Prospective, longitudinal study of leisure-time exercise in women with early-stage breast cancer

Energy balance in cancer survivors at risk of weight gain: a review

PURPOSE

The study of energy balance [i.e., energy intake (EI) and energy expenditure (EE)] is a powerful tool for understanding body weight regulation and may contribute to our understanding of rapid weight gain risk in certain cancer survivors post-diagnosis. The purpose of this review was to summarize studies that assessed longitudinal, prospective changes in components of energy balance from diagnosis/start of treatment to any duration of follow-up in cancer survivors with prior evidence of weight gain (breast, prostate, thyroid, gynecologic, testicular, and acute lymphoblastic leukemia) RESULTS: The available literature suggests that energy balance components may be altered in cancer survivors who have a heightened risk of weight gain post-diagnosis. The evidence for EI was overall inconsistent. Conversely, decreases in resting and physical activity EE during the active phases of treatment (e.g., chemotherapy, hypothyroid state) were commonly noted, which then slowly rebounded towards baseline levels at the end of treatment and during follow-up assessments. Much of this evidence is based on data collected from breast cancer survivors, which highlights a paucity of data currently available on other cancer types.

CONCLUSIONS

While there is growing acknowledgement that weight management interventions in cancer survivors are needed, it is important to recognize that changes in both behavioral (EI, physical activity EE) and passive (resting EE, thermic effect of food) components of energy balance may occur post-diagnosis. This information can help to inform weight management interventions which often entail modifications in diet and/or physical activity.

A longitudinal study of physical activity among Malaysian breast cancer survivors

Regular physical activity (PA) after a breast cancer diagnosis is associated with reduced mortality and better quality of life. In this prospective cohort study, we aimed to explore the trends of PA among breast cancer survivors over three years and identify factors associated with low PA. Interviews on 133 breast cancer patients were conducted at baseline, one and three years after the diagnosis of breast cancer at University Malaya Medical Centre in Kuala Lumpur. Physical activity was measured by using the Global Physical Activity Questionnaire. PA was categorised as active (≥ 600 MET-min/week) and inactive (<600 MET-min/week). We used the generalised estimating equation method to examine PA levels and factors affecting PA longitudinally. The survivors' mean age was 56.89 (±10.56) years; half were Chinese (50.4%), and 70.7% were married. At baseline, 48.1% of the patients were active, but the proportion of active patients declined to 39.8% at one year and 35.3% in the third year. The mean total PA decreased significantly from 3503±6838.3 MET-min/week to 1494.0±2679.8 MET-min/week (one year) and 792.5±1364 MET-min/week (three years) (p<0.001). Three years after diagnosis (adjusted odds ratio [AOR]: 1.74, p = 0.021); Malay ethnicity (AOR: 1.86, p = 0.042) and being underweight (AOR: 3.43, p = 0.004) were significantly associated with inactivity. We demonstrated that breast cancer survivors in Malaysia had inadequate PA levels at diagnosis, which decreased over time. Thus, it is vital to communicate about the benefits of PA on cancer outcomes and continue to encourage breast cancer survivors to be physically active throughout the extended survivorship period, especially in the Malay ethnic group and underweight patients.

Adherence to Mediterranean Diet and Nutritional Status in Women with Breast Cancer: What Is Their Impact on Disease Progression and Recurrence-Free Patients' Survival?

Introduction: Nutritional status impacts the survival of patients with cancer. There are few studies that investigate the role of nutritional status on breast cancer survival in women with breast cancer, and even fewer regarding the impact of adhering to the Mediterranean diet (MD). The present study aims to assess the nutritional status, MD adherence, physical activity levels and health-related quality of life (HRQOL) in women diagnosed with breast cancer and evaluate these parameters regarding recurrence-free survival. Methods: A total of 114 women, aged 35-87 years old, diagnosed with breast cancer in Larissa, Greece, participated in the study. Tumor histopathology was reported, and anthropometric indices were measured by a trained nurse, while questionnaires regarding nutritional status (via mini nutritional assessment), HRQOL via EORTC QLQ-C30, physical activity levels via IPAQ and Mediterranean diet adherence via MedDietScore were administered. The participants were followed-up for a maximum time interval of 42 months or until recurrence occurred. Results: A total of 74% of patients were overweight or obese, while 4% of women were undernourished, and 28% were at risk of malnutrition. After 42 months of follow-up, 22 patients (19.3%) had relapsed. The median time to recurrence was 38 months (IQR: 33-40 months) and ranged between 23 to 42 months. Higher levels of MD adherence were significantly associated with lower body mass index (BMI) values, earlier disease stage, smaller tumor size, absence of lymph node metastases and better physical activity levels (p < 0.05). Normal nutritional status was significantly associated with higher BMI values and better health-related quality of life (p ≤ 0.05). In univariate analysis, patients with higher levels of MD adherence and well-nourished patients had significantly longer recurrence-free survival (p < 0.05). In multivariate analysis, MD adherence and nutritional status were independently associated with recurrence-free patients' survival after adjustment for several confounding factors (p < 0.05). Conclusions: The impact of MD on time to recurrence is still under investigation, and future interventional studies need to focus on the role of adhering to the MD before and after therapy in survival and breast cancer progression. Furthermore, the present study also highlights the importance of an adequate nutritional status on disease progression, and the need for nutritional assessment, education and intervention in women with breast cancer.

Breast cancer survivors’ physical activity and experiences while transitioning to a virtual cardiovascular rehabilitation program during a pandemic (COVID-19)

Breast cancer accounts for 25% of all cancers among Canadian females. Despite successes of decreased mortality, adverse treatment effects, such as cardiotoxicity, contribute to a sedentary lifestyle and decreased quality of life. Physical activity (PA) is a possible therapy for the late effects; however, COVID-19 restricted access to in-person cardiovascular rehabilitation (CR) programs. The purposes are as follows: (1) compare PA of breast cancer survivors’ in-person CR to virtual CR following a transition during COVID-19 and (2) compare the PA of the pandemic cohort to a matched cohort who had completed the program in 2018/2019; (3) explore survivors’ experiences of transitioning to and engaging in virtual CR. Mixed methods included analysis of CR PA data from a pandemic cohort (n = 18) and a 2018/2019 cohort (n = 18) and semi-structured focus group interviews with the pandemic cohort (n = 9) in the context of the PRECEDE-PROCEED model. After the transition, there were no significant differences in mean activity duration, frequency, and cumulative activity (expressed as MET-minutes) (p > 0.05). However, variation of PA duration doubled following the transition from in-person to virtual (p = 0.029), while for the 2018/2019 cohort, variation remained unchanged. Focus groups revealed that women valued their CR experiences pre-COVID-19 and had feelings of anxiety during the transition. Perceived factors affecting participation were environmental, personal, and behavioural. Recommendations for virtual programs were to increase comradery, technology, and professional guidance. PA experiences during a transition to virtual care prompted by a pandemic vary among breast cancer survivors. Targeting individualised strategies and exercise prescriptions are important for improving PA programs and patient outcomes.

