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Wilson JM, Franqueiro AR, Rosado E, Falso VR, Muñoz-Vergara D, Smith MT, Klerman EB, Shen S, Schreiber KL. Preoperative decreased physical activity is associated with greater postoperative pain: the mediating role of preoperative sleep disturbance. Support Care Cancer 2024; 32:429. [PMID: 38872065 DOI: 10.1007/s00520-024-08625-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 06/01/2024] [Indexed: 06/15/2024]
Abstract
PURPOSE Engagement in physical activity (PA) is often associated with better sleep quality and less pain severity among patients diagnosed with breast cancer. However, less research has focused on whether patients' PA prior to breast surgery, including their perceived decrease in PA level, is associated with worse preoperative sleep quality, and subsequently, greater postoperative pain. This longitudinal study investigated whether patients' preoperative PA was associated with their postoperative pain. We also explored whether preoperative sleep disturbance partially mediated the relationship between preoperative PA and postoperative pain. METHODS Prior to breast surgery, patients self-reported both their overall level of PA and whether they perceived a decrease in their PA since the diagnosis/onset of treatment for cancer. Patients also completed a measure of preoperative sleep disturbance. Two weeks after surgery, patients completed a measure of postoperative surgical-area pain severity. RESULTS Our results showed that preoperatively perceiving a decrease in PA level was significantly associated with greater preoperative sleep disturbance and postoperative pain. A mediation analysis revealed that the association between preoperative decreased PA and postoperative pain was partially mediated by preoperative sleep disturbance. Notably, patients' overall preoperative level of PA was not related to preoperative sleep disturbance or postoperative pain. CONCLUSION These findings suggest that maintaining, or even increasing, PA after diagnosis/treatment may be more important than the absolute amount of PA that women engage in during the preoperative period. Potentially, some patients with breast cancer may benefit from a preoperative intervention focused on both maintaining PA and bolstering sleep quality.
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Affiliation(s)
- Jenna M Wilson
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, 45 Francis St, Boston, MA, 02115, USA.
| | - Angelina R Franqueiro
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, 45 Francis St, Boston, MA, 02115, USA
| | - Emily Rosado
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, 45 Francis St, Boston, MA, 02115, USA
| | - Victoria R Falso
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, 45 Francis St, Boston, MA, 02115, USA
| | - Dennis Muñoz-Vergara
- Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Osher Center for Integrative Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Michael T Smith
- Department of Psychiatry, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Elizabeth B Klerman
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham & Women's Hospital, Boston, MA, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
| | - Shiqian Shen
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Kristin L Schreiber
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, 45 Francis St, Boston, MA, 02115, USA
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Pan M, Wu K, Zhao J, Hou X, Chen P, Wang B. Effects of wearable physical activity tracking for breast cancer survivors: A systematic review and meta-analysis. Int J Nurs Knowl 2024; 35:117-129. [PMID: 36843066 DOI: 10.1111/2047-3095.12418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 02/05/2023] [Indexed: 02/28/2023]
Abstract
PURPOSE Breast cancer is the most common cancer type worldwide, with its survivors often experiencing physical and psychosocial health problems. Wearable device use is an innovative and effective way to promote physical activity and improve health-related outcomes in breast cancer survivors; however, the current evidence is unclear. We aimed to determine the effects of wearable devices on physical activity and health-related outcomes in breast cancer survivors. METHODS PubMed, Embase, Web of Science, and Cochrane Library databases were searched to identify eligible studies from inception to September 2022. Additional relevant studies were obtained from the reference lists of the identified studies. Two reviewers independently screened the eligible studies, appraised the risk of bias, and extracted the data. Meta-analysis was conducted using Review Manager version 5.3. FINDINGS Sixteen randomized controlled trials were included. Physical activity tracking and pedometer-based interventions improved moderate-intensity physical activity (standardized mean difference [SMD] = 0.32, 95% confidence interval [CI]: 0.17-0.46, p < 0.0001), moderate-to-vigorous physical activity (SMD = 0.85, 95%CI: 0.38-1.32, p = 0.0004), total physical activity (SMD = 0.51, 95%CI: 0.12-0.90, p = 0.01), quality of life (SMD = 0.17, 95%CI: 0.03-0.31, p = 0.01), physical function (SMD = 0.21, 95%CI: 0.04-0.38, p = 0.02), and mood state profiles (SMD = -0.58, 95%CI: -1.13 to 0.02, p = 0.04) in breast cancer survivors. However, the effects of low-intensity physical activity, vigorous-intensity physical activity, fatigue, anxiety, depression, and sleep quality could not be ascertained. CONCLUSIONS Physical activity tracking and pedometer-based interventions were effective in increasing physical activity and improving health-related outcomes in breast cancer survivors. IMPLICATIONS FOR NURSING PRACTICE This review offers availability of credible evidence supporting the potential usefulness and effectiveness of wearable physical activity trackers on physical activity and health-related outcomes in breast cancer survivors.
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Affiliation(s)
- Mingyue Pan
- Department of Nursing, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Keyang Wu
- Graduate School of Nursing, Huzhou University, Huzhou, Zhejiang, China
| | - Jiaxin Zhao
- Graduate School of Nursing, Huzhou University, Huzhou, Zhejiang, China
| | - Xiaohui Hou
- Graduate School of Nursing, Huzhou University, Huzhou, Zhejiang, China
| | - Piao Chen
- Department of Nursing, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Bing Wang
- Key Laboratory of Vector Biology and Pathogen Control of Zhejiang Province, Huzhou University, Huzhou, Zhejiang, China
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Chandran G, Tang N, Ngo ELP, Huang S, Tong SI, Ong JX, Chew E. Comparing the efficacy of a multi-dimensional breast cancer rehabilitation programme versus a home-based exercise programme during adjuvant cancer treatment. BMC Cancer 2024; 24:361. [PMID: 38509471 PMCID: PMC10956284 DOI: 10.1186/s12885-024-12080-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 03/04/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Breast cancer is the most common female malignancy worldwide and a major cause of morbidity and mortality. Exercise during adjuvant treatment improves function and relieves symptoms in breast cancer survivors. However, it is unclear if an unsupervised exercise programme may be as effective as a supervised multimodal group. We investigated the feasibility and efficacy of a centre-based multidimensional rehabilitation (MDR) programme for breast cancer survivors undergoing adjuvant treatment and compared it to an unsupervised home-based exercise (HE) programme. METHODS Participants were self-allocated to either MDR or HE group. MDR participants underwent 24 supervised exercise classes and 10 education classes over 12 weeks. HE participants were instructed on a home exercise regime. Outcome measures, including the 6-min walk test (6MWT) and Frenchay Activities Index (FAI), FACT-Cognitive Function scale, and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30, were conducted at baseline (W0), post-intervention (W12) and 6-months post-intervention (M6). Variance between time points and the 2 groups were analysed using a linear mixed model (unstructured covariance matrix) and adjusted with Bonferroni. RESULT Twenty-five participants attended at least half of the MDR interventions, while 21 completed the HE interventions. The former showed significant improvement in 6MWT, from 406.88 m (W0) to 443.34 m (W12) to 452.81 m (M6), while the improvement in the HE group was not significant (407.67 m (W0) to 433.14 m (W12) to 430.96 m (M6)). Both groups showed a significant improvement in FAI, with earlier significant improvement noted at W12 in the MDR group (22.71 (W0) to 27.65 (W12) to 28.81 (M6)) compared to the HE group (23.16 (W0) to 26.47 (W12) to 29.85 (M6)). Dropout rate was 16% in the MDR group and 34% in HE group. Overall satisfaction with the MDR programme was high. CONCLUSION Both MDR and HE programmes were feasible. MDR was superior in improving endurance and earlier return to instrumental activities for those who completed at least half of the sessions. Future studies could explore use of technology to improve adherence to exercise. TRIAL REGISTRATION The study was registered with ClinicalTrial.gov on 01/04/2022 with the registration number NCT05306808.
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Affiliation(s)
- Gobinathan Chandran
- Department of Medicine, Division of Rehabilitation Medicine, National University Hospital, NUHS Tower Block, Level 10, 1E Kent Ridge Road, Singapore, 119228, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore, 117597, Singapore
| | - Ning Tang
- Department of Medicine, Division of Rehabilitation Medicine, National University Hospital, NUHS Tower Block, Level 10, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Ednajoy Lay Poh Ngo
- Division of Oncology Nursing, National University Cancer Institute, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
| | - Serene Huang
- Department of Medicine, Division of Rehabilitation Medicine, National University Hospital, NUHS Tower Block, Level 10, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Shuk In Tong
- Department of Rehabilitation, National University Hospital, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
| | - Jie Xin Ong
- Department of Rehabilitation, National University Hospital, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
| | - Effie Chew
- Department of Medicine, Division of Rehabilitation Medicine, National University Hospital, NUHS Tower Block, Level 10, 1E Kent Ridge Road, Singapore, 119228, Singapore.
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore, 117597, Singapore.
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Plante A, Gauvin L, Sabiston CM, Doré I. Perceived autonomy support from healthcare professionals and physical activity among breast cancer survivors: A propensity score analysis. PLoS One 2023; 18:e0295751. [PMID: 38134008 PMCID: PMC10745153 DOI: 10.1371/journal.pone.0295751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 11/28/2023] [Indexed: 12/24/2023] Open
Abstract
The majority of women treated for breast cancer are physically inactive although physical activity (PA) could attenuate many adverse effects of cancer and treatment. Autonomy support from healthcare professionals may improve PA initiation, adherence and maintenance. This study aimed to determine, using a causal inference approach, whether or not perceived autonomy support (PAS) from healthcare professionals is associated with light, moderate, and vigorous intensity PA among women treated for breast cancer. Data were drawn from the longitudinal study "Life After Breast Cancer: Moving On" (n = 199). PAS was measured with the Health Care Climate Questionnaire and PA was assessed using GT3X triaxial accelerometers. Associations between PAS and PA were estimated with linear regressions and adjusted estimations were obtained using propensity score-based inverse probability of treatment weights (IPTW). Results reveal no association between PAS and PA of light ([Formula: see text](95%CI) = -0.09 (-0.68, 0.49)), moderate ([Formula: see text] (95%CI) = -0.03 (-0.17, 0.11)), or vigorous ([Formula: see text](95%CI) = 0.00 (-0.03, 0.02)) intensity. Different forms of engagement and support by healthcare professionals should be explored to identify the best intervention targets to encourage women to adopt and maintain regular PA in the cancer continuum.
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Affiliation(s)
- Audrey Plante
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, Canada
- École de Santé Publique de l’Université de Montréal, Montréal, Canada
| | - Lise Gauvin
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, Canada
- École de Santé Publique de l’Université de Montréal, Montréal, Canada
| | - Catherine M. Sabiston
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada
| | - Isabelle Doré
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, Canada
- École de Santé Publique de l’Université de Montréal, Montréal, Canada
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada
- École de kinésiologie et des sciences de l’activité physique, Faculté de Médecine, Université de Montréal, Montréal, Canada
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Cao C, Patel AV, Liu R, Cao Y, Friedenreich CM, Yang L. Trends and cancer-specific patterns of physical activity, sleep duration, and daily sitting time among US cancer survivors, 1997-2018. J Natl Cancer Inst 2023; 115:1563-1575. [PMID: 37527029 PMCID: PMC10699842 DOI: 10.1093/jnci/djad146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/21/2023] [Accepted: 07/28/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Physical activity, sufficient sleep, and limiting sedentary time may improve cancer survivorship. METHODS Utilizing US nationally representative samples from the National Health Interview Survey 1997-2018 and the National Health and Nutrition Examination Survey 2007-2018, this study investigated the trends of meeting physical activity guidelines, insufficient sleep duration, and sitting time in US cancer survivors (n = 58 527) and noncancer adults (n = 640 109). RESULTS From 1997 to 2018, the prevalence of meeting physical activity guidelines was consistently lower in cancer survivors than in noncancer adults. Among cancer survivors, the prevalence of meeting physical activity guidelines increased from 34.9% (95% confidence interval [CI] = 33.1% to 36.8%) to 46.5% (95% CI = 45.0% to 48.1%) for aerobic (≥150 minutes per week at moderate intensity or 75 minutes per week at vigorous intensity), from 13.9% (95% CI = 12.8% to 15.1%) to 23.1% (95% CI = 21.8% to 24.4%) for muscle strengthening (≥2 days per week) activities, and from 9.5% (95% CI = 8.4% to 10.7%) to 17.9% (95% CI = 16.7% to 19.1%) for both combined (all Ptrend < .001). From 2004 to 2018, the prevalence of insufficient sleep duration (<7 hours per day) increased from 28.4% (95% CI = 26.3% to 30.5%) to 30.8% (95% CI = 29.3% to 32.2%) (Ptrend = .004). Daily sitting time increased from 6.09 hours per day (95% CI = 5.71 to 6.46 hours per day) in 2007-2008 to 7.36 hours per day (95% CI = 7.05 to 7.68 hours per day) in 2013-2014 and attenuated to 6.20 hours per day (95% CI = 5.74 to 6.65 hours per day) in 2017-2018. The pattern of physical activity, sleep, and sitting time varied by sex, race and ethnicity, body mass index, cancer type, and time since cancer diagnosis. CONCLUSIONS More than half of US cancer survivors did not meet physical activity guidelines, and a large proportion had insufficient sleep duration and prolonged sitting time.
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Affiliation(s)
- Chao Cao
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Alpa V Patel
- Department of Population Sciences, American Cancer Society, Atlanta, GA, USA
| | - Raymond Liu
- San Francisco Medical Center, Kaiser Permanente Northern California, San Francisco, CA, USA
| | - Yin Cao
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, MO, USA
- Alvin J. Siteman Cancer Center, Washington University School of Medicine, St Louis, MO, USA
- Division of Gastroenterology, Department of Medicine, Washington University School of Medicine, St Louis, MO, USA
| | - Christine M Friedenreich
- Department of Cancer Epidemiology and Prevention Research, Cancer Research & Analytics, Cancer Care Alberta, Alberta Health Services, Calgary, AB, Canada
- Departments of Oncology and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Lin Yang
- Department of Cancer Epidemiology and Prevention Research, Cancer Research & Analytics, Cancer Care Alberta, Alberta Health Services, Calgary, AB, Canada
- Departments of Oncology and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Van Dijck S, De Groef A, Kothari J, Dams L, Haenen V, Roussel N, Meeus M. Barriers and facilitators to physical activity in cancer survivors with pain: a systematic review. Support Care Cancer 2023; 31:668. [PMID: 37922014 DOI: 10.1007/s00520-023-08141-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 10/23/2023] [Indexed: 11/05/2023]
Abstract
PURPOSE Pain post-treatment is a debilitating symptom in the growing population of cancer survivors. While physical activity is an integral part of pain management, low levels of physical activity are often observed in this population. The aim of this systematic review is to gain insight into the barriers and facilitators to physical activity in cancer survivors afflicted with pain. METHODS In December 2021, a systematic search was conducted using PubMed and Web of Science. All studies exploring barriers and/or facilitators to physical activity in cancer survivors with pain were included. The methodological quality of the evidence was appraised with the Mixed Methods Appraisal Tool (version 2018). RESULTS Six articles were included. Current literature was limited and mostly focused on female breast cancer survivors. The identified barriers and facilitators could be categorized into six different domains: the logistical, symptoms, cognitive, clinical, social, and knowledge domain. The barrier of pain was reported as a barrier on its own that is closely linked to other barriers in this specific population. CONCLUSION Barriers and facilitators to physical activity were categorized in six different domains. The barrier of pain distinguishes itself and brings along additional obstacles such as anxiety, fear, and avoidance behavior. Current evidence is limited and focuses mostly on female breast cancer survivors. Further research in larger cohorts representing various subsets of cancer survivors with pain is warranted, as well as studies that implement these insights in physical activity interventions.
