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Barriers to physical activity: a study of academic and community cancer survivors with pain

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Journal of Cancer Survivorship Aims and scope Submit manuscript

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.

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References

  1. Miller KD, Siegel RL, Lin CC, Mariotto AB, Kramer JL, Rowland JH, et al. Cancer treatment and survivorship statistics, 2016. CA Cancer J Clin. 2016;66(4):271–89. https://doi.org/10.3322/caac.21349.

    Article  PubMed  Google Scholar 

  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 

  4. Berger AM, Mooney K, Alvarez-Perez A, Breitbart WS, Carpenter KM, Cella D, et al. Cancer-related fatigue, version 2.2015. J Natl Compr Cancer Netw. 2015;13(8):1012–39.

    Article  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.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Swarm RA, Abernethy AP, Anghelescu DL, Benedetti C, Buga S, Cleeland C, et al. Adult cancer pain. J Natl Compr Cancer Netw. 2013;11(8):992–1022.

    Article  Google Scholar 

  7. Syrjala KL, Jensen MP, Mendoza ME, Yi JC, Fisher HM, Keefe FJ. Psychological and behavioral approaches to cancer pain management. J Clin Oncol. 2014;32(16):1703–11. https://doi.org/10.1200/jco.2013.54.4825.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Schmitz KH, Courneya KS, Matthews C, Demark-Wahnefried W, Galvao DA, Pinto BM, et al. American College of Sports Medicine roundtable on exercise guidelines for cancer survivors. Med Sci Sports Exerc. 2010;42(7):1409–26. https://doi.org/10.1249/MSS.0b013e3181e0c112.

    Article  PubMed  Google Scholar 

  9. Rock CL, Doyle C, Demark-Wahnefried W, Meyerhardt J, Courneya KS, Schwartz AL, et al. Nutrition and physical activity guidelines for cancer survivors. CA Cancer J Clin. 2012;62(4):243–74. https://doi.org/10.3322/caac.21142.

    Article  PubMed  Google Scholar 

  10. Wolin KY, Schwartz AL, Matthews CE, Courneya KS, Schmitz KH. Implementing the exercise guidelines for cancer survivors. J Support Oncol. 2012;10(5):171–7. https://doi.org/10.1016/j.suponc.2012.02.001.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Garcia DO, Thomson CA. Physical activity and cancer survivorship. Nutr Clin Pract. 2014;29(6):768–79. https://doi.org/10.1177/0884533614551969.

    Article  PubMed  PubMed Central  Google 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.

    Article  PubMed  Google Scholar 

  13. Tarasenko YN, Linder DF, Miller EA. Muscle-strengthening and aerobic activities and mortality among 3+ year cancer survivors in the U.S. Cancer Causes Control. 2018;29(4):475–84. https://doi.org/10.1007/s10552-018-1017-0.

    Article  PubMed  Google 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.

    Article  CAS  PubMed  Google Scholar 

  15. Henriksson A, Arving C, Johansson B, Igelstrom H, Nordin K. Perceived barriers to and facilitators of being physically active during adjuvant cancer treatment. Patient Educ Couns. 2016;99(7):1220–6. https://doi.org/10.1016/j.pec.2016.01.019.

    Article  PubMed  Google 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.

    Article  PubMed  Google Scholar 

  17. Yang DD, Hausien O, Aqeel M, Klonis A, Foster J, Renshaw D, et al. Physical activity levels and barriers to exercise referral among patients with cancer. Patient Educ Couns. 2017;100(7):1402–7. https://doi.org/10.1016/j.pec.2017.01.019.

    Article  PubMed  Google Scholar 

  18. Clifford BK, Mizrahi D, Sandler CX, Barry BK, Simar D, Wakefield CE, et al. Barriers and facilitators of exercise experienced by cancer survivors: a mixed methods systematic review. Support Care Cancer. 2018;26(3):685–700. https://doi.org/10.1007/s00520-017-3964-5.

    Article  PubMed  Google Scholar 

  19. Fisher A, Wardle J, Beeken RJ, Croker H, Williams K, Grimmett C. Perceived barriers and benefits to physical activity in colorectal cancer patients. Support Care Cancer. 2016;24(2):903–10. https://doi.org/10.1007/s00520-015-2860-0.

    Article  PubMed  Google Scholar 

  20. Brown JC, Mao JJ, Stricker C, Hwang WT, Tan KS, Schmitz KH. Aromatase inhibitor associated musculoskeletal symptoms are associated with reduced physical activity among breast cancer survivors. Breast J. 2014;20(1):22–8. https://doi.org/10.1111/tbj.12202.

    Article  CAS  PubMed  Google 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.

  22. Leeuw M, Goossens ME, Linton SJ, Crombez G, Boersma K, Vlaeyen JW. The fear-avoidance model of musculoskeletal pain: current state of scientific evidence. J Behav Med. 2007;30(1):77–94. https://doi.org/10.1007/s10865-006-9085-0.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Mao JJ, Armstrong K, Bowman MA, Xie SX, Kadakia R, Farrar JT. Symptom burden among cancer survivors: impact of age and comorbidity. J Am Board Fam Med. 2007;20(5):434–43. https://doi.org/10.3122/jabfm.2007.05.060225.

    Article  PubMed  Google 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.