Continuous, objective measurement of physical activity during chemotherapy for breast cancer: the Activity in Treatment pilot study

Despite many potential benefits of physical activity during and after breast cancer treatment, activity levels typically decline from pre- to posttreatment. Most previous research has relied on self-reported activity. The purpose of this study were to assess patterns of daily, to objectively measured physical activity throughout chemotherapy for breast cancer, and to identify predictors of physical activity patterns. Participants were given a Fitbit before starting chemotherapy and asked to wear it throughout chemotherapy. Restricted cubic splines assessed nonlinear patterns of Fitbit measured total physical activity (TPA) and moderate-to-vigorous physical activity (MVPA) throughout the duration of chemotherapy (mean = 17 weeks, standard deviation [SD] = 6.3). Mixed-effects regression models assessed the rate of physical activity decline. Regressions of subject-level random slope assessed predictors of the rate of physical activity decline on participant and cancer characteristics and self-reported physical and cognitive functioning. Participants (n = 32) were on average 50 years old; the majority had stage II breast cancer. MVPA declined linearly at a mean rate of 1.4 min/day (p = .002) for every 10% of chemotherapy completed, whereas TPA declined linearly at an average rate of 13.4 min/day (p = .0007) for every 10% of chemotherapy completed, until around halfway through chemotherapy, when activity rates leveled off. HER+ receptor status was associated with a greater rate of MVPA decline, β = 13.3, p = .04. This novel study of objectively measured daily MVPA throughout chemotherapy showed that most reductions in activity occurred during the first half of a course of chemotherapy. Targeting this early period of chemotherapy may be important for preventing declines in activity levels throughout chemotherapy.

Comparing the Effectiveness of a Wearable Activity Tracker in Addition to Counseling and Counseling Only to Reinforce Leisure-Time Physical Activity among Breast Cancer Patients: A Randomized Controlled Trial

This randomized controlled trial aimed to compare the effectiveness of a wearable activity tracker (WAT) in addition to counseling (WAT+counseling) and counseling only for reinforcing leisure-time physical activity (LTPA) among breast cancer patients during radiotherapy (RT). A total of 152 breast cancer patients who were planning to undergo radiation therapy (RT) after surgery participated in the study. The WAT+counseling group (n = 76) underwent physical activity (PA) self-monitoring using a WAT and participated in counseling. The counseling-only group (n = 76) received telephone counseling once a week during RT and did not receive WAT. The WAT+counseling group had increased relative change in self-reported LTPA (102.8) compared with the counseling-only group (57.8) immediately after RT compared to baseline. Although the relative changes of self-reported LTPA of the WAT+counseling group were higher at three and six months after the end of RT compared to in the counseling-only group, the results were not significant. The mean average daily step count of the WAT+counseling group was 9351.7, which increased to 11,592.2 during RT and 12,240.1 after RT. In the subgroup analysis, patients who did not perform regular PA before cancer diagnosis had significantly increased step counts. This study shows the feasibility of WAT with counseling to reinforce PA among breast cancer patients.

Congruence and trajectories of device-measured and self-reported physical activity during therapy for early breast cancer

Purpose

This study examines congruence between self-reported and device-measured physical activity data in women with early breast cancer and compares trajectories under different treatments.

Methods

Women with non-metastatic breast cancer were recruited before primary therapy. In four weeks distributed over six months after treatment start, patients reported time spent on work, transport, chores and sports via diary and wore Garmin^® vivofit 3 accelerometers to assess steps taken. Associations between these measures and agreement regarding guideline adherence were tested with Spearman’s Correlation Coefficient and Weighted Kappa statistic. Effects of time and treatment were evaluated using mixed analyses of variance.

Results

Ninety-nine participants (median age = 50) were treated with adjuvant (N= 23), neoadjuvant (N= 21) or without chemotherapy (N= 55). Coherence between self-report and device data was strong (r = 0.566). Agreement about reaching recommendations was only “fair” (kappa coefficient = 0.321 and 0.249, resp.). Neither treatment or week nor their interaction had effects on step counts (all p > 0.05). Self-reported activity time was lower for patients with chemotherapy than for those without (adjuvant: ∆ = 69min, p= 0.006, neoadjuvant: ∆ = 45min, p= 0.038) and lower in week 18 than in week 3 (∆ = 43min, p= 0.010).

Conclusion

Results show that consumer-grade activity monitors and self-reports correlate but show different perspectives on physical activity in breast cancer patients. In general, patients perceive some decline regardless of primary treatment regimen. Those affected should be offered assistance to gain the benefits of activity. Accelerometers may help professionals to identify these individuals and patients to verify appraisal of their activity levels.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10549-021-06195-7.

Relationship between weight gain and survival rate in patients with metastatic lung cancer

Background: Lung cancer accounts for about 13% of all cancers and about 60% of patients with lung cancer also experience weight loss during treatment. There seems to be a clear correlation between the therapeutic outcomes of patients based on their weight changes during treatment. The aim of this study was to investigate the relationship between weight changes during and after treatment and the therapeutic outcomes of a patient with metastatic lung cancer.

Methods: This cohort study was performed on patients with the diagnosis of non-surgical metastatic lung cancer referred to Hematology and Oncology Clinic, Rasoul-e-Akram Hospital. Patients were divided into two groups with a weight gain of more than 5% and a weight gain of 5% and less. The information was entered into the SPSS version 21 software. In the descriptive analysis, mean and standard deviation (SD) were used. To compare quantitative variables, independent samples t-test, Mann-Whitney, chi-square or Fisher exact tests were used to compare qualitative variables and correlation test was used to determine the correlation between quantitative data. Survival curves were used to show differences in two groups of studies. A regression model was used to calculate the hazard ratio. The significance level was less than 0.05.

Results: Sixty patients, including 40 males (66.7%) and 20 females (33.3%) were studied. The mean age of patients was 62.22±9.00 years (43-83 years). The mean weight changes in the patients were -1.28±6.11 kg (-16 to 16kg). Forty-seven patients (78.3%) had weight gain less than 5%. There was no significant difference in overall survival (OS) and progression-free survival (PFS) according to weight gain.

Conclusion: Finally, the findings of the study showed that, despite the fact that PFS and OS in the weight gain group were greater than 5% of the original weight; the difference was not statistically significant.

Longitudinal changes in sports activity from pre-diagnosis to first five years post-diagnosis: a prospective Chinese breast cancer cohort study

Background

To compare change in level of physical activity between pre-and post- diagnosis of breast cancer in Chinese women.

Methods

Based on an on-going prospective study consisting of a sample of Chinese women with breast cancer, a validated modified Chinese Baecke questionnaire was used to measure physical activity at baseline (12 months before cancer diagnosis), 18-, 36- and 60-months after diagnosis (over the previous 12 months before each interview).

Results

In our cohort of 1462 Chinese women with a mean age of 52 years, the mean level of physical activity at post-diagnosis was 9.6 metabolic equivalent of task (MET)-hours/week, which was significantly higher than that at pre-diagnosis with mean level of 5.9 MET-hours/week (P < 0.001). The mean levels of physical activity at 18-, 36- and 60-months follow-up were 9.9, 9.8 and 9.3 MET-hours/week, respectively. There was no significant difference between any two of the three follow-ups at post-diagnosis. The proportions of participant who met World Cancer Research Fund/ American Institute for Cancer Research (WCRF/AICR) recommendation before and after cancer diagnosis were both low, being 20.7 and 35.1%, respectively. Compared to pre-diagnosis, most of the patients improved or had no change on level of physical activity at post-diagnosis, with the respective proportion being 48.2 and 43.8%.

Conclusions

Adherence to current lifestyle recommendation for cancer survivors, Chinese women with breast cancer significantly increased level of physical activity level after cancer diagnosis, and such improvement was sustained to 5 years post-diagnosis. The proportion of patients who met the exercise recommendation for cancer survivors was still low. Encouraging patients on the importance of durable high level of physical activity in breast cancer survivorship is warranted.

Daily Physical Activity and Symptom Reporting in Breast Cancer Patients Undergoing Chemotherapy: An Intensive Longitudinal Examination

BACKGROUND

Increased activity is beneficial during chemotherapy, but treatment-related symptoms may be a barrier. This study examines the relationship between daily fluctuations in symptoms and activity during chemotherapy.