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Affiliation(s)
- Sophie Van Dijck
- Department of Rehabilitation Sciences and Physiotherapy, MOVANT, University of Antwerp, Antwerp, Belgium.
- Pain in Motion International Research Group, Brussels, Belgium.
| | - An De Groef
- Department of Rehabilitation Sciences and Physiotherapy, MOVANT, University of Antwerp, Antwerp, Belgium
- Pain in Motion International Research Group, Brussels, Belgium
- Department of Rehabilitation Sciences, KU Leuven, University of Leuven, Louvain, Belgium
| | - Janan Kothari
- Department of Rehabilitation Sciences and Physiotherapy, MOVANT, University of Antwerp, Antwerp, Belgium
| | - Lore Dams
- Department of Rehabilitation Sciences and Physiotherapy, MOVANT, University of Antwerp, Antwerp, Belgium
- Pain in Motion International Research Group, Brussels, Belgium
- Department of Rehabilitation Sciences, KU Leuven, University of Leuven, Louvain, Belgium
| | - Vincent Haenen
- Department of Rehabilitation Sciences and Physiotherapy, MOVANT, University of Antwerp, Antwerp, Belgium
- Pain in Motion International Research Group, Brussels, Belgium
- Department of Rehabilitation Sciences, KU Leuven, University of Leuven, Louvain, Belgium
| | - Nathalie Roussel
- Department of Rehabilitation Sciences and Physiotherapy, MOVANT, University of Antwerp, Antwerp, Belgium
| | - Mira Meeus
- Department of Rehabilitation Sciences and Physiotherapy, MOVANT, University of Antwerp, Antwerp, Belgium
- Pain in Motion International Research Group, Brussels, Belgium
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Jones TL, Edbrooke L, Rawstorn JC, Hayes SC, Maddison R, Denehy L, Short CE. Self-efficacy, motivation, and habits: psychological correlates of exercise among women with breast cancer. Support Care Cancer 2023; 31:584. [PMID: 37728796 PMCID: PMC10511352 DOI: 10.1007/s00520-023-08040-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 09/04/2023] [Indexed: 09/21/2023]
Abstract
PURPOSE The purpose of this analysis was to explore associations between exercise behaviour among breast cancer survivors and three behavioural constructs from distinct theories: self-efficacy from social cognitive theory, motivation from self-determination theory, and habits from habit theory. METHODS Breast cancer survivors (n = 204) completed a cross-sectional survey that collected demographic and disease characteristics, exercise levels, and self-efficacy, motivation, and habits. Multivariable linear regression models were used to identify constructs associated with total activity and resistance training. RESULTS Participants were a mean (SD) age of 57.3 (10.8) years and most were diagnosed with early-stage disease (72%) and engaged in sufficient levels of total activity (94%), though only 45% completed ≥ 2 resistance training sessions/week. Identified motivation (ꞵ[95% CI] = 7.6 [3.9-11.3]) and habits (ꞵ[95% CI] = 4.4 [1.4-7.4]) were significantly associated with total activity (as were body mass index and disease stage), whilst identified motivation (ꞵ[95% CI] = 0.6 [0.3-0.9]) and coping self-efficacy (ꞵ[95% CI] = 0.02 [< 0.01-0.03]) were significantly associated with resistance training. The models explained 27% and 16% of variance in total activity and resistance training behaviour, respectively. CONCLUSION Results suggest that incorporating strategies that support identified motivation, habits, and coping self-efficacy in future interventions could promote increased exercise behaviour among breast cancer populations. Future longitudinal research should examine associations with exercise in a more representative, population-based sample.
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Affiliation(s)
- Tamara L Jones
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia.
| | - Lara Edbrooke
- Melbourne School of Health Sciences, The University of Melbourne, Melbourne, Australia
- Department of Health Services Research, The Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Jonathan C Rawstorn
- Institute for Physical Activity and Nutrition, Deakin University, Melbourne, Australia
| | - Sandra C Hayes
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- School of Health Sciences and Social Work, Griffith University, Brisbane, Australia
| | - Ralph Maddison
- Institute for Physical Activity and Nutrition, Deakin University, Melbourne, Australia
| | - Linda Denehy
- Melbourne School of Health Sciences, The University of Melbourne, Melbourne, Australia
- Department of Health Services Research, The Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Camille E Short
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
- Melbourne School of Health Sciences, The University of Melbourne, Melbourne, Australia
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Marell PS, Vierkant RA, Olson JE, Herrmann J, Larson NL, Lebrasseur NK, D’Andre SD, Ehlers DK, Stan DL, Cheville AL, Barksdale T, Loprinzi CL, Couch FJ, Ruddy KJ. Changes in amount and intensity of physical activity over time in breast cancer survivors. JNCI Cancer Spectr 2023; 7:pkad056. [PMID: 37561108 PMCID: PMC10471529 DOI: 10.1093/jncics/pkad056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/28/2023] [Accepted: 08/01/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Physical activity is associated with decreased breast cancer recurrence and mortality, as well as fewer treatment-related symptoms. Nevertheless, most breast cancer survivors do not meet physical activity guidelines. The purpose of this manuscript is to characterize physical activity trends over time in breast cancer survivors. METHODS Mayo Clinic Breast Disease Registry participants received surveys at baseline and at 1 and 4 years after diagnosis; breast cancer recurrence and/or metastatic disease were exclusion criteria. Participants were considered to be meeting guidelines if they self-reported at least 150 minutes of moderate-intensity (eg, fast walking) and/or strenuous (eg, jogging) physical activity per week. Statistical analyses include analysis of covariance methods, paired t tests, conditional logistic regression models, and McNemar tests of homogeneity. RESULTS A total of 171 participants were included in the analysis. The amount of total physical activity decreased over time (P = .07). Mild-intensity physical activity (eg, easy walking) decreased most over time (P = .05). Among participants aged 18-49 years, mild-intensity (P = .05) and moderate-intensity (P = .02) physical activity decreased over time. Strenuous-intensity physical activity levels decreased over time among participants with a normal body mass index (P = .002) and with obesity (P = .01). CONCLUSIONS We found a trend-level decrease in total physical activity over time, driven mostly by a decrease in mild-intensity physical activity. Young breast cancer survivors are especially likely to reduce their physical activity over time. Further research on implementing physical activity guidelines in clinical practice is warranted.
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Affiliation(s)
- Paulina S Marell
- Community Internal Medicine, Geriatrics, and Palliative Care, Mayo Clinic, Rochester, MN, USA
| | | | - Janet E Olson
- Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Joerg Herrmann
- Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Nicole L Larson
- Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | | | | | - Diane K Ehlers
- Quantitative Health Sciences, Mayo Clinic, Phoenix, AZ, USA
| | - Daniela L Stan
- General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Andrea L Cheville
- Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | - Toure Barksdale
- Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | | | - Fergus J Couch
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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Gildea GC, Spence RR, Jones TL, Turner JC, Macdonald ER, Hayes SC, Sandler CX. Barriers, facilitators, perceptions and preferences influencing physical activity participation, and the similarities and differences between cancer types and treatment stages - A systematic rapid review. Prev Med Rep 2023; 34:102255. [PMID: 37273528 PMCID: PMC10236469 DOI: 10.1016/j.pmedr.2023.102255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 04/25/2023] [Accepted: 05/19/2023] [Indexed: 06/06/2023] Open
Abstract
The aim of this systematic rapid review was to explore barriers, facilitators, perceptions and preferences of physical activity for people diagnosed with cancer, by cancer type and treatment stage. The search strategy, implemented through four databases, included terms relating to cancer, physical activity, barriers, facilitators, perceptions and preferences, and relevant study designs. Studies reporting the outcomes of interests for adults diagnosed with cancer and living in Western countries were included and grouped according to the Social-Ecological Model and the Health Belief Model, and pragmatically. A total of 118 studies, involving 15 cancers were included. Outcomes were most commonly explored within samples involving mixed cancers (32 studies) and breast cancer (31 studies), and at the post-treatment phase (52 studies). Across all cancers and during- and post-treatment, treatment- and disease-related side-effects were the most commonly identified barrier, social support and guidance was the most commonly identified facilitator, and promoting health and recovery was the most commonly identified perception of benefit of physical activity. Notable differences were identified in barriers, facilitators and perceptions across cancer types and treatment stages, with specific examples including: comorbidities were inconsistently reported as a barrier across cancers; time pressure was more commonly reported as a barrier post-treatment; and women with breast cancer reported inaccessibility of appropriate services more commonly during-treatment than post-treatment. Preference findings varied widely across cancer types and treatment phases. These findings can be used to aid efforts to improve physical activity levels post-cancer by providing healthcare professionals with information to facilitate individualised advice and services.
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Affiliation(s)
- Gabrielle C. Gildea
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- School of Health Science and Social Work, Griffith University, Brisbane, Queensland, Australia
| | - Rosalind R. Spence
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- School of Health Science and Social Work, Griffith University, Brisbane, Queensland, Australia
| | - Tamara L. Jones
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Melbourne School of Psychological Sciences, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Victoria, Australia
| | - Jemma C. Turner
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Eliza R. Macdonald
- Department of Exercise Physiology, School of Health Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Sandra C. Hayes
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- School of Health Science and Social Work, Griffith University, Brisbane, Queensland, Australia
| | - Carolina X. Sandler
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
- School of Health Sciences, Western Sydney University, Sydney, New South Wales, Australia
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Álvarez-Salvago F, Jiménez-García JD, Martínez-Amat A, Pujol-Fuentes C, Atienzar-Aroca S, Molina-García C, Aibar-Almazán A. Does participation in therapeutic exercise programs after finishing oncology treatment still ensure an adequate health status for long-term breast cancer survivors? A ≥ 5 years follow-up study. Support Care Cancer 2023; 31:343. [PMID: 37199790 DOI: 10.1007/s00520-023-07801-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 05/04/2023] [Indexed: 05/19/2023]
Abstract
PURPOSE The aims of this study were to evaluate whether the effects of two therapeutic exercise programs are sustained over time (≥ 5 years) in long-term breast cancer survivors (LTBCS). Second, to determine the influence of the current level of physical activity (PA) performed on cancer-related fatigue (CRF) that these patients may present ≥5 years later. METHODS A prospective observational study was conducted with a cohort of 80 LTBCS in Granada during 2018. Firstly, considering their participation in one of the programs, they were allocated into two groups: usual care and therapeutic exercise program, to assess CRF, pain and pressure pain sensitivity, muscle strength, functional capacity, and quality of life. Secondly, they were also classified into 3 groups according to current level of weekly PA performed: ≤ 3, 3.1-7.4, and ≥ 7.5 (MET-hour/week) respectively, to assess its impact over CRF. RESULTS Although the positive effects of the programs are not sustained over time, a trend toward significance can be observed for a greater reduction in overall CRF levels, lower intensity of pain in the affected arm and cervical region, and greater functional capacity and quality of life in the group that underwent therapeutic exercise. Additionally, 66.25% of LTBCS are inactive ≥ 5 years after completion of the program and furthermore, such inactivity is accompanied by higher CRF levels (P .013 to .046). CONCLUSION The positive effects of therapeutic exercise programs are not maintained over time for LTBCS. Additionally, more than half of these women (66.25%) are inactive ≥ 5 years after completion of the program, this inactivity being accompanied by higher levels of CRF.
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Affiliation(s)
- Francisco Álvarez-Salvago
- Department of Physiotherapy, Faculty of Health Sciences, European University of Valencia, Valencia, Spain
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, Jaén, Spain
| | - José Daniel Jiménez-García
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, Jaén, Spain.
- Department of Physiotherapy, Faculty of Health Sciences, University of Jaén, Jaén, Spain, Campus Las Lagunillas s/n, 23071, Jaén, Spain.
| | - Antonio Martínez-Amat
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, Jaén, Spain
| | - Clara Pujol-Fuentes
- Department of Physiotherapy, Faculty of Health Sciences, European University of Valencia, Valencia, Spain
| | - Sandra Atienzar-Aroca
- Department of Dentistry, Faculty of Health Sciences, European University of Valencia, Valencia, Spain
| | | | - Agustín Aibar-Almazán
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, Jaén, Spain
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11
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Morishita S, Suzuki K, Okayama T, Inoue J, Tanaka T, Nakano J, Fukushima T. Recent Findings in Physical Exercise for Cancer Survivors. Phys Ther Res 2023; 26:10-16. [PMID: 37181484 PMCID: PMC10169310 DOI: 10.1298/ptr.r0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 02/10/2023] [Indexed: 05/16/2023]
Abstract
In recent years, the number of cancer survivors has been increasing each year due to advances in the early diagnosis and treatment of cancer. Cancer survivors present a variety of physical and psychological complications due to cancer and its treatment. Physical exercise is an effective nonpharmacological treatment for complications in cancer survivors. Furthermore, recent evidence has shown that physical exercise improves the prognosis of cancer survivors. The benefits of physical exercise have been widely reported, and guidelines for physical exercise for cancer survivors have been published. These guidelines recommend that cancer survivors engage in moderate- or vigorous-intensity aerobic exercises and/or resistance training. However, many cancer survivors have a poor commitment to physical exercise. In the future, it is necessary to promote physical exercise among cancer survivors through outpatient rehabilitation and community support.
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Affiliation(s)
- Shinichiro Morishita
- Department of Physical Therapy, School of Health Sciences, Fukushima Medical University, Japan
| | | | - Taro Okayama
- Division of Rehabilitation Medicine, Shizuoka Cancer Center, Japan
| | - Junichiro Inoue
- Division of Rehabilitation Medicine, Kobe University Hospital International Clinical Cancer Research Center, Japan
| | - Takashi Tanaka
- Department of Rehabilitation, Hyogo Medical University Hospital, Japan
| | - Jiro Nakano
- Faculty of Rehabilitation, Kansai Medical University, Japan
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12
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Way KM, Bourne JE, Armstrong MEG. "I'm Hooked on e-cycling, I Can Finally Be Active Again": Perceptions of e-cycling as a Physical Activity Intervention during Breast Cancer Treatment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5197. [PMID: 36982111 PMCID: PMC10049330 DOI: 10.3390/ijerph20065197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/06/2023] [Accepted: 03/10/2023] [Indexed: 06/18/2023]
Abstract
Electrically-assisted bicycles (e-bikes) are a means through which to increase individual physical activity (PA) and overcome some commonly reported barriers to engaging in conventional cycling. Fatigue is a common side effect to breast cancer treatment, and the rate of PA engagement drops significantly following a breast cancer diagnosis. The aim of this qualitative study was to examine perceptions of e-cycling as a means of increasing PA in this population. Twenty-four participants (mean age = 57.88 (standard deviation 10.8), 100% female) who have had a breast cancer diagnosis, completed two semi-structured interviews via Zoom. One interview was conducted prior to an e-bike taster session and a second, after the session. Taster sessions were conducted by certified cycling instructors in the community. Interviews were conducted between December 2021 and May 2022. Data were transcribed verbatim and analyzed thematically using NVivo 12 software. An inductive and deductive approach to analysis was adopted. Five themes were generated: (1) Perceived role of e-bikes during treatment, (2) The relationship between e-bikes and fatigue, (3) Cancer-specific considerations, (4) Is e-cycling 'enough'?, and (5) Optimizing the intervention. Negative perceptions of e-bikes noted before the taster session were altered following riding an e-bike. The multiple levels of assistance made cycling manageable and less impacted by fatigue, thereby enabling individuals to re-establish previous cycling habits. E-cycling may be a suitable option to increase PA behavior amongst individuals being treated for breast cancer, with the potential to overcome many of the barriers of conventional cycling. Enabling this population to trial an e-bike elicits positive physical and psychological responses that may help to promote future engagement.
