lower health-care costs than usual care and improved health-related quality of life.

FUTURE WORK

Future work should focus on the implementation of exercise programmes in clinical practice for those at highest risk of shoulder problems.

TRIAL REGISTRATION

This trial is registered as ISRCTN35358984.

FUNDING

This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 15. See the NIHR Journals Library website for further project information.

Predictors of completion and response to a psychological intervention to promote health behavior adherence in heart failure

OBJECTIVE

Most individuals with heart failure (HF) struggle to adhere to one or more health behaviors, and interventions to promote adherence are time-intensive and costly. In this analysis, we examined the predictors of engagement and response related to a telephone-delivered health behavior intervention for individuals with HF.

METHOD

Using data from two pilot trials (N = 25) of a behavioral intervention for individuals with New York Heart Association (NYHA) class I-II HF, we examined predictors of intervention engagement and response using linear and mixed effects regression analyses. Predictors included medical (NYHA class, physical health-related quality of life [HRQoL], and HF symptoms) and intervention (ease and usefulness/utility ratings of the first intervention exercise) characteristics. Outcomes included percentage of sessions completed, accelerometer-measured physical activity, and sodium intake.

RESULTS

Lower physical HRQoL and more frequent HF symptoms were associated with completion of more sessions. In contrast, more frequent HF symptoms and higher NYHA class were associated with less physical activity improvement. Finally, participants' ratings of the first session's utility were associated with greater improvements in physical activity at follow-up.

CONCLUSIONS

These findings suggest that while individuals with greater functional impairment are more engaged in a behavioral intervention, they may be less able to increase physical activity in response to the program. Furthermore, the perceived utility of an initial session may predict longer-term behavior change. Larger studies are needed to clarify the presence of additional predictors and determine how they can be used to better tailor health behavior interventions.

Physical activity and sedentary time: associations with fatigue, pain, and depressive symptoms over 4 years post-treatment among breast cancer survivors

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.

Exploring the Effects of Yoga Therapy on Heart Rate Variability and Patient-Reported Outcomes After Cancer Treatment: A Study Protocol

BACKGROUND

Following cancer treatment, adults commonly report worsened patient-reported outcomes (PROs) such as anxiety, stress, depression, persistent and upsetting cognitive complaints, unrelenting fatigue, and reduced quality of life. Poorer PROs are associated with disrupted autonomic nervous system functioning as measured by heart rate variability (HRV), both of which have been associated with greater morbidity and mortality. Interventions to improve HRV and PROs among adults following cancer treatment are needed. Yoga therapy holds promise as an intervention to improve HRV and PROs. Therefore, we conducted a single-subject exploratory experimental study to investigate the effects of yoga therapy on HRV and specific PROs (ie, cancer-related fatigue, anxiety, cognitive function, depression, stress, quality of life) in adults treated for cancer. To reduce publication bias, improve reproducibility, and serve as a reference for forthcoming reporting of study results, we present the study protocol for this study herein.

METHODS

Participants were adults who completed cancer treatment that were recruited from the Ottawa Integrative Cancer Centre. Consenting and eligible participants received one 1:1 yoga therapy session (ie, 1 participant, 1 Yoga Therapist) and 6 weekly group-based yoga therapy sessions (ie, 2-3 participants, 1 Yoga Therapist). Participants completed assessments 7 times: 3 times prior to the program (ie, -6 weeks, -3 weeks, immediately prior to the 1:1 yoga therapy session), immediately following the 1:1 yoga therapy session, prior to the first group-based yoga therapy session, after the last group-based yoga therapy session, and at a 6-week follow-up. Hierarchical linear modeling will be used to test the average effects of the yoga therapy program across participants.

DISCUSSION

This study will explore several novel hypotheses, including whether yoga therapy can improve HRV and/or specific PROs among adults treated for cancer acutely (ie, during a 1:1 yoga therapy session) and/or through repeated exposure (ie, after completing 6 weeks of group-based yoga therapy). Although the findings will require confirmation or refutation in future trials, they may provide initial evidence that YT may benefit adults treated for cancer.

