Supportive Care in Cancer

, Volume 23, Issue 1, pp 159–167 | Cite as

Associations between self-reported post-diagnosis physical activity changes, body weight changes, and psychosocial well-being in breast cancer survivors

  • Siobhan M. PhillipsEmail author
  • Edward McAuley
Original Article



Decreased physical activity and weight gain post-breast cancer diagnosis are associated with negative psychosocial, health, and disease outcomes, but little is known about how these factors interact. The purpose of the present study was to conduct a preliminary examination of the association between post-diagnosis physical activity changes, weight changes, and psychosocial well-being in breast cancer survivors.


We examined the association between retrospectively collected, self-reported post-diagnosis changes in physical activity and body weight and post-diagnosis fatigue, anxiety, depression, stress, self-esteem, and health-related quality of life (HRQOL) in breast cancer survivors (N = 1,348) using univariate analyses of covariance with Bonferroni’s adjustment.


After adjusting for covariates, maintaining and/or increasing physical activity post-diagnosis was significantly (p < 0.05 for all), independently associated with lower fatigue, anxiety, depression and stress and higher physical self-worth, physical, social, emotional, functional and breast cancer specific well-being and overall HRQOL (effect sizes = 0.23 to 0.60). Maintaining and/or losing weight was significantly (p < 0.05), independently associated with lower fatigue and higher physical self-worth, physical and breast cancer-specific well-being, and overall HRQOL (effect sizes = .28 to 0.87). There were no significant interaction effects between physical activity and body weight changes.


This study provides preliminary data to suggest that maintaining or increasing physical activity and controlling weight post-diagnosis may be independently, positively associated with psychosocial well-being and HRQOL in breast cancer survivors. In addition, weight management effects may be larger and more outcome-specific while physical activity effects may be more general. Future research is warranted to replicate and confirm these findings.


Physical activity Body weight Breast cancer survivors Quality of life Fatigue Depression Self-esteem Stress 



This work was supported by the National Institute on Aging Award #F31AG034025 to Siobhan M. Phillips and Award #AG020118 to Edward McAuley. Edward McAuley is also supported by a Shahid and Ann Carlson Khan endowed professorship.

Conflict of interest

The authors have no conflicts of interest. The authors have full control of all primary data and agree to allow the journal to review these data upon request.


  1. 1.
    Siegel R, DeSantis C, Virgo K et al (2012) Cancer treatment and survivorship statistics, 2012. CA Cancer J Clin 62(4):220–241PubMedCrossRefGoogle Scholar
  2. 2.
    Rock CL, Doyle C, Demark-Wahnefried W et al (2012) Nutrition and physical activity guidelines for cancer survivors. CA Cancer J Clin 62(4):242–274CrossRefGoogle Scholar
  3. 3.
    Ligibel J (2012) Lifestyle factors in cancer survivorship. J Clin Oncol 30(30):3697–3704PubMedCrossRefGoogle Scholar
  4. 4.
    Protani M, Coory M, Martin JH (2010) Effect of obesity on survival of women with breast cancer: systematic review and meta-analysis. Breast Cancer Res Treat 123(3):627–635PubMedCrossRefGoogle Scholar
  5. 5.
    Ibrahim EM, Al-Homaidh A (2011) Physical activity and survival after breast cancer diagnosis: meta-analysis of published studies. Med Oncol 28(3):753–765PubMedCrossRefGoogle Scholar
  6. 6.
    McNeely ML, Campbell KL, Rowe BH, Klassen TP, Mackey JR, Courneya KS (2006) Effects of exercise on breast cancer patients and survivors: a systematic review and meta-analysis. CMAJ 175(1):34–41PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    Speck RM, Courneya KS, Masse LC, Duval S, Schmitz KH (2010) An update of controlled physical activity trials in cancer survivors: a systematic review and meta-analysis. J Cancer Surviv 4(2):87–100PubMedCrossRefGoogle Scholar
  8. 8.
    Beasley JM, Kwan ML, Chen WY et al (2012) Meeting the physical activity guidelines and survival after breast cancer: findings from the after breast cancer pooling project. Breast Cancer Res Treat 131(2):637–643PubMedCentralPubMedCrossRefGoogle Scholar
  9. 9.
    Alfano CM, Smith AW, Irwin ML et al (2007) Physical activity, long-term symptoms, and physical health-related quality of life among breast cancer survivors: a prospective analysis. J Cancer Surviv 1(2):116–128PubMedCentralPubMedCrossRefGoogle Scholar
  10. 10.
    Irwin ML, Smith AW, McTiernan A et al (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):3958–3964PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    Patterson RE, Cadmus LA, Emond JA, Pierce JP (2010) Physical activity, diet, adiposity and female breast cancer prognosis: a review of the epidemiologic literature. Maturitas 66(1):5–15PubMedCrossRefGoogle Scholar
  12. 12.
    Chlebowski RT (2012) Clinical perspective: influence of modifiable lifestyle factors, body weight, physical activity, and alcohol on breast cancer outcome. BMC Cancer l 6(35):1–11Google Scholar
  13. 13.
    Sestak I, Distler W, Forbes JF, Dowsett M, Howell A, Cuzick J (2010) Effect of body mass index on recurrences in tamoxifen and anastrozole treated women: an exploratory analysis from the ATAC trial. J Clin Oncol 28(21):3411–3415PubMedCrossRefGoogle Scholar
  14. 14.
    Rock CL, Demark-Wahnefried W (2002) Can lifestyle modification increase survival in women diagnosed with breast cancer? J Nutr 132(11):3504S–3509SPubMedGoogle Scholar
  15. 15.
    Demark-Wahnefried W, Rock CL (2003) Nutrition-related issues for the breast cancer survivor. Semin Oncol 30(6):789–798PubMedCrossRefGoogle Scholar
  16. 16.
    Chlebowski RT, Aiello E, McTiernan A (2002) Weight loss in breast cancer patient management. J Clin Oncol 20(4):1128–1143PubMedCrossRefGoogle Scholar
  17. 17.
    Ligibel J (2011) Obesity and breast cancer. Oncology 25(11):994–1000PubMedGoogle Scholar
  18. 18.
    Chlebowski RT (2012) Obesity and breast cancer outcome: adding to the evidence. J Clin Oncol 30(2):126–128PubMedCrossRefGoogle Scholar
  19. 19.
    Kroenke CH, Chen WY, Rosner B, Holmes MD (2005) Weight, weight gain, and survival after breast cancer diagnosis. J Clin Oncol 23(7):1370–1378PubMedCrossRefGoogle Scholar
  20. 20.
    Caan BJ, Emond JA, Natarajan L et al (2006) Post-diagnosis weight gain and breast cancer recurrence in women with early stage breast cancer. Breast Cancer Res Treat 99(1):47–57PubMedCrossRefGoogle Scholar
  21. 21.
    Caan BJ, Kwan ML, Hartzell G et al (2008) Pre-diagnosis body mass index, post-diagnosis weight change, and prognosis among women with early stage breast cancer. Cancer Causes Control 19(10):1319–1328PubMedCentralPubMedCrossRefGoogle Scholar
  22. 22.
    Caan BJ, Kwan ML, Shu XO et al (2012) Weight change and survival after breast cancer in the after breast cancer pooling project. Cancer Epidemiol Biomarkers Prev 21(8):1260–1271PubMedCentralPubMedCrossRefGoogle Scholar
  23. 23.
    Caan BJ, Emond JA, Su HI et al (2012) Effect of postdiagnosis weight change on hot flash status among early-stage breast cancer survivors. J Clin Oncol 30(13):1492–1497PubMedCrossRefGoogle Scholar
  24. 24.
    Moshler CE, Sloane R, Morey MC et al (2009) Associations between lifestyle factors and quality of life among older long-term breast, prostate, and colorectal cancer survivors. Cancer 115(17):4001–4009CrossRefGoogle Scholar
  25. 25.
    Irwin ML, Alvarez-Reeves M, Cadmus L et al (2009) Exercise improves body fat, lean mass, and bone mass in breast cancer survivors. Obesity 17(8):1534–1541PubMedCentralPubMedCrossRefGoogle Scholar
  26. 26.
    Rogers LQ, Hopkins-Price P, Vicari S et al (2009) Physical activity and health outcomes three months after completing a physical activity behavior change intervention: persistent and delayed effects. Cancer Epidemiol Biomarkers Prev 18(5):1410–1418PubMedCrossRefGoogle Scholar
  27. 27.
    Demark-Wahnefried W, Hars V, Conaway MR et al (1997) Reduced rates of metabolism and decreased physical activity in breast cancer patients receiving adjuvant chemotherapy. Am J Clin Nutr 65(5):1495–1501PubMedGoogle Scholar
  28. 28.
    Demark-Wahnefried W, Peterson BL, Winer EP et al (2001) Changes in weight, body composition, and factors influencing energy balance among premenopausal breast cancer patients receiving adjuvant chemotherapy. J Clin Oncol 19(9):2381–2389PubMedGoogle Scholar
  29. 29.
    Kwan ML, Sternfeld B, Ergas IJ et al (2012) Change in physical activity during active treatment in a prospective study of breast cancer survivors. Breast Cancer Res Treat 131(2):679–690PubMedCentralPubMedCrossRefGoogle Scholar
  30. 30.
    Courneya KS, Tamburrini AL, Woolcott CG et al (2011) The Alberta physical activity and breast cancer prevention trial: quality of life outcomes. Prev Med 52(1):26–32PubMedCrossRefGoogle Scholar
  31. 31.
    Phillips SM, McAuley E (2013) Social cognitive influences on physical activity participation in long-term breast cancer survivors. Psychooncology 22(4):783–791PubMedCentralPubMedCrossRefGoogle Scholar
  32. 32.
    Godin G, Shephard RJ (1985) A simple method to assess exercise behavior in the community. Can J Appl Sport Sci 10(3):141PubMedGoogle Scholar
  33. 33.
    Zigmond AS, Snaith R (1983) The hospital anxiety and depression scale. Acta Psychiatr 67(6):361–370CrossRefGoogle Scholar
  34. 34.
    Fox KR, Corbin CB (1989) The physical self-perception profile: development and preliminary validation. J Sport Exerc Psychol 11(4):408–430Google Scholar
  35. 35.
    Rosenberg M (1979) Conceiving the self. Basic Books, New YorkGoogle Scholar
  36. 36.
    Cohen S, Kamarck T, Mermelstein R (1983) A global measure of perceived stress. J Health Soc Behav 24(4):385–396PubMedCrossRefGoogle Scholar
  37. 37.
    Hann D, Jacobsen P, Azzarello L et al (1998) Measurement of fatigue in cancer patients: development and validation of the fatigue symptom inventory. Qual Life Res 7(4):301–310PubMedCrossRefGoogle Scholar
  38. 38.
    Brady MJ, Cella DF, Mo F et al (1997) Reliability and validity of the functional assessment of cancer therapy-breast quality-of-life instrument. J Clin Oncol 15(3):974–986PubMedGoogle Scholar
  39. 39.
    Cella DF, Tulsky DS, Gray G et al (1993) The functional assessment of cancer therapy scale: development and validation of the general measure. J Clin Oncol 11(3):570–579PubMedGoogle Scholar
  40. 40.
    Corp IBM (2010) SPSS statistics for windows, version 19.0. IBM Corp, ArmonkGoogle Scholar
  41. 41.
    Cohen J (1988) Statistical power analysis for the behavioral sciences, 2nd edn. Lawrence Earlbaum Associates, HillsdaleGoogle Scholar
  42. 42.
    Brenner DR, Neilson HK, Courneya KS, Friedenreich CM (2014) Physical activity after breast cancer: effect on survival and patient-reported outcomes. Curr Breast Cancer Rep. doi:  10.1007/s12609-014-0147-y Google Scholar
  43. 43.
    Yost KJ, Eton DT, Garcia SF, Cella D (2011) Minimally important differences were estimated for six patient-reported outcomes measurement information system-cancer scales in advanced stage cancer patients. J Clin Epidemiol 64(5):507–516PubMedCentralPubMedCrossRefGoogle Scholar
  44. 44.
    Webster K, Cella D, Yost K. The Functional Assessment of Chronic Illiness Therapy (FACIT) Measurement System: properties, applications and interpretation. Health Qual Life Outcomes. 2003;1(79): doi:  10.1186/1477-7525-1-79.
  45. 45.
    Puhan MA, Frey M, Büchi S & Schünemann HJ. The minimal important difference of the hospital anxiety and depression scale in patients with chronic obstructive pulmonary disease. Health Qual Life Outcomes. 2008; 6(46): doi:  10.1186/1477-7525-6-46
  46. 46.
    Donovan KA, Jacobsen PB, Small BJ et al (2008) Identifying clinically meaningful fatigue with the fatigue symptom inventory. J Pain Symptom Manag 36(5):480–487CrossRefGoogle Scholar
  47. 47.
    Blair SN, Dowda M, Pate RR et al (1991) Reliability of long-term recall of participation in physical activity by middle-aged men and women. Am J Epidemiol 133(3):266–275PubMedGoogle Scholar
  48. 48.
    Steven J, Keil JE, Randolph W, Gaze PC (1989) Accuracy of current, 4-year and 28-year self-reported weigh in an elderly population. Am J Epidemiol 132(6):1156–1163Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  1. 1.Division of Behavioral Medicine, Department of Preventive Medicine, Feinberg School of MedicineNorthwesternUniversityChicagoUSA
  2. 2.Department of Kinesiology and Community HealthUniversity of IllinoisUrbanaUSA

Personalised recommendations