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13
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Nechuta SJ, Lipworth L, Chen WY, Shu XO, Zheng W, Blot WJ. Physical activity in association with mortality among Black women diagnosed with breast cancer in the Southern Community Cohort Study. Cancer Causes Control 2023; 34:277-286. [PMID: 36550258 PMCID: PMC10187641 DOI: 10.1007/s10552-022-01663-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Physical activity (PA) is associated with many health benefits. While PA has been associated with reduced mortality after breast cancer diagnosis in many studies, few studies have examined the role of PA in breast cancer survival among underserved and minority populations, including Black women. We investigated PA in association with mortality among Black predominantly low-income breast cancer survivors in the Southern Community Cohort Study (SCCS). METHODS Study participants were women diagnosed with incident breast cancer (n = 949) in the SCCS, which is a prospective cohort study of predominantly low-income adults aged 40-79 years recruited from 12 Southeastern states between 2002 and 2009. Participants completed a detailed baseline questionnaire, with annual follow-up for mortality via registry linkages. Cox regression models were used to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for associations of pre-diagnosis PA (measured via a validated questionnaire) with all-cause and breast cancer-specific mortality. RESULTS Breast cancer survivors had a mean age of 61.1 years and most (79.3%) had a household income of < $25,000. In adjusted models, higher levels of total PA (MET-hours/day) were inversely associated with all-cause mortality with HRs (95% CIs): 0.79 (0.59-1.06), 0.66 (0.49-0.90), and 0.60 (0.43-0.84), for Q2, Q3, and Q4 (reference: Q1), respectively, ptrend ≤ 0.01. A similar inverse association was found for breast cancer-specific mortality. CONCLUSION Higher levels of pre-diagnosis PA were associated with improved survival among low-income Black breast cancer survivors. Resources to reduce barriers to PA participation and increase support for education and intervention efforts to promote PA among Black women are needed.
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Affiliation(s)
- Sarah J Nechuta
- School of Interdisciplinary Health, College of Health Professions, Grand Valley State University, 500 Lafayette Ave NE, Grand Rapids, MI, 49503, USA.
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, and Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Loren Lipworth
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, and Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Wendy Y Chen
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Deptartment of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Xiao Ou Shu
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, and Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Wei Zheng
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, and Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - William J Blot
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, and Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
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Rubio MA, Mejía-Arbeláez CM, Wilches-Mogollon MA, Moreno S, Finck C, Rosas LG, Romero SA, Guevara P, Cabas S, Rubiano O, Flórez-Pregonero A, León JG, Alarcón LF, Haile R, Sarmiento OL, King AC. "My Body, My Rhythm, My Voice": a community dance pilot intervention engaging breast cancer survivors in physical activity in a middle-income country. Pilot Feasibility Stud 2023; 9:30. [PMID: 36855214 PMCID: PMC9971676 DOI: 10.1186/s40814-023-01253-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 01/28/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Interventions to promote physical activity among women breast cancer survivors (BCS) in low- to middle-income countries are limited. We assessed the acceptability and preliminary effectiveness of a theory-driven, group-based dance intervention for BCS delivered in Bogotá, Colombia. METHODS We conducted a quasi-experimental study employing a mixed-methods approach to assess the 8-week, 3 times/week group dance intervention. The effect of the intervention on participants' physical activity levels (measured by accelerometry), motivation to engage in physical activity, and quality of life were evaluated using generalized estimating equation analysis. The qualitative method included semi-structured interviews thematically analyzed to evaluate program acceptability. RESULTS Sixty-four BCS were allocated to the intervention (n = 31) or the control groups (n = 33). In the intervention arm, 84% attended ≥ 60% of sessions. We found increases on average minutes of moderate-to-vigorous physical activity per day (intervention: +8.99 vs control: -3.7 min), and in ratings of motivation (intervention change score = 0.45, vs. control change score= -0.05). BCS reported improvements in perceived behavioral capabilities to be active, captured through the interviews. CONCLUSIONS The high attendance, behavioral changes, and successful delivery indicate the potential effectiveness, feasibility, and scalability of the intervention for BCS in Colombia. TRIAL REGISTRATION ClinicalTrial.gov NCT05252780, registered on Dec 7th, 2021-retrospectively registered unique protocol ID: P20CA217199-9492018.
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Affiliation(s)
- María Alejandra Rubio
- grid.7247.60000000419370714School of Medicine, Universidad de los Andes, Carrera 1, #18ª-12, Bogotá, Colombia
| | - Carlos M. Mejía-Arbeláez
- grid.7247.60000000419370714School of Medicine, Universidad de los Andes, Carrera 1, #18ª-12, Bogotá, Colombia
| | - Maria A. Wilches-Mogollon
- grid.7247.60000000419370714School of Engineering, Universidad de los Andes, Carrera 1 #18ª-12, Bogotá, Colombia
| | - Sergio Moreno
- grid.7247.60000000419370714School of Medicine, Universidad de los Andes, Carrera 1, #18ª-12, Bogotá, Colombia
| | - Carolyn Finck
- grid.7247.60000000419370714Department of Psychology, Universidad de los Andes, Carrera 1 #18ª-12, Bogotá, Colombia
| | - Lisa G. Rosas
- grid.168010.e0000000419368956Department of Epidemiology and Population Health, Stanford University School Medicine, Stanford, CA 94305 USA ,grid.168010.e0000000419368956Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305 USA
| | - Sol A. Romero
- grid.442177.30000 0004 0486 1713Faculty of Health Sciences, Universidad Manuela Beltrán, Bogotá, Colombia
| | - Paula Guevara
- grid.7247.60000000419370714School of Medicine, Universidad de los Andes, Carrera 1, #18ª-12, Bogotá, Colombia
| | - Santiago Cabas
- grid.7247.60000000419370714School of Medicine, Universidad de los Andes, Carrera 1, #18ª-12, Bogotá, Colombia
| | - Oscar Rubiano
- grid.442175.10000 0001 2106 7261Research Department, Universidad Libre, Bogotá, Colombia
| | - Alberto Flórez-Pregonero
- grid.41312.350000 0001 1033 6040School of Education, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - José G. León
- Sports Medicine Service, Hospital de San José, Bogotá, Colombia
| | - Luis Fernando Alarcón
- grid.7247.60000000419370714School of Medicine, Universidad de los Andes, Carrera 1, #18ª-12, Bogotá, Colombia
| | | | - Olga L. Sarmiento
- grid.7247.60000000419370714School of Medicine, Universidad de los Andes, Carrera 1, #18ª-12, Bogotá, Colombia
| | - Abby C. King
- grid.168010.e0000000419368956Department of Epidemiology and Population Health, Stanford University School Medicine, Stanford, CA 94305 USA ,grid.168010.e0000000419368956Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305 USA
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15
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Salerno EA, Gao R, Fanning J, Gothe NP, Peterson LL, Anbari AB, Kepper MM, Luo J, James AS, McAuley E, Colditz GA. Designing home-based physical activity programs for rural cancer survivors: A survey of technology access and preferences. Front Oncol 2023; 13:1061641. [PMID: 36761969 PMCID: PMC9907024 DOI: 10.3389/fonc.2023.1061641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 01/03/2023] [Indexed: 01/26/2023] Open
Abstract
Background While technology advances have increased the popularity of remote interventions in underserved and rural cancer communities, less is understood about technology access and preferences for home-based physical activity programs in this cancer survivor population. Purpose To determine access, preferences, and needs, for a home-based physical activity program in rural cancer survivors. Methods A Qualtrics Research Panel was recruited to survey adults with cancer across the United States. Participants self-reported demographics, cancer characteristics, technology access and usage, and preferences for a home-based physical activity program. The Godin Leisure Time Exercise Questionnaire (GLTEQ) assessed current levels of physical activity. Descriptive statistics included means and standard deviations for continuous variables, and frequencies for categorical variables. Independent samples t-tests explored differences between rural and non-rural participants. Results Participants (N=298; mean age=55.2 ± 16.5) had a history of cancer (mean age at diagnosis=46.5), with the most commonly reported cancer type being breast (25.5%), followed by prostate (16.1%). 74.2% resided in rural hometowns. 95% of participants reported accessing the internet daily. On a scale of 0-100, computer/laptop (M=63.4) and mobile phone (M=54.6) were the most preferred delivery modes for a home-based physical activity intervention, and most participants preferred balance/flexibility (72.2%) and aerobic (53.9%) exercises. Desired intervention elements included a frequency of 2-3 times a week (53.5%) for at least 20 minutes (75.7%). While there were notable rural disparities present (e.g., older age at diagnosis, lower levels of education; ps<.001), no differences emerged for technology access or environmental barriers (ps>.08). However, bias due to electronic delivery of the survey should not be discounted. Conclusion These findings provide insights into the preferred physical activity intervention (e.g., computer delivery, balance/flexibility exercises) in rural cancer survivors, while highlighting the need for personalization. Future efforts should consider these preferences when designing and delivering home-based interventions in this population.
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Affiliation(s)
- Elizabeth A. Salerno
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
- Alvin J. Siteman Cancer Center, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
| | - Rohana Gao
- Academic Program of Medical Education, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
| | - Jason Fanning
- Department of Gerontology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Neha P. Gothe
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, United States
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | - Lindsay L. Peterson
- Alvin J. Siteman Cancer Center, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
- Division of Medical Oncology, Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
| | - Allison B. Anbari
- Sinclair School of Nursing, University of Missouri, Columbia, MO, United States
| | - Maura M. Kepper
- Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Jingqin Luo
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
- Alvin J. Siteman Cancer Center, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
| | - Aimee S. James
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
- Alvin J. Siteman Cancer Center, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
| | - Edward McAuley
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, United States
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | - Graham A. Colditz
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
- Alvin J. Siteman Cancer Center, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
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Suzuki K, Naito T, Okayama T, Yonenaga Y, Kitagawa M, Sato R, Suzuki K, Ishii T, Mitsuhashi N, Uehara R, Shimizu A, Nishizawa T, Fuseya H. Perception of the prognostic impact of physical activity among cancer survivors: a narrative review. SPORT SCIENCES FOR HEALTH 2023. [DOI: 10.1007/s11332-022-01033-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Abstract
Purpose
Little is known about cancer survivors’ perceptions of the prognostic impact of physical activity (PA) and the association between perceptions and PA. Therefore, the present narrative review aimed to identify cancer survivors' perceptions of the prognostic impact of PA, perception barriers, and association with PA.
Methods
A literature search was performed via PubMed and Scopus with search terms including “physical activity”, “cancer survivor”, and “perception” in November 2022. Inclusion criteria were studies that investigated cancer survivors’ perceptions of the prognostic impact of PA written in English. Studies were excluded for patients undergoing cancer treatment or advanced cancer patients only.
Results
Our search identified a total of 13,080 articles, and 14 studies met the inclusion criteria. The study sample size ranged from 8 to 1003 participants. Most studies showed that cancer survivors poorly understood the prognostic impact of PA. Perception barriers were cited as a lack of advice from health care professionals (HCPs). Several studies reported a positive association between the perception of the prognostic impact of PA and actual PA.
Conclusions
This narrative review revealed that most reports showed that cancer survivors have a poor perception of the prognostic impact of PA. In addition, the lack of advice from HCPs may also be contributing to the lack of perception among cancer survivors. Therefore, to increase the amount of PA among cancer survivors, it is necessary to improve the perception of the prognostic impact of PA in both cancer survivors and HCPs.
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17
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A longitudinal study of physical activity among Malaysian breast cancer survivors. PLoS One 2022; 17:e0277982. [PMID: 36409745 PMCID: PMC9678261 DOI: 10.1371/journal.pone.0277982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 11/07/2022] [Indexed: 11/22/2022] Open
Abstract
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.
