Associations between physical activity and comorbidities in Korean cancer survivors

Determinants of physical activity during cancer treatment: a longitudinal exploration of psycho-cognitive variables and physician counseling

Individuals with cancer are recommended to engage in regular physical activity (PA) even during cancer therapy. The aim of this study was to explore how patient-reported physician PA counseling influences their PA intention and behavior in addition to psycho-cognitive determinants derived from the theory of planned behavior (TPB). A longitudinal study during cancer treatment was conducted among N = 115 patients with breast, prostate, or colorectal cancer (Mage = 58.0, SD = 11.5; 55.7% female). The median time since diagnosis was 2 months, and 19.1% were diagnosed with metastases. Participants provided information on PA counseling by their physicians and on psycho-cognitive variables of the TPB at three measurement points. Additionally, they wore accelerometers for seven days at baseline and three months later. Nearly half of participants (48%) reported basic PA counseling and 30% reported in-depth PA counseling. Patients in poorer health and with lower education reported significantly less in-depth counseling. In addition to patient self-efficacy in performing PA, only in-depth physician PA counseling, but not basic physician counseling, predicted intention for PA four weeks later. Patients' PA three months after baseline was predicted by patients' PA at baseline and their intention for PA. Overall, the PA level at baseline was identified as the most important predictor of PA three months later. Nevertheless, physicians seem to have the ability to increase their cancer patients' intention for PA by in-depth counseling.

Exercise Across the Phases of Cancer Survivorship: A Narrative Review

Exercise has long been recognized as an important component of treatment for various diseases. However, the benefits and risks of exercise interventions must be carefully evaluated to ensure the former outweighs the latter. As cancer patients undergo diverse treatment modalities with distinct objectives, a systematic approach partitioning the cancer journey into distinct phases is necessary to inform tailored exercise prescriptions. This narrative review summarizes exercise benefits and mechanisms for cancer patients and survivors across four distinct survivorship periods-before surgery, after surgery and before adjuvant treatment, during nonsurgical treatment (adjuvant and neoadjuvant), and during extended survival. In summary, exercise reduces the risks of complications and declines in physical functioning while improving fatigue, quality of life, and the ability to manage treatment effects. Although additional research is warranted, existing evidence is sufficient to integrate exercise into clinical oncology practice and cancer survivorship programs.

Metabolic Syndrome According to Dietary and Health-Related Lifestyle in Male Cancer Survivors and Non-Cancer over 40 Years of Age

Researchers often report higher metabolic syndrome (MetS) pr\4;evalence among cancer survivors than among non-cancer individuals. This study aims to explore the impact of cancer presence, activity type, and dietary lifestyle on MetS in males over 40 years of age. Participants (n = 9846; 618 cancer survivors, 9228 non-cancer) were selected by extracting data from a Korean government database spanning the years 2016 to 2021. Physical activity patterns, dietary habits, and MetS factors were measured, and a multiple logistic regression analysis was statistically processed for an odds ratio (OR). MetS was present in 32.8% of cancer survivors and 28.6% of non-cancer individuals. Gastric cancer survivors exhibited a 16% lower OR for MetS versus non-cancer participants. The ORs were higher by 1.60-, 1.45-, and 1.26-fold for colorectal, urinary, and other cancers, respectively. Cancer survivors with high calorie, carbohydrate, and fat intakes exhibited ORs of 2.01 (95% CI 1.28-4.04), 2.33 (95% CI 1.28-4.54), and 1.39 (95% CI 1.05-2.37) compared to the recommended level. The high fiber-intake group reduced the MetS OR by 20%. In conclusion, The MetS prevalence was higher in survivors with colorectal cancer, urinary cancer, and other cancers, while it was lower in patients with gastric cancer. Survivors with low rates of eating three meals a day, high skipping breakfast, increased eating-out rate, and no nutritional learning opportunity displayed higher MetS prevalence. Additionally, cancer survivors who had more strength and leisure activities had a lower OR of MetS.

Co-designing Healthy Living after Cancer Online: an online nutrition, physical activity, and psychosocial intervention for post-treatment cancer survivors

PURPOSE

The aim of the present study was to co-design Healthy Living after Cancer Online (HLaC Online), an online intervention supporting cancer survivors to set and meet their healthy living goals.