METHODS

Women undergoing chemotherapy for breast cancer [n = 67; M _age = 48.6 (SD = 10.3)] wore an accelerometer 24 hours/day and received four text prompts/day to rate symptoms for 10 consecutive days at the beginning, middle, and end of chemotherapy. Mixed-effects models were used to examine the between and within-person relationships between symptom ratings on a given day and moderate to vigorous physical activity (MVPA) and light physical activity (LPA) on that day and the following day controlling for relevant covariates and using the Bonferroni correction for multiple comparisons.

RESULTS

For MVPA and LPA, within-person associations were statistically significant for same day affect, fatigue, pain, walking, activities of daily living (ADL) physical function, and cognitive function. Previous day anxiety was associated with next day LPA. Every one point worse symptom rating than an individual's overall average was associated with: (i) between 1.49 (pain) and 4.94 (fatigue) minutes less MVPA and between 4.48 (pain) and 24.72 (ADL physical function) minutes less LPA that day, and (ii) 11.28 minutes less LPA the next day. No between-person effects were significant for MVPA or LPA.

CONCLUSIONS

Daily within-person variations in symptoms were associated with MVPA and LPA during chemotherapy for breast cancer.

IMPACT

Future work should explore relationships between symptoms and activity further and identify whether tailoring to symptoms enhances efficacy of physical activity promotion interventions during chemotherapy.

Bridging the gap: incorporating exercise evidence into clinical practice in breast cancer care

PURPOSE

To determine the feasibility (recruitment, retention, and adherence rates) of implementing a multi-dimensional knowledge translation (KT) intervention designed for women with breast cancer, and to explore preliminary estimates of effects of the implementation strategy on exercise level, exercise knowledge and behavior, health-related quality of life, and overall health status among breast cancer survivors.

METHODS

Design: Implementation Trial.

PARTICIPANTS

Community-dwelling women, over 18 years of age, currently undergoing chemotherapy for stage 1-3 BRCA. Randomization and Blinding: A blinded researcher randomized participants on a record-by-record basis to the intervention or control group. A researcher blinded to the group allocation of the participants conducted the statistical analysis. Intervention Group: Eight sessions of moderate intensity aerobic exercise along with eight self-management modules were delivered during chemotherapy within the cancer institution.

CONTROL GROUP

Usual care.

PRIMARY OUTCOME

Feasibility of implementation strategy measured through recruitment, retention, and adherence rates.

RESULTS

Twenty-nine women were screened for this study. Twenty-seven met inclusion criteria and twenty-six participants were enrolled in the study. The implementation strategy was determined to be feasible and had a recruitment rate of 96%, retention rate of 100%, and adherence rate of 89%. The intervention group had significantly higher exercise levels (mean difference = 25.38, 95%CI = (9.35, 41.42)) post-intervention compared with the control group. No adverse events were reported.

CONCLUSIONS

The implementation of this KT intervention is feasible and demonstrates preliminary effects for secondary outcomes for women with breast cancer during chemotherapy. Findings support the implementation of this intervention in a multi-center trial.

TRIAL REGISTRATION

NCT03087461.

Acute physical exercise in humans enhances reconsolidation of emotional memories

Increasing evidence suggests that when a memory is reactivated through retrieval, it becomes temporarily vulnerable to environmental or pharmacological manipulation, which can consequently update or strengthen the memory. Physical exercise has been shown to modulate the maintenance of fear memories in animals following memory reactivation. This study investigated the effect of intense exercise in modulating the reconsolidation of trauma memories. Fifty-four undergraduate students watched a trauma film depicting the aftermath of a highway car crash. Two days later, participants engaged in either (a) 20-25min of incremental cycling following a memory reactivation induction (Reactivation/Exercise), (b) 20-25min of mild cycling (Reactivation/No Exercise) following memory reactivation, or (c) 20-25min of incremental cycling but no memory reactivation (No Reactivation/Exercise). Saliva samples were collected to index salivary amylase and cortisol at baseline and post activity. Participants completed memory questionnaires relating to declarative and intrusive memory recall two days after memory reactivation. Reactivation/Exercise participants recalled more central details of the trauma film relative to other participants. Increased cortisol predicted better total memory recall in the Reactivation/Exercise, but not in the other conditions. These findings suggest that intense exercise during the period of memory reactivation enhances subsequent trauma memory, and provides human evidence consistent with recent findings of exercise-induced fear reconsolidation in animals.

Posttreatment trajectories of physical activity in breast cancer survivors

BACKGROUND

Breast cancer survivors face a risk of disease recurrence and a higher risk of developing comorbidities such as cardiovascular disease when compared with the general population. Physical activity (PA) has been shown to reduce such risks. The current analyses sought to identify: 1) unique patterns of PA among breast cancer survivors; and 2) characteristics associated with the level of PA.

METHODS

A total of 548 women reported PA and sociodemographic, health-related, and psychosocial factors at 3 time points, 6 months apart, after primary treatment of breast cancer. Cancer-related factors were obtained from chart reviews. Finite mixture modeling was used to examine trajectory groups of moderate-intensity to vigorous-intensity PA (MVPA) in the early posttreatment period. The authors then examined the characteristics associated with trajectory group membership.

RESULTS

Three groups with distinct, stable patterns of PA were identified: the low MVPA (42.5% of patients), medium MVPA (45.5% of patients), and high MVPA (12.0% of patients) groups. In a multivariable setting, compared with more active breast cancer survivors, the least active group was found to have a higher body mass index, were less likely to report alcohol consumption, were more likely to smoke cigarettes, and had worse physical functioning and vitality scores. Cancer treatment-related factors did not significantly predict group membership.

CONCLUSIONS

A large percentage of breast cancer survivors remain physically inactive after treatment, suggesting the need for interventions to reduce morbidity and mortality in this population. Cancer 2017;123:2773-80. © 2017 American Cancer Society.

Randomized Face-to-Face vs. Home Exercise Interventions in Pregnant Women with Gestational Diabetes

OBJECTIVES

Evaluate effects of a theoretically-based, semi-intensive (Face-to-Face; F2F) exercise intervention and minimum-contact (Home) exercise intervention to the standard care (Control) on exercise, its motivational determinants, blood glucose levels, and insulin use of pregnant women with gestational diabetes mellitus (GDM).

DESIGN

Randomized control trial with two intervention arms and control (standard care).

METHOD

Participants (N=65) were randomized to a Control (standard prenatal care/GDM dietary counseling), Home (standard care + phone education/support + home exercise), or F2F (standard care + on-site education/support + guided exercise with instructor on 2 days/week) group from ~20 weeks gestation to delivery. Assessments of exercise and motivational determinants were obtained at baseline (20-weeks gestation) and follow-up (32-weeks gestation). Blood glucose levels (fasting/postprandial mg/dL) and insulin use were extrapolated from medical records.

RESULTS

At the 32-week follow-up, the F2F group had significantly higher exercise min, pedometer steps/day, and motivational determinants (attitude, subjective norm, perceived control, intention) than controls (p's < .05) and significantly higher exercise min and subjective norm than the Home group (p's < .05); these effect sizes were medium-large (η2 = .11-.23). There was a medium effect (η2 = .13) on postprandial blood glucose at 36-weeks gestation with the F2F group having lower values than controls. Although not significant, the F2F group started insulin later (33 weeks gestation) than the Home (27 weeks) and Control (31 weeks) groups.

CONCLUSION

A theoretically-based, F2F exercise intervention has multiple health benefits and may be the necessary approach for promoting exercise motivation and behavior among GDM women.