TRIAL REGISTRATION

ISRCTN registry, ISRCTN64763228. Registered on December 12, 2021. This trial was registered retrospectively. URL of trial registry record: https://www.isrctn.com/ISRCTN64763228.

Physical activity and sedentary time: associations with fatigue, pain, and depressive symptoms over 4 years post-treatment among breast cancer survivors

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.

Physical Activity as an Imperative Support in Breast Cancer Management

Breast cancer (BC) is the most common malignancy and the second cause of cancer-related death among women. It is estimated that 9 in 10 cases of BC are due to non-genetic factors, and approximately 25% to 30% of total breast cancer cases should be preventable only by lifestyle interventions. In this context, physical activity represents an excellent and accessible approach not only for the prevention, but also for being a potential support in the management of breast cancer. The present review will collect the current knowledge of physical activity in the background of breast cancer, exploring its systemic and molecular effects, considering important variables in the training of these women and the evidence regarding the benefits of exercise on breast cancer survival and prognosis. We will also summarize the various effects of physical activity as a co-adjuvant therapy in women receiving different treatments to deal with its adverse effects. Finally, we will reveal the impact of physical activity in the enhancement of quality of life of these patients, to conclude the central role that exercise must occupy in breast cancer management, in an adequate context of a healthy lifestyle.

Feasibility and preliminary efficacy of a positive psychology-based intervention to promote health behaviors in heart failure: The REACH for Health study

OBJECTIVE

Most patients with heart failure (HF) struggle to adhere to health behaviors, and existing health behavior interventions have significant limitations. We developed a 12-week, phone-delivered, combined positive psychology (PP) and motivational interviewing (MI) intervention to promote well-being and adherence to physical activity, diet, and medications. In this three-arm, randomized trial, we assessed the feasibility, acceptability, and preliminary efficacy of the intervention compared to treatment as usual and MI-alone conditions in 45 patients with HF and suboptimal health behavior adherence.

METHODS

Participants in the PP-MI or MI-alone conditions completed weekly phone sessions for 12 weeks. Those in PP-MI completed weekly PP exercises and set health behavior goals, while those in the MI-alone condition learned about HF-specific health behaviors and identified potential behavior changes. Primary study outcomes were feasibility (sessions completed) and acceptability (0-10 ratings of PP exercise ease and utility). The intervention's impact on psychological and behavioral outcomes was assessed using mixed effects regression analyses.

RESULTS

Participants in the PP-MI condition completed 73% of sessions and rated PP exercises as easy to complete (mean = 7.5 [SD 1.7] out of 10) and subjectively useful (mean = 7.5 [SD 1.6] out of 10). Compared to the control conditions, PP-MI led to medium effect-size improvements in positive affect (Cohen's d = 0.32-0.77), moderate to vigorous physical activity (d = 0.41-0.74), and medication adherence (d = 0.48-0.78).

CONCLUSION

This PP-MI intervention was feasible, well-accepted, and associated with promising improvements in well-being and health behavior outcomes. Larger trials are needed to examine this intervention's impact on health behavior adherence and other important outcomes (NCT03220204).

Relationship of objectively measured physical activity and sedentary behaviour with health-related quality of life among breast cancer survivors

Background

Lack of physical activity throughout one’s lifetime has been associated with obesity and it is also an important risk factor of breast cancer. This study aimed to determine the relationship between objectively measured physical activity and sedentary behaviour with health-related quality of life (HRQoL) among breast cancer survivors in the East Coast region of Peninsular Malaysia.

Methods

A cross-sectional study involving 83 breast cancer survivors was carried out in two main government referral hospitals in the region. Participants wore the ActivPAL3™ microdevice physical activity monitor for seven consecutive days. The validated European Organization for Research and Treatment of Cancer Quality of Life Questionnaires (EORTC QLQ–C30) and Breast Cancer Supplementary Measure (EORTC QLQ-BR23) were used to measure their HRQoL. Multiple linear regression analysis was conducted to determine the relationship between objectively measured physical activity and sedentary behaviour with HRQoL.