METHODS

Adapted from an initial telephone-delivered Healthy Living after Cancer program, wireframes (PDF black and white mock-ups) of the proposed online program were presented in a series of focus groups and interviews to our stakeholder group, which consisted of cancer survivors, oncology healthcare professionals, and representatives from cancer support organisations. Stakeholders were prompted for feedback on the wireframe and given end-user scenarios to encourage deeper engagement with the co-design process. Transcriptions underwent thematic analysis to determine which features of the program needed change or expansion.

RESULTS

27 participants took part in one of 8 focus groups or 10 interviews. Five themes were identified relating to (a) website design elements, (b) promoting and maintaining long-term engagement, (c) relatability and relevance, (d) navigating professional support, and (e) family and peer support. Recommended changes, such as simple activities and guidance videos, were integrated into the HLaC Online prototype.

CONCLUSIONS

Involving end-users in the co-design process ensured the intervention's relevance and specificity to the needs of cancer survivors. Next steps include feasibility testing the prototype, prior to commencing a national randomised control trial of HLaC Online.

IMPLICATIONS FOR CANCER SURVIVORS

HLaC Online aims to support cancer survivors to improve their quality of life by making healthy lifestyle changes in their physical activity, healthy eating, weight management, mental health, and fatigue management.

Association of dietary sodium intake with impaired fasting glucose in adult cancer survivors: A population-based cross-sectional study

BACKGROUND

Dietary sodium intake is a crucial lifestyle factor that should be assessed in adult cancer survivors due to their increased risk of adverse health outcomes compared to the general population. However, its with impaired fasting glucose (IFG) in adult cancer survivors remains unclear. This study aimed to investigate the association of dietary sodium intake categorized by the American Heart Association (AHA) recommendation with IFG in the community-dwelling adult cancer survivors.

METHODS

A total of 1,052 adult cancer survivors without diabetes were identified from the sixth and seventh Korea National Health and Nutrition Examination Survey (KNHANES), 2013-2018. Data on dietary sodium intake was categorized as <1,500 mg/day, 1,500-2,999 mg/day, 2,300-3,999 mg/day, and ≥4,000 mg/day according to the AHA recommendation. A multiple logistic regression model adjusted for demographic, lifestyle, and health status was used to compute odds ratios (OR) and 95% confidence intervals (95% CI) for IFG according to dietary sodium intake categories.

RESULTS

After adjusting for confounding variables identified in the KNHANES, the adjusted OR among the adult cancer survivors who consumed 1,500-2,999 mg/day, 2,300-3,999 mg/day, and ≥4,000 mg/day of dietary sodium were 1.16 (95% CI: 0.25-5.27), 1.93 (95% CI: 0.40-9.37), and 2.67 (95% CI: 0.59-12.18), respectively, as compared to those who consumed <1,500 mg/day (P value for trend = 0.036).

CONCLUSION

Among community-dwelling adult cancer survivors, high dietary sodium intake was marginally associated with increased odds of IFG. Well-designed cohort studies or randomized clinical trials are needed to establish more epidemiologic evidence on this association in adult cancer survivors.

Sedentary Behaviour, Physical Activity, and Their Associations with Health Outcomes at the Time of Diagnosis in People with Inoperable Lung Cancer

This study aimed to examine sedentary behaviour (SB), physical activity (PA) and their associations with health-related measures at the time of diagnosis in people with inoperable lung cancer. People newly diagnosed with inoperable lung cancer were invited to participate in the study and asked to wear an accelerometer for seven consecutive days. Variables analysed included time spent in SB, light intensity PA (LIPA) and moderate-to-vigorous intensity PA (MVPA). Daily steps were also recorded. Data on symptoms, health-related quality of life (HRQoL), hand grip force, comorbidities and lung function were collected. Of the 120 patients referred to the study, 89 (74%) consented to participate, and SB/PA data were available for 79 (age 71 ± 11 years; 29 females). Participants spent 71% of their waking time in SB, 28% in LIPA and 1% in MVPA. Regression models demonstrated that increased SB was associated with more symptoms of fatigue and dyspnoea (p ≤ 0.02 for both), poorer HRQoL (general health and physical component score; p ≤ 0.02 for all) and lower hand grip force. For PA variables, higher daily step count was associated with better scores in all health-related measures (p < 0.05 for all). LIPA was associated with more health-related outcomes than MVPA. These findings may guide future interventions in this population.

