Supportive Care in Cancer

, Volume 26, Issue 5, pp 1675–1683 | Cite as

Ease of walking associates with greater free-living physical activity and reduced depressive symptomology in breast cancer survivors: pilot randomized trial

  • Stephen J. CarterEmail author
  • Gary R. Hunter
  • Lyse A. Norian
  • Bulent Turan
  • Laura Q. Rogers
Original Article



We hypothesized exercise training-induced improvements in ease of walking would associate with favorable changes in objectively measured physical activity (PA) and self-reported depressive symptoms following a PA behavior-change intervention in non-metastatic breast cancer survivors (BCS).


Twenty-seven BCS received random assignment to an intervention (INT) or control group (CON). INT included counseling/group discussions coupled with supervised exercise tapered to unsupervised exercise. PA, depressive symptoms, and ease of walking were evaluated pre-/post-intervention using 10-day accelerometry, HADS depression subscale, and indirect calorimetry during a standardized treadmill test, respectively. PA composite score was calculated by converting weekly minutes of moderate-to-vigorous PA and average steps/day to z-scores then dividing the sum by 2. Cardiac efficiency was determined by dividing steady-state oxygen uptake by heart rate to evaluate the volume of oxygen consumed per heartbeat.


ANCOVA revealed a significant time by group interaction showing the INT group exhibited greater positive changes in the PA composite compared to the CON (INT, + 0.14 ± 0.66 au vs. CON, − 0.48 ± 0.49 au; p = 0.019; η p 2 = 0.21). Changes occurring from baseline to follow-up, among all participants, revealed improved ease of walking (less oxygen uptake) associated with increased PA composite (r = − 0.52; p = 0.010) and lower depressive symptomology (r = 0.50; p = 0.012) adjusted for age, race, and months since cancer diagnosis. Increased cardiac efficiency during the standardized treadmill test also associated with less daily sedentary time (r = − 0.52; p = 0.021).


These data support the assertion that reducing the physiological difficulty of walking may contribute to greater engagement in free-living PA, less sedentary time, and decreased psychosocial distress among BCS.


Cardiovascular Exercise Mobility Quality of life Survivorship 



We would like to recognize David R. Bryan, MA, and Sara Mansfield, MS, for their commitment and respective contributions. The authors also wish to express their appreciation to the participants for their willingness to complete this investigation.


This project was supported by the following funding sources: R25CA047888, U01CA136859, and P30DK056336.

Compliance with ethical standards

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2017

Authors and Affiliations

  • Stephen J. Carter
    • 1
    Email author
  • Gary R. Hunter
    • 1
    • 2
  • Lyse A. Norian
    • 1
  • Bulent Turan
    • 3
  • Laura Q. Rogers
    • 1
  1. 1.Department of Nutrition SciencesUniversity of Alabama at BirminghamBirminghamUSA
  2. 2.Department of Human StudiesUniversity of Alabama at BirminghamBirminghamUSA
  3. 3.Department of PsychologyUniversity of Alabama at BirminghamBirminghamUSA

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