Physical Activity After Breast Cancer Surgery: Does Depression Make Exercise Feel More Effortful than It Actually Is?
Prior to treatment, breast cancer patients are less physically fit compared to peers; during cancer treatment, their fitness typically declines. Depressive symptoms are associated with reduced activity up to 5 years post-treatment, but research has not identified mechanisms linking depression and lower activity. The current study assessed relationships among breast cancer patients’ depression and perceived exertion during exercise as well as heart rate, an objective indicator of exertion.
Participants were 106 breast cancer patients, stages I–IIIA, who completed surgery but had not started adjuvant treatment. Heart rate and self-rated exertion, measured using the Borg Scale of Perceived Exertion, were assessed every 2 min during a graded exercise test. Depression was assessed using the CES-D and a structured clinical interview.
Compared to women below the CES-D clinical cutoff, women with significant depressive symptoms reported steeper increases in exertion during the exercise test (p = .010) but had similar heart rates (p = .224) compared to women below the cutoff. Major depression history was unrelated to perceived exertion (ps > .224) and heart rate (ps > .200) during exercise.
Women with currently elevated depressive symptoms experienced exercise as more difficult compared to women below the CES-D cutoff, but these self-perceptions did not reflect actual heart rate differences. Depression may make exercise feel more demanding, which could ultimately decrease patients’ likelihood of engaging in regular exercise. Results support the use of depression screening tools following breast cancer surgery to identify and intervene on individuals at risk for decreased physical activity during survivorship.
KeywordsBreast cancer Physical activity Exercise Perceived exertion Depression Depressive symptoms
This work was supported in part by the National Institutes of Health grant nos. R01 CA186720, UL1TR001070, K05 CA172296, T32 DE014320, and a Pelotonia Postdoctoral Fellowship from Ohio State University’s Comprehensive Cancer Center. The first author also receives support from the National Institutes of Health grant no. R01 CA186720-02S2, and the third author receives support from the National Institutes of Health grant no. R01 CA186720-02S1.
Compliance with Ethical Standards
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.
Conflict of Interest
The authors declare that they have no conflict of interest.
- 5.Irwin ML, McTiernan A, Bernstein L, Gilliland FD, Baumgartner R, Baumgartner K, et al. Physical activity levels among breast cancer survivors. Med Sci Sports Exerc. 2004;36:1484–91.Google Scholar
- 12.Beck AT. Depression: clinical, experimental, and theoretical aspects. New York: Harper & Row; 1967.Google Scholar
- 26.Eriksen L, Grønbaek M, Helge JW, Tolstrup JS. Cardiorespiratory fitness in 16,025 adults aged 18-91 years and associations with physical activity and sitting time. Scand J Med Sci Sports. 2015.Google Scholar
- 28.Borg G. Pyschophysical bases of perceived exertion. Med Sci Sports Exerc. 1982;14:377–81.Google Scholar
- 29.Borg G. Borg’s perceived exertion and pain scales. Champaign: Human Kinetics; 1998.Google Scholar
- 34.First MB, Spitzer RL, Gibbon M, Williams JBW. Structured clinical interview for DSM-IV-TR axis I disorders, research version, non-patient edition. (SCID-I/NP). New York: Biometrics Research, New York State Psychiatric Institute; 2002.Google Scholar
- 38.Godin G, Shephard RJ. A simple method to assess exercise behavior in the community. Can J Appl Sport Sci. 1985;10:141–6.Google Scholar
- 44.Wiebking C, de Greck M, Duncan NW, Tempelmann C, Bajbouj M, Northoff G. Interoception in insula subregions as a possible state marker for depression—an exploratory fMRI study investigating healthy, depressed and remitted participants. Front Behav Neurosci. 2015;9.Google Scholar
- 45.Blanchfield A, Hardy J, Marcora S. Non-conscious visual cues related to affect and action alter perception of effort and endurance performance. Front Hum Neurosci. 2014;8.Google Scholar
- 64.McNeely ML, Campbell K, Ospina M, Rowe BH, Dabbs K, Klassen TP, et al. Exercise interventions for upper-limb dysfunction due to breast cancer treatment. Cochrane Database Syst Rev. 2010:CD005211.Google Scholar
- 65.Furmaniak AC, Menig M, Markes MH. Exercise for women receiving adjuvant therapy for breast cancer. Cochrane Database Syst Rev. 2016;9:CD005001.Google Scholar