Brief exercise enhances intrusive memories of traumatic stimuli

Brief physical exercise enhances memories for neutral events, and recently has been shown to modulate fear learning in animals. To date there is no evidence pertaining to the impact of exercise on emotional memories in humans. Accordingly, this study investigated the role of brief exercise in the development of emotional intrusive memories. Forty-nine university students (18-29year olds) viewed a car accident film depicting accident and injury, and were then randomly assigned to engage in either 10min of intense exercise or easy walking. Two days following the experiment participants were assessed for both intrusive memories of the film and intentional recall of film details. Results indicated that participants in the exercise relative to the walking condition reported more intrusive memories, but not voluntarily recalled memories, of the car accident film two days later. These findings are consistent with recent evidence of exercise-induced emotional learning in animals, and point to the potential for physical activity to contribute to the development of intrusions in the context of encoding emotionally-laden information.

Role of BDNF val66met polymorphism in modulating exercised-induced emotional memories

Brief physical exercise enhances memories for neutral events, and modulates fear learning in animals. Exercise-induced arousal induces the release of brain-derived neurotrophic factor (BDNF), which may moderate memory-enhancing effects. This study investigated the effect of exercise, and the extent to which the BDNF val66met polymorphism (which limits BDNF activity-dependent secretion) influenced emotional memories. Sixty-two healthy participants were randomly assigned to either 10min of intense exercise (n=31) or slow walking (control condition; n=31), and then immediately viewed positive and negative images. Saliva samples were collected to index salivary cortisol, and to determine BDNF val66met genotype. Participants completed memory questionnaires two days later. Participants in the exercise had a significant increase in cortisol, and recalled more emotional images relative to the walking condition. Regression analyses indicated that the interaction between the BDNF val/val allele and cortisol response predicted stronger emotional memory in the exercise condition. These findings are consistent with evidence of acute exercise-induced emotional learning in animals, and suggests that a genetic predisposition involving BDNF may be important in determining the impact of acute exercise on emotional memory formation.

Strength Training to Enhance Early Recovery after Hematopoietic Stem Cell Transplantation

Intensive cancer treatment followed by hematopoietic stem cell transplantation (HCT) results in moderate to severe fatigue and physical inactivity, leading to diminished functional ability. The purpose of this study was to determine the efficacy of an exercise intervention, strength training to enhance early recovery (STEER), on physical activity, fatigue, muscle strength, functional ability, and quality of life after HCT. This single-blind, randomized clinical trial compared strength training (n = 33) to usual care plus attention control with health education (UC + AC with HE) (n = 34). Subjects were stratified by type of transplantation and age. STEER consisted of a comprehensive program of progressive resistance introduced during hospitalization and continued for 6 weeks after hospital discharge. Fatigue, physical activity, muscle strength, functional ability, and quality of life were assessed before HCT hospital admission and after intervention completion. Data were analyzed using split-plot analysis of variance. Significant time × group interactions effects were noted for fatigue (P = .04). The STEER group reported improvement in fatigue from baseline to after intervention whereas the UC + AC with HE group reported worsened fatigue from baseline to after intervention. Time (P < .001) and group effects (P = .05) were observed for physical activity. Physical activity declined from baseline to 6 weeks after hospitalization. The STEER group was more physically active. Functional ability tests (timed stair climb and timed up and go) resulted in a significant interaction effect (P = .03 and P = .05, respectively). Subjects in the UC + AC with HE group were significantly slower on both tests baseline to after intervention, whereas the STEER group's time remained stable. The STEER group completed both tests faster than the UC + AC with HE group after intervention. Study findings support the use of STEER after intensive cancer treatment and HCT. Strength training demonstrated positive effects on fatigue, physical activity, muscle strength, and functional ability. The exact recovery patterns between groups and over time varied; the STEER group either improved or maintained their status from baseline to after intervention (6 weeks after hospital discharge) whereas the health education group generally declined over time or did not change.

Impact of Body Weight and Body Composition on Ovarian Cancer Prognosis

Measures of body weight and anthropometrics such as body mass index (BMI) are commonly used to assess nutritional status in clinical conditions including cancer. Extensive research has evaluated associations between body weight and prognosis in ovarian cancer patients, yet little is known about the potential impact of body composition (fat mass (FM) and fat-free mass (FFM)) in these patients. Thus, the purpose of this publication was to review the literature (using PubMed and EMBASE) evaluating the impact of body weight and particularly body composition on surgical complications, morbidity, chemotherapy dosing and toxicity (as predictors of prognosis), and survival in ovarian cancer patients. Body weight is rarely associated with intra-operative complications, but obesity predicts higher rates of venous thromboembolism and wound complications post-operatively in ovarian cancer patients. Low levels of FM and FFM are superior predictors of length of hospital stay compared to measures of body weight alone, but the role of body composition on other surgical morbidities is unknown. Obesity complicates chemotherapy dosing due to altered pharmacokinetics, imprecise dosing strategies, and wide variability in FM and FFM. Measurement of body composition has the potential to reduce toxicity if the results are incorporated into chemotherapy dosing calculations. Some findings suggest that excess body weight adversely affects survival, while others find no such association. Limited studies indicate that FM is a better predictor of survival than body weight in ovarian cancer patients, but the direction of this relationship has not been determined. In conclusion, body composition as an indicator of nutritional status is a better prognostic tool than body weight or BMI alone in ovarian cancer patients.

Effects of exercise intervention in breast cancer survivors: a meta-analysis of 33 randomized controlled trails

Background

Exercise is associated with favorable outcomes in cancer survivors. The purpose of this meta-analysis is to comprehensively summarize the effects of exercise intervention in breast cancer survivors.

Methods

A systematic search of PubMed, Elsevier, and Google scholar was conducted up to March 2015. References from relevant meta-analyses and reviews were also checked.

Results

Thirty-three randomized controlled trials were included in this meta-analysis, including 2,659 breast cancer survivors. Compared with the control group, quality of life was significantly improved in exercise intervention group, especially in mental health and general health subscales of short form 36 questionnaire, as well as emotion well-being and social well-being subscales of the Functional Assessment of Cancer Therapy. Besides, exercise alleviated the symptoms of depression and anxiety in the exercise group. Furthermore, exercise was also associated with positive outcomes in body mass index, lean mass, and muscle strength. In addition, the serum concentration of insulin, insulin-like growth factor-II, and insulin-like growth factor binding protein-1 was significantly reduced in exercise intervention group. However, based on the current data of this meta-analysis, there were no significant differences in sleep dysfunction or fatigue between groups.

Conclusion

Our study suggested that exercise intervention was beneficial to breast cancer survivors. Therefore, exercise should be recommended to this patient group.

The use of the Godin-Shephard Leisure-Time Physical Activity Questionnaire in oncology research: a systematic review

BACKGROUND

The Godin-Shephard Leisure-Time Physical Activity Questionnaire (GSLTPAQ) is one of the most often used questionnaires in oncology research, yet modifications to the scale are done with little evidence of psychometric testing. This study aimed to (i) document the frequency of use of the questionnaire for ranking (i.e., level of activity) and classification (i.e., active versus insufficiently active) purposes, (ii) summarize how the GSLTPAQ is used in terms of item content and scoring, and (iii) evaluate the extent to which validity evidence supports the use of the scale among cancer survivors.

METHODS

A systematic review was conducted with evidence drawn from English-written articles published between January 1(st) 1985 (year the GSLTPAQ was published) and December 31, 2014. A search of six databases, a scan of reference list of included articles, and a cited reference search identified articles that reported using the GSLTPAQ among cancer survivors.

