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Patterns, perceptions, and perceived barriers to physical activity in adult cancer survivors

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Abstract

Purpose

Physical activity (PA) during and after cancer treatment is associated with improved cancer- and non-cancer-related outcomes. We assessed for predictors of change in PA levels among cancer survivors.

Methods

Adult cancer survivors from a comprehensive cancer center completed a one-time questionnaire retrospectively assessing PA levels before, during, and after cancer treatment along with their perceptions of PA. Multivariable logistic regression models evaluated the association of clinico-demographics variables and perceptions of PA with changes in whether patients were meeting PA guidelines after cancer diagnosis.

Results

Among the 1003 patients, 319 (32%) met moderate to vigorous PA (MVPA) guidelines before diagnosis. Among those meeting guidelines before diagnosis, 50% still met guidelines after treatment; 12% not meeting MVPA guidelines initially met them after treatment/at follow-up. Among patients meeting guidelines before diagnosis, better ECOG performance status at follow-up, receiving curative therapy, and spending a longer time on PA initially were each associated with meeting guidelines at follow-up. After controlling for other variables, perceiving that PA improves quality of life (adjusted odds ratio, aOR = 11.09, 95%CI [1.42–86.64], P = 0.02) and overall survival (aOR = 8.52, 95%CI [1.12–64.71], P = 0.04) was each associated with meeting MVPA guidelines during/after treatment, in patients who did not meet guidelines initially. Only 13% reported receiving counseling, which was not associated with PA levels. Common reported barriers to PA included fatigue, lacking motivation, and being too busy.

Conclusions

Patient perceptions of PA benefits are strongly associated with improving PA levels after a cancer diagnosis. Clinician counseling should focus on patient education and changing patient perceptions.

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References

  1. Stull VB, Snyder DC, Demark-Wahnefried W (2007) Lifestyle interventions in cancer survivors: designing programs that meet the needs of this vulnerable and growing population. J Nutr 137:243S–248S

    Article  CAS  Google Scholar 

  2. Sabatino SA, Coates RJ, Uhler RJ, Pollack LA, Alley LG, Zauderer LJ (2007) Provider counseling about health behaviors among cancer survivors in the United States. J Clin Oncol 25:2100–2106

    Article  Google Scholar 

  3. Demark-Wahnefried W, Aziz NM, Rowland JH, Pinto BM (2005) Riding the crest of the teachable moment: promoting long-term health after the diagnosis of cancer. J Clin Oncol 23:5814–5830

    Article  Google Scholar 

  4. Vijayvergia N, Denlinger CS (2015) Lifestyle factors in cancer survivorship: where we are and where we are headed. J Pers Med 5:243–263

    Article  Google Scholar 

  5. Burnham TR, Wilcox A (2002) Effects of exercise on physiological and psychological variables in cancer survivors. Med Sci Sports Exerc 34:1863–1867

    Article  Google Scholar 

  6. Demark-Wahnefried W, Morey MC, Sloane R, Snyder DC, Miller PE, Hartman TJ, Cohen HJ (2012) Reach out to enhance wellness home-based diet-exercise intervention promotes reproducible and sustainable long-term improvements in health behaviors, body weight, and physical functioning in older, overweight/obese cancer survivors. J Clin Oncol 30:2354–2361

    Article  Google Scholar 

  7. Garcia DO, Thomson CA (2014) Physical activity and cancer survivorship. Nutr Clin Pract 29:768–779

    Article  Google Scholar 

  8. Holmes MD, Chen WY, Feskanich D, Kroenke CH, Colditz GA (2005) Physical activity and survival after breast cancer diagnosis. JAMA 293:2479–2486

    Article  CAS  Google Scholar 

  9. Lee IM, Wolin KY, Freeman SE, Sattlemair J, Sesso HD (2014) Physical activity and survival after cancer diagnosis in men. J Phys Act Health 11:85–90

    Article  Google Scholar 

  10. Zeng Y, Huang M, Cheng AS, Zhou Y, So WK (2014) Meta-analysis of the effects of exercise intervention on quality of life in breast cancer survivors. Breast Cancer 21:262–274

    Article  Google Scholar 

  11. Loughney L, West MA, Kemp GJ, Grocott MP, Jack S (2016) Exercise intervention in people with cancer undergoing neoadjuvant cancer treatment and surgery: a systematic review. Eur J Surg Oncol 42:28–38