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18
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Marell PS, Vierkant RA, Olson JE, Herrmann J, Larson N, LeBrasseur NK, D’Andre SD, Cheville AL, Barksdale T, Loprinzi CL, Couch F, Ruddy KJ. Factors Associated With Physical Activity Levels in Patients With Breast Cancer. Oncologist 2022; 27:e811-e814. [PMID: 35946834 PMCID: PMC9526500 DOI: 10.1093/oncolo/oyac159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 07/01/2022] [Indexed: 01/21/2023] Open
Abstract
Physical activity (PA) is associated with improvement in breast cancer treatment-related symptoms and survival, yet most breast cancer survivors do not meet national PA guidelines. This study aimed to identify characteristics of participants that were associated with an increased likelihood of meeting PA guidelines. Adults with breast cancer seen at Mayo Clinic (Rochester, MN) were surveyed regarding their PA participation, and those who self-reported at least 150 minutes of moderate and/or strenuous aerobic PA weekly on average were considered to be "meeting guidelines". Three thousand participants returned PA data. Younger age, completion of the survey 7-12 years after diagnosis, absence of recurrence, no bilateral mastectomy, absence of metastatic disease, and lower BMI at the time of survey completion were associated with PA participation (P < .05 in univariate and multivariate analyses). Findings were similar when a threshold of 90 minutes was applied. These results may inform the development of targeted PA-facilitating interventions.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Fergus Couch
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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19
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Swartz MC, Lewis ZH, Deer RR, Stahl AL, Swartz MD, Christopherson U, Basen-Engquist K, Wells SJ, Silva HC, Lyons EJ. Feasibility and Acceptability of an Active Video Game-Based Physical Activity Support Group (Pink Warrior) for Survivors of Breast Cancer: Randomized Controlled Pilot Trial. JMIR Cancer 2022; 8:e36889. [PMID: 35994321 PMCID: PMC9446134 DOI: 10.2196/36889] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 07/01/2022] [Accepted: 07/04/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Survivors of breast cancer with functional limitations have a 40% higher mortality rate than those without. Despite the known benefits of physical activity (PA), <40% of survivors of breast cancer meet the recommendations for PA. The combination of active video games (AVGs) and group-based PA counseling may hold potential for motivating PA adoption and improving physical function. However, this method has not been widely studied in survivors of breast cancer. OBJECTIVE We aimed to determine the feasibility and acceptability of a group AVG-based multicomponent PA intervention and estimate its effect size and variability on PA and physical function in female survivors of breast cancer in a clinic setting. METHODS Female survivors of breast cancer (N=60) were recruited through the clinic and randomly assigned to the intervention group (12 weekly sessions) or the control group (existing support group). The intervention group received game-based pedometers and participated in weekly group AVG sessions, PA behavioral coaching, and survivorship navigation discussions. A participant manual with weekly reflection worksheets was provided to reinforce the coaching lessons and promote self-led PA. The control group received conventional pedometers and participated in an existing breast cancer support group. Feasibility was assessed by enrollment rate (≥50%), retention rate (≥80%), group attendance rate (75% attending ≥9 sessions [intervention group]), and the number of technological issues and adverse events. Acceptability was measured by participants' attitudes (from strongly disagree=1 to strongly agree=5) toward the use of AVGs and the overall program. The outcomes included PA (accelerometers) and physical function (Short Physical Performance Battery and gait speed). Analysis of covariance was used to determine differences in PA and physical function between the groups. The Cohen d and its 95% CI determined the effect size and variability, respectively. All the analyses followed the intention-to-treat principle. RESULTS Participants were an average of 57.4 (SD 10.5) years old, 70% (42/60) White, and 58% (35/60) off treatment. The enrollment rate was 55.9% (66/118). Despite substantial long-term hurricane-related disruptions, we achieved an 80% (48/60) retention. The intervention group's attendance rate was 78% (14/18), whereas the control group's attendance rate was 53% (9/17). Of the 26 game-based pedometers, 3 (12%) were damaged or lost. No study-related adverse events occurred. Acceptability items were highly rated. Steps (β=1621.64; P=.01; d=0.72), Short Physical Performance Battery (β=.47; P=.01; d=0.25), and gait speed (β=.12; P=.004; d=0.48) had a significant intervention effect. CONCLUSIONS The intervention was feasible and acceptable in this population despite the occurrence of a natural disaster. Pilot results indicate that group AVG sessions, PA coaching, and survivorship navigation produced moderate effects on PA and physical functioning. AVGs with PA counseling can potentially be used in existing breast cancer support groups to encourage PA and improve physical function. TRIAL REGISTRATION ClinicalTrials.gov NCT02750241; https://clinicaltrials.gov/ct2/show/NCT02750241.
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Affiliation(s)
- Maria C Swartz
- Department of Pediatrics-Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Zakkoyya H Lewis
- Department of Kinesiology & Health Promotion, California State Polytechnic University, Pomona, Pomona, CA, United States
| | - Rachel R Deer
- Department of Nutrition, Metabolism and Rehabilitation Sciences, Sealy Center on Aging, The University of Texas Medical Branch, Galveston, TX, United States
| | - Anna L Stahl
- Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston, School of Public Health, Houston, TX, United States
| | - Michael D Swartz
- Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston, School of Public Health, Houston, TX, United States
| | - Ursela Christopherson
- Department of Nutrition, Metabolism and Rehabilitation Sciences, The University of Texas Medical Branch, Galveston, TX, United States
| | - Karen Basen-Engquist
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Stephanie J Wells
- Department of Pediatrics-Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - H Colleen Silva
- Department of Surgery, The University of Texas Medical Branch, Houston, TX, United States
| | - Elizabeth J Lyons
- Department of Nutrition, Metabolism and Rehabilitation Sciences, Sealy Center on Aging, The University of Texas Medical Branch, Galveston, TX, United States
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20
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Murray J, Perry R, Pontifex E, Selva-Nayagam S, Bezak E, Bennett H. The impact of breast cancer on fears of exercise and exercise identity. PATIENT EDUCATION AND COUNSELING 2022; 105:2443-2449. [PMID: 35272904 DOI: 10.1016/j.pec.2022.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 02/17/2022] [Accepted: 03/04/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Low exercise adherence is common amongst breast cancer (BC) patients. This study aimed to understand BC patients exercise identity and fears of exercise to identify barriers to exercise participation. METHODS Women (18 years plus) currently undergoing, or completed (in remission), chemotherapy for BC, and women (18 years plus) with no cancer history completed three validated questionnaires: Exercise Identity Scale (EI), Exercise Fear Avoidance Scale (EFAS) and Fear of Physical Activity/Exercise Scale - Breast Cancer. RESULTS 86 women were included (BC: n = 51 - non-cancer: n = 35). There were no significant differences between groups when comparing overall EI (p = 0.240; d=0.127) and EFAS (p = 0.060; d=0.203) scores. BC reported significantly higher scores on specific questions related to fear during exercise (EFAS 2,3, and 5; p = <0.005). Associations were observed between EI and EFAS questionnaire scores in BC (r = -0.342; p = 0.014), and EI scores and exercise levels in both groups (BC, r = 0.527; p = <0.001; non-cancer, r = 0.639; p = <0.001). CONCLUSION Results suggest women with BC may have specific concerns and fears of exercise compared to age-matched controls. Education may mitigate fears, increase exercise identity, and promote exercise uptake. PRACTICAL IMPLICATIONS Education provided by clinicians at BC diagnosis regarding the benefits and safety of exercise may help mitigate fear and promote exercise identity.
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Affiliation(s)
- James Murray
- Allied Health and Human Performance, University of South Australia, Adelaide, Australia; Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, Adelaide, Australia; Cancer Research Institute, University of South Australia, Adelaide, Australia.
| | - Rebecca Perry
- Allied Health and Human Performance, University of South Australia, Adelaide, Australia; Cancer Research Institute, University of South Australia, Adelaide, Australia.
| | - Emma Pontifex
- Cancer Centre, Royal Adelaide Hospital, Adelaide, Australia.
| | | | - Eva Bezak
- Allied Health and Human Performance, University of South Australia, Adelaide, Australia; Cancer Research Institute, University of South Australia, Adelaide, Australia; Department of Physics, University of Adelaide, Adelaide, Australia.
| | - Hunter Bennett
- Allied Health and Human Performance, University of South Australia, Adelaide, Australia; Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, Adelaide, Australia.
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21
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Bentley JR, Yu X, Karmarkar AM, Downer B, Prochaska J, Lyons EJ. Feasibility and thematic analysis of narrative visualization materials with physical activity monitoring among breast cancer survivors. BMC Cancer 2022; 22:553. [PMID: 35578196 PMCID: PMC9112443 DOI: 10.1186/s12885-022-09629-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 05/03/2022] [Indexed: 11/10/2022] Open
Abstract
Background Breast cancer survivors have a unique risk for negative health outcomes. Engaging in routine physical activity (PA) can reduce these risks. However, PA levels are low among this population. Narrative visualization (NV) is a technique that uses drawings, photographs, and text to contextualize data, which may increase integrated regulation, or motivation related to personal values and identity. A PA intervention targeting breast cancer survivors using an NV strategy may improve PA behavior. The purpose of this study was to determine whether scrapbooking activities could successfully be used as an NV strategy for older (55+) breast cancer survivors. Methods Breast cancer survivors were given workbooks, wearable electronic activity monitors, instant cameras, and art supplies including a variety of stickers (e.g., emojis, affirmations). Participants were instructed to use these materials for 7 days. The workbook pages prompted participants to re-draw their daily activity graphs from the wearable’s mobile app, then annotate them with text, photographs, stickers, etc. to reflect what the data meant to them. Hybrid thematic analysis was used to analyze the photographs, drawings, and written content to identify emergent themes. Content analysis was also used to investigate use of stickers and photographs. Results Of the 20 consented women (mean age 67 ± 5 years, 45% non-Hispanic white), 3 participants were lost to follow-up or unable to complete the procedures. The NV procedures were successfully utilized by the remaining 17 participants, who collectively used 945 stickers over 7 days, most of which were emojis. Emojis were both positively and negatively valanced. Participants took a mean of 9 photos over 7 days and completed workbook questions regarding current PA and PA goals. Themes within the photos included family, specific locations, everyday objects, religion, and friends. Themes within the written portions of the workbook included family, chores and obligations, health, personal reflection, hobbies, and shopping. Conclusions The materials provided allowed breast cancer survivors to successfully use NV techniques to reflect on their PA data and behavior. These techniques show promise for promoting integrated regulation in activity monitoring interventions. Trial registration This study was funded by the National Cancer Institute (R21CA218543) beginning July 1, 2018.
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Affiliation(s)
- Jason R Bentley
- University of Texas Medical Branch, Galveston, TX, USA. .,University of Houston Clear Lake, Houston, TX, USA.
| | - Xiaoying Yu
- University of Texas Medical Branch, Galveston, TX, USA
| | | | - Brian Downer
- University of Texas Medical Branch, Galveston, TX, USA
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22
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Owusu C, Margevicius S, Nock NL, Austin K, Bennet E, Cerne S, Hergenroeder P, Moore HCF, Petkac J, Schluchter M, Schmitz KH, Webb Hooper M, Wimbley L, Berger NA. A randomized controlled trial of the effect of supervised exercise on functional outcomes in older African American and non-Hispanic White breast cancer survivors: Are there racial differences in the effects of exercise on functional outcomes? Cancer 2022; 128:2320-2338. [PMID: 35289926 DOI: 10.1002/cncr.34184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/24/2022] [Accepted: 02/24/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND The objective of this study was to test the hypothesis that exercise would be more effective than a support group plus Fitbit (SG+Fitbit) program in improving functional outcomes in older breast cancer survivors (BCSs) and that race would moderate the exercise effect on outcomes. METHODS Older African American (AA) and non-Hispanic White (NHW) BCSs were purposively recruited and enrolled into the 52-week randomized controlled trial. The interventions included 20 weeks of supervised moderate-intensity aerobic and resistance training followed by 32 weeks of unsupervised exercise called IMPROVE (n = 108) and a 20-week SG+Fitbit program followed by 32 weeks of unsupervised activity (n = 105). Study outcomes were assessed at 20 and 52 weeks. The primary outcome was the change in Short Physical Performance Battery (SPPB) scores 20 weeks from the baseline between arms. Secondary outcomes included change in the 6-Minute Walk Test (6MWT) in meters 20 weeks from the baseline between arms. General linear regression and multivariable logistic regression analyses were used. RESULTS The mean age was 71.9 years (SD, 5.9 years), and 44% were AA. SPPB scores did not differ between arms (adjusted difference in mean change, 0.13; 95% CI, -0.28 to 0.55; P = .53). However, the exercise arm (vs the SG+Fitbit arm) improved on the 6MWT (21.6 m; 95% CI, 2.5-40.6 m; P = .03). Race moderated the exercise effect on the 6MWT (adjusted interaction effect, 43.3 m; 95% CI, 6.3-80.2 m; P = .02); this implied that the change in the adjusted mean for the 6MWT at 20 weeks from the baseline was 43.3 m higher in AA exercise participants versus NHW exercise participants. CONCLUSIONS Combined aerobic and resistance exercise appears to improve physical performance in older BCSs, and the exercise effect might be moderated by race, with AAs appearing to derive larger benefits in comparison with NHWs. Larger studies are warranted to confirm the study findings.
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Affiliation(s)
- Cynthia Owusu
- Division of Hematology/Oncology, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio.,Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio
| | - Seunghee Margevicius
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio.,Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio
| | - Nora L Nock
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio.,Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio
| | - Kristina Austin
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio
| | | | | | | | - Halle C F Moore
- Department of Hematology/Oncology, Cleveland Clinic, Cleveland, Ohio
| | - Jean Petkac
- University Hospitals of Cleveland, Cleveland, Ohio
| | - Mark Schluchter
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio.,Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio
| | | | - Monica Webb Hooper
- National Institute on Minority Health and Disparities, National Institutes of Health, Bethesda, Maryland
| | - Leonard Wimbley
- Division of Hematology/Oncology, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Nathan A Berger
- Division of Hematology/Oncology, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio.,Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio
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23
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Impact of a randomized weight loss trial on breast tissue markers in breast cancer survivors. NPJ Breast Cancer 2022; 8:29. [PMID: 35256599 PMCID: PMC8901848 DOI: 10.1038/s41523-022-00396-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 02/01/2022] [Indexed: 11/08/2022] Open
Abstract
Few trials have examined the effect of lifestyle behavioral interventions on tissue markers in patients with cancer. The purpose of this study was to examine the feasibility and impact of a 6-month weight loss intervention on breast tissue and serum biomarkers in women with breast cancer. Fifty-one women who completed breast cancer treatment and had a BMI ≥ 25.0 kg/m2 were randomized to a weight loss intervention or usual care. Breast tissue biopsies, fasting blood draw and body composition were collected at baseline and 6 months, with between-group changes examined using analysis of covariance method. Baseline and post-intervention biopsies were conducted in 49 and 42 women, respectively, with pre- and post-epithelial tissue available from 25 tissue samples. Average 6-month weight loss was 6.7% for the weight loss group and 2.0% increase for the usual care group (p < 0.0001). At baseline, body fat and serum insulin levels were inversely associated with breast tissue insulin receptor levels and CD68 (p < 0.05). At 6 months, favorable changes were observed in serum leptin and adiponectin levels and tissue CD163 among women randomized to weight loss vs. adverse change in women randomized to usual care (p < 0.05). Breast tissue biopsies are feasible to collect in a clinical research setting among breast cancer survivors, with weight loss favorably impacting metabolic and inflammatory markers associated with breast cancer.
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24
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Krok-Schoen JL, Pennell ML, Saquib N, Naughton M, Zhang X, Shadyab AH, Kroenke CH, Bea JW, Peterson LL, Crane T, Wactawski-Wende J, Paskett ED. Correlates of physical activity among older breast cancer survivors: Findings from the Women's Health Initiative LILAC study. J Geriatr Oncol 2022; 13:143-151. [PMID: 34893462 PMCID: PMC9346622 DOI: 10.1016/j.jgo.2021.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/09/2021] [Accepted: 11/29/2021] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Physical activity can attenuate cancer-related declines in physical functioning, improve emotional well-being, and prolong survival among older (≥65 years) breast cancer survivors. However, factors associated with physical activity among older breast cancer survivors are not well-understood. MATERIALS AND METHODS Participants were enrolled in the Women's Health Initiative (WHI) Life and Longevity After Cancer (LILAC) study. Descriptive statistics, multiple linear regression, and relative risk [RR] regression were used to assess the association of demographic, clinical, physical and psychosocial variables with the total duration of and participation in physical activity among postmenopausal breast cancer survivors. Age-specific correlates (65-74 years vs. 75-84 years vs. ≥85 years) of physical activity were also examined. RESULTS The majority of participants (n = 3710, mean age = 78.8 ± 5.9) were white (90.7%) and had in situ/localized breast cancer (78.9%). Women who had higher education (RR = 1.47 for graduate/professional school versus high school or less, 95% CI: 1.32, 1.63), higher self-rated health (RR = 1.04 for 10 point increase, 95% CI:1.02, 1.07), higher physical functioning (RR = 1.03 for 5 point increase, 95% CI: 1.02, 1.04), and higher social support (RR = 1.41 for social support all of the time versus none of the time, 95% CI: 1.01, 1.96), were more likely to engage in any physical activity. Similar results were observed for duration of physical activity. Among women aged <75, radiation therapy, but not chemotherapy, was associated with longer duration of total physical activity (adjusted difference = 19.7 min/week, 95% CI: 6.1, 33.3), but was not associated with duration among older women. The association between pain and duration of moderate/strenuous activity also differed with age: among women aged <75, those with moderate pain averaged fewer minutes of moderate/strenuous physical activity than those with no pain (adjusted difference:-14.4 min/week, 95% CI:-28.5, -0.1). However, among women aged ≥85, those with moderate pain averaged more minutes of moderate/strenuous physical activity per week than those with no pain (adjusted difference:16.6 min/week; 95% CI:2.9, 30.3). DISCUSSION Multiple factors were associated with physical activity among older breast cancer survivors in the WHI. Future physical activity interventions should focus on age-related (e.g., comorbidities) and treatment-related factors (e.g., radiation) as well as certain subgroups, such as women with higher symptom burden.
