Physical activity and breast cancer survivorship

The Role of Physical Activity on Quality of Life Among Breast Cancer Survivors in the Black Women's Health Study

PURPOSE

Black breast cancer survivors (BCS) are more likely to experience poor quality of life (QoL) compared to White BCS. Physical activity (PA) has been shown to improve QoL in cancer survivors. However, there is limited evidence demonstrating associations between PA and multiple QoL domains among Black BCS. This study examined the association between PA duration and intensity level (e.g., ≥ 150 min/week of moderate activity) and multiple QoL domains (e.g., physical health) among BCS in the Black Women's Health Study (BWHS).

METHODS

A total of 904 BWHS participants were eligible to participate in this study. The 2019 BWHS follow questionnaire, which assessed multiple QoL domains was used to address the primary aim. Adjusted multinomial logistic regression models were fit to estimate the odds ratios and 95% confidence intervals for the associations with each exposure variable (PA) and outcome variable (QoL). Multiple imputation was used to address missing data.

RESULTS

The average participant age was 66, and the average body mass index was 29 kg/m2 at the time of QoL assessment. There were significant and positive associations between PA duration and intensity level and multiple domains of QoL (p < 0.05). Participants who engaged in higher durations of moderate PA (e.g., ≥ 150 minutes/week) had increased odds of optimal social functioning (aOR = 2.67; 95% CI 1.40, 5.08) and functional wellbeing (aOR = 4.10; 95% CI 1.71, 9.83) than those who engaged in lower durations of moderate PA (e.g., < 150 minutes/week). Compared to participants who engaged in lower durations of vigorous PA (e.g., < 60 minutes/week), those who engaged in higher durations of vigorous PA (e.g., ≥ 60 minutes/week) had greater odds of optimal physical health (aOR = 4.27; 95% CI 2.04, 8.90), social functioning (aOR = 4.48; 95% CI 2.27, 8.86), and financial wellbeing (aOR = 1.64; 95% CI 1.03, 2.63).

CONCLUSIONS

Black BCS who engage in higher durations of moderate and vigorous PA tend to have better QoL. These findings may help to build upon the importance of PA and the relevance of PA in the context of supportive care for racial and ethnic minority BCS. Future longitudinal studies are needed to establish clear temporal associations between PA and QoL in this group.

Karate as a supporting therapy of secondary prevention in breast cancer: a pilot study

BACKGROUND

Breast cancer is a major health burden for women and the most common female cancer. Regarding secondary prevention, it is important to evaluate new approaches of supportive care. Recently, exercise interventions derived from martial arts have been applied in breast cancer patients. The aim of this pilot study was to describe the feasibility of a health-related karate intervention in breast cancer patients.

METHODS

In this pilot study, health-related karate was offered to 20-60 years old women after primary cancer treatment. Participants were recruited in an oncological outpatient center. Feasibility of the intervention was described by eligibility, uptake, adherence, class attendance, adverse events, and continuation after the study.

RESULTS

The uptake rate was 46.5% out of 88% eligible patients. Class attendance of the 15 participating women (median age 52 years) was 84%. Adherence during intervention was 93% and 12 women (80%) continued the karate training after the study. No adverse events were reported.

CONCLUSIONS

Health-related karate exercises are feasible in breast cancer patients after finished primary cancer treatment. High eligibility, uptake and adherence allow the initiation of exercise classes.

Autonomy-supportive exercise behaviors promote breast cancer survivors' well-being

Background: Grounded in self-determination theory (SDT), this pilot study aimed to test an autonomy-supportive exercise instructing style to promote hedonic (seeking comfort and pleasure) and eudaimonic (seeking to develop the best within one and pursue excellence)orientations, exercise motivation, and psychological well-being of breast cancer survivors.

Methods: Twenty-four breast cancer survivors were randomized in either autonomy-supportive exercise instructing style (treatment condition) or usual exercise instructing style (control condition). The study consisted of a pre-intervention session followed by 22 exercise sessions and a post-intervention session. Hedonic and eudaimonic orientations, exercise motivation, and psychological well-being (subjective vitality) measured at baseline and post-intervention sessions.