    Article  CAS  Google Scholar 

  12. Segal R, Zwaal C, Green E, Tomasone JR, Loblaw A, Petrella T, Exercise for People with Cancer Guideline Development Group (2017) Exercise for people with cancer: a systematic review. Curr Oncol 24:e290–e315

    Article  CAS  Google Scholar 

  13. Toohey K, Pumpa K, McKune A, Cooke J, Semple S (2018) High-intensity exercise interventions in cancer survivors: a systematic review exploring the impact on health outcomes. J Cancer Res Clin Oncol 144:1–12

    Article  Google Scholar 

  14. Kushi LH, Doyle C, McCullough M, Rock CL, Demark-Wahnefried W, Bandera EV, Gapstur S, Patel AV, Andrews K, Gansler T, American Cancer Society 2010 Nutrition and Physical Activity Guidelines Advisory Committee (2012) American Cancer Society Guidelines on nutrition and physical activity for cancer prevention: reducing the risk of cancer with healthy food choices and physical activity. CA Cancer J Clin 62:30–67

    Article  Google Scholar 

  15. 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

    Article  Google Scholar 

  16. Rogers LQ, Courneya KS, Shah P, Dunnington G, Hopkins-Price P (2007) Exercise stage of change, barriers, expectations, values and preferences among breast cancer patients during treatment: a pilot study. Eur J Cancer Care (Engl) 16:55–66

    Article  CAS  Google Scholar 

  17. Courneya KS, Friedenreich CM, Reid RD, Gelmon K, Mackey JR, Ladha AB, Proulx C, Vallance JK, Segal RJ (2009) Predictors of follow-up exercise behavior 6 months after a randomized trial of exercise training during breast cancer chemotherapy. Breast Cancer Res Treat 114:179–187

    Article  Google Scholar 

  18. Hair BY, Hayes S, Tse CK, Bell MB, Olshan AF (2014) Racial differences in physical activity among breast cancer survivors: implications for breast cancer care. Cancer 120:2174–2182

    Article  Google Scholar 

  19. Pinto BM, Trunzo JJ (2005) Health behaviors during and after a cancer diagnosis. Cancer 104:2614–2623

    Article  Google Scholar 

  20. Lynch BM, Cerin E, Newman B, Owen N (2007) Physical activity, activity change, and their correlates in a population-based sample of colorectal cancer survivors. Ann Behav Med 34:135–143

    Article  Google Scholar 

  21. Naik H, Qiu X, Brown MC, Eng L, Pringle D, Mahler M, Hon H, Tiessen K, Thai H, Ho V, Gonos C, Charow R, Pat V, Irwin M, Herzog L, Ho A, Xu W, Jones JM, Howell D, Liu G (2016) Socioeconomic status and lifestyle behaviours in cancer survivors: smoking and physical activity. Curr Oncol 23:e546–e555

    Article  CAS  Google Scholar 

  22. Huy C, Schmidt ME, Vrieling A, Chang-Claude J, Steindorf K (2012) Physical activity in a German breast cancer patient cohort: one-year trends and characteristics associated with change in activity level. Eur J Cancer 48:297–304

    Article  Google Scholar 

  23. Hackshaw-McGeagh LE, Penfold CM, Walsh E, Donovan JL, Hamdy FC, Neal DE, Jeffreys M, Martin RM, Lane JA, ProtecT Study Group (2015) Physical activity, alcohol consumption, BMI and smoking status before and after prostate cancer diagnosis in the ProtecT trial: opportunities for lifestyle modification. Int J Cancer 137:1509–1515

    Article  CAS  Google Scholar 

  24. Bock C, Schmidt ME, Vrieling A, Chang-Claude J, Steindorf K (2013) Walking, bicycling, and sports in postmenopausal breast cancer survivors—results from a German patient cohort study. Psychooncology 22:1291–1298

    Article  Google Scholar 

  25. Fassier P, Zelek L, Partula V, Srour B, Bachmann P, Touillaud M, Druesne-Pecollo N, Galan P, Cohen P, Hoarau H, Latino-Martel P, Menai M, Oppert JM, Hercberg S, Deschasaux M, Touvier M (2016) Variations of physical activity and sedentary behavior between before and after cancer diagnosis: results from the prospective population-based NutriNet-Sante cohort. Medicine (Baltimore) 95:e4629