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Affiliation(s)
- Jessica L. Krok-Schoen
- Division of Health Sciences, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, 453 W. 10 Ave., 306 Atwell Hall, Columbus, OH 43210, USA,Corresponding author at: Division of Health Sciences, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, 453 W. 10th Ave., 306 Atwell Hall, Columbus, OH 43210, USA. (J.L. Krok-Schoen)
| | - Michael L. Pennell
- Division of Biostatistics, College of Public Health, The Ohio State University, 246 Cunz Hall, 1841 Neil Ave., Columbus, OH 43210, USA
| | - Nazmus Saquib
- College of Medicine, Sulaiman Alrajhi University, PO Box 777, Bukariyah, Qassim 51941, Saudi Arabia
| | - Michelle Naughton
- Division of Cancer Prevention and Control, Department of Medicine, College of Medicine, The Ohio State University, 1590 N. High St., Columbus, OH 43210, USA
| | - Xiaochen Zhang
- Division of Population Sciences, The Ohio State University Comprehensive Cancer Center, 1590 N. High St., Columbus, OH 43210, USA
| | - Aladdin H. Shadyab
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California at San Diego, 9500 Gilman Dr., La Jolla, CA 92093, USA
| | - Candyce H. Kroenke
- Kaiser Permanente Northern California Division of Research, 2000 Broadway, Oakland, CA, 94612, USA
| | - Jennifer W. Bea
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1515 N. Campbell Ave, Tucson, AZ 85724, USA
| | - Lindsay L. Peterson
- Division of Oncology, Department of Medicine, Washington University School of Medicine, 660 S. Euclid Ave., St. Louis, MO 63110, USA
| | - Tracy Crane
- Sylvester Comprehensive Cancer Center, University of Miami, 1475 NW 12th Ave, Miami, FL 33136, USA
| | - Jean Wactawski-Wende
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, 410 Kimball Tower, Buffalo, NY 14214, USA
| | - Electra D. Paskett
- Division of Cancer Prevention and Control, Department of Medicine, College of Medicine, The Ohio State University, 1590 N. High St., Columbus, OH 43210, USA
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25
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Greaney SK, Amin N, Prudner BC, Compernolle M, Sandell LJ, Tebb SC, Weilbaecher KN, Abeln P, Luo J, Tao Y, Hirbe AC, Peterson LL. Yoga Therapy During Chemotherapy for Early-Stage and Locally Advanced Breast Cancer. Integr Cancer Ther 2022; 21:15347354221137285. [PMID: 36412916 PMCID: PMC9706042 DOI: 10.1177/15347354221137285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: Chemotherapy is associated with decreased quality of life (QOL), fatigue, depression, and weight gain in patients with breast cancer. Weight gain is associated with poorer prognosis. Yoga improves QOL, fatigue, and mood in women with breast cancer but its effect on treatment-related weight gain has not been studied. The aim of this trial was to determine the feasibility of personalized yoga therapy in women receiving treatment for early-stage or locally advanced breast cancer and assess its impact on weight gain. Methods: Thirty women were randomized 1:1 to receive yoga therapy by a certified yoga therapist during treatment or a control group. Participants in the yoga arm were asked to complete three 30 minute yoga sessions weekly (which included movement, breath work, mindfulness, and relaxation) throughout adjuvant or neoadjuvant chemotherapy (N = 29) or endocrine (N = 1); the control arm received breast cancer treatment without yoga. For comparability between participants randomized to yoga therapy, the single patient treated with endocrine therapy was excluded from the analysis. Primary outcomes were feasibility and weight change. Additional outcomes were mood, fatigue, QOL, serum tumor necrosis factor-alpha (TNF-alpha), and C-reactive protein (CRP) as immune mediator biomarkers. Results: Mean age was 51.6 years, 75.9% were white and 24.1% were people of color, reflecting the cancer center population. 80% had stage II-III disease. Enrollment was completed in 9 months. Compliance was lower than predicted; however, participants participated in on average 1.7 yoga sessions/week for a mean 15.6 weeks duration. There were no adverse events. Control arm participants gained on average 2.63% body weight during treatment while yoga participants lost 0.14% body weight (weight change = −0.36 in yoga arm vs. 2.89 in standard of care arm, Wilcoxon rank sum test P = .024). Control participants reported increased fatigue and decreased QOL, while yoga participants reported no change in QOL. No significant change in TNF-alpha or CRP was noted in either arm. Conclusion: This feasibility study suggests that personalized yoga therapy is beneficial for QOL and weight maintenance among women undergoing chemotherapy for early-stage or locally advanced breast cancer. Weight maintenance associated with yoga therapy may be of clinical significance in this population given the poorer prognosis associated with weight gain in breast cancer survivors. Trial Registration: NIH Clinicaltrials.gov #NCT03262831; August 25, 2017. https://clinicaltrials.gov/ct2/show/NCT03262831
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Affiliation(s)
| | - Neha Amin
- Washington University School of Medicine, Saint Louis, MO, USA
| | | | | | | | | | | | - Peri Abeln
- Washington University School of Medicine, Saint Louis, MO, USA
| | - Jingqin Luo
- Washington University School of Medicine, Saint Louis, MO, USA
| | - Yu Tao
- Washington University School of Medicine, Saint Louis, MO, USA
| | - Angela C. Hirbe
- Washington University School of Medicine, Saint Louis, MO, USA
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26
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Dunn M, Milius L, Ivarra A, Cooper M, Bhakta N. Motivations and Experiences in a Physical Activity Program for Cancer Survivors: Findings from Key Informant Interviews. Am J Health Promot 2021; 36:497-505. [PMID: 34969306 DOI: 10.1177/08901171211061939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE LIVESTRONG at the YMCA is an evidence-based 12-week physical activity (PA) program for cancer survivors. The purpose of our study was to understand the factors that motivated cancer survivors to begin the program, how the program impacted their habits, and how their experience influenced their motivation to continue with the program. APPROACH OR DESIGN Key informant interviews. SETTING Phone interviews conducted between April 15 and June 1, 2020. PARTICIPANTS 27 cancer survivors in Texas who previously participated in the LS program. METHOD Participants completed a 30- to 60-minute interview with one of four interviewers. All interviews were recorded, transcribed, and analyzed for themes. RESULTS Most interviewees were motivated to begin the program because of a desire to feel better after treatment. The most cited motivator to continue in the program was the community of cancer survivors. During the program, interviewees enjoyed learning different exercises, the community of cancer survivors, and the supportive teachers. Nearly all interviewees adopted or changed a healthy habit as a result of the program. CONCLUSION These results could be used by healthcare professionals to better understand what motivates cancer survivors to participate in a PA program. Results could also be used to plan or modify other PA programs for cancer survivors.
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Affiliation(s)
- Melissa Dunn
- Health Promotion and Chronic Disease Prevention Section, 8193Texas Department of State Health Services, Austin, TX, USA
| | - Lauren Milius
- Health Promotion and Chronic Disease Prevention Section, 8193Texas Department of State Health Services, Austin, TX, USA
| | - Amanda Ivarra
- Health Promotion and Chronic Disease Prevention Section, 8193Texas Department of State Health Services, Austin, TX, USA
| | - Maria Cooper
- Health Promotion and Chronic Disease Prevention Section, 8193Texas Department of State Health Services, Austin, TX, USA
| | - Nimisha Bhakta
- Health Promotion and Chronic Disease Prevention Section, 8193Texas Department of State Health Services, Austin, TX, USA
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27
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Koeppel M, Körbi C, Winkels RM, Schmitz KH, Wiskemann J. Relationship Between Cancer Related Fatigue, Physical Activity Related Health Competence, and Leisure Time Physical Activity in Cancer Patients and Survivors. Front Sports Act Living 2021; 3:687365. [PMID: 34423290 PMCID: PMC8374069 DOI: 10.3389/fspor.2021.687365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/12/2021] [Indexed: 12/18/2022] Open
Abstract
Background: A large body of evidence supports the positive effects of leisure time physical activity (LTPA) and exercise on cancer survivors. However, only a fraction of survivors manages to attain international PA recommendations. This can be attributed to several external and internal barriers toward PA those patients seem to encounter, with cancer related fatigue (CRF) being the most reported internal barrier. Nevertheless, self-efficacy and knowledge about the utilization of LTPA can serve as facilitators of PA, which also correspond to certain constituents of physical activity related health competence (PAHCO). Since PAHCO is not investigated in cancer survivors we investigated if PAHCO can mediate the negative relationship between CRF and LTPA. Methods: We surveyed 398 cancer survivors with different cancer types and therapy status. The patients completed the EORTC QLQ-FA12 (EORTC FA12) to assess CRF, the PAHCO questionnaire to assess PAHCO and the SQUASH to assess LTPA. We followed a two-step structural equation modeling approach. The first step established the measurement model, in the second step we fitted the mediation model. Since 163 patients chose not to answer the SQUASH, the mediation model was only fitted to the data of the remaining 235 participants. Results: The proposed measurement model of the PAHCO offered an excellent fit. We found small to moderate positive associations between the PAHCO dimensions and the LTPA, and negative moderate relationships between the PAHCO and the EORTC FA12 dimensions. We did not observe a relationship between the EORTC FA12 dimensions and the LTPA (p > 0.05). The hypothesized mediation models did not display an appropriate fit. Conclusion: The PAHCO confirmed its factorial validity; furthermore, it appears to have a positive relationship to LTPA. Therefore, integrating psycho-educational aspects can be beneficial in order to increase the PAHCO in exercise interventions. Because of the cross-sectional character of this study, causal conclusions are not suitable, therefore the longitudinal relationships of LTPA, CRF, and PAHCO require further investigation.
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Affiliation(s)
- Maximilian Koeppel
- Institute of Sport Science, Heidelberg University, Heidelberg, Germany.,Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States.,Working Group Exercise Oncology, Division Medical Oncology, National Center for Tumordiseases Heidelberg and Heidelberg University Hospital, Heidelberg, Germany
| | - Carlotta Körbi
- Institute of Sport Science, Heidelberg University, Heidelberg, Germany
| | - Renate M Winkels
- Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States.,Division of Human Nutrition and Health, Wageningen University, Wageningen, Netherlands
| | - Kathryn H Schmitz
- Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States
| | - Joachim Wiskemann
- Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States.,Working Group Exercise Oncology, Division Medical Oncology, National Center for Tumordiseases Heidelberg and Heidelberg University Hospital, Heidelberg, Germany
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28
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Kong S, Lee JK, Kang D, Kim N, Shim YM, Park W, Choi D, Cho J. 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. Cancers (Basel) 2021; 13:cancers13112692. [PMID: 34070937 PMCID: PMC8199478 DOI: 10.3390/cancers13112692] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/25/2021] [Accepted: 05/27/2021] [Indexed: 12/18/2022] Open
Abstract
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.
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Affiliation(s)
- Sunga Kong
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul 06351, Korea; (S.K.); (D.K.)
- Patient-Centered Outcomes Research Institute, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul 06351, Korea;
| | - Jae Kyung Lee
- Patient-Centered Outcomes Research Institute, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul 06351, Korea;
| | - Danbee Kang
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul 06351, Korea; (S.K.); (D.K.)
- Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Nayeon Kim
- Cancer Education Center, Samsung Comprehensive Cancer Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
| | - Young Mog Shim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
| | - Won Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 6351, Korea;
| | - Dooho Choi
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 6351, Korea;
- Correspondence: (D.C.); (J.C.); Tel.: +82-2-3410-2436 (D.C.); +82-2-3410-1448 (J.C.)
| | - Juhee Cho
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul 06351, Korea; (S.K.); (D.K.)
- Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
- Department of Epidemiology and Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
- Correspondence: (D.C.); (J.C.); Tel.: +82-2-3410-2436 (D.C.); +82-2-3410-1448 (J.C.)
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Petrella AR, Sabiston CM, Vani MF, Matthew A, Santa Mina D. Psychological Needs Satisfaction, Self-Rated Health and the Mediating Role of Exercise Among Testicular Cancer Survivors. Am J Mens Health 2021; 15:15579883211012601. [PMID: 33926293 PMCID: PMC8114270 DOI: 10.1177/15579883211012601] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Exploring tenets of basic psychological needs theory, the objective of this study was to examine the association between psychological needs satisfaction, exercise behavior, and physical and mental health among testicular cancer survivors. The present study investigated whether psychological needs satisfaction was directly associated with increased self-rated health, and if this relationship was mediated by engagement in exercise. Testicular cancer survivors (N = 135; Mage = 32.45; SD = 7.63) self-reported current psychological needs satisfaction, exercise behavior, and perceived global physical and mental health during routine oncology visits. Associations were examined using path analysis. Psychological needs satisfaction was a positive correlate of both self-rated physical and mental health in this sample, and exercise mediated the association between needs satisfaction and self-rated physical health. This study supports the assumptions underpinning basic psychological needs theory in this unique clinical population. Based on the findings, exercise engagement represents one mechanism associated with perceived health after cancer. Supportive care interventions should aim to enhance satisfaction of psychological needs and investigate exercise as a mechanism underpinning the relationship between needs satisfaction and perceived health in testicular cancer survivors.
