Advertisement

Supportive Care in Cancer

, Volume 22, Issue 4, pp 989–997 | Cite as

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

  • J. M. BroderickEmail author
  • J. Hussey
  • M. J. Kennedy
  • D. M. O’Donnell
Original Article

Abstract

Purpose

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

Methods

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

Results

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

Conclusion

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

Keywords

Rehabilitation Exercise Fatigue Quality of life Body mass index 

Notes

Acknowledgments

The authors would like to acknowledge the Health Research Board, Ireland which funded this work.

Conflict of interest

I can confirm that there is no financial relationship between the authors and the organisation which funded this research. The corresponding author has full control of all primary data which can be reviewed should this be required.

References

  1. 1.
    Kangas M, Bovbjerg DH, Montgomery GH (2008) Cancer-related fatigue: a systematic and meta-analytic review of non-pharmacological therapies for cancer patients. Psychol Bull 134(5):700–741. doi: 10.1037/a0012825 PubMedCrossRefGoogle Scholar
  2. 2.
    Schmitz KH, Stout NL, Andrews K, Binkley JM, Smith RA (2012) Prospective evaluation of physical rehabilitation needs in breast cancer survivors. A call to action. Cancer 118(8):2187–2190. doi: 10.1002/cncr.27471 PubMedCrossRefGoogle Scholar
  3. 3.
    Roder DM, de Silva P, Zorbas HM, Kollias J, Malycha PL, Pyke CM, Campbell ID (2012) Age effects on survival from early breast cancer in clinical settings in Australia. ANZ J Surg 82(7–8):524–528. doi: 10.1111/j.1445-2197.2012.06114.x PubMedCrossRefGoogle Scholar
  4. 4.
    Knobf MT, Coviello J (2011) Lifestyle interventions for cardiovascular risk reduction in women with breast cancer. Curr Cardiol Rev 7(4):250–257PubMedCrossRefGoogle Scholar
  5. 5.
    Holick CN, Newcomb PA, Trentham-Dietz A (2008) Physical activity and survival after diagnosis of invasive breast cancer. Cancer Epidemiol Biomarkers Prev 17:379–386. doi: 10.1158/1055-9965.EPI-07-0771 PubMedCrossRefGoogle Scholar
  6. 6.
    Irwin ML, Smith AW, Mc Tiernan A, Ballard-Barbash R, Cronin K, Gilliland FD, Baumgartner RN, Baumgartner RN, Bernstein L (2008) Influence of pre- and postdiagnosis physical activity on mortality in breast cancer survivors: the health, eating, activity and lifestyle study. J Clin Oncol 26(24):3958–3964. doi: 10.1200/JCO.2007 PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    Lynch BM, Dunstan DW, Vallance JK, Owen N (2013) Don’t take cancer sitting down: a new survivorship research agenda. Cancer 119(11):1928–1935. doi: 10.1002/cncr.28028 PubMedCrossRefGoogle Scholar
  8. 8.
    Demark-Wahnefried W, Aziz NM, Rowland JH, Pinto BM (2005) Riding the crest of the teachable moment: promoting long-term health after the diagnosis of cancer. J Clin Oncol 23(24):5814–5830. doi: 10.1200/jco.2005.01.230 PubMedCentralPubMedCrossRefGoogle Scholar
  9. 9.
    Courneya KS, Friedenreich CM (2001) Framework PEACE: an organizational model for examining physical exercise across the cancer experience. Ann Behav Med 23(4):263–272PubMedCrossRefGoogle Scholar
  10. 10.