    Article  Google Scholar 

  26. Littman AJ, Tang MT, Rossing MA (2010) Longitudinal study of recreational physical activity in breast cancer survivors. J Cancer Surviv 4:119–127

    Article  Google Scholar 

  27. Rosenstock IM, Strecher VJ, Becker MH (1988) Social learning theory and the Health Belief Model. Health Educ Q 15:175–183

    Article  CAS  Google Scholar 

  28. Godin G, Shephard RJ (1985) A simple method to assess exercise behavior in the community. Can J Appl Sport Sci 10:141–146

    CAS  PubMed  Google Scholar 

  29. Rogers LQ, Courneya KS, Robbins KT, Malone J, Seiz A, Koch L, Rao K (2008) Physical activity correlates and barriers in head and neck cancer patients. Support Care Cancer 16:19–27

    Article  Google Scholar 

  30. Ottenbacher AJ, Day RS, Taylor WC, Sharma SV, Sloane R, Snyder DC, Kraus WE, Demark-Wahnefried W (2011) Exercise among breast and prostate cancer survivors—what are their barriers? J Cancer Surviv 5:413–419

    Article  Google Scholar 

  31. Coups EJ, Park BJ, Feinstein MB, Steingart RM, Egleston BL, Wilson DJ, Ostroff JS (2009) Correlates of physical activity among lung cancer survivors. Psychooncology 18:395–404

    Article  Google Scholar 

  32. Szymlek-Gay EA, Richards R, Egan R (2011) Physical activity among cancer survivors: a literature review. N Z Med J 124:77–89

    PubMed  Google Scholar 

  33. Rabin C, Pinto B (2006) Cancer-related beliefs and health behavior change among breast cancer survivors and their first-degree relatives. Psychooncology 15:701–712

    Article  Google Scholar 

  34. Fishbein M, Ajzen I (1975) Belief, attitude, intention, and behavior: an introduction to theory and research. Addison-Wesley, Reading

    Google Scholar 

  35. Trost SG, Owen N, Bauman AE, Sallis JF, Brown W (2002) Correlates of adults’ participation in physical activity: review and update. Med Sci Sports Exerc 34:1996–2001

    Article  Google Scholar 

  36. Lynch BM, Owen N, Hawkes AL, Aitken JF (2010) Perceived barriers to physical activity for colorectal cancer survivors. Support Care Cancer 18:729–734

    Article  Google Scholar 

  37. Peddle CJ, Au HJ, Courneya KS (2008) Associations between exercise, quality of life, and fatigue in colorectal cancer survivors. Dis Colon Rectum 51:1242–1248

    Article  Google Scholar 

  38. Titz C, Hummler S, Thomas M, Wiskemann J (2016) Physical exercise in advanced cancer patients undergoing palliative treatment 1:433–442

  39. Eyigor S, Akdeniz S (2014) Is exercise ignored in palliative cancer patients? World J Clin Oncol 5:554–559

    Article  Google Scholar 

  40. Ganz PA (2005) A teachable moment for oncologists: cancer survivors, 10 million strong and growing! J Clin Oncol 23:5458–5460

    Article  Google Scholar 

  41. Demark-Wahnefried W, Pinto BM, Gritz ER (2006) Promoting health and physical function among cancer survivors: potential for prevention and questions that remain. J Clin Oncol 24:5125–5131

    Article  Google Scholar 

  42. Denlinger CS, Engstrom PF (2011) Colorectal cancer survivorship: movement matters. Cancer Prev Res (Phila) 4:502–511

    Article  CAS  Google Scholar 

  43. Jones LW, Eves ND, Haykowsky M, Freedland SJ, Mackey JR (2009) Exercise intolerance in cancer and the role of exercise therapy to reverse dysfunction. Lancet Oncol 10:598–605

    Article  Google Scholar 

  44. Mishra SI, Scherer RW, Geigle PM, Berlanstein DR, Topaloglu O, Gotay CC, Snyder C (2012) Exercise interventions on health-related quality of life for cancer survivors. Cochrane Database Syst Rev (8):CD007566

  45. Fong DY, Ho JW, Hui BP, Lee AM, Macfarlane DJ, Leung SS, Cerin E, Chan WY, Leung IP, Lam SH, Taylor AJ, Cheng KK (2012) Physical activity for cancer survivors: meta-analysis of randomised controlled trials. BMJ 344:e70