RESULTS

A total of 212 articles were retrieved. The GSLTPAQ was used for classifying cancer survivors into active and insufficiently active categories in 51 % of the articles. Moreover, a modified version of the questionnaire was used in 81 % of the research studies. Three studies reported validity evidence based on the relationship between the scores on the GSLTPAQ (i.e., leisure score index, LSI) and accelerometer or pedometer-derived activity data. Validity evidence supporting the use of the GSLTPAQ for assessing changes in LSI was computed from six randomized trials.

CONCLUSIONS

The use of the GSLTPAQ for classification purpose in oncology research is common. Standardization in the use and interpretation of the GSLTPAQ in oncology research is warranted. Although limited, there is support for using the original form of the GSLTPAQ and interpreting the LSI for ranking cancer survivors from the lowest to highest levels of leisure-time physical activity.

Feasibility of a pedometer-based walking program for survivors of breast and head and neck cancer undergoing radiation therapy

PURPOSE

This pilot study assessed the feasibility and acceptability of a pedometer-based walking program for people with breast cancer and head and neck cancer (HNC) undergoing radiation therapy treatment.

METHODS

Participants were given a pedometer and prescribed a home-based walking program that included an individualized weekly step-count goal during the 3- to 5-week course of radiation therapy. Feasibility was determined by calculating recruitment rate, completion rate, and rate of adherence. Secondary outcomes included 6-minute walk test (6MWT) distance, step count, physical activity level, and psychological outcomes of depression, happiness, self-esteem, and sleep quality.

RESULTS

A total of 21 participants were recruited. All participants completed the study; adherence to prescribed step counts was 91% at follow-up. Analysis found a significant improvement in happiness, as measured by the Oxford Happiness Questionnaire (mean difference 0.3, p=0.003), and a borderline significant improvement in 6MWT distance (mean difference 35 m, p=0.008).

CONCLUSION

This pilot study demonstrated the feasibility of a pedometer-based walking program for survivors of breast cancer and HNC undergoing radiation therapy.

Validation of the Godin-Shephard Leisure-Time Physical Activity Questionnaire classification coding system using accelerometer assessment among breast cancer survivors

PURPOSE

The aim of this research was to provide convergent validity evidence for the use of the Godin-Shephard Leisure-Time Physical Activity Questionnaire (GSLTPAQ) to classify breast cancer survivors into active and insufficiently active categories.

METHODS

Data were collected among a sample of breast cancer survivors (N = 199; mean age = 55 years) to examine the association between physical activity assessed with a GT3X triaxial accelerometer and the use of the GSLTPAQ's coding system recently proposed by Godin (2011). Participants self-reported moderate and vigorous physical activity (MVPA) performed in a typical week on the GSLTPAQ and those with MVPA leisure score index ≥ 24 were classified as active.

RESULTS

ANCOVA revealed that the adjusted mean [95% CI] number of recorded MVPA minutes was higher for respondents classified as active (145.54 [127.26; 163.83]) compared to respondents classified as insufficiently active (86.99 [74.04; 99.94]). The GSLTPAQ and accelerometer classified 33.8 and 27.2% of participants as active, respectively (agreement = 70.8%). Sensitivity and specificity values were 75.3 and 58.5%, respectively.

CONCLUSION

The GSLTPAQ can be used to classify cancer survivors into active and insufficiently active categories in reference to cancer survivors' physical activity guidelines. However, it has greater capacity to correctly identify insufficiently active respondents.

IMPLICATIONS FOR CANCER SURVIVORS

The use of the GSLTPAQ's classification coding in oncology research could improve the quality of physical activity recommendations and interventions handed out to cancer survivors.

Exercise in breast cancer patients: impact on health

SUMMARY 

As a consequence of breast cancer diagnosis and treatment side effects, many patients reduce their physical activity, resulting in physical deconditioning. However, it has been shown that both aerobic and resistance exercise are feasible and safe throughout the breast cancer continuum. Exercise can reduce fatigue, depression and anxiety, improve quality of life and self-esteem, as well as cardiorespiratory fitness, muscle strength, physical functioning and body composition. In addition, as early-stage breast cancer patients may be at higher risk for cardiac events owing to cardiotoxic therapy, exercise can mitigate cardiovascular impairments. There is increasing evidence that higher physical activity levels are associated with improved overall survival after breast cancer; therefore, patients should receive support and be encouraged to engage in exercise training during and after cancer treatment.

Hot flashes severity, complementary and alternative medicine use, and self-rated health in women with breast cancer

CONTEXT

Hot flashes (HF) are a common distressing symptom in women with breast cancer (BC). Current pharmacologic options are moderately effective and are associated with bothersome side effects. Complementary and alternative medicine is commonly used by cancer patients. However, information on the association of hot flashes severity with such use and self-rated health is lacking.

OBJECTIVE

To examine the hot flashes severity in women with breast cancer and its association with complementary and alternative medicine use and self-rated health (SRH).

DESIGN

Longitudinal multicenter study to assess information needs of cancer outpatients.

PARTICIPANTS

Patients with a diagnosis of breast cancer who were scheduled to undergo chemotherapy and/or radiotherapy.

OUTCOME MEASURES

Hot flashes severity (0 = not present and 10 = as bad as you can imagine), use of complementary and alternative medicine (yes/no), and self-rating of health (SRH) status post-treatment and six-months thereafter (1-5, higher score = better SRH).

RESULTS

The majority of women with HF (mean age = 54.4 years) were Caucasian and married, with higher education, and 93% had received surgical treatment for BC. At the end of treatment, 79% women reported experiencing HF [mean severity = 5.87, standard deviation (SD) = 2.9]; significantly more severe HF were reported by younger women with poor SRH, poor performance status, and those reporting doing spiritual practices. At follow-up, 73% had HF (mean severity = 4.86, SD = 3.0), and more severe HF were reported by younger women with poor self-rated health who had undergone chemotherapy plus radiotherapy, used vitamins, and did not exercise.

CONCLUSIONS

A high percentage of women experienced hot flashes at the end of treatment and at six-month follow-up. A significant association of hot flashes severity with spiritual practice, increased vitamin use, and reduced exercise emphasize the need for future studies to confirm the results. This can facilitate safe use of complementary and alternative medicine and favorable outcomes while managing cancer-related hot flashes.

Energy balance and metabolism after cancer treatment

Unfavorable physiological, biological, and behavioral alterations during and following treatment for cancer may lead to chronic energy imbalance predisposing to a myriad of deleterious health conditions including obesity, dyslipidemia, and the metabolic syndrome. In addition to the cardiovascular and musculoskeletal effects of these conditions, energy imbalance and metabolic changes after cancer treatment can also affect cancer-related morbidity and mortality. To this end, lifestyle interventions such as diet and physical activity are especially relevant to mitigate the deleterious impact of chronic energy imbalance in cancer survivors.

Testing the 'teachable moment' premise: does physical activity increase in the early survivorship phase?

PURPOSE

Little is known about objectively measured physical activity during the early survivorship period. This study measured physical activity, fatigue, and quality of life (QOL) in breast cancer patients over the first year after completion of chemotherapy and compared results to a matched non-cancer group.

METHODS

Data was obtained from 24 breast cancer subjects (mean ± SD) 50.9 ± 12.8 years at time points of 6 weeks, 6 months and 1 year after completion of adjuvant chemotherapy and from 20 matched women. The following variables were assessed, physical activity (RT3 accelerometer and International Physical Activity Questionnaire), quality-of-life (EORTC QLQ C-30) and fatigue (Brief Fatigue Inventory).