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Affiliation(s)
- Anika R Petrella
- Department of Kinesiology and Physical Education, University of Toronto, Toronto, Canada
| | - Catherine M Sabiston
- Department of Kinesiology and Physical Education, University of Toronto, Toronto, Canada
| | - Madison F Vani
- Department of Kinesiology and Physical Education, University of Toronto, Toronto, Canada
| | - Andrew Matthew
- Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Daniel Santa Mina
- Department of Kinesiology and Physical Education, University of Toronto, Toronto, Canada
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Ballinger TJ, Althouse SK, Olsen TP, Miller KD, Sledge JS. A Personalized, Dynamic Physical Activity Intervention Is Feasible and Improves Energetic Capacity, Energy Expenditure, and Quality of Life in Breast Cancer Survivors. Front Oncol 2021; 11:626180. [PMID: 33912450 PMCID: PMC8072267 DOI: 10.3389/fonc.2021.626180] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 02/25/2021] [Indexed: 12/14/2022] Open
Abstract
Purpose Despite survival and quality of life benefits associated with physical activity, many breast cancer survivors remain inactive. Effective, sustainable interventions must account for individual differences in capability, motivation, and environment. Here, we evaluate the feasibility, mechanics, and efficacy of delivering an individualized, dynamic intervention to increase energetic capacity and energy expenditure. Methods Stage 0–III breast cancer patients who had completed primary treatment were enrolled. Prior to the intervention, detailed movement data was collected with a wearable GPS and accelerometer for 3 weeks to establish baseline activity. Movement data was collected continuously throughout the 12-week intervention, during which patients received electronically delivered, tailored, dynamic activity “prescriptions”, adjusted based on demonstrated individual capability, daily movement in their environment, and progress. Results Of 66 enrolled, 57 participants began and completed the intervention. The intervention resulted in significant improvements in average steps (+558 steps/day, p = 0.01), energetic capacity measured by power generation on a stationary bicycle (1.76 to 1.99 W/kg lean mass, p < 0.01), and quality of life (FACT-B TOI, 72.8 to 74.8, p = 0.02). The greatest improvement in functional energetic capacity was seen in the lowest performing tertile at baseline (0.76 to 1.12 W/kg, p < 0.01). Discussion Wearable technology delivery of personalized activity prescriptions based on individual capability and movement behaviors demonstrates feasibility and early effectiveness. The high variability seen in baseline activity and function, as well as in response to the intervention, supports the need for future work in precision approaches to physical activity (NCT03158519).
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Affiliation(s)
- Tarah J Ballinger
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Sandra K Althouse
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Timothy P Olsen
- Department of Urban and Regional Planning, University of Wisconsin, Madison, WI, United States
| | - Kathy D Miller
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Jeffrey S Sledge
- Department of Urban and Regional Planning, University of Wisconsin, Madison, WI, United States
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31
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Martin E, Di Meglio A, Charles C, Ferreira A, Gbenou A, Blond M, Fagnou B, Arvis J, Pistilli B, Saghatchian M, Vaz Luis I. Use of mHealth to Increase Physical Activity Among Breast Cancer Survivors With Fatigue: Qualitative Exploration. JMIR Cancer 2021; 7:e23927. [PMID: 33749606 PMCID: PMC8088868 DOI: 10.2196/23927] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 01/29/2021] [Accepted: 02/20/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Physical activity has shown beneficial effects in the treatment of breast cancer fatigue; nevertheless, a significant portion of patients remain insufficiently physically active after breast cancer. Currently most patients have a smartphone, and therefore mobile health (mHealth) holds the promise of promoting health behavior uptake for many of them. OBJECTIVE In this study, we explored representations, levers, and barriers to physical activity and mHealth interventions among inactive breast cancer patients with fatigue. METHODS This was an exploratory, qualitative study including breast cancer patients from a French cancer center. A total of 4 focus groups were conducted with 9 patients; 2 independent groups of patients (groups A and B) were interviewed at 2 consecutive times (sessions 1 to 4), before and after their participation in a 2-week mHealth group experience consisting of (1) a competitive virtual exercise group activity (a fictitious world tour), (2) participation in a daily chat network, and (3) access to physical activity information and world tour classification feedback. We used a thematic content analysis. RESULTS Several physical activity levers emerged including (1) physical factors such as perception of physical benefit and previous practice, (2) psychological factors such as motivation increased by provider recommendations, (3) social factors such as group practice, and (4) organizational factors including preplanning physical activity sessions. The main barriers to physical activity identified included late effects of cancer treatment, lack of motivation, and lack of time. The lack of familiarity with connected devices was perceived as the main barrier to the use of mHealth as a means to promote physical activity. The tested mHealth group challenge was associated with several positive representations including well-being and good habit promotion and being a motivational catalyzer. Following feedback, modifications were implemented into the mHealth challenge. CONCLUSIONS mHealth-based, easily accessed group challenges were perceived as levers for the practice of physical activity in this population. mHealth-based group challenges should be explored as options to promote physical activity in a population with fatigue after breast cancer.
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Bloomquist K, Krustrup P, Fristrup B, Sørensen V, Helge JW, Helge EW, Soelberg Vadstrup E, Rørth M, Hayes SC, Uth J. Effects of football fitness training on lymphedema and upper-extremity function in women after treatment for breast cancer: a randomized trial. Acta Oncol 2021; 60:392-400. [PMID: 33423594 DOI: 10.1080/0284186x.2020.1868570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Breast cancer survivors are encouraged to be physically active. A recent review suggests that football training is an effective exercise modality for women across the lifespan, positively influencing health variables such as strength, fitness and social well-being. However, football is a contact sport, potentially posing an increased risk of trauma-related injury. Against this backdrop, breast cancer survivors are advised to avoid trauma or injury to the affected or at-risk arm in order to protect against lymphedema onset or exacerbation. The aim of this study was therefore to evaluate the feasibility and safety of Football Fitness training in relation to lymphedema and upper-extremity function after treatment for breast cancer. MATERIAL AND METHODS Sixty-eight women aged 18-75 years, who had received surgery for stage I-III breast cancer and completed (neo) adjuvant chemotherapy and/or radiotherapy within five years, were randomized (2:1) to a Football Fitness group (FFG, n = 46) or a control group (CON, n = 22) for twelve months. Secondary analyses using linear mixed models were performed to assess changes in upper-body morbidity, specifically arm lymphedema (inter-arm volume % difference, dual energy X-ray absorptiometry; extracellular fluid (L-Dex), bioimpedance spectroscopy), self-reported breast and arm symptoms (EORTC breast cancer-specific questionnaire (BR23) and upper-extremity function (DASH questionnaire) at baseline, six- and twelve-month follow-up. RESULTS We observed similar point prevalent cases of lymphedema between groups at all time points, irrespective of measurement method. At the six-month post-baseline assessment, reductions in L-Dex (extracellular fluid) were found in FFG versus CON. These significant findings were not maintained at the twelve-month assessment. No difference between groups was observed for inter-limb volume difference %, nor any of the remaining outcomes. CONCLUSION While superiority of Football Fitness was not observed, the results support that participation in Football Fitness training is feasible and suggests no negative effects on breast cancer-specific upper-body morbidity, including lymphedema. TRIAL REGISTRATION The trial was registered at ClinicalTrials.gov. NCT03284567.
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Affiliation(s)
- Kira Bloomquist
- University Hospitals Centre for Health Research (UCSF), Copenhagen University Hospital, Copenhagen, Denmark
| | - Peter Krustrup
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Bjørn Fristrup
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Victor Sørensen
- University Hospitals Centre for Health Research (UCSF), Copenhagen University Hospital, Copenhagen, Denmark
| | - Jørn Wulff Helge
- Department of Biomedical Sciences, Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Eva Wulff Helge
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | | | - Mikael Rørth
- University Hospitals Centre for Health Research (UCSF), Copenhagen University Hospital, Copenhagen, Denmark
| | - Sandra C. Hayes
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Jacob Uth
- University Hospitals Centre for Health Research (UCSF), Copenhagen University Hospital, Copenhagen, Denmark
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Karkou V, Dudley-Swarbrick I, Starkey J, Parsons A, Aithal S, Omylinska-Thurston J, Verkooijen HM, van den Boogaard R, Dochevska Y, Djobova S, Zdravkov I, Dimitrova I, Moceviciene A, Bonifacino A, Asumi AM, Forgione D, Ferrari A, Grazioli E, Cerulli C, Tranchita E, Sacchetti M, Parisi A. Dancing With Health: Quality of Life and Physical Improvements From an EU Collaborative Dance Programme With Women Following Breast Cancer Treatment. Front Psychol 2021; 12:635578. [PMID: 33716903 PMCID: PMC7943865 DOI: 10.3389/fpsyg.2021.635578] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 01/27/2021] [Indexed: 12/24/2022] Open
Abstract
Background: Women's health has received renewed attention in the last few years including health rehabilitation options for women affected by breast cancer. Dancing has often been regarded as one attractive option for supporting women's well-being and health, but research with women recovering from breast cancer is still in its infancy. Dancing with Health is multi-site pilot study that aimed to evaluate a dance programme for women in recovery from breast cancer across five European countries. Methods: A standardized 32 h dance protocol introduced a range of Latin American dances presented within a sports and exercise framework with influences from dance movement therapy. Fifty-four women (M age 53.51; SD 7.99) participated in the study who had a breast cancer diagnosis <3 years, chemotherapy >6 weeks, no indication of metastasis, or scheduled surgery/chemotherapy/radiation treatment for the duration of the intervention. Primary outcome data was collected for anthropometric and fitness measures next to cancer-related quality of life. T-tests and Wilcoxon signed ranked tests were used to establish differences pre and post intervention. Cohen's d was also calculated to determine the effect size of the intervention. Results: Statistically significant changes were found for: (i) weight, right and left forearm circumference and hip; (ii) 6 min walking, right and left handgrip, sit-to-stand and sit-and-reach; (iii) the EORTC-QLQ C30 summary score as well as the subscales of emotional and social functioning and symptoms. In all cases the direction of change was positive, while Cohen's d calculated showed that the effect of the intervention for these parameters ranged from intermediate to large. Conclusion: Changes on the above anthropometric, fitness and quality of life measures suggest that the intervention was of value to the participating women recovering from breast cancer. Results also advocate collaborative efforts across countries to further research.
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Affiliation(s)
- Vicky Karkou
- Research Centre for Arts and Wellbeing, Edge Hill University, Ormskirk, United Kingdom
| | | | - Jennifer Starkey
- Research Centre for Arts and Wellbeing, Edge Hill University, Ormskirk, United Kingdom
| | - Ailsa Parsons
- Research Centre for Arts and Wellbeing, Edge Hill University, Ormskirk, United Kingdom
| | - Supritha Aithal
- Research Centre for Arts and Wellbeing, Edge Hill University, Ormskirk, United Kingdom
| | | | | | | | | | - Stefka Djobova
- Bulgarian Sports Development Association, Sofia, Bulgaria
| | | | | | | | | | | | - Dolores Forgione
- Istituto Europeo per lo Sviluppo Socio Economico, Alessandria, Italy
| | - Andrea Ferrari
- Istituto Europeo per lo Sviluppo Socio Economico, Alessandria, Italy
| | - Elisa Grazioli
- Department of Human Movement Sciences and Health, Università degli Studi di Roma Foro Italico, Rome, Italy
| | - Claudia Cerulli
- Department of Human Movement Sciences and Health, Università degli Studi di Roma Foro Italico, Rome, Italy
| | - Eliana Tranchita
- Department of Human Movement Sciences and Health, Università degli Studi di Roma Foro Italico, Rome, Italy
| | - Massimo Sacchetti
- Department of Human Movement Sciences and Health, Università degli Studi di Roma Foro Italico, Rome, Italy
| | - Attilio Parisi
- Department of Human Movement Sciences and Health, Università degli Studi di Roma Foro Italico, Rome, Italy
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Jones T, Sandler C, Vagenas D, Janda M, Obermair A, Hayes S. Physical activity levels among ovarian cancer survivors: a prospective longitudinal cohort study. Int J Gynecol Cancer 2021; 31:553-561. [PMID: 33462088 DOI: 10.1136/ijgc-2020-002107] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 12/21/2020] [Accepted: 12/23/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Physical activity following cancer diagnosis is associated with improved outcomes, including potential survival benefits, yet physical activity levels among common cancer types tend to decrease following diagnosis and remain low. Physical activity levels following diagnosis of less common cancers, such as ovarian cancer, are less known. The objectives of this study were to describe physical activity levels and to explore characteristics associated with physical activity levels in women with ovarian cancer from pre-diagnosis to 2 years post-diagnosis. METHODS As part of a prospective longitudinal study, physical activity levels of women with ovarian cancer were assessed at multiple time points between pre-diagnosis and 2 years post-diagnosis. Physical activity levels and change in physical activity were described using metabolic equivalent task hours and minutes per week, and categorically (sedentary, insufficiently, or sufficiently active). Generalized Estimating Equations were used to explore whether participant characteristics were related to physical activity levels. RESULTS A total of 110 women with ovarian cancer with a median age of 62 years (range 33-88) at diagnosis were included. 53-57% of the women were sufficiently active post-diagnosis, although average physical activity levels for the cohort were below recommended levels throughout the 2-year follow-up period (120-142.5min/week). A decrease or no change in post-diagnosis physical activity was reported by 44-60% of women compared with pre-diagnosis physical activity levels. Women diagnosed with stage IV disease, those earning a lower income, those receiving chemotherapy, and those currently smoking or working were more likely to report lower physical activity levels and had increased odds of being insufficiently active or sedentary. CONCLUSIONS Interventions providing patients with appropriate physical activity advice and support for behavior change could potentially improve physical activity levels and health outcomes.
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Affiliation(s)
- Tamara Jones
- School of Allied Health Sciences, Griffith University, Brisbane, Queensland, Australia
| | - Carolina Sandler
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.,School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Dimitrios Vagenas
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Monika Janda
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.,Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Andreas Obermair
- Queensland Centre for Gynaecological Cancer Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Sandra Hayes
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
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35
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Wilcoxon A, Kober KM, Viele C, Topp K, Smoot B, Abrams G, Chesney M, Paul SM, Conley YP, Levine JD, Miaskowski C. Association Between Physical Activity Levels and Chemotherapy-Induced Peripheral Neuropathy Severity in Cancer Survivors. Oncol Nurs Forum 2020; 47:703-719. [PMID: 33063789 DOI: 10.1188/20.onf.703-719] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To evaluate for differences in demographic and clinical characteristics, as well as subjective and objective measures of chemotherapy-induced peripheral neuropathy (CIPN), among different exercise groups. SAMPLE & SETTING Cancer survivors (N = 290) were recruited from throughout the San Francisco Bay Area. METHODS & VARIABLES Based on the recommended 150 minutes or more of exercise per week, survivors were classified into the no exercise (NoEx), less exercise (LessEx), or recommended exercise (RecEx) group. Survivors completed self-report questionnaires and underwent sensory and balance testing. RESULTS Compared to the RecEx group, survivors in the NoEx group had less education, were less likely to be married/partnered, had a lower household income, had a higher level of comorbidity, and had poorer functional status. No differences were found among the groups in CIPN duration; pain intensity scores; or changes in light touch, cold, and pain sensations. IMPLICATIONS FOR NURSING Clinicians can recommend walking as a therapeutic option for survivors with CIPN and refer them to physical therapy.