Application of the theory of planned behavior to understand physical activity intentions and behavior among Korean breast cancer survivors

PURPOSE

The purpose of this study was to apply the theory of planned behavior (TPB) to understand physical activity intentions and behaviors among Korean breast cancer survivors.

METHODS

A total of 286 Korean breast cancer survivors (M_age52.3 ± 8.3) completed a self-reported survey administered face to face by a trained interviewer. The survey assessed the physical activity frequency and intensity in a typical week after breast cancer diagnosis, demographic factors, and theory of planned behavior variables including attitude, subjective norm, perceived behavioral control (PBC), planning, and intentions to participate in physical activity. We used structural equation modeling to examine the direct and indirect effects of the TPB variables on physical activity intentions and behavior. Covariates included age, cancer stage, and clinical treatment.

RESULTS

Confirmatory factor analyses indicated a satisfactory model fit. We observed direct effects for instrumental attitude (ß = 0.34, p < 0.001), subjective norm (ß = 0.12, p < 0.05), and PBC (ß = 0.57, p < 0.001) on physical activity intentions. PBC (ß = .17, p < 0.01) and physical activity intentions (ß = 0.46, p < 0.01) had direct effects on planning. PBC (ß = 0.28, p < 0.01) and planning (ß = 0.22, p < 0.01) had direct effects on physical activity behavior.

CONCLUSION

The TPB was a useful model for understanding Korean breast cancer survivors' physical activity intentions and behavior. Interventions that can enhance attitudes, subjective norm, PBC, intention, and planning may facilitate physical activity intentions and behaviors in this population.

Connected device and therapeutic patient education to promote physical activity among women with localised breast cancer (DISCO trial): protocol for a multicentre 2×2 factorial randomised controlled trial

INTRODUCTION

Despite safety and benefits of physical activity during treatment of localised breast cancer, successful exercise strategies remain to be determined. The primary objective of the 'dispositif connecté', that is, connected device in English trial is to evaluate the efficacy of two 6-month exercise interventions, either single or combined, concomitant to adjuvant treatments, on the physical activity level of patients with breast cancer, compared with usual care: an exercise programme using a connected device (activity tracker, smartphone application, website) and a therapeutic patient education intervention. Secondary objectives are to evaluate adherence to interventions, their impact at 6 and 12 months, representations and acceptability of interventions, and to assess the cost-effectiveness of the interventions using quality-adjusted life-years.

METHODS AND ANALYSIS

This is a 2×2 factorial, multicentre, phase III randomised controlled trial. The study population (with written informed consent) will consist of 432 women diagnosed with primary localised invasive breast carcinoma and eligible for adjuvant chemotherapy, hormonotherapy and/or radiotherapy. They will be randomly allocated between one of four arms: (1) web-based connected device (evolving target number of daily steps and an individualised, semisupervised, adaptive programme of two walking and one muscle strengthening sessions per week in autonomy), (2) therapeutic patient education (one educational diagnosis, two collective educational sessions, one evaluation), (3) combination of both interventions and (4) control. All participants will receive the international physical activity recommendations. Assessments (baseline, 6 and 12 months) will include physical fitness tests, anthropometrics measures, body composition (CT scan, bioelectrical impedance), self-administered questionnaires (physical activity profile (Recent Physical Activity Questionnaire), quality of life (European Organization for Research and Treatment of Cancer Quality-Of-Life Questionnaire-30, EQ-5D-5L), fatigue (Piper Fatigue Scale-12), social deprivation (Evaluation of Deprivation and Inequalities in Health Examination Centres), lifestyle, physical activity barriers, occupational status) and biological parameters (blood draw).

ETHICS AND DISSEMINATION

This study was reviewed and approved by the French Ethics Committee. The findings will be disseminated to the scientific and medical community via publications in peer-reviewed journals and conference presentations.

