Ease of walking associates with greater free-living physical activity and reduced depressive symptomology in breast cancer survivors: pilot randomized trial
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.
KeywordsCardiovascular 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.
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.
- 8.Runowicz CD, Leach CR, Henry NL, Henry KS, Mackey HT, Cowens-Alvarado RL, Cannady RS, Pratt-Chapman ML, Edge SB, Jacobs LA, Hurria A, Marks LB, LaMonte SJ, Warner E, Lyman GH, Ganz PA (2016) American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline. J Clin Oncol 34(6):611–635. https://doi.org/10.1200/JCO.2015.64.3809. CrossRefPubMedGoogle Scholar
- 9.Schmitz KH, Courneya KS, Matthews C, Demark-Wahnefried W, Galvao DA, Pinto BM, Irwin ML, Wolin KY, Segal RJ, Lucia A, Schneider CM, von Gruenigen VE, Schwartz AL, American College of Sports Medicine (2010) American College of Sports Medicine roundtable on exercise guidelines for cancer survivors. Med Sci Sports Exerc 42:1409–1426. https://doi.org/10.1249/MSS.0b013e3181e0c112 CrossRefPubMedGoogle Scholar
- 11.Jones LW, Courneya KS, Mackey JR, Muss HB, Pituskin EN, Scott JM, Hornsby WE, Coan AD, Herndon JE 2nd, Douglas PS, Haykowsky M (2012) Cardiopulmonary function and age-related decline across the breast cancer survivorship continuum. J Clin Oncol 30:2530–2537. https://doi.org/10.1200/JCO.2011.39.9014 CrossRefPubMedCentralPubMedGoogle Scholar
- 12.Phillips SM, Dodd KW, Steeves J, McClain J, Alfano CM, McAuley E (2015) Physical activity and sedentary behavior in breast cancer survivors: new insight into activity patterns and potential intervention targets. Gynecol Oncol 138(2):398–404. https://doi.org/10.1016/j.ygyno.2015.05.026. CrossRefPubMedCentralPubMedGoogle Scholar
- 15.Parker ND, Hunter GR, Treuth MS, Kekes-Szabo T, Kell SH, Weinsier R, White M (1996) Effects of strength training on cardiovascular responses during a submaximal walk and a weight-loaded walking test in older females. J Cardpulm Rehabil 16(1):56–62. https://doi.org/10.1097/00008483-199601000-00007 CrossRefGoogle Scholar
- 16.Hunter GR, Plaisance EP, Carter SJ, Fisher G (2017) Why intensity is not a bad word: optimizing health status at any age. Clin Nutr. Feb 9. pii: S0261-5614(17)300054-7. https://doi.org/10.1016/j.clnu.2017.02.004
- 19.Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67(6):361–370. https://doi.org/10.1111/j.1600-0447.1983.tb09716.x CrossRefPubMedGoogle Scholar
- 20.American College of Sports Medicine (2010) ACSM’s guidelines for exercise testing and prescription. Lippincott, Williams, and Wilkins, BaltimoreGoogle Scholar
- 23.Masse LC, Fuemmeler BF, Anderson CB, Matthews CE, Trost SG, Catellier DJ, Treuth M (2005) Accelerometer data reduction: a comparison of four reduction algorithms on select outcome variables. Med Sci Sports Exerc 37(Supplement):S544–S554. https://doi.org/10.1249/01.mss.0000185674.09066.8a CrossRefPubMedGoogle Scholar
- 24.Rogers LQ, McAuley E, Anton PM, Courneya KS, Vicari S, Hopkins-Price P, Verhulst S, Mocharnuk R, Hoelzer K (2012) Better exercise adherence after treatment for cancer (BEAT Cancer) study: rationale, design, and methods. Contemp Clin Trials 33(1):124–137. https://doi.org/10.1016/j.cct.2011.09.004 CrossRefPubMedGoogle Scholar
- 25.Physical Activity Guidelines Advisory Committee (2008) Physical activity guidelines advisory committee report, 2008 2008:A1-H14Google Scholar
- 29.Rogers LQ, Courneya KS, Anton PM, Verhulst S, Vicari SK, Robbs RS, McAuley E (2016) Effects of a multicomponent physical activity behavior change intervention on fatigue, anxiety, and depressive symptomatology in breast cancer survivors: randomized trial. Psychooncology. https://doi.org/10.1002/pon.4254
- 35.Friedenreich CM, Neilson HK, O’Reilly R, Duha A, Yasui Y, Morielli AR, Adams SC, Courneya KS (2015) Effects of a high vs moderate volume of aerobic exercise on adiposity outcomes in postmenopausal women: a randomized clinical trial. JAMA Oncol 1(6):766–776. https://doi.org/10.1001/jamaoncol.2015.2239 CrossRefPubMedGoogle Scholar
- 36.Arem H, Sorkin M, Cartmel B, Fiellin M, Capozza S, Harrigan M, Ercolano E, Zhou Y, Sanft T, Gross C, Schmitz K, Neogi T, Hershman D, Ligibel J, Irwin ML (2016) Exercise adherence in a randomized trial of exercise on aromatase inhibitor arthralgias in breast cancer survivors: the Hormones and Physical Exercise (HOPE) study. J Cancer Surviv 10(4):654–662. https://doi.org/10.1007/s11764-015-0511-6 CrossRefPubMedCentralPubMedGoogle Scholar
- 38.Gross AL, May BJ, Axilbund JE, Armstrong DK, Roden RB, Visvanathan K (2015) Weight change in breast cancer survivors compared to cancer-free women: a prospective study in women at familial risk of breast cancer. Cancer Epidemiol Biomark Prev 24(8):1262–1269. https://doi.org/10.1158/1055-9965.EPI-15-0212 CrossRefGoogle Scholar
- 40.Carter SJ, Hunter GR, McAuley E, Courneya KS, Anton PM, Rogers LQ (2016) Lower rate-pressure product during submaximal walking: a link to fatigue improvement following a physical activity intervention among breast cancer survivors. J Cancer Surviv. https://doi.org/10.1007/s11764-016-0539-2
- 41.Murata M, Adachi H, Oshima S, Kurabayashi M (2017) Influence of stroke volume and exercise tolerance on peak oxygen pulse in patients with and without beta-adrenergic receptor blockers in patients with heart disease. J Cardiol 69(1):176–181. https://doi.org/10.1016/j.jjcc.2016.02.017 CrossRefPubMedGoogle Scholar