    Article  Google Scholar 

  46. Velthuis MJ, Agasi-Idenburg SC, Aufdemkampe G, Wittink HM (2010) The effect of physical exercise on cancer-related fatigue during cancer treatment: a meta-analysis of randomised controlled trials. Clin Oncol (R Coll Radiol) 22:208–221

    Article  CAS  Google Scholar 

  47. Peeters C, Stewart A, Segal R, Wouterloot E, Scott CG, Aubry T (2009) Evaluation of a cancer exercise program: patient and physician beliefs. Psychooncology 18:898–902

    Article  CAS  Google Scholar 

  48. Santa Mina D, Alibhai SM, Matthew AG, Guglietti CL, Steele J, Trachtenberg J, Ritvo PG (2012) Exercise in clinical cancer care: a call to action and program development description. Curr Oncol 19:e136–e144

    Article  CAS  Google Scholar 

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Funding

This research was supported in part by the Alan B Brown Chair in Molecular Genomics, the CCO Chair in Experimental Therapeutics and Population Studies and the Posluns Family Foundation.

Author information

Author notes

  1. Geoffrey Liu, Shabbir M. H. Alibhai and Jennifer M. Jones contributed equally to this work.

Authors and Affiliations

  1. Division of Medical Oncology and Hematology, Department of Medicine, Princess Margaret Cancer Centre/University Health Network and University of Toronto, Toronto, Ontario, Canada

    Lawson Eng, Hiten Naik, Geoffrey Liu & Jennifer M. Jones

  2. Ontario Cancer Institute, Toronto, Ontario, Canada

    Lawson Eng, Dan Pringle, Jie Su, XiaoWei Shen, Mary Mahler, Chongya Niu, Rebecca Charow, Kyoko Tiessen, Christine Lam, Oleksandr Halytskyy, Hiten Naik, Henrique Hon, Margaret Irwin, Vivien Pat, Christina Gonos, Catherine Chan, Jodie Villeneuve, Luke Harland, Ravi M. Shani, M. Catherine Brown, Doris Howell, Wei Xu, Geoffrey Liu & Jennifer M. Jones

  3. Department of Medicine, University Health Network and University of Toronto, Toronto, Ontario, Canada

    Lawson Eng & Shabbir M. H. Alibhai

  4. Department of Biostatistics, Princess Margaret Cancer Centre/University Health Network and University of Toronto, Toronto, Ontario, Canada

    Jie Su, XiaoWei Shen, Wei Xu & Geoffrey Liu

  5. Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada

    Peter Selby, Wei Xu, Geoffrey Liu & Jennifer M. Jones

  6. Medicine in Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada

    Peter Selby

  7. Department of Family and Community Medicine, University of Toronto, Toronto, Canada

    Peter Selby

  8. Department of Psychiatry, University of Toronto, Toronto, Canada

    Peter Selby

Authors
  1. Lawson Eng
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  2. Dan Pringle
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  3. Jie Su
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  4. XiaoWei Shen
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  5. Mary Mahler
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  7. Rebecca Charow
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  8. Kyoko Tiessen
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  9. Christine Lam
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  10. Oleksandr Halytskyy
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  11. Hiten Naik
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  12. Henrique Hon
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  13. Margaret Irwin
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  14. Vivien Pat
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  15. Christina Gonos
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  16. Catherine Chan
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  17. Jodie Villeneuve
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  18. Luke Harland
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  19. Ravi M. Shani
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  20. M. Catherine Brown
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  21. Peter Selby
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  22. Doris Howell
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  23. Wei Xu
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  24. Geoffrey Liu
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  25. Shabbir M. H. Alibhai
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  26. Jennifer M. Jones
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Corresponding author

Correspondence to Geoffrey Liu.

Ethics declarations

The institutional (University Health Network) research ethics board approved the study. Informed consent was obtained from all individual participants included in the study.

Conflict of interest

The authors declare that they have no conflict of interest.

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Eng, L., Pringle, D., Su, J. et al. Patterns, perceptions, and perceived barriers to physical activity in adult cancer survivors. Support Care Cancer 26, 3755–3763 (2018). https://doi.org/10.1007/s00520-018-4239-5

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  • DOI: https://doi.org/10.1007/s00520-018-4239-5

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