RESULTS

At 6 weeks after completion of chemotherapy, high levels of sedentary behaviour were found (6.8 ± 1.9 h sedentary per day), which did not improve, and was no different to the comparison group (6.5 ± 1.4 h). Less light activity was performed in the cancer cohort compared to the comparison group (p = 0.003). Body mass index (BMI) increased significantly in the cancer cohort (p = 0.015) and 1 year after chemotherapy finished only 13% (n = 3) had a BMI <25, while the comparable value was 45% (n = 9) in the non-cancer group. The QOL domain of cognitive function improved over the first 6 months (p = 0.034) but physical functioning declined (p = 0.008) over this time period. Fatigue did not change, and at the 1-year time point, 38% of the cancer patients (n = 11) reported high levels of fatigue.

CONCLUSION

This study highlighted the unchanging sedentary behaviour and weight gain of breast cancer survivors during the first year after completion of chemotherapy, which may inform rehabilitation models in this population.

Exercise after diagnosis and metabolic syndrome among breast cancer survivors: a report from the Shanghai Breast Cancer Survival Study

Metabolic syndrome (MetS) is an established risk factor for cardiovascular diseases and mortality. Limited data are available on the prevalence of MetS and its association with exercise among breast cancer survivors. The present study included 1,696 breast cancer survivors from the Shanghai Breast Cancer Survival Study, a population-based prospective cohort study conducted between April 2002 and October 2011 in Shanghai, China. All women had a physical examination taken at study clinic approximately 60 months post-diagnosis. Exercise was assessed at approximately 6, 18, 36, and 60 months post-diagnosis. Information on medical history, tumor characteristics, cancer treatment, anthropometrics, and lifestyle was collected at study enrollment. Associations between exercise and MetS at 60 months post-diagnosis were evaluated with multivariable logistic regression models. The mean age of the study population was 56.68 at 60-month survey, and the mean follow-up since cancer diagnosis was 63.66 months. The prevalence of MetS using National Cholesterol Education Program Adult Treatment Panel III criteria at approximately 60 months after diagnosis was 33.14%. Among overweight and obesity breast cancer survivors (body mass index (BMI) ≥ 25 kg/m(2) at baseline), the prevalence was 55.18%. The most common type of exercise in this population was walking (45.40%) at baseline. Exercise participation between 6 and 60 months post-diagnosis was inversely associated with the prevalence of MetS with the adjusted odds ratio (OR) for exercise participation of ≥ 3.5 h/week (30 min/day) being 0.69 (95% confidence interval (CI) 0.48-0.98). In addition consistent exercise participation reduced the prevalence of MetS (adjusted OR 0.70 (95% CI 0.50-1.00). Associations of exercise with MetS were not modified by baseline waist circumference, BMI, comorbidity, baseline menopausal status, TNM stage, cancer treatment, or ER/PR status (p interactions > 0.05). Regular and persistent exercise after cancer diagnosis, even at low-to-moderate intensity level, decreases the prevalence of MetS among long-term breast cancer survivors.

Association of pre-diagnosis physical activity with recurrence and mortality among women with breast cancer

Evidence is emerging that physical activity (PA) may improve overall survival after breast cancer diagnosis. However, the effect of PA on breast cancer recurrence and on cause-specific mortality is less investigated. We assessed the association of pre-diagnosis PA with recurrence, overall and cause-specific survival in a prospective cohort study in Germany including 3,393 non-metastatic breast cancer patients aged 50-74 years. Cox proportional hazards models were calculated adjusted for relevant prognostic factors. During a median follow-up of 5.6 years, 367 patients deceased. Overall mortality was significantly inversely associated with pre-diagnosis recreational PA. However, this effect was mainly attributed to deaths due to causes other than breast cancer. Multiple fractional polynomial analyses yielded a nonlinear association with markedly increased non-breast cancer mortality for women who did not engage in any sports or cycling in the years before the breast cancer diagnosis with a hazard ratio (HR, none vs. any) of 1.71, 95% confidence interval (1.16, 2.52). There were no further risk reductions with increasing activity levels. The association with breast cancer-specific mortality showed a similar dose-response but was far less pronounced with HR (none vs. any) = 1.22 (0.91, 1.64). In contrast, regarding cancer recurrence the dose-response was linear. However, this association was restricted to estrogen/progesterone receptor-negative (ER-/PR-) cases (p interaction = 0.033) with HR (highest vs. no recreational PA) = 0.53 (0.24, 1.16), p trend = 0.0045. Thus, breast cancer patients with a physically inactive lifestyle pre-diagnosis may decease prematurely irrespective of their cancer prognosis. Higher levels of exercise may reduce the risk of recurrence of ER-/PR- breast tumors.

Physical activity and the risk of breast cancer recurrence: a literature review

PURPOSE/OBJECTIVES

To examine the association between physical activity and breast cancer mortality and recurrence, and to provide an overview of factors related to physical activity behavior in women with breast cancer.

DATA SOURCES

An extensive review of the epidemiologic literature on the effect of physical activity on breast cancer recurrence and mortality was conducted using PubMed up to December 2010, involving the following key words: physical activity, exercise, breast cancer, breast cancer recurrence, and breast cancer mortality.

DATA SYNTHESIS

For breast cancer recurrence and breast cancer-related mortality, studies were included if physical activity served as the independent variable and a measure of association was reported. To examine determinants of physical activity, studies were included if a hypothesized factor served as the independent variable and a measure of association was reported.

CONCLUSIONS

Of the six studies that examined the influence of physical activity on breast cancer mortality, four (67%) reported a protective effect (i.e., inverse association), two examined the influence of physical activity on breast cancer recurrence and reported a nonsignificant risk reduction. Few studies have examined factors that influence physical activity behavior in women with breast cancer, and findings suggest that psychosocial factors play an important role in influencing the activity patterns of breast cancer survivors. Future longitudinal studies are needed to confirm those findings.

IMPLICATIONS FOR NURSING

To prevent breast cancer recurrence and breast cancer-related mortality, nurses should encourage breast cancer survivors to engage in regular exercise.

Walking, bicycling, and sports in postmenopausal breast cancer survivors--results from a German patient cohort study

OBJECTIVES

Physical activity (PA) is increasingly discussed as a means to achieve both physical and psychological benefits for breast cancer patients and survivors. However, little is known about activity-specific PA behavior following diagnosis. Our objectives were to describe sports and active transportation in the course of breast cancer and to identify factors associated with these activities.

METHODS

We used data from a German cohort study including 1067 postmenopausal breast cancer survivors aged 50-75 years. Data were collected about walking and bicycling for transportation purposes and sports before diagnosis, during therapy, and 1 year after surgery. Associations between these activities and clinical, behavioral, and social characteristics were analyzed with logistic regression.

RESULTS

The proportions of physically active women decreased significantly during therapy compared with before diagnosis (walking: 75.1% vs. 89.7%; bicycling: 19.3% vs. 56.5%; sports: 14.8% vs. 64.5%; all p < 0.001). Calisthenics, swimming, and walking for exercise were the most frequent types of sport. Chemotherapy/radiotherapy was negatively associated with sports (odds ratio [OR]: 0.35 [0.17-0.73]) but positively associated with walking during therapy (OR: 2.08 [1.04-4.15]). Although sociodemographic factors showed weak associations with PA, participation in rehabilitation increased the likelihood for bicycling (OR: 1.48 [1.06-2.09]) and sports (OR: 1.88 [1.38-2.58]) 1 year after surgery.

CONCLUSIONS

The majority of women stopped exercising and bicycling during breast cancer therapy. Interventions promoting in particular moderate activities after breast cancer diagnosis are required for this population. Increasing participation in rehabilitation might help to increase the proportion of women who bicycle and engage in sports after breast cancer diagnosis.