TRIAL REGISTRATION NUMBER

NCT03529383; Pre-results.

The association between physical activity, sedentary time and health-related quality of life in cancer survivors

Background

Although physical activity (PA) and sedentary time in cancer survivors (CSs) were associated with health-related quality of life (HRQOL), it was not clear whether their associations were similar among CSs with different number of comorbid chronic diseases (CCDs). This study aimed to investigate the associations between PA, sedentary time and HRQOL in CSs with different number of CCDs.

Methods

A cross-sectional study was conducted among 1546 CSs between June and September 2018 in Shanghai, China. Data were collected with a self-reported questionnaire including sociodemographic characteristics, CCDs, PA, sedentary time and HRQOL. International Physical Activity Questionnaire and Cancer Quality of Life Questionnaire-Core30 were respectively used to measure PA and HRQOL of CSs. Associations of PA and sedentary time with HRQOL among CSs with different number of CCDs were evaluated by using logistic regression, adjusted for confounding factors.

Results

About seventy-five percent CSs had at least one CCD. Approximately three fifths CSs had high PA level and < 4 h/day sedentary time. Moderate PA level and high PA level were shown to be associated with better HRQOL among all participants. In CSs with ≤ 2 CCDs, high PA level was significantly associated with higher scores of physical function and lower scores of nausea and vomiting, appetite loss. However, there was a positive association between high PA level and constipation score among CSs with ≥ 3 CCDs. CSs with shorter sedentary time had better HRQOL in those with CCDs.

Conclusions

High PA level and long sedentary time have significant association with worse HRQOL of CSs with ≥ 3 CCDs, while high PA level is positively associated with HRQOL in CSs with ≤ 2 CCDs. Our findings may support further studies of the causal association between PA, sedentary times and HRQOL to provide targeted proposal to improve the HRQOL of CSs according to their number of CCDs.

Associations of health inequality factors with physical activity and sedentary behaviors in Korean cancer survivors

BACKGROUND

Although physical activity (PA) benefits cancer survivors physically and psychosocially, health inequality may limit these benefits in a subset of cancer survivors, and its association with PA in cancer survivors has not been investigated. Therefore, the purpose of this study is to explore PA levels with regard to health inequality factors (i.e., demographic and socioeconomic profiles) in Korean cancer survivors using the Korean National Health and Nutrition Examination Survey (KNHANES).

METHODS

Data of 900 cancer survivors from the KNHANES in 2014-2017 were used. ANCOVA was used to determine differences in PA and sedentary behavior by healthy inequality factors. Logistic regression was used to estimate the associations of the health inequality factors with meeting the aerobic PA guidelines.

RESULTS

Higher PA was reported in participants who were male (p = 0.004), younger (p = 0.006), and with higher education (p = 0.003). In adjusted logistic regression models, females were 37% less likely to meet the guideline compared to males (p = 0.045). Participants who were ≥ 70 years were 78% less likely to meet the guideline compared to < 50 years (p < 0.001). Compared to participants who graduated from college/university, participants who graduated from high-, middle-, or elementary-school were 50% (p = 0.005), 53% (p = 0.023), and 71% (p < 0.001) less likely to meet the guideline, respectively.

CONCLUSIONS

Lower PA was prevalent in cancer survivors who were female, older, and less educated. Systematic efforts to promote PA are required for targeted cancer subgroups.

Correlates of Aerobic and Strength Exercise in Korean Cancer Patients: Data From the 2014-2016 Korea National Health and Nutrition Examination Survey

BACKGROUND

Understanding the prevalence and correlates of exercise in Korean cancer patients is important to improve their health-related fitness and quality of life.

OBJECTIVE

The aim of this study was to examine the prevalence and correlates of aerobic and strength exercise in Korean cancer patients.

METHODS

Overall, 640 cancer patients from the Korea National Health and Nutrition Examination Survey 2014-2016 were categorized as meeting the exercise guidelines as follows: (a) neither, (b) strength only, (c) aerobic only, or (d) combined. Correlates included demographic, medical, health-related fitness, and quality of life variables. Univariate and stepwise multinomial logistic regression were used for statistical analyses.