    Prince SA, Adamo KB, Hamel ME, Hardt J, Gorber SC, Tremblay M (2008) A comparison of direct versus self-report measures for assessing physical activity in adults: a systematic review. Int J Behav Nut Phys Act 5:56. doi: 10.1186/1479-5868-5-56 CrossRefGoogle Scholar
  11. 11.
    Irwin ML, Crumlet D, Mc Tiernan A (2003) Physical activity levels before and after a diagnosis of breast carcinoma: the Health, Eating, Activity (HEAL) study. Cancer 97(7):1746–1757PubMedCentralPubMedCrossRefGoogle Scholar
  12. 12.
    Harrison S, Hayes SC, Newman B (2009) Level of physical activity and characteristics associated with change following breast cancer diagnosis and treatment. Psychooncology 18(4):387–394. doi: 10.1002/pon.1504 PubMedCrossRefGoogle Scholar
  13. 13.
    Andrykowski MA, Beacham AO, Jacobsen PB (2007) Prospective, longitudinal study of leisure-time exercise in women with early-stage breast cancer. Cancer Epidemiol Biomarkers Prev 16:430–438. doi: 10.1158/1055-9965.EPI-06-0735 PubMedCrossRefGoogle Scholar
  14. 14.
    Meyerhardt JA, Giovannucci EL, Holmes MD, Chan AT, Chan JA, Colditz GA, Fuchs CS (2006) Physical activity and survival after colorectal cancer diagnosis. J Clin Oncol 24:3527–3534. doi: 10.1200/JCO.2006.06.0855 PubMedCrossRefGoogle Scholar
  15. 15.
    Hawkes AL, Lynch BM, Youlden DR, Owen N, Aitken JF (2008) Health behaviors of Australian colorectal cancer survivors, compared with noncancer population controls. Support Care Cancer 16(10):1097–1104. doi: 10.1007/s00520-008-0421-5 PubMedCrossRefGoogle Scholar
  16. 16.
    Emery CF, Yang HC, Frierson GM (2009) Determinants of physical activity among women treated for breast cancer in a 5-year longitudinal follow-up investigation. Psychooncology 18:377–386. doi: 10.1002/pon.1519 PubMedCentralPubMedCrossRefGoogle Scholar
  17. 17.
    Voskuil DW, van Nes JGH, Junggeburt JMC, van de Velde CJH, van Leeuwen FE, de Haes JCJM (2010) Maintenance of physical activity and body weight in relation to subsequent quality of life in postmenopausal breast cancer patients. Ann Oncol 21:2094–2101. doi: 10.1093/annonc/mdq151 PubMedCrossRefGoogle Scholar
  18. 18.
    Colbert LH, Schoeller DA (2011) Expending our physical activity (measurement) budget wisely. J Appl Physiol 111(2):606–607. doi: 10.1152/japplphysiol.00089.2011 PubMedCrossRefGoogle Scholar
  19. 19.
    Sloane R, Clutter Snyder D, Demark-Wahnefried W, Lobach D, Kraus WE (2009) Comparing the 7-Day PAR with a triaxial accelerometer for measuring time in exercise. Med Sci Sports Exerc 41(6):1334–1340. doi: 10.1249%2FMSS.0b013e3181984fa8 PubMedCentralPubMedCrossRefGoogle Scholar
  20. 20.
    Pinto BM, Frierson GM, Rabin C, Trunzo JJ, Marcus BH (2005) Home-based physical activity intervention for breast cancer patients. J Clin Oncol 23(15):3577–3587. doi: 10.1200/jco.2005.03.080 PubMedCrossRefGoogle Scholar
  21. 21.
    Matthews CE, Wilcox S, Hanby CL, Der Ananian C, Heiney SP, Gebretsadik T, Shintani A (2007) Evaluation of a 12-week home-based walking intervention for breast cancer survivors. Support Care Cancer 15(2):203–211. doi: 10.1007/s00520-006-0122-x PubMedCrossRefGoogle Scholar
  22. 22.
    Lynch BM, Dunstan DW, Healy GN, Winkler E, Eakin E, Owen N (2010) Objectively measured physical activity and sedentary time of breast cancer survivors, and associations with adiposity; findings from NHANES (2003–2006). Cancer Causes Control 21:283–288PubMedCrossRefGoogle Scholar
  23. 23.