Results

Longer time spent on moderate to vigorous physical activity (MVPA) was significantly associated with an improvement of HRQoL (p = 0.039) whereas longer time spent on sedentary behaviour significantly reduced the functioning score (p = 0.005). In addition, prolonged sedentary bouts were also significantly associated with better body image that led to improved HRQoL (p = 0.013).

Conclusions

The study findings suggest that an increase in the time spent on MVPA was associated with improved HRQoL while sedentary behaviour was associated with poorer HRQoL among breast cancer survivors. Thus, it is essential to displace sedentary behaviour with MVPA to improve the quality of life of breast cancer survivors.

Depression and Objectively Measured Physical Activity: A Systematic Review and Meta-Analysis

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.

Correlates of light physical activity among cancer survivors

OBJECTIVE

Emerging evidence demonstrates the positive health benefits of light physical activity (LPA) for cancer survivors. Yet, little research has explored modifiable factors that facilitate or hinder LPA behavior in this population. Correlates of LPA among cancer survivors were examined, and stratified by moderate-to-vigorous physical activity (MVPA) status.

METHODS

A cross-sectional analysis using the American Cancer Society's Studies of Cancer Survivors-I (N = 1751) was conducted. Correlates of interest were health-care provider support for physical activity, perceived health competence, perceived social support, unsupportive partner behaviors, and perceived susceptibility to cancer recurrence. The primary outcome was self-reported LPA categorized at 0, 1-59, 60-119, and 120+ minutes per week. Multivariable ordinal regressions using forced entry were conducted, stratified by MVPA status.

RESULTS

Adjusted multivariable models revealed that, among those reporting no MVPA (n = 757), greater provider support for physical activity (adjusted odds ratio [aOR] = 1.51; 95% CI, 1.05-2.17; P = 0.03), greater perceived health competence (aOR = 1.44; 95% CI, 1.10-1.88; P = 0.01), and greater unsupportive partner behaviors (aOR = 1.06; 95% CI, 1.01-1.12; P = 0.03) were significantly correlated with higher LPA. No social cognitive constructs were correlated with LPA among those already engaging in MVPA (n = 994).

CONCLUSIONS

LPA interventions targeting cancer survivors not engaging in any MVPA are warranted and may optimize limited intervention resources. Furthermore, interventions may be more efficacious by applying behavior change techniques that incorporate health-care provider support and improves health competence and positive interpersonal skills.

Life after breast cancer: moving on, sitting down or standing still? A prospective study of Canadian breast cancer survivors

INTRODUCTION

Breast cancer (BC) is associated with serious physical and psychological health sequelae that affect quality and quantity of life. Physical activity (PA) and sedentary behaviour can prevent or diminish these sequelae; yet, little is known about how these lifestyle behaviours change after cancer treatment and if these changes affect post-treatment health. The first aim of this study is to describe natural trends in lifestyle behaviours (ie, PA, sedentary behaviour) in women treated for BC. The second aim is to examine the longitudinal associations between lifestyle behaviour changes and (1) physical health (eg, acute symptoms, chronic conditions, body composition, patient-reported fatigue, pain and functioning), (2) psychological health and illness (eg, depression, stress, affect, post-traumatic growth, cancer worry, mood, body image) and (3) biological functioning (eg, cortisol and C-reactive protein). The third aim is to examine modifiable self-regulation (ie, goal adjustment strategies) and motivation constructs (ie, self-determined regulations) that predict trends in lifestyle behaviours.

METHOD AND ANALYSIS

This is a prospective longitudinal study of 201 women treated for BC. Data (eg, surveys, accelerometers, saliva, blood) are collected every 3 months during the first year after women complete systemic treatment for a first diagnosis of BC, and once every year for 4 years thereafter. Data analyses assess trends and changes in PA and sedentary lifestyle behaviours, examine associations between these trends and changes in health outcomes and identify modifiable predictors of PA and sedentary lifestyle behaviours using multilevel modelling.