RESULTS

Over 70% of Korean cancer patients did not meet either exercise guideline. Higher education was associated with being more likely to meet the combined (odds ratio [OR], 4.69; P < .001), aerobic-only (OR, 3.58; P < .001), and strength-only (OR, 1.87; P = .042) guidelines. Higher hand-grip strength (per 10 kg) was associated with being more likely to meet the combined (OR, 1.78; P = .003) and strength-only (OR, 1.73; P < .001) guidelines. Older age (per 10 years) was associated with being less likely to meet the combined (OR, 0.69; P = .009) and aerobic-only (OR, 0.59; P < .001) guidelines and more likely to meet the strength-only guideline (OR, 1.46; P = .004).

CONCLUSIONS

Exercise levels are very low among Korean cancer patients and are correlated with age, education, and physical strength.

IMPLICATIONS FOR PRACTICE

Oncology nurses in Korea should consider promoting exercise to cancer patients, especially older, less educated, and physically weaker patients.

Physical activity status in relation to quality of life and dietary habits in breast cancer survivors: subset analyses of KROG 14-09 nationwide questionnaire study

PURPOSE

We investigated the relationship of physical activity with dietary habits and quality of life (QoL) in breast cancer survivors in accordance with the recommendations of the American Cancer Society.

METHODS

Data of 928 breast cancer survivors were obtained from the KROG 14-09 study to measure QoL in early phase after adjuvant radiotherapy. According to the extent of physical activity, survivors were divided into four groups: inactivity (0-149 min/week, N = 144), regular activity (150-450 min/week, N = 309), moderate activity (451-900 min/week, N = 229), and marked activity (901-1800 min/week, N = 164) excluding hyperactivity (> 1800 min/week, N = 82) as it is a difficult condition to recommend to survivors. Global physical activity questionnaire, 5-dimensional questionnaire by EuroQoL (EQ-5D-3L), QoL Questionnaire-breast cancer (QLQ-BR23) from EORTC, and dietary habits were surveyed. A linear-to-linear association test for EQ-5D-3L and Kruskal-Wallis analysis for QLQ-BR23 and dietary habit were conducted.

RESULTS

Overall, 15.5% respondents (144/928) were classified as physically inactive. The trends of frequent intake of fruits (p = 0.001) and vegetable (p = 0.005) and reluctance toward fatty food (p < 0.001) were observed in physically active groups. Mobility (p = 0.021) and anxiety (p = 0.030) of EQ-5D-3L, and systemic therapy side effect (p = 0.027) and future perspective (p = 0.008) of QLQ-BR23 were better in physically active groups besides body image (p = 0.003) for the survivors with breast-conserving surgery. However, moderate and marked activities did not further improve QoL than regular activity.

CONCLUSION

Physicians and care-givers have to pay attention to inactive survivors to boost their physical activity, thereby facilitating a better QoL and dietary habit.

Motivation and preferences of cancer patients to perform physical training

OBJECTIVE

The aims of this cross-sectional study were to investigate the knowledge about and experience with exercise as well as the motivation and preferences (e.g. availability) of cancer patients to participate in training groups.

METHODS

From 11/2017-06/2018, 181 cancer patients undergoing or completing treatment responded to a compiled questionnaire. The stage of motivation (transtheoretical model of behavioural change), exercise-related knowledge, experience and preferences were evaluated.

RESULTS

Knowledge about the positive effects of exercise was not associated with higher motivation stages. Higher motivation stages showed significant correlations with age (p = 0.044), exercise experience before cancer disease onset (p = 0.022) and exercise experience during cancer therapy (p = 0.013). For 59% of patients, group offers were an attractive option. Physically inactive patients preferred specialised cancer exercise groups (p = 0.002), whereas physically active patients preferred cross-disease rehabilitation exercise groups (p = 0.034) and exercise groups with healthy people (p = 0.018).

CONCLUSIONS

Results indicate that motivation of cancer patients for exercise depends on their experiences with physical training before and during disease treatment. Motivation could be increased by integrating exercise programmes during cancer therapy. These programmes should focus on patients inexperienced in physical training.