    Rowlands AV, Stone MR, Eston RG (2007) Influence of speed and step frequency during walking and running on motion sensor output. Med Sci Sports Exerc 39(4):716–727. doi: 10.1249/mss.0b013e318031126c PubMedCrossRefGoogle Scholar
  24. 24.
    Rowlands AV, Thomas PWM, Eston RG, Topping R (2004) Validation of the RT3 triaxial accelerometer for the assessment of physical activity. Med Sci Sports Exerc 36(3):518–524. doi: 10.1249/01.MSS.0000117158.14542.E7 PubMedCrossRefGoogle Scholar
  25. 25.
    Powell SMP, Rowlands AV (2004) Inter-monitor variability of the RT3 accelerometer during a variety of physical activities. Med Sci Sports Exerc 36:324–330. doi: 10.1249/01.MSS.0000113743.68789.36 PubMedCrossRefGoogle Scholar
  26. 26.
    Esliger DW, Tremblay MS (2006) Technical reliability of three accelerometer models in a mechanical setup. Med Sci Sports Exerc 38:2173–2181. doi: 10.1249/01.mss.0000239394.55461.08 PubMedCrossRefGoogle Scholar
  27. 27.
    Craig CL, Marshall AL, Sjostrom M, Bauman AE, Booth ML, Ainsworth BE (2003) International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc 35:1381–1395. doi: 10.1249/01.MSS.0000078924.61453.FB PubMedCrossRefGoogle Scholar
  28. 28.
    Hagstromer M, Oja P, Sjostro M (2006) The International Physical Activity Questionnaire (IPAQ): a study of concurrent and construct validity. Public Health Nutr 9(6):755–762. doi: 10.1079/PHN2005898 PubMedCrossRefGoogle Scholar
  29. 29.
    Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ (1993) The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85:365–376PubMedCrossRefGoogle Scholar
  30. 30.
    Fayers PM, Aaronson NK, Bjordal K, Groenvold M, Curran D, Bottomly A (2001) The EORTC QLQ-C30 Scoring Manual, 3rd edn. European Organisation for Research and Treatment of Cancer, BrusselsGoogle Scholar
  31. 31.
    Mendoza TR, Wang XS, Cleeland CS, Morrissey M, Johnson BA, Wendt JK, Huber SL (1999) The rapid assessment of fatigue severity in cancer patients: use of the Brief Fatigue Inventory. Cancer 85(1186–1196)Google Scholar
  32. 32.
    Agasi-Idenburga C, Velthuisc M, Wittink H (2010) Quality criteria and user-friendliness in self-reported questionnaires on cancer-related fatigue: a review. J Clin Epidemiol 63(7):705–711. doi: 10.1016/j.clinepi.2009.08.027 CrossRefGoogle Scholar
  33. 33.
    Haskell WL, Lee IM, Pate RR, Powell KE, Blair SN, Franklin BA, Macera CA, Heath GW, Thompson PD, Bayman A (2007) Physical activity and public health: updated recommendations for adults from the American College of Sports Medicine and the American Heart Association. Circulation 116:1081–1093. doi: 10.1161/CIRCULATIONAHA.107.185649 PubMedCrossRefGoogle Scholar
  34. 34.
    Grimmett C, Wardle J, Steptoe A (2009) Health behaviours in older cancer survivors in the English Longitudinal Study of Ageing. Eur J Cancer 45(12):2180–2186. doi: 10.1016/j.ejca.2009.02.024 PubMedCrossRefGoogle Scholar
  35. 35.
    Eakin EG, Youlden DR, Baade PD, Lawler SP, Reeves MM, Heyworth JS, Fritschi L (2007) Health behaviors of cancer survivors: data from an Australian population-based survey. Cancer Causes Control 18(8):881–894. doi: 10.1007/s10552-007-9033-5 PubMedCrossRefGoogle Scholar
  36. 36.
    Courneya KS, Katzmarzyk PT, Bacon E (2008) Physical activity and obesity in Canadian cancer survivors: population-based estimates from the 2005 Canadian Community Health Survey. Cancer 112(11):2475–2482. doi: 10.1002/cncr.23455 PubMedCrossRefGoogle Scholar