Location, Timing, and Social Structure Patterns Related to Physical Activity Participation in Weight Loss Programs

Less than half of the adults in the United States meet national guidelines for physical activity. Physical activity programs can induce short-term improvements in physical activity. To develop effective interventions, researchers and practitioners should consider the timing, location, and social structure patterns of participants. Using a pretest, posttest study design, 329 adults in a weight loss program completed surveys on their patterns and physical activity participation. Men preferred weight lifting, cycling, and jogging, whereas women preferred walking and aerobics. Black participants preferred being active in the home. Additionally, participating in a mix of group and individual activities compared with individual-only activities was predictive of posttest moderate-to-vigorous intensity and total physical activity. Providing a variety of activities for adults in both location and social structure may lead to sustained physical activity participation.

Theory-based predictors of follow-up exercise behavior after a supervised exercise intervention in older breast cancer survivors

PURPOSE

Supervised exercise interventions can elicit numerous positive health outcomes in older breast cancer survivors. However, to maintain these benefits, regular exercise needs to be maintained long after the supervised program. This may be difficult, as in this transitional period (i.e., time period immediately following a supervised exercise program), breast cancer survivors are in the absence of on-site direct supervision from a trained exercise specialist. The purpose of the present study was to identify key determinants of regular exercise participation during a 6-month follow-up period after a 12-month supervised exercise program among women aged 65+ years who had completed adjuvant treatment for breast cancer.

METHODS

At the conclusion of a supervised exercise program and 6 months later, 69 breast cancer survivors completed surveys examining their exercise behavior and key constructs from the Transtheoretical Model.

RESULTS

After adjusting for weight status and physical activity at the transition point, breast cancer survivors with higher self-efficacy at the point of transition were more likely to be active 6 months after leaving the supervised exercise program (odds ratio [95% confidence interval, 1.10 [1.01-1.18]). Similarly, breast cancer survivors with higher behavioral processes of change use at the point of transition were more likely to be active (odds ratio [95% confidence interval], 1.13 [1.02-1.26]).

CONCLUSION

These findings suggest that self-efficacy and the behavioral processes of change, in particular, play an important role in exercise participation during the transition from a supervised to a home-based program among older breast cancer survivors.

Change in physical activity during active treatment in a prospective study of breast cancer survivors

Physical activity offers many benefits to breast cancer survivors, yet research on physical activity during the immediate period following a breast cancer diagnosis is limited. In a prospective cohort study of 1,696 women diagnosed with invasive breast cancer in the Kaiser Permanente Northern California Medical Care Program from 2006-2009, we describe change in self-reported physical activity levels from around diagnosis to 6 months post-diagnosis and determine factors associated with change. Participants completed a comprehensive physical activity questionnaire at baseline (2 months post-diagnosis) and at follow-up (8 months post-diagnosis). Predictors of physical activity change were determined by multivariable linear regression. Reductions in all physical activity levels were observed (P < 0.0001); mean (SD) change (h/week) of moderate-vigorous physical activity (MVPA) was -1.28 (4.48) and sedentary behavior was -0.83 (6.95). In fully-adjusted models, overweight and obesity were associated with greater declines in MVPA of -1.58 h/week (SD = 0.92) and -1.29 h/week (SD = 0.93), respectively (P = 0.0079). Receipt of chemotherapy only was also associated with a greater decrease in MVPA (-2.12 h/week; SD = 0.92; P < 0.0001), specifically for recreational activities (-1.62 h/week; SD = 0.64; P = 0.0001). These data suggest challenges in maintaining physical activity levels during active treatment among women with breast cancer. Interventions to encourage physical activity in breast cancer survivors should be pursued.

Predictors of follow-up exercise behavior 6 months after a randomized trial of supervised exercise training in lymphoma patients

OBJECTIVES

Supervised exercise is beneficial for lymphoma patients, but it needs to be maintained to optimize long-term benefits. Here, we report the predictors of follow-up exercise behavior 6 months after a randomized controlled trial in lymphoma patients.

METHODS

Lymphoma patients were randomly assigned to 12 weeks of supervised aerobic exercise (n = 60) or usual care (n = 62). At baseline and post-intervention, data were collected on demographic, medical, health-related fitness, quality of life, and motivational variables. At 6-month follow-up, participants were mailed a questionnaire that assessed exercise behavior and were categorized as meeting or not meeting public health exercise guidelines.

RESULTS

At 6-month follow-up, 110 participants (90.2%) responded, of which 61 (55.5%) were meeting public health exercise guidelines. In univariate analyses, 16 variables predicted 6-month follow-up exercise behavior. In a stepwise regression analysis, five variables entered the model and explained 38% (p < 0.001) of the variance including the following: accepting a post-intervention exercise prescription (β = 0.33; p < 0.001), achieving a higher peak power output at post-intervention (β = 0.28; p = 0.001), experiencing a larger positive change in perceived behavioral control (β = 0.18; p = 0.028), having Hodgkin lymphoma (β = 0.19; p = 0.025), and having a stronger post-intervention intention (β = 0.18; p = 0.034).

CONCLUSION

Exercise behavior in lymphoma patients 6 months after a randomized trial was predicted by a wide range of demographic, medical, health-related fitness, quality of life, and motivational variables. These findings may help facilitate the uptake of self-directed exercise after short-term supervised exercise in lymphoma patients.

Relationship of exercise to quality of life in cancer patients beginning chemotherapy

CONTEXT

Cancer diagnosis and treatment, particularly chemotherapy, has well-established adverse effects on individuals. Exercise has been found to confer benefits to patients, although the current evidence base is limited primarily to patients assessed during or after treatment. Although exercise has been a target of intervention efforts, its relationship to quality of life in patients about to begin chemotherapy has not fully been examined.

OBJECTIVES

To examine the relationship of pre-treatment exercise rates to patient's quality of life.

METHODS

One hundred ninety-two adults diagnosed with Stages I-IV cancer and Eastern Cooperative Oncology Group performance status ≤ 2, provided data on exercise, distress (anxiety and depression), and health-related quality of life prior to their initial chemotherapy infusion.

RESULTS

As predicted, higher rates of exercise activity were associated with lower levels of anxiety and depression, and better overall mental and physical quality of life. These relationships were independent of demographic variables (i.e., body mass index and age) also associated with quality of life in the present analyses.

CONCLUSION

These findings further highlight the importance of assessing exercise before the start of chemotherapy as part of broader efforts to link patients to appropriate interventions aimed at enhancing quality of life. Findings also raise the possibility that assessing exercise rates could be useful in matching patients to the type of intervention most likely to benefit them. Future research should use prospective longitudinal designs to further explore this association.

Relationship of exercise to quality of life in cancer patients beginning chemotherapy

CONTEXT

Cancer diagnosis and treatment, particularly chemotherapy, has well-established adverse effects on individuals. Exercise has been found to confer benefits to patients, although the current evidence base is limited primarily to patients assessed during or after treatment. Although exercise has been a target of intervention efforts, its relationship to quality of life in patients about to begin chemotherapy has not fully been examined.

OBJECTIVES

To examine the relationship of pre-treatment exercise rates to patient's quality of life.

METHODS

One hundred ninety-two adults diagnosed with Stages I-IV cancer and Eastern Cooperative Oncology Group performance status ≤ 2, provided data on exercise, distress (anxiety and depression), and health-related quality of life prior to their initial chemotherapy infusion.

RESULTS

As predicted, higher rates of exercise activity were associated with lower levels of anxiety and depression, and better overall mental and physical quality of life. These relationships were independent of demographic variables (i.e., body mass index and age) also associated with quality of life in the present analyses.