ETHICS AND DISSEMINATION

Ethical approval was obtained from the University of Toronto (REB# 28180) and has been funded by the Canadian Institutes of Health Research (#186128). Study findings will be disseminated through peer-reviewed publications, academic conferences, local community-based presentations such as the Canadian Cancer Society and similar organisations.

Replacing sedentary time with physical activity or sleep: effects on cancer-related cognitive impairment in breast cancer survivors

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).

The role of physical activity enjoyment in the pathways from the social and physical environments to physical activity of early adolescent girls

Most girls experience a notable decline in physical activity (PA) in early adolescence, increasing their risk for harmful health outcomes. Enjoyment for PA (i.e., positive feelings toward PA) is a determinant of PA among girls during adolescence and sustained PA throughout adulthood. Previous studies recommended increasing girls' PA enjoyment in order to increase their PA, but did not include environmental-level strategies for how families, schools, or communities do this. To gain insight on such strategies, this study examines the role of PA enjoyment as a mediator of social and physical environments to moderate-to-vigorous intensity PA of early adolescent girls. Cross-sectional, secondary analyses, using structural equation modeling, were conducted on a U.S. national dataset of 1721 sixth grade girls from the Trial of Activity for Adolescent Girls in 2003. Mediation model fit parameters included χ2 (292, N = 1721) = 947.73 p < 0.001, CFI = 0.95, RMSEA = 0.04 (90% CI = 0.03, 0.04), and SRMR = 0.037 suggesting overall good fit. There were no indirect effects on PA through PA enjoyment from the social or physical environmental factors. To PA, there were significant direct effects only from social support from friends (β = 0.15, CI = 0.09, 0.22). To PA enjoyment, there were significant direct effects from social support from family (β = 0.15, CI = 0.08, 0.23), school climate (teachers β = 0.15, CI = 0.10, 0.21 and boys β = 0.15, CI = 0.09, 0.20), and neighborhood environment (β = 0.10, CI = 0.04, 0.17). The findings of this study identified several direct effects of the social and physical environment on PA enjoyment that can begin to inform environmental-level strategies for increasing PA enjoyment among early adolescent girls.

Effects of physical activity on psychological well-being outcomes in breast cancer survivors from prediagnosis to posttreatment survivorship

OBJECTIVE

The purpose of this study was to examine the effects of physical activity from prediagnosis to posttreatment survivorship on the psychological well-being (PWB) outcomes of fatigue, depression, anxiety, and quality of life (QoL) in breast cancer survivors (BCS).

METHODS

Participants (N = 387) completed a questionnaire battery by using an iPad-based platform. Measures included self-reported PA (before diagnosis and currently) and perceptions of fatigue, depression, anxiety, and QoL. Multivariate analysis of covariance was used to examine differences in PWB among BCS categorized into 1 of 4 physical activity levels: (a) low-active prediagnosis, low-active currently (low-active maintainers; n = 128); (b) low-active prediagnosis, active currently (increasers; n = 74); (c) active prediagnosis, low-active currently (decreasers; n = 52); and (d) active prediagnosis, active currently (high-active maintainers; n = 136). Participants were classified as active (≥24 units) or low-active (<24 units) by using Godin Leisure-Time Exercise Questionnaire cut-points for health benefits.

RESULTS

Fatigue and depression were lowest, and QoL was highest among women in the high-active maintainers category, followed by the increasers, low-active maintainers, and decreasers. No differences in anxiety were observed across categories. Women in the high-active maintainers category differed significantly in fatigue, depression, and QoL from both low-active categories (low-active maintainers and decreasers), P ≤ .001. Women in the increasers category also differed significantly in fatigue, depression, and QoL from the decreasers, P ≤ .01.

CONCLUSION

Low physical activity during survivorship was associated with greater fatigue and depression and lower QoL.

IMPLICATIONS FOR CANCER SURVIVORS

Efforts to help increase or maintain high levels of physical activity may be critical to helping BCS maintain their PWB.