Barriers to physical activity: a study of academic and community cancer survivors with pain
- 94 Downloads
Despite the numerous benefits of physical activity (PA) for patients with cancer, many cancer survivors report challenges to participating in PA. The objectives of this study were (1) to assess barriers to PA and (2) to examine participant characteristics associated with modifiable barriers to PA among cancer survivors with pain.
We conducted a cross-sectional survey study at one academic medical center and 11 community hospitals. Participants completed the 12-item Physical Activity Barriers After Cancer (PABAC) instrument (Cronbach’s alpha = 0.75). Multivariable regression models examined participant characteristics associated with PABAC scores with a higher score indicating more barriers to PA.
Among 662 survivors, 67% had moderate or severe pain (rating 4 or greater on a scale of 0 to 10). Seventy-five percent of survivors did not meet the American Cancer Society PA recommendations on average, and these individuals had higher mean PABAC scores (beta coefficient (β) = 2.02, 95% confidence interval (CI) 0.96–3.09, p < 0.001). In adjusted analyses, cancer survivors who were non-white (β = 1.55, 0.28–2.82, p = 0.02), treated at a community hospital (β = 1.07, 0.09–2.05, p = 0.03), had surgery (β = 1.69, 0.69–2.69, p = 0.001), or within 12 months of diagnosis (β = 1.15, 0.20–2.10, p = 0.02) reported greater barriers to PA.
The majority of cancer survivors with pain are not adequately participating in PA. Key demographic and clinical characteristics are associated with survivors’ barriers.
Implications for Cancer Survivors
Efforts to overcome specific barriers are needed to promote PA after a cancer diagnosis.
KeywordsPhysical activity Barriers Cancer survivors Pain
The authors would like to thank the cancer survivors, oncologists, nurses, and clinical staff at all study sites for their contributions to this study.
Research related to the development of this paper was supported in part by the National Cancer Institute grants to the University of Pennsylvania Abramson Cancer Center (2P30CA016520-40) and the Memorial Sloan Kettering Cancer Center (3P30CA008748-50; 5T32CA9461-32), and the Translational Research and Integrative Medicine Fund at Memorial Sloan Kettering Cancer Center.
Compliance with ethical standards
The institutional review board of the University of Pennsylvania approved the study protocol and survey.
Conflict of interest
The authors declare that they have no conflict of interest. Dr. Mao has full control of all primary data and agrees to allow the journal to review the data if requested. The content is solely the responsibility of the authors and does not necessarily represent official views of the National Institutes of Health.
Research involving human participants
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.
Informed consent was obtained from all individual participants included in the study.
- 2.CDC. Basic information for cancer survivors. 2017. https://www.cdc.gov/cancer/survivorship/basic_info/survivors/index.htm. Accessed April 9 2018.
- 3.CDC. Cancer survivors--United States, 2007. MMWR Morb Mortal Wkly Rep. 2011;60(9):269–72.Google Scholar
- 5.Bower JE, Bak K, Berger A, Breitbart W, Escalante CP, Ganz PA, et al. Screening, assessment, and management of fatigue in adult survivors of cancer: an American Society of Clinical Oncology clinical practice guideline adaptation. J Clin Oncol. 2014;32(17):1840–50. https://doi.org/10.1200/JCO.2013.53.4495.CrossRefPubMedPubMedCentralGoogle Scholar
- 12.Ottenbacher A, Yu M, Moser RP, Phillips SM, Alfano C, Perna FM. Population estimates of meeting strength training and aerobic guidelines, by gender and cancer survivorship status: findings from the health information National Trends Survey (HINTS). J Phys Act Health. 2015;12(5):675–9. https://doi.org/10.1123/jpah.2014-0003.CrossRefPubMedGoogle Scholar
- 14.Blaney JM, Lowe-Strong A, Rankin-Watt J, Campbell A, Gracey JH. Cancer survivors' exercise barriers, facilitators and preferences in the context of fatigue, quality of life and physical activity participation: a questionnaire-survey. Psychooncology. 2013;22(1):186–94. https://doi.org/10.1002/pon.2072.CrossRefPubMedGoogle Scholar
- 16.Courneya KS, Friedenreich CM, Quinney HA, Fields AL, Jones LW, Vallance JK, et al. A longitudinal study of exercise barriers in colorectal cancer survivors participating in a randomized controlled trial. Ann Behav Med. 2005;29(2):147–53. https://doi.org/10.1207/s15324796abm2902_9.CrossRefPubMedGoogle Scholar
- 21.Brown JC, Ligibel JA. The role of physical activity in oncology care. J Natl Cancer Inst Monogr. 2017;2017(52). https://doi.org/10.1093/jncimonographs/lgx017.
- 23.Larsson C, Ekvall Hansson E, Sundquist K, Jakobsson U. Impact of pain characteristics and fear-avoidance beliefs on physical activity levels among older adults with chronic pain: a population-based, longitudinal study. BMC Geriatr. 2016;16:50. https://doi.org/10.1186/s12877-016-0224-3.CrossRefPubMedPubMedCentralGoogle Scholar
- 25.Champion VL, Wagner LI, Monahan PO, Daggy J, Smith L, Cohee A, et al. Comparison of younger and older breast cancer survivors and age-matched controls on specific and overall quality of life domains. Cancer. 2014;120(15):2237–46. https://doi.org/10.1002/cncr.28737.CrossRefPubMedPubMedCentralGoogle Scholar
- 32.Hartman SJ, Nelson SH, Cadmus-Bertram LA, Patterson RE, Parker BA, Pierce JP. Technology- and phone-based weight loss intervention: pilot RCT in women at elevated breast cancer risk. Am J Prev Med. 2016;51(5):714–21. https://doi.org/10.1016/j.amepre.2016.06.024.CrossRefPubMedPubMedCentralGoogle Scholar
- 36.Mishra SI, Scherer RW, Snyder C, Geigle PM, Berlanstein DR, Topaloglu O. Exercise interventions on health-related quality of life for people with cancer during active treatment. Cochrane Database Syst Rev. 2012(8):Cd008465. https://doi.org/10.1002/14651858.CD008465.pub2.
- 38.Jones LW, Courneya KS, Fairey AS, Mackey JR. Effects of an oncologist's recommendation to exercise on self-reported exercise behavior in newly diagnosed breast cancer survivors: a single-blind, randomized controlled trial. Ann Behav Med. 2004;28(2):105–13. https://doi.org/10.1207/s15324796abm2802_5.CrossRefPubMedGoogle Scholar
- 41.Courneya KS, McKenzie DC, Reid RD, Mackey JR, Gelmon K, Friedenreich CM, et al. Barriers to supervised exercise training in a randomized controlled trial of breast cancer patients receiving chemotherapy. Ann Behav Med. 2008;35(1):116–22. https://doi.org/10.1007/s12160-007-9009-4.CrossRefPubMedGoogle Scholar