CONCLUSION

These findings further highlight the importance of assessing exercise before the start of chemotherapy as part of broader efforts to link patients to appropriate interventions aimed at enhancing quality of life. Findings also raise the possibility that assessing exercise rates could be useful in matching patients to the type of intervention most likely to benefit them. Future research should use prospective longitudinal designs to further explore this association.

Rehabilitation interventions for cancer survivors: The influence of context

BACKGROUND

Today more and more people survive cancer. Cancer survivors need help to recover both from the cancer and the treatment. Rehabilitative interventions have been set up to meet their needs. However, there are studies that report no major effects following careful, targeted intervention. Furthermore, it seems difficult to define whether an effect is caused by the intervention or whether it is due to contextual parameters such as human interactions, the organisation, the staff, the physical surroundings or the general atmosphere. The present study examines the influence of three contextual parameters in rehabilitation courses for cancer survivors in Denmark.

METHODS

The study was based on an ethnographic fieldwork with participant observation at nine week-long courses, on in-depth interviews and on written sources. Fieldwork is well-suited for studying interventions in context, such as social interactions between people and their physical, material and institutional surroundings. The analysis is based on Duranti's and Goodwin's theoretical approach to context.

RESULTS

The findings are categorised into three contextual parameters. The setting, including its aesthetic value, its physical surroundings and the scheduling of the courses. The behavioural environment, which comprised work commitment and the care provided by the staff. The language environment insofar as it facilitated a sense of community.

DISCUSSION

The results demonstrate the influence of contextual parameters not formalised in the intervention programme. Contexts affect the outcome of an intervention because they frame and inform the teaching, communication and various forms of social gathering. The study suggests that the effects of the intervention as measured by quantitative studies cannot be properly interpreted without taking into account the context within which the intervention is embedded.

Adherence to Physical Activity Guidelines in Breast Cancer Survivors

Physical activity in breast cancer survivors has been shown to improve outcomes. This study evaluated breast cancer patients’ adherence to physical activity guidelines in a population-based study. Data from the 2007 National Health Interview Survey were used to compare adherence to physical activity guidelines in patients with breast cancer with the general population. Statistical analyses were performed using SUDAAN software. In 2007, 327 breast cancer survivors and 23,030 others from the general population were surveyed. Breast cancer survivors were significantly older than the general population (mean age 64.9 vs 45.6 years, P < 0.001) and tended to be female (99.4 vs 51.2%, P < 0.001). Despite being significantly more likely to have interacted with a healthcare professional within the past year (96.7 vs 82.1%, P < 0.001), fewer breast cancer survivors reported following physical activity guidelines than nonbreast cancer survivors (4.64 vs 12.0%, P < 0.001). Controlling for age, gender, and interaction with healthcare providers, breast cancer survivors were no more likely to follow physical activity guidelines than the general population (OR: 0.73; 95% CI: 0.41-1.30, P = 0.282). Despite more interaction with healthcare providers, breast cancer survivors are no more likely to adhere to activity guidelines than the general population.

Longitudinal study of recreational physical activity in breast cancer survivors

INTRODUCTION

Few longitudinal studies have examined physical activity (PA) levels in breast cancer survivors and how those levels change following cancer diagnosis and treatment.

METHODS

We conducted a longitudinal cohort study of 315 female residents of Washington State, aged 21-74 years, diagnosed with a first primary invasive breast cancer between 2002 and 2004, and identified by a population-based cancer registry. Recreational PA was assessed for the 2-year period before diagnosis and at three intervals after diagnosis (1-12, 13-18, and 19-30 months). We calculated average metabolic equivalent task (MET) hours/wk of total, low-, moderate-, and vigorous-intensity PA.

RESULTS

Mean PA levels decreased by 50% in the 12 months after diagnosis relative to before diagnosis (from 18.8 to 9.2 MET-hours/wk). At 19-30 months post-diagnosis, overall PA levels had increased from the low levels reported in the first year after diagnosis, but remained approximately 3 MET-hours/wk lower than before diagnosis. Reductions were limited to moderate- and vigorous-intensity activities. Declines in PA differed according to certain characteristics of the study population, with the greatest reductions observed in women <40 years at diagnosis and with a pre-diagnosis body mass index <25 kg/m(2); these women were also more likely to report the greatest activity before diagnosis.

CONCLUSIONS

These results, if replicated in other studies, suggest that effective intervention strategies to increase PA in breast cancer survivors may differ according to patient characteristics.

IMPLICATIONS FOR CANCER SURVIVORS

Younger, normal weight, and relatively active women may benefit most from interventions to minimize the decline in PA following diagnosis, while women who are older, overweight, and relatively inactive at diagnosis may benefit from interventions to increase long-term PA.

Level of physical activity and characteristics associated with change following breast cancer diagnosis and treatment

OBJECTIVE

While the physical and psychosocial benefits of participating in physical activity (PA) during and following breast cancer treatment are well understood, less is known about rates and uptake of PA following diagnosis. This paper explores the levels and patterns of PA among women recently diagnosed with breast cancer and the factors associated with change in activity levels.

METHODS

Using a population-based recruitment approach, PA levels of 287 breast cancer patients were assessed at 6, 12 and 18 months post-diagnosis using the Behavioral Risk Factor Surveillance System, and then converted to MET (metabolic equivalent task)-hours/week. Regression analyses were used to explore the correlates associated with change between 6 and 18 months post-diagnosis.

RESULTS

Although more than 80% of women participated in PA at each testing phases, more than 50% were considered insufficiently active or sedentary according to national recommendations and less than one-third reported engagement in vigorous or strength activities. Mean change in total MET-hours/week between 6 and 18 months post-diagnosis was minor (mean=0.10, median=0.0), however individual changes were substantial (ranging from -100 to +174 MET-hours/week). Results are more encouraging for the lower threshold of 3+ MET-hours/week, which may be most relevant specifically for breast cancer outcomes.

CONCLUSIONS

Since the majority of women report insufficient levels of PA, there is a clear need for exercise interventions during and following breast cancer treatment. Few characteristics predict declines or improvements in PA levels, hence for optimal benefit, interventions should target the entire breast cancer population.

Physical activity behaviors in women with newly diagnosed ductal carcinoma-in-situ

Epidemiological evidence suggests that physical activity may affect breast cancer risk and other health outcomes. Little information is available regarding changes in activity after diagnosis and treatment of in-situ cancer. We enrolled 487 women with newly diagnosed ductal carcinoma-in-situ (DCIS) in a longitudinal cohort study. Exercise behaviors were assessed at enrollment and at 18 months. Changes in exercise frequency over time were compared, and the impact of demographic and treatment-related variables was evaluated. Enrollment and 18-month exercise data were available for 391 women (80%). At enrollment, most women performed strenuous physical activity infrequently, and only half engaged in any type of exercise more than twice a week. Overall activity patterns did not change greatly over the course of the study. However, logistic regression modeling of changes in exercise revealed that women who underwent unilateral or bilateral mastectomy (hazard ratio [HR], 2.4; 95% confidence interval [95% CI], 1.3-4.4) and those who were anxious at enrollment (HR, 2.1; 95% CI, 1.1-4.1) were statistically significantly more likely to decrease exercise levels, and women who worked were significantly more likely to increase exercise over the course of the study (HR, 1.9; 95% CI, 1.1-3.3). Nonsignificant variables included age, reconstructive surgery, depressive symptoms, financial status, education, and tamoxifen use. A large proportion of women with newly diagnosed DCIS were inactive and remained so over time. Women who underwent mastectomy, as well as women who were more anxious, were more likely to decrease their level of physical activity. Women with DCIS might benefit from targeted interventions to increase physical activity.