  37. 37.
    Coups EJ, Ostroff JS (2005) A population-based estimate of the prevalence of behavioral risk factors among adult cancer survivors and noncancer controls. Prev Med 40(6):702–711. doi: 10.1016/j.ypmed.2004.09.011 PubMedCrossRefGoogle Scholar
  38. 38.
    Littman AJ, Tang M, Rossing MA (2010) Longitudinal study of recreational physical activity in breast cancer survivors. J Cancer Surviv 4:119–127. doi: 10.1007/s11764-009-0113-2 PubMedCrossRefGoogle Scholar
  39. 39.
    Vallance JK, Courneya KS, Plotnikoff RC, Yasui Y, Mackey JR (2007) Randomized controlled trial of the effects of print materials and step pedometers on physical activity and quality of life in breast cancer survivors. J Clin Oncol 25(17):2352–2359. doi: 10.1200/jco.2006.07.9988 PubMedCrossRefGoogle Scholar
  40. 40.
    Rogers LQ, Hopkins-Price P, Vicari S, Pamenter R, Courneya KS, Markwell S, Verhulst S, Hoelzer K, Naritoku C, Jones L, Dunnington G, Lanzotti V, Wynstra J, Shah L, Edson B, Graff A, Lowy M (2009) A randomized trial to increase physical activity in breast cancer survivors. Med Sci Sports Exerc 41(4):935–946. doi: 10.1249/MSS.0b013e31818e0e1b PubMedCrossRefGoogle Scholar
  41. 41.
    Ingram C, Brown JK (2004) Patterns of weight gain and body composition change in post-menopausal women with early stage breast cancer. Cancer Nurs 27(483–490)Google Scholar
  42. 42.
    Kroenke CH, Chen WY, Rosner B (2005) Weight, weight gain, and survival after breast cancer diagnosis. J Clin Oncol 23:1370–1378. doi: 10.1200/JCO.2005.01.079 PubMedCrossRefGoogle Scholar
  43. 43.
    Courneya KS, Friedenreich CM (1997) Relationship between exercise pattern across the cancer experience and current quality of life in colorectal cancer survivors. J Altern Complement Med 3:215–226PubMedCrossRefGoogle Scholar
  44. 44.
    Cramp F, Daniel J (2008) Exercise for the management of cancer-related fatigue in adults. Cochrane database of systematic reviews 6(2):CD006145. doi: 10.1002/14651858.CD006145.pub2 Google Scholar
  45. 45.
    Dimeo FC, Stieglitz RD, Novelli-Fischer U, Fetscher S, Keul J (1999) Effects of physical activity on the fatigue and physiologic status of cancer patients during chemotherapy. Cancer 85:2273–2277PubMedCrossRefGoogle Scholar
  46. 46.
    Ahlberg K, Ekman T, Gaston-Johansson F, Mock V (2003) Assessment and management of cancer-related fatigue in adults. Lancet 362(9384):640–650. doi: 10.1016/s0140-6736(03)14186-4 PubMedCrossRefGoogle Scholar
  47. 47.
    Dimeo F, Rumberger BG, Keul J (1998) Aerobic exercise as therapy for cancer fatigue. Med Sci Sports Exerc 30:475–477PubMedCrossRefGoogle Scholar
  48. 48.
    Williams K, Steptoe A, Wardle J (2013) Is a cancer diagnosis a trigger for health behaviour change? Findings from a prospective, population-based study. Br J Cancer 108(11):2407–2412. doi: 10.1038/bjc.2013.254 PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • J. M. Broderick
    • 1
    Email author
  • J. Hussey
    • 1
  • M. J. Kennedy
    • 2
  • D. M. O’Donnell
    • 2
  1. 1.School of Medicine, Trinity Centre for Health ScienceSt. James’s HospitalDublinIreland
  2. 2.Academic Unit of Clinical and Medical OncologySt. James’s HospitalDublinIreland

Personalised recommendations