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Monteiro-Guerra F, Signorelli GR, Rivera-Romero O, Dorronzoro-Zubiete E, Caulfield B. Breast Cancer Survivors' Perspectives on Motivational and Personalization Strategies in Mobile App-Based Physical Activity Coaching Interventions: Qualitative Study. JMIR Mhealth Uhealth 2020; 8:e18867. [PMID: 32955446 PMCID: PMC7536602 DOI: 10.2196/18867] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 05/22/2020] [Accepted: 06/04/2020] [Indexed: 12/24/2022] Open
Abstract
Background Despite growing evidence supporting the vital benefits of physical activity (PA) for breast cancer survivors, the majority do not meet the recommended levels of activity. Mobile app–based PA coaching interventions might be a feasible strategy to facilitate adherence of breast cancer survivors to the PA guidelines. To engage these individuals, PA apps need to be specifically designed based on their needs and preferences and to provide targeted support and motivation. However, more information is needed to understand how these technologies can provide individual and relevant experiences that have the ability to increase PA adherence and retain the individual’s interest in the long term. Objective The aim of this study is to explore insights from breast cancer survivors on motivational and personalization strategies to be used in PA coaching apps and interventions. Methods A qualitative study was conducted, using individual semistructured interviews, with 14 breast cancer survivors. The moderator asked open-ended questions and made use of a slideshow presentation to elicit the participants’ perspectives on potential mobile app–based intervention features. Transcribed interviews were evaluated by 3 reviewers using thematic content analysis. Results Participants (mean age 53.3, SD 8.7 years) were White women. In total, 57% (8/14) of the participants did not adhere to the PA guidelines. In general, participants had access to and were interested in using technology. The identified themes included (1) barriers to PA, (2) psychological mediators of PA motivation, (3) needs and suggestions for reinforcing motivation support, (4) personalization aspects of the PA coaching experience, and (5) technology trustworthiness. Motivational determinants included perceived control, confidence and perceived growth, and connectedness. Participants were interested in having a straightforward app for monitoring and goal setting, which would include a prescribed activity program and schedule, and positive communication. Opinions varied in terms of social and game-like system possibilities. In addition, they expressed a desire for a highly personalized coaching experience based on as much information collected from them as possible (eg, disease stage, physical limitations, preferences) to provide individualized progress information, dynamic adjustment of the training plan, and context-aware activity suggestions (eg, based on weather and location). Participants also wanted the app to be validated or backed by professionals and were willing to share their data in exchange for a more personalized experience. Conclusions This work suggests the need to develop simple, guiding, encouraging, trustworthy, and personalized PA coaching apps. The findings are in line with behavioral and personalization theories and methods that can be used to inform intervention design decisions. This paper opens new possibilities for the design of personalized and motivating PA coaching app experiences for breast cancer survivors, which might ultimately facilitate the sustained adherence of these individuals to the recommended levels of activity.
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Affiliation(s)
- Francisco Monteiro-Guerra
- Salumedia Tecnologías, Seville, Spain.,The Insight Centre for Data Analytics, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Gabriel Ruiz Signorelli
- The Insight Centre for Data Analytics, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland.,Oncoavanze, Seville, Spain
| | | | | | - Brian Caulfield
- The Insight Centre for Data Analytics, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
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Orman A, Johnson DL, Comander A, Brockton N. Breast Cancer: A Lifestyle Medicine Approach. Am J Lifestyle Med 2020; 14:483-494. [PMID: 32922233 DOI: 10.1177/1559827620913263] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Breast cancer is the most common female cancer diagnosis in the United States (excluding skin cancers), and the second leading cause of female cancer death. This article highlights the role that lifestyle plays in primary breast cancer prevention, breast cancer treatment, and tertiary breast cancer prevention. Current data regarding the benefits of a predominantly plant-based diet in combination with physical activity and maintenance of a healthy body weight will be reviewed. The evidenced-based patient-focused recommendations developed by the World Cancer Research Fund/American Institute for Cancer Research will be discussed in the context of an overall lifestyle strategy. It is our hope that this publication empowers clinicians to provide patients with personalized cancer-protective lifestyle prescriptions.
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Affiliation(s)
| | | | - Amy Comander
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Nigel Brockton
- American Institute for Cancer Research, Arlington, Virginia
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Level of Exercise Influences the Severity of Fatigue, Energy Levels, and Sleep Disturbance in Oncology Outpatients Receiving Chemotherapy. Cancer Nurs 2020; 45:3-11. [DOI: 10.1097/ncc.0000000000000875] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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39
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Geng Z, Ning L, Cai L, Liu Y, Wang J, Zhang Y, Wu F, Yuan C. Usability of a Theory-based Mobile Health Physical Activity Intervention for Breast Cancer Patients during Chemotherapy: Mixed Method Study (Preprint). JMIR Form Res 2020. [DOI: 10.2196/22858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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40
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Hayes S, Singh B, Bloomquist K, Johansson K. Do Women with Breast Cancer–related Lymphoedema Need to Wear Compression While Exercising?: Results from a Systematic Review and Meta-analysis. CURRENT BREAST CANCER REPORTS 2020. [DOI: 10.1007/s12609-020-00373-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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41
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Monteiro-Guerra F, Signorelli GR, Tadas S, Dorronzoro Zubiete E, Rivera Romero O, Fernandez-Luque L, Caulfield B. A Personalized Physical Activity Coaching App for Breast Cancer Survivors: Design Process and Early Prototype Testing. JMIR Mhealth Uhealth 2020; 8:e17552. [PMID: 32673271 PMCID: PMC7391671 DOI: 10.2196/17552] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 03/25/2020] [Accepted: 03/29/2020] [Indexed: 12/17/2022] Open
Abstract
Background Existing evidence supports the many benefits of physical activity (PA) in breast cancer survival. However, few breast cancer survivors adhere to the recommended levels of activity. A PA coaching app that provides personalized feedback, guidance, and motivation to the user might have the potential to engage these individuals in a more active lifestyle, in line with the general recommendations. To develop a successful tool, it is important to involve the end users in the design process and to make theoretically grounded design decisions. Objective This study aimed to execute the design process and early prototype evaluation of a personalized PA coaching app for posttreatment breast cancer survivors. In particular, the study explored a design combining behavioral theory and tailored coaching strategies. Methods The design process was led by a multidisciplinary team, including technical and health professionals, and involved input from a total of 22 survivors. The process comprised 3 stages. In stage 1, the literature was reviewed and 14 patients were interviewed to understand the needs and considerations of the target population toward PA apps. In stage 2, the global use case for the tool was defined, the features were ideated and refined based on theory, and a digital interactive prototype was created. In stage 3, the prototype went through usability testing with 8 patients and was subjected to quality and behavior change potential evaluations by 2 human-computer interaction experts. Results The design process has led to the conceptualization of a personalized coaching app for walking activities that addresses the needs of breast cancer survivors. The main features of the tool include a training plan and schedule, adaptive goal setting, real-time feedback and motivation during walking sessions, activity status through the day, activity history, weekly summary reports, and activity challenges. The system was designed to measure users’ cadence during walking, use this measure to infer their training zone, and provide real-time coaching to control the intensity of the walking sessions. The outcomes from user testing and expert evaluation of the digital prototype were very positive, with scores from the system usability scale, mobile app rating scale, and app behavior change scale of 95 out of 100, 4.6 out of 5, and 15 out of 21, respectively. Conclusions Implementing a user-centered design approach for the development and early evaluation of an app brings essential considerations to tailor the solution to the user’s needs and context. In addition, informing the design on behavioral and tailored coaching theories supports the conceptualization of the PA coaching system. This is critical for optimizing the usability, acceptability, and long-term effectiveness of the tool. After successful early in-laboratory testing, the app will be developed and evaluated in a pilot study in a real-world setting.
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Affiliation(s)
- Francisco Monteiro-Guerra
- Insight Centre for Data Analytics, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Gabriel Ruiz Signorelli
- Insight Centre for Data Analytics, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland.,Salumedia Tecnologias, Seville, Spain
| | - Shreya Tadas
- Insight Centre for Data Analytics, School of Computer Science, University College Dublin, Dublin, Ireland
| | | | | | | | - Brian Caulfield
- Insight Centre for Data Analytics, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
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Relationship of objectively measured physical activity and sedentary behaviour with health-related quality of life among breast cancer survivors. Health Qual Life Outcomes 2020; 18:222. [PMID: 32650777 PMCID: PMC7350582 DOI: 10.1186/s12955-020-01478-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 07/03/2020] [Indexed: 12/14/2022] Open
Abstract
Background Lack of physical activity throughout one’s lifetime has been associated with obesity and it is also an important risk factor of breast cancer. This study aimed to determine the relationship between objectively measured physical activity and sedentary behaviour with health-related quality of life (HRQoL) among breast cancer survivors in the East Coast region of Peninsular Malaysia. Methods A cross-sectional study involving 83 breast cancer survivors was carried out in two main government referral hospitals in the region. Participants wore the ActivPAL3™ microdevice physical activity monitor for seven consecutive days. The validated European Organization for Research and Treatment of Cancer Quality of Life Questionnaires (EORTC QLQ–C30) and Breast Cancer Supplementary Measure (EORTC QLQ-BR23) were used to measure their HRQoL. Multiple linear regression analysis was conducted to determine the relationship between objectively measured physical activity and sedentary behaviour with HRQoL. Results Longer time spent on moderate to vigorous physical activity (MVPA) was significantly associated with an improvement of HRQoL (p = 0.039) whereas longer time spent on sedentary behaviour significantly reduced the functioning score (p = 0.005). In addition, prolonged sedentary bouts were also significantly associated with better body image that led to improved HRQoL (p = 0.013). Conclusions The study findings suggest that an increase in the time spent on MVPA was associated with improved HRQoL while sedentary behaviour was associated with poorer HRQoL among breast cancer survivors. Thus, it is essential to displace sedentary behaviour with MVPA to improve the quality of life of breast cancer survivors.
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Sheppard VB, Dash C, Nomura S, Sutton AL, Franco RL, Lucas A, Ross M, Adams-Campbell L. Physical activity, health-related quality of life, and adjuvant endocrine therapy-related symptoms in women with hormone receptor-positive breast cancer. Cancer 2020; 126:4059-4066. [PMID: 32614992 DOI: 10.1002/cncr.33054] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 06/03/2020] [Accepted: 06/03/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Physical activity (PA) is recommended for women with breast cancer (BC); however, data are sparse on the association of PA with quality of life (QOL) and patient-reported symptoms for women on adjuvant endocrine therapy (AET). METHODS Women with hormone receptor-positive BC who were taking AET completed standardized surveys about their health-related QOL, AET-related symptoms, and levels of PA using validated measures. A Wald chi-square test and an analysis of variance were used to assess associations with PA and independent variables. Generalized linear regression analyses assessed associations between PA, QOL, and AET-related symptoms. RESULTS The analytic cohort included 485 Black and White women. Black race, a high body mass index (BMI), and being on aromatase inhibitors (vs tamoxifen) were associated with lower PA in a bivariate analysis. In a multivariate analysis, lower self-reported PA was associated with a high BMI (P = .02) and chemotherapy uptake (P = .006). Better health-related QOL (P = .01), less severe overall AET-related symptoms (P = .02), and less severe gynecological symptoms (P = .03) were associated with increasing levels of moderate PA. CONCLUSIONS Among women taking AET, moderate levels of PA may be associated with fewer medication-related symptoms and overall better ratings of health-related QOL. Because of the low levels of PA observed in the sample overall and particularly for Black women, identifying successful strategies to promote PA are needed.
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Affiliation(s)
- Vanessa B Sheppard
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, Virginia.,Office of Health Equity and Disparities Research, Massey Cancer Center, Virginia Commonwealth University, Richmond, Virginia
| | - Chiranjeev Dash
- Department of Oncology, Georgetown University, Washington, DC
| | - Sarah Nomura
- Department of Oncology, Georgetown University, Washington, DC
| | - Arnethea L Sutton
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Robert Lee Franco
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University College of Humanities and Sciences, Richmond, Virginia
| | - Alexander Lucas
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Masey Ross
- Department of Internal Medicine, Virginia Commonwealth University Health System, Richmond, Virginia
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Tollosa DN, Holliday E, Hure A, Tavener M, James EL. A 15-year follow-up study on long-term adherence to health behaviour recommendations in women diagnosed with breast cancer. Breast Cancer Res Treat 2020; 182:727-738. [PMID: 32535764 DOI: 10.1007/s10549-020-05704-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 05/21/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Whilst a cancer diagnosis may prompt health behaviour change, there is limited evidence regarding whether such changes are maintained in the long-term. We aimed to investigate the impact of cancer diagnosis on health behaviour changes over the long-term survivorship period among breast cancer survivors (BCSs). METHODS The sample comprised 153 BCSs and 4778 cancer-free women, aged 49-55 years in 2001 (our baseline), from the 1946-1951 birth cohort of the Australian Longitudinal Study on Women's Health. Health behaviours (physical activity, smoking, alcohol, diet and Body Mass Index), recommended by the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR), were assessed in five survivorship periods: ≤ 3 years, 3 to ≤ 6 years, 6 to ≤ 9 years, 9 to ≤ 12 years, and 12 to 15 years since diagnosis. A validated semi-quantitative Food Frequency Questionnaire was used for dietary assessment. Pre-diagnosis (baseline) health behaviours of BCSs and cancer-free women were compared (using Generalized Linear Models (GLM)). Multilevel (mixed effect) models were used for longitudinal data in BCSs. RESULTS There was no significant difference in health behaviours between BCSs (prior to diagnosis) and cancer-free women. Following diagnosis, BCSs were significantly more physically active (≥ 600 MET min/week; 50.8% to 63.3%; p = 0.02) and consumed more fruit (≥ 2 serves/day; 57.4% to 66.4%; p = 0.01) in the recent survivorship period, but were less likely to be classified in the healthy weight range (p < 0.01). The proportion of non-drinkers and non-smokers slightly increased over the survivorship period. Whole-vegetable intake did not significantly change; however, the intake of non-starchy vegetables significantly increased from pre-diagnosis (LS mean = 89.1 g/day) to post-diagnosis, 6 to ≤ 9 years (LS mean = 137.1 g/day), and 9 to ≤ 12 years (LS mean = 120.8 g/day). There were no significant changes in the total intake of fibre, carotenoids, calcium, fat, saturated fat, vitamin C, or vitamin E observed, except for increased total energy intake (p = 0.012). CONCLUSION Before diagnosis, BCSs had similar adherence to health behaviours compared to cancer-free women. Initial positive changes to health behaviours were observed post BC diagnosis, except healthy body weight, but maintenance of such changes over the long-term was poor. BCSs may benefit from additional advice and support to make healthy lifestyle choices throughout survivorship.
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Affiliation(s)
- Daniel N Tollosa
- School of Medicine and Public Health, University of Newcastle, New Lambton Heights, Newcastle, NSW, 2305, Australia. .,Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, Newcastle, NSW, 2305, Australia.
| | - Elizabeth Holliday
- School of Medicine and Public Health, University of Newcastle, New Lambton Heights, Newcastle, NSW, 2305, Australia.,Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, Newcastle, NSW, 2305, Australia
| | - Alexis Hure
- School of Medicine and Public Health, University of Newcastle, New Lambton Heights, Newcastle, NSW, 2305, Australia.,Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, Newcastle, NSW, 2305, Australia
| | - Meredith Tavener
- School of Medicine and Public Health, University of Newcastle, New Lambton Heights, Newcastle, NSW, 2305, Australia.,Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, Newcastle, NSW, 2305, Australia
| | - Erica L James
- School of Medicine and Public Health, University of Newcastle, New Lambton Heights, Newcastle, NSW, 2305, Australia.,Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, Newcastle, NSW, 2305, Australia
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Shi Z, Rundle A, Genkinger JM, Cheung YK, Ergas IJ, Roh JM, Kushi LH, Kwan ML, Greenlee H. Distinct trajectories of moderate to vigorous physical activity and sedentary behavior following a breast cancer diagnosis: the Pathways Study. J Cancer Surviv 2020; 14:393-403. [PMID: 32130627 PMCID: PMC7955660 DOI: 10.1007/s11764-020-00856-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 01/27/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE To identify distinct trajectories of total moderate-to-vigorous physical activity (MVPA) and sedentary behavior following a breast cancer diagnosis and their correlates. METHODS The analysis examined 3000 female breast cancer survivors within Kaiser Permanente Northern California between 2006 and 2013. Self-reported time spent on total MVPA and sedentary behaviors were assessed at baseline (mean = 1.8 months post-diagnosis) and at 6 and 24 months follow up. Trajectory groups were identified using group-based trajectory modeling and K-means for longitudinal data analysis. Trajectory groups were named by baseline activity level (high, medium, or low) and direction of change (increaser, decreaser, or maintainer). RESULTS Trajectory analyses identified three MVPA trajectories [high decreaser (7%), medium decreaser (35%), low maintainer (58%)] and four sedentary behavior trajectories [high maintainer (18%), high decreaser (27%), low increaser (24%), and low maintainer (31%)]. Women with higher education (ORs: 1.63-4.37), income (OR: 1.37), dispositional optimism (ORs: 1.60-1.86), and social support (OR: 1.33) were more likely to be high or medium decreasers of MVPA (all P < 0.05). High maintainers and high decreasers of sedentary behavior were more likely to have higher education (OR: 1.84) and social support (ORs: 1.42-1.86), but lower income (OR: 0.66; all P < 0.05). CONCLUSIONS In the 24 months following breast cancer diagnosis, 42% of survivors decreased MVPA and 73% maintained or increased time on sedentary behavior. Socioeconomic status and stress coping at diagnosis predicted subsequent PA trajectory. IMPLICATIONS FOR CANCER SURVIVORS It is important to prioritize exercise intervention and counseling during early stage of breast cancer survivorship, especially in survivors who are at high risk of becoming physically inactive post-diagnosis.
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Affiliation(s)
- Zaixing Shi
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China.
- Key Laboratory of Health Technology Assessment of Fujian Province, School of Public Health, Xiamen University, Xiamen, China.
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
- Columbia University Mailman School of Public Health, New York, NY, USA.
| | - Andrew Rundle
- Columbia University Mailman School of Public Health, New York, NY, USA
- Herbert Irving Comprehensive Cancer Center, New York, NY, USA
| | - Jeanine M Genkinger
- Columbia University Mailman School of Public Health, New York, NY, USA
- Herbert Irving Comprehensive Cancer Center, New York, NY, USA
| | - Ying Kuen Cheung
- Columbia University Mailman School of Public Health, New York, NY, USA
- Herbert Irving Comprehensive Cancer Center, New York, NY, USA
| | - Isaac J Ergas
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Janise M Roh
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Lawrence H Kushi
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Marilyn L Kwan
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Heather Greenlee
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Columbia University Mailman School of Public Health, New York, NY, USA
- Seattle Cancer Care Alliance, Seattle, WA, USA
- University of Washington, Seattle, WA, USA
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Owusu C, Nock NL, Hergenroeder P, Austin K, Bennet E, Cerne S, Moore H, Petkac J, Schluchter M, Schmitz KH, Webb Hooper M, Atkins L, Asagba O, Wimbley L, Berger NA. IMPROVE, a community-based exercise intervention versus support group to improve functional and health outcomes among older African American and non-Hispanic White breast cancer survivors from diverse socioeconomic backgrounds: Rationale, design and methods. Contemp Clin Trials 2020; 92:106001. [PMID: 32304828 PMCID: PMC7325580 DOI: 10.1016/j.cct.2020.106001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 03/24/2020] [Accepted: 04/13/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND African Americans (AA) and socioeconomic status (SES) disadvantaged older breast cancer survivors (BCS) are more likely to experience poor functional and health outcomes. However, few studies have evaluated the putative beneficial effects of exercise on these outcomes in older racial minority and SES-disadvantaged BCS. METHODS This is a mixed-methods study that includes a randomized-controlled trial, "IMPROVE", to evaluate a group-based exercise intervention compared to a support group program in older BCS, followed by post-intervention semi-structured interviews to evaluate the intervention. The trial aims to recruit 220 BCS with 55 in each of four strata defined by race (AA versus Non-Hispanic Whites) and SES (disadvantaged vs. non-disadvantaged). Participants are ≥65 years old and within five years of treatment completion for stage I-III breast cancer. Participants are randomized to a 52-week, three sessions/week, one-hour/session, moderate intensity aerobic and resistance group exercise intervention, (n = 110) or a 52-week, one hour/week, support group intervention [attention-control arm], (n = 110). The first 20 weeks of both programs are supervised and the last 32 weeks, unsupervised. The primary outcome is the change in Short Physical Performance Battery (SPPB) Scores at 20 weeks from baseline, between the two arms. Secondary outcomes include change in SPPB scores at 52 weeks, change in body composition and biomarkers, at 20 and 52 weeks from baseline, between arms. DISCUSSION Results of the trial may contribute to a better understanding of factors associated with recruitment, and acceptability, and will inform future exercise programs to optimally improve health outcomes for older BCS.
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Affiliation(s)
- Cynthia Owusu
- Division of Hematology/Oncology, Department of Medicine, Case Western Reserve University (CWRU) School of Medicine, Cleveland, OH, United States of America; Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, United States of America.
| | - Nora L Nock
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, United States of America; Department of Population and Quantitative Health Sciences, CWRU, Cleveland, OH, United States of America
| | - Paul Hergenroeder
- Department of Medicine, Division of Hematology/Oncology, MetroHealth Medical Center, Cleveland, OH, United States of America
| | - Kristina Austin
- The Gathering Place, Beachwood, OH, United States of America
| | | | - Stephen Cerne
- The Gathering Place, Beachwood, OH, United States of America
| | - Halle Moore
- Cleveland Clinic, Department of Hematology/Oncology, Cleveland, OH, United States of America
| | - Jean Petkac
- University Hospitals of Cleveland, Cleveland, OH, United States of America
| | - Mark Schluchter
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, United States of America; Department of Population and Quantitative Health Sciences, CWRU, Cleveland, OH, United States of America
| | - Kathryn H Schmitz
- Penn State University College of Medicine, Hershey, PA, United States of America
| | - Monica Webb Hooper
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, United States of America
| | - Lindsay Atkins
- California Baptist University, Riverside, CA, United States of America
| | - Oghenerukeme Asagba
- West Virginia University School of Medicine, Morgantown, WV, United States of America
| | - Leonard Wimbley
- Division of Hematology/Oncology, Department of Medicine, Case Western Reserve University (CWRU) School of Medicine, Cleveland, OH, United States of America
| | - Nathan A Berger
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, United States of America
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Socio-ecological correlates of physical activity in breast and colon cancer survivors 4 years after participation in a randomized controlled exercise trial (PACT study). PLoS One 2020; 15:e0231663. [PMID: 32298326 PMCID: PMC7161977 DOI: 10.1371/journal.pone.0231663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 03/27/2020] [Indexed: 11/19/2022] Open
Abstract
Background Having a physically active lifestyle after cancer diagnosis is beneficial for health, and this needs to be continued into survivorship to optimize long-term benefits. We found that patients, who participated in an 18-week exercise intervention, reported significant higher physical activity (PA) levels 4 years after participation in a randomized controlled trial of supervised exercise delivered during chemotherapy (PACT study). This study aimed to identify social-ecological correlates of PA levels in breast and colon cancer survivors 4 years after participation in the PACT study. Methods Self-reported PA levels and potential correlates (e.g. physical fitness, fatigue, exercise history, and built environment) were assessed in 127 breast and colon cancer survivors shortly after diagnosis (baseline), post-intervention and 4 years later. Multivariable linear regression analyses were performed to identify social-ecological correlates of PA 4 years post-baseline. Results The final model revealed that lower baseline physical fatigue (β = -0.25, 95% CI -0.26; -0.24) and higher baseline total PA (0.06, 95% CI, 0.03; 0.10) were correlated with higher total PA levels 4 years post-baseline. Higher baseline leisure and sport PA (0.02, 95% CI 0.01; 0.03), more recreational facilities within a buffer of 1 km (4.05, 95% CI = 1.28; 6.83), lower physical fatigue at 4-year follow-up (-8.07, 95% CI -14.00; -2.13), and having a positive change in physical fatigue during the intervention period (0.04, 95% CI 0.001; 0.07) were correlates of sport and leisure PA levels 4 years post-baseline. Conclusions This study suggests that baseline and 4-year post-baseline physical fatigue, and past exercise behaviour, were significant correlates of PA 4 years after participation in an exercise trial. Additionally, this study suggests that the built environment should be taken into account when promoting PA. Understanding of socio-ecological correlates of PA can provide insights into how future exercise interventions should be designed to promote long-term exercise behaviour. Trial registration Current Controlled Trials ISRCTN43801571, Dutch Trial Register NTR2138. Trial registered on 9 December 2009, http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2138
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Befort CA, Kimler BF, Bantis LE, Phillips TA, Fabian CJ. Effects of Weight Loss and Weight Regain on Circulating Biomarkers in Overweight/Obese Breast Cancer Survivors Enrolled in a Weight Loss Trial in the Rural Midwest. Cancer Epidemiol Biomarkers Prev 2020; 29:1321-1328. [PMID: 32277008 DOI: 10.1158/1055-9965.epi-19-1572] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/23/2020] [Accepted: 04/07/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Obesity is associated with worse breast cancer prognosis, however little is known about the level of weight loss required to improve pathway biomarkers. The effects of weight regain on biomarkers are also largely unknown. METHODS Overweight/obese breast cancer survivors enrolled in an 18-month behavioral weight loss trial provided weight and serum biomarkers [leptin, adiponectin, insulin, plasminogen activator inhibitor-1 (PAI-1), IL-6, TNFα, and hepatocyte growth factor HGF] at baseline, 6, and 18 months (n = 138). Change in biomarkers over time and by weight loss thresholds were examined. RESULTS Mean weight loss at 6 months was 13.3 ± 5.0 kg; from 6 to 18 months, mean regain was 4.0 ± 5.2 kg. Favorable biomarker modulations were observed at 6 months for leptin, adiponectin, insulin, PAI-1, IL-6, and HGF (P < 0.006 to P < 0.0001). These changes remained significant overall at 18 months despite attenuation in some. Women who lost <10% of baseline weight showed significantly smaller modulation effects for leptin (P < 0.0001), adiponectin:leptin (A/L) ratio (P < 0.0001), PAI-1 (P < 0.001), and insulin (P = 0.003) compared with women who lost >10%. Women who lost >10% observed a significant increase in adiponectin (P < 0.0001), and these women continued to show improved adiponectin from 6 to 18 months despite weight regain. Physical activity contributed additional effects on biomarker change for leptin, A/L ratio, and PAI-1. CONCLUSIONS These findings are consistent with a clinical target of 10% weight. IMPACT Sustained increases in adiponectin likely confer benefits for breast cancer prognosis even with weight regain.
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Affiliation(s)
- Christie A Befort
- University of Kansas Medical Center, University of Kansas Cancer Center, Kansas City, Kansas.
| | - Bruce F Kimler
- University of Kansas Medical Center, University of Kansas Cancer Center, Kansas City, Kansas
| | - Leonidas E Bantis
- University of Kansas Medical Center, University of Kansas Cancer Center, Kansas City, Kansas
| | - Teresa A Phillips
- University of Kansas Medical Center, University of Kansas Cancer Center, Kansas City, Kansas
| | - Carol J Fabian
- University of Kansas Medical Center, University of Kansas Cancer Center, Kansas City, Kansas
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Morris M, Crank H, Loosemore M, Stevinson C. Identification of Research Priorities in Exercise Oncology: A Consensus Study. J Cancer 2020; 11:2702-2707. [PMID: 32201540 PMCID: PMC7066012 DOI: 10.7150/jca.42992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 01/30/2020] [Indexed: 11/05/2022] Open
Abstract
The growth of research in the field of exercise oncology has resulted in a large evidence base for the role of physical activity in preventing and managing cancer outcomes. Nonetheless, there remain many unanswered questions across the multidisciplinary field. This study aimed to determine the priority research questions within exercise oncology using a systematic consensus method. Forty-seven exercise oncology experts engaged in the five-step process of the Nominal Group Technique to generate a list of research questions in small groups and rank the 10 most important. One hundred questions resulted from the process and fifteen received total scores (sum of ranks) of at least 50 from a maximum score of 470. The highest ranked question (score of 125) related to the identification of functional markers of recovery. The next five questions concerned minimum exercise parameters, health professional education, translation of behavioural interventions, effects of exercise on the tumour microenvironment and development of in vitro models to study the impact of exercise on cancer cell growth and metastasis. The study has demonstrated the importance of future research across all disciplinary areas of exercise oncology and identified the priority questions to which resources might be directed.
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Affiliation(s)
- Mhairi Morris
- School of Sport, Exercise and Health Sciences, Loughborough University, United Kingdom.,National Centre of Sport and Exercise Medicine East Midlands, United Kingdom
| | - Helen Crank
- Centre for Sport and Exercise Science, Sheffield Hallam University, United Kingdom.,National Centre of Sport and Exercise Medicine Sheffield, United Kingdom
| | - Mike Loosemore
- Institute of Sport Exercise and Health, University College London, United Kingdom.,National Centre of Sport and Exercise Medicine London, United Kingdom
| | - Clare Stevinson
- School of Sport, Exercise and Health Sciences, Loughborough University, United Kingdom.,National Centre of Sport and Exercise Medicine East Midlands, United Kingdom
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Moving forward on all fronts: impact, patterns, and barriers to exercise in cancer survivors and patients living with advanced disease. Support Care Cancer 2020; 28:4979-4988. [PMID: 32034513 DOI: 10.1007/s00520-020-05344-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 02/02/2020] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Exercise is recommended for all patients with cancer, but there has been limited study of exercise habits in patients across the spectrum of illness. PURPOSE This pragmatic survey aimed to identify the unmet supportive care needs, self-reported symptoms, and exercise habits among both cancer survivors and patients living with advanced disease to determine adherence to exercise guidelines and to identify barriers and opportunities to improve exercise. METHODS An anonymous cross-sectional self-administered paper survey was distributed to patients with cancer presenting for oncology clinic visits at an academic cancer center. Survey measures included presence of symptoms and health problems in addition to weekly time spent exercising, change in exercise levels since diagnosis, interest in exercise, and self-reported barriers. Participants reporting at least 150 min of exercise per week were characterized as adherent to guidelines. RESULTS Among 640 survey respondents, 570 (89%) completed questions about exercise. Only 44% of cancer survivors and 34% of patients living with advanced disease met current guidelines. Survivors who met exercise guidelines had a lower prevalence of fatigue and memory impairments, but this finding was not seen among patients with advanced cancer. Over 70% of patients with advanced disease and 47% of survivors reported decreasing exercise post-diagnosis compared to pre-diagnosis. Prominent barriers to exercise among both groups included burden of illness and time constraints but interest in increasing exercise was high. CONCLUSIONS There is an opportunity to improve exercise and related outcomes among a large percentage of both cancer survivors and patients living with advanced disease.
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