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Physical Activity After Breast Cancer Surgery: Does Depression Make Exercise Feel More Effortful than It Actually Is?

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Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

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Funding

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.

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Authors and Affiliations

  1. Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, 460 Medical Center Drive, Columbus, OH, 43210, USA

    Avelina C. Padin, Stephanie J. Wilson, William B. Malarkey & Janice K. Kiecolt-Glaser

  2. Department of Psychology, The Ohio State University, Columbus, OH, USA

    Avelina C. Padin

  3. Department of Mathematics and Statistics, Amherst College, Amherst, USA

    Brittney E. Bailey

  4. Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, USA

    Maryam B. Lustberg, Raquel E. Reinbolt, Robert Wesolowski, Nicole Williams, Sagar Sardesai, Bhuvaneswari Ramaswamy, Anne M. Noonan, Jeffrey B. Vandeusen & Garrie J. Haas

  5. Department of Surgery, The Ohio State University College of Medicine, Columbus, OH, USA

    William B. Farrar, Stephen P. Povoski & Doreen M. Agnese

  6. Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, OH, USA

    Janice K. Kiecolt-Glaser

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  1. Avelina C. Padin
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Correspondence to Avelina C. Padin.

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Padin, A.C., Wilson, S.J., Bailey, B.E. et al. Physical Activity After Breast Cancer Surgery: Does Depression Make Exercise Feel More Effortful than It Actually Is?. Int.J. Behav. Med. 26, 237–246 (2019). https://doi.org/10.1007/s12529-019-09778-3

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