Elsevier

General Hospital Psychiatry

Volume 49, November 2017, Pages 37-43
General Hospital Psychiatry

How changes in physical activity relate to fatigue interference, mood, and quality of life during treatment for non-metastatic breast cancer

https://doi.org/10.1016/j.genhosppsych.2017.05.007Get rights and content

Abstract

Objective

Physical activity (PA) following surgery for breast cancer may improve depressive symptoms and quality of life (QoL) via reduction in fatigue-related daily interference (FRDI). Less is known about how change in PA may relate to these psychosocial factors throughout the course of treatment. In a secondary analysis of a previous psychosocial intervention trial, we examined relationships between change in PA, depressive symptoms, and functional QoL, as mediated by change in FRDI, and whether naturally occurring change in PA provided benefit independent of the intervention.

Method

Women (N = 240) with non-metastatic stage 0–III breast cancer were randomized to cognitive-behavioral stress management (CBSM) or a control 2–10 weeks post-surgery. PA, FRDI, clinician-rated depressive symptoms, self-reported depressed mood, and functional QoL were assessed at baseline and three months post-intervention.

Results

Increased PA was associated with reductions in clinician-rated depressive symptoms, depressed mood, and improved QoL, mediated by a reduction in FRDI. This was above and beyond the effect of CBSM.

Conclusions

Increased PA may mitigate FRDI and improve depressive symptoms and functional QoL for women undergoing breast cancer treatment, beyond effects of a psychosocial intervention. Benefits of an integrated PA and psychosocial approach should be investigated further.

Introduction

Fatigue, depressive symptoms, and diminished quality of life (QoL) are among the serious breast cancer treatment-related side effects [1]. Physical activity may mitigate the severity of physical and psychological sequelae associated with a breast cancer diagnosis and treatment [2], [3], [4]; women with breast cancer who engage in physical activity have less fatigue [5], [6], depressive symptoms [6], and better quality of life (QoL) [5], [6], [7]. The process by which physical activity reduces these symptoms is less understood [8]. Previously, women with non-metastatic breast cancer reported greater physical activity and had less concurrent perceived daily interference due to fatigue, less clinician- and self-rated depressive symptoms, and better functional QoL following surgery [9]. Moreover, fatigue interference served an intermediary role; greater physical activity was related to less depressive symptoms and better functional QoL via reduced fatigue interference [9]. While these findings suggest a potential mechanism relating physical activity to mood outcomes, the relationships must be examined longitudinally for better understanding.

Despite potential benefits, most women with breast cancer do not meet the American College of Sports Medicine (ACSM) physical activity