Results: As expected, participants in the treatment condition reported greater eudaimonic and hedonic orientations and subjective vitality compared to the participants in the control condition. The results showed no difference in exercise motivation across conditions.

Conclusion: We concluded that the SDT-based intervention was successful in helping breast cancer survivors increase hedonic and eudaimonic orientations and subjective vitality. Practical and theoretical implications, along with limitations and future research suggestions are discussed inside.

The Trials within Cohorts design faced methodological advantages and disadvantages in the exercise oncology setting

OBJECTIVES

The Trials within Cohorts (TwiCs) design is an alternative for pragmatic randomized controlled trials (RCTs) and might overcome disadvantages such as difficult recruitment, dropout after randomization to control, and contamination. We investigated the applicability of the TwiCs design in an exercise oncology study regarding the recruitment process, representativeness of the study sample, contamination, participation, and dropout.

METHODS

The Utrecht cohort for Multiple BREast cancer intervention studies and Long-term evaLuAtion (UMBRELLA) Fit TwiCs evaluates an exercise intervention in inactive breast cancer patients. Eligible patients participating in the prospective UMBRELLA were identified and randomized. Patients randomized to the intervention (n = 130) were offered the intervention, whereas controls (n = 130) were not informed.

RESULTS

Fifty-two percent (n = 68) accepted the intervention. Because this rate was lower than expected, a larger sample size was required than initially estimated (n = 166). However, recruitment of 260 patients was still completed by one researcher within 30 months. Unselective eligibility screening and randomization before invitation improved representativeness. Disadvantage of the design might be inclusion of ineligible patients when cohort information is limited. Furthermore, the design faced higher noncompliance in the intervention group, but prevention of contamination.

CONCLUSION

The TwiCs design improved logistics in recruitment and prevented contamination, but noncompliance due to refusal of the intervention was higher compared with conventional pragmatic exercise oncology RCTs, which may dilute the estimated intervention effect.

Pilates for breast cancer: A systematic review and meta-analysis

INTRODUCTION

Breast cancer is the leading type of cancer causing death in women worldwide. The incidence of the disease is expected to grow worldwide due to the aging of the population and risk factors related to lifestyle behaviors. Considering the lifestyle of women with breast cancer before or after surgery, pilates exercise may be a complementary intervention additionally to standard treatment.

OBJECTIVE

To analyze the efficacy of pilates compared to other exercises and to no exercise for women with breast cancer diagnosis.

METHOD

We searched Medline via Pubmed, Embase via Ovid, Amed via EBSCO, Biosis via Ovid, Lilacs and the Cochrane Library for relevant publications until March 2017. The keywords used were pilates and "breast cancer," and only randomized controlled trials were included. Critical appraisal was done using Risk of Bias Tool and GRADE score for assessing the quality of evidence.

RESULTS

A total of five studies were included in our review. Our results demonstrate that pilates or home-based exercises are better than no exercise in each individual study. We observed significant improvements in the pilates groups compared to home-based exercises. Additionally, in the individual studies, we observed improvements in range of motion, pain and fatigue.

CONCLUSION

The evidence shows that pilates or home-based exercise should be encouraged to women with breast cancer.

A Preliminary Study on the Efficacy of a Community-Based Physical Activity Intervention on Physical Function-Related Risk Factors for Falls Among Breast Cancer Survivors

OBJECTIVE

The aim of this study was to examine the effects of a 6-week community-based physical activity (PA) intervention on physical function-related risk factors for falls among 56 breast cancer survivors (BCS) who had completed treatments.

DESIGN

This was a single-group longitudinal study. The multimodal PA intervention included aerobic, strengthening, and balance components. Physical function outcomes based on the 4-meter walk, chair stand, one-leg stance, tandem walk, and dynamic muscular endurance tests were assessed at 6-week pre-intervention (T1), baseline (T2), and post-intervention (T3). T1 to T2 and T2 to T3 were the control and intervention periods, respectively.

RESULTS

All outcomes, except the tandem walk test, significantly improved after the intervention period (P < 0.05), with no change detected after the control period (P > 0.05). Based on the falls risk criterion in the one-leg stance test, the proportion at risk for falls was significantly lower after the intervention period (P = 0.04), but not after the control period.

CONCLUSIONS

A community-based multimodal PA intervention for BCS may be efficacious in improving physical function-related risk factors for falls, and lowering the proportion of BCS at risk for falls based on specific physical function-related falls criteria. Further larger trials are needed to confirm these preliminary findings.

Longitudinal social cognitive influences on physical activity and sedentary time in Hispanic breast cancer survivors

OBJECTIVE

This study evaluated the effect of two home-based exercise interventions (one culturally adapted and one standard) on changes in social cognitive theory (SCT) variables, physical activity (PA), and sedentary time (ST), and determined the association between changes in SCT variables and changes in PA and ST in Hispanic breast cancer survivors.

METHOD

Project VIVA! was a 16-week randomized controlled pilot study to test the effectiveness and feasibility of a culturally adapted exercise intervention for Mexican American and Puerto Rican breast cancer survivors in Houston, Texas and San Juan, Puerto Rico, respectively. Women (N = 89) completed questionnaires on SCT variables, PA, and ST and were then randomized to a 16-week culturally adapted exercise program, a non-culturally adapted standard exercise intervention or a wait-list control group. Multiple regression models were used to determine associations between changes in SCT variables and changes in PA and ST.

RESULTS

Participants were in their late 50s (58.5 ± 9.2 years) and obese (31.0 ± 6.5 kg/m2 ). Women reported doing roughly 34.5 min/day of PA and spending over 11 h/day in sedentary activities. Across groups, women reported significant increases in exercise self-efficacy and moderate-intensity, vigorous-intensity, and total PA from baseline to follow-up (p < 0.05). Increased social support from family was associated with increases in vigorous-intensity PA. Increases in social modeling were associated with increases in moderate-intensity and total PA and with decreases in ST from baseline to follow-up (p < 0.05).

CONCLUSIONS

Hispanic cancer survivors benefit from PA interventions that focus on increasing social support from family and friends and social modeling. Copyright © 2015 John Wiley & Sons, Ltd.

Tai chi chuan exercise for patients with breast cancer: a systematic review and meta-analysis

Objective. Tai Chi Chuan (TCC) is a form of aerobic exercise that may be an effective therapy for improving psychosomatic capacity among breast cancer survivors. This meta-analysis analyzed the available randomized controlled trials (RCTs) on the effects of TCC in relieving treatment-related side effects and quality of life in women with breast cancer. Methods. RCTs were searched in PubMed, Embase, Web of Science, and Cochrane Library through April 2014. Data were analyzed on pathology (pain, interleukin-6, and insulin-like growth factor 1), physical capacity (handgrip, limb physical fitness, and BMI), and well-being (physical, social, emotional, and general quality of life). Results. Nine RCTs, including a total of 322 breast cancer patients, were examined. Compared with control therapies, the pooled results suggested that TCC showed significant effects in improving handgrip dynamometer strength, limb elbow flexion (elbow extension, abduction, and horizontal adduction). No significant differences were observed in pain, interleukin-6, insulin-like growth factor, BMI, physical well-being, social or emotional well-being, or general health-related quality of life. Conclusion. The short-term effects of TCC may have potential benefits in upper limb functional mobility in patients with breast cancer. Additional randomized controlled trials with longer follow-up are needed to provide more reliable evidence.

Breast cancer survivors' barriers and motives for participating in a group-based physical activity program offered in the community

Purpose

The purpose of this qualitative study was to explore the barriers and motives experienced by women attending an 8-week group-based physical activity program offered in the community following treatment for breast cancer.

Methods

Seven women were interviewed during the first and last week of the program. Data were analyzed using thematic analysis.

Results

Factors that hindered women’s continued participation could be subdivided into situational barriers, which encompassed community (i.e., distance of center and traffic) and institutional factors (i.e., competing roles and responsibilities), and internal barriers, which consisted of cancer-specific limitations. Motives for initial and continued participation were situational (i.e., gaining social support, networking, and being around similar others) and internal (i.e., feeling a sense of personal fulfillment, acquiring health benefits, and recovering from cancer).

Conclusions

The findings contribute to a deeper understanding of women’s motives to engage in a group-based physical activity program after treatment for breast cancer. Further, they underscore the necessity of considering situational and internal barriers when developing group-based physical activity programs to increase regular participation, optimize adherence, and reduce drop-out.

Taking the next step: a systematic review and meta-analysis of physical activity and behavior change interventions in recent post-treatment breast cancer survivors

Research has shown that recent post-treatment breast cancer survivors face significant challenges around physical activity as they transition to recovery. This review examined randomized controlled trials targeting physical activity behavior change in breast cancer survivors <5 years post-treatment and described (1) characteristics of interventions for breast cancer survivors as well as (2) effect size estimates for these studies. A systematic search was conducted following PRISMA guidelines with Medline, PubMed, PsycINFO, CINAHL, and Scopus databases. Data were abstracted for primary intervention strategies and other details (e.g., setting, duration, theory use). A subgroup analysis was conducted to assess intensity of exercise supervision/monitoring and intervention effectiveness. The search produced 14 unique behavior intervention trials from the US and abroad published 2005-2013. The mean sample size was 153 participants per study. All interventions included moderate-intensity activities plus various behavioral change strategies. Most interventions were partially or entirely home based. The overall standardized mean difference was 0.47 (0.23, 0.67) with p < 0.001. Most interventions were effective in producing short-term behavior changes in physical activity, but varied greatly relative to intervention strategies and intensity of supervision/monitoring. Highly structured interventions tended to produce larger behavior change effects overall, but many larger effect sizes came from interventions supported by phone counseling or e-mail. We observed that 'more' may not be better in terms of direct supervision/monitoring in physical activity behavior interventions. This may be important in exploring less resource-intensive options for effective behavior change strategies for recent post-treatment survivors.

Better postdiagnosis diet quality is associated with less cancer-related fatigue in breast cancer survivors

PURPOSE

A comprehensive understanding of the role of modifiable health behaviors in effective management of cancer-related fatigue is needed. Among breast cancer survivors, we examined how postdiagnosis diet quality, independently and jointly with physical activity, is related to fatigue, and the potential mediating role of inflammation.

METHODS

Seven hundred seventy women diagnosed with stage 0-IIIA breast cancer in the Health, Eating, Activity, and Lifestyle study completed food frequency and physical activity questionnaires 30 months postdiagnosis. We scored diet quality using the Healthy Eating Index 2010 (HEI-2010). Serum concentrations of C-reactive protein (CRP) were measured in fasting 30-ml blood samples. Multidimensional fatigue was measured 41 months postdiagnosis using the 22-item revised Piper Fatigue Scale. In multivariate linear models, we determined whether fatigue was associated HEI-2010 quartiles (Q1-Q4), and a variable jointly reflecting HEI quartiles and physical activity levels.

RESULTS

Survivors with better-quality diets (Q4 vs. Q1) had lower total fatigue (4.1 vs. 4.8, p-contrast = 0.003) and subscale scores (behavioral severity 3.4 vs. 4.2, p-contrast = 0.003; affective meaning 3.9 vs. 4.8, p-contrast = 0.007; sensory 4.4 vs. 5.2, p-contrast = 0.003; cognitive 4.6 vs. 5.0, p-contrast = 0.046). Least squares estimates of fatigue were similar in models including CRP. Compared to survivors with poor-quality diets and no physical activity, survivors with better-quality diets and meeting physical activity recommendations had significantly lower behavioral severity (3.2 vs. 4.7, p-contrast = 0.002) and sensory (3.8 vs. 4.8. p-contrast = 0.006) fatigue scores.

CONCLUSION

In this large breast cancer survivor cohort, postdiagnosis diet quality was inversely and independently associated with fatigue.

IMPLICATIONS FOR CANCER SURVIVORS

Future interventions designed to improve multiple energy balance behaviors can provide insight into their associations with fatigue.

Physical performance and psychosocial status in lung cancer patients: results from a pilot study

BACKGROUND

The aim of this study was to assess the physical performance and psychosocial status of lung cancer patients.

PATIENTS AND METHODS

Patients with predominantly advanced-stage non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC) were recruited. Muscle strength was assessed via hand-held dynamometry (HHD) and endurance capacity via the 6-minute walk test (6MWT), and results were compared to healthy reference values. Psychosocial status, lung cancer-specific symptoms, and quality of life (QoL) outcomes were evaluated.

RESULTS

39 patients (NSCLC n = 22, SCLC n = 17) with predominantly advanced-stage disease and a median age of 62 years (range 44-83 years) were enrolled. Compared to a healthy reference population, mean muscle strength values of upper (elbow flexion -28.2% (±17.5), elbow extension -12.4% (±11.1)) and lower (knee extension -47.6% (±19.3), hip abduction -44.9% (±14.9), hip flexion -13% (±24.2)) extremities, and 6MWT were lower (male/female: 434/411 m vs. 597/514 m). Lung cancer-specific symptoms and QoL were comparable to published data.

CONCLUSION

Our results indicate that lung cancer patients experience muscular weakness, lower endurance performance, and decreased QoL compared to a healthy reference population. The feasibility and benefit of a structured exercise intervention in this specific population need to be evaluated, in particular its effect on psychosocial well-being.

Disparities in Health Risk Behavior and Psychological Distress Among Gay Versus Heterosexual Male Cancer Survivors

Gay men have been found to have higher rates of cancer diagnoses than heterosexual men and poorer outcomes postcancer diagnosis. The two aims of this study were to examine rates of cancer diagnosis in a national sample of gay and heterosexual men, and to examine disparities in health risk behavior between gay and heterosexual men and gay and heterosexual cancer survivors. The current study utilized data from a total sample of 14,354 men, including 373 gay men, collected as part of the Behavioral Risk Factor Surveillance System survey conducted in 2009 in the states of Arizona, California, Massachusetts, Ohio, and Wisconsin. This study replicated the finding that prevalence of self-reported cancer diagnoses differed significantly between gay and heterosexual men, with gay men 82% more likely to report a lifetime history of cancer diagnosis (p<0.05); however, this disparity became nonsignificant after controlling for a weakened immune system proxy variable (p=0.06). Gay men were more likely than heterosexual men to report health risk behaviors, including less time spent exercising, more psychological distress, more current alcohol use, more current smoking, and a lifetime history of smoking. Some of these disparities in health risk behavior persisted for gay cancer survivors postcancer diagnosis. This study offers a perspective on behavioral risk factors previously shown to be higher among gay men that may continue postcancer diagnosis. Future research should test the degree to which these disparities are caused by minority stress, as previous studies have indicated that increased health risk behaviors among sexual minority populations may result from exposure to chronic stress and discrimination. Developing behavior change interventions to address these risk behaviors is vital for improving cancer outcomes among gay men.

Cancer, physical activity, and exercise

This review examines the relationship between physical activity and cancer along the cancer continuum, and serves as a synthesis of systematic and meta-analytic reviews conducted to date. There exists a large body of epidemiologic evidence that conclude those who participate in higher levels of physical activity have a reduced likelihood of developing a variety of cancers compared to those who engage in lower levels of physical activity. Despite this observational evidence, the causal pathway underlying the association between participation in physical activity and cancer risk reduction remains unclear. Physical activity is also a useful adjunct to improve the deleterious sequelae experienced during cancer treatment. These deleterious sequelae may include fatigue, muscular weakness, deteriorated functional capacity, and many others. The benefits of physical activity during cancer treatment are similar to those experienced after treatment. Despite the growing volume of literature examining physical activity and cancer across the cancer continuum, a number of research gaps exist. There is little evidence on the safety of physical activity among all cancer survivors, as most trials have selectively recruited participants. The specific dose of exercise needed to optimize primary cancer prevention or symptom control during and after cancer treatment remains to be elucidated.

Understanding barriers to exercise implementation 5-year post-breast cancer diagnosis: a large-scale qualitative study

Due to the amount of literature supporting exercise participation after cancer diagnosis, there has been recent interest in barriers to exercise engagement among cancer patients. However, little is known regarding reasons why people choose to disengage and how this disengagement occurs over time. This study aimed to qualitatively study the perceived barriers to exercise implementation, 5-year post-breast cancer diagnosis. Eighty-three female breast cancer survivors participated in a one-to-one semi-structured interview, regarding their experience of exercise over the past 5 years following their original participation in a group-based structured exercise intervention after diagnosis (41 from intervention and 42 from original control group). The data were analysed using inductive thematic analysis. The findings included three main themes and several subthemes regarding the women's perceived barriers: psychological barriers (lack of motivation, fears, dislike of gym, not being the 'sporty type'), physical barriers (the ageing process, cancer treatment and other physical co-morbidities, fatigue and weight gain) and contextual and environmental barriers (employment, traditional female care-giving roles, proximity/access to facilities, seasonal weather). The findings add inductive support to the current survivor health research advocating the use of activity immediately after diagnosis, as well as the need for tailored activity programmes in order to overcome potential obstacles.

Designing iCanFit: A Mobile-Enabled Web Application to Promote Physical Activity for Older Cancer Survivors

BACKGROUND

Most older cancer survivors (OCS) do not engage in regular physical activity (PA) despite well-known health benefits. With the increased use of mobile technologies among older adults, mobile tools may be an effective method to deliver PA promotion programs for OCS.

OBJECTIVE

To document the process of designing an OCS-friendly mobile-enabled Web application of PA promotion program.

METHODS

Mixed methods encompassing group discussions, individual interviews, and brief surveys with community leaders, OCS, cancer care providers, and software professionals were used in this formative research.

RESULTS

The varied stakeholders welcomed the idea of developing an online tool to promote PA in OCS. Our formative research revealed several major barriers to regular PA including limited access to senior-friendly PA resources, lack of motivation and social support, and insufficient knowledge and skills on building safe and appropriate workout plans. This feedback was incorporated into the development of iCanFit, a mobile-enabled Web application, designed specifically for OCS. The iCanFit online tools allow users to locate PA resources, set and track goals for PA, network with peer OCS in a secure online space, and receive practical and evidence-informed healthy tips.

CONCLUSIONS

Our mixed-method formative research led to the design of iCanFit protocol to promote PA and well-being of OCS. The involvement of stakeholders is critical in the planning and design of the mobile application in order to enhance program relevance, appeal, and match with the needs of target users.

Impact of Diet, Body Mass Index, and Physical Activity on Cancer Survival

With the increase in the number of cancer patients worldwide in the coming years, the need for knowledge on the influence of lifestyle factors on cancer survival is increasing. In this paper, the current knowledge on diet, body mass index, and physical activity in relation to cancer outcome is summarized. Also, challenges are identified to be addressed to provide evidence-based recommendations for cancer patients. Studies in patients with breast, colorectal, or prostate cancer show that the influence of dietary factors on survival remains to be determined. Adiposity and a lack of physical activity, however, appear to influence cancer outcome negatively. Subsequent studies should focus on more detailed aspects of these lifestyle factors, such as body composition and dose of exercise, and on the timing with respect to diagnosis and treatment. Research should be directed toward investigating diet and physical activity simultaneously and on how changes in health behavior can be established.

Interventions to Alleviate Symptoms Related to Breast Cancer Treatments and Areas of Needed Research

Treatments for breast cancer produce a host of side effects, which can become debilitating. Some cancer treatment-related side effects occur in up to 90% of patients during treatment and can persist for months or years after treatment has ended. As the number of breast cancer survivors steadily increases, the need for cancer control intervention research to alleviate side effects also grows. This review provides a general overview of recent clinical research studies of selected topics in the areas of symptom management for breast cancer with a focus on cognitive difficulties, fatigue, cardiotoxicity, bone loss, insomnia, and cancer pain. We review both pharmacological and behavioral intervention clinical research studies, conducted with breast cancer patients and survivors. Additionally, clinical perspectives on symptom management and recommendations for areas of needed research are provided.