    Article  PubMed  Google Scholar 

  26. Moye J, June A, Martin LA, Gosian J, Herman LI, Naik AD. Pain is prevalent and persisting in cancer survivors: differential factors across age groups. J Geriatr Oncol. 2014;5(2):190–6. https://doi.org/10.1016/j.jgo.2013.12.006.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Rogers LQ, Markwell SJ, Verhulst S, McAuley E, Courneya KS. Rural breast cancer survivors: exercise preferences and their determinants. Psychooncology. 2009;18(4):412–21. https://doi.org/10.1002/pon.1497.

    Article  PubMed  Google Scholar 

  28. Parks SE, Housemann RA, Brownson RC. Differential correlates of physical activity in urban and rural adults of various socioeconomic backgrounds in the United States. J Epidemiol Community Health. 2003;57(1):29–35.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Hardcastle SJ, Cohen PA. Effective physical activity promotion to survivors of cancer is likely to be home based and to require oncologist participation. J Clin Oncol. 2017;35(32):3635–7. https://doi.org/10.1200/jco.2017.74.6032.

    Article  PubMed  Google Scholar 

  30. Johnson DP, Whisman MA. Gender differences in rumination: a meta-analysis. Personal Individ Differ. 2013;55(4):367–74. https://doi.org/10.1016/j.paid.2013.03.019.

    Article  Google Scholar 

  31. Beg MS, Gupta A, Stewart T, Rethorst CD. Promise of wearable physical activity monitors in oncology practice. J Oncol Pract. 2017;13(2):82–9. https://doi.org/10.1200/JOP.2016.016857.

    Article  PubMed  PubMed Central  Google 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.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Wang JB, Cataldo JK, Ayala GX, Natarajan L, Cadmus-Bertram LA, White MM, et al. Mobile and wearable device features that matter in promoting physical activity. J Mob Technol Med. 2016;5(2):2–11. https://doi.org/10.7309/jmtm.5.2.2.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Le A, Mitchell HR, Zheng DJ, Rotatori J, Fahey JT, Ness KK, et al. A home-based physical activity intervention using activity trackers in survivors of childhood cancer: a pilot study. Pediatr Blood Cancer. 2017;64(2):387–94. https://doi.org/10.1002/pbc.26235.

    Article  PubMed  Google Scholar 

  35. Silver JK, Baima J, Mayer RS. Impairment-driven cancer rehabilitation: an essential component of quality care and survivorship. CA Cancer J Clin. 2013;63(5):295–317. https://doi.org/10.3322/caac.21186.

    Article  PubMed  Google 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.

  37. Demark-Wahnefried W, Schmitz KH, Alfano CM, Bail JR, Goodwin PJ, Thomson CA, et al. Weight management and physical activity throughout the cancer care continuum. CA Cancer J Clin. 2018;68(1):64–89. https://doi.org/10.3322/caac.21441.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  39. Tarasenko YN, Miller EA, Chen C, Schoenberg NE. Physical activity levels and counseling by health care providers in cancer survivors. Prev Med. 2017;99:211–7. https://doi.org/10.1016/j.ypmed.2017.01.010.

    Article  PubMed  Google Scholar 

  40. Ormel HL, van der Schoot GGF, Sluiter WJ, Jalving M, Gietema JA, Walenkamp AME. Predictors of adherence to exercise interventions during and after cancer treatment: a systematic review. Psychooncology. 2018;27(3):713–24. https://doi.org/10.1002/pon.4612.

    Article  CAS  PubMed  PubMed Central  Google 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.

    Article  PubMed  Google Scholar 

  42. Rogers LQ, Courneya KS, Verhulst S, Markwell S, Lanzotti V, Shah P. Exercise barrier and task self-efficacy in breast cancer patients during treatment. Support Care Cancer. 2006;14(1):84–90. https://doi.org/10.1007/s00520-005-0851-2.

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors would like to thank the cancer survivors, oncologists, nurses, and clinical staff at all study sites for their contributions to this study.

Funding

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.

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Authors and Affiliations

  1. Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Sally A. D. Romero, Q. Susan Li & Jun J. Mao

  2. Memorial Sloan Kettering Cancer Center, Bendheim Integrative Medicine Center, 1429 First Avenue, New York, NY, 10021, USA

    Sally A. D. Romero & Jun J. Mao

  3. Dana–Farber Cancer Institute, Boston, MA, USA

    Justin C. Brown

  4. Department of Medicine, Perelman School of Medicine, University of Pennsylvania, PA, Philadelphia, USA

    Joshua M. Bauml & Roger B. Cohen

  5. Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Jennifer L. Hay

Authors
  1. Sally A. D. Romero
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Corresponding authors

Correspondence to Sally A. D. Romero or Jun J. Mao.

Ethics declarations

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

Informed consent was obtained from all individual participants included in the study.

Additional information

Presentation: Accepted for poster presentation at the Society for Integrative Oncology 2017 14th International Conference; Chicago, IL; November 12, 2017.

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Romero, S.A.D., Brown, J.C., Bauml, J.M. et al. Barriers to physical activity: a study of academic and community cancer survivors with pain. J Cancer Surviv 12, 744–752 (2018). https://doi.org/10.1007/s11764-018-0711-y

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  • DOI: https://doi.org/10.1007/s11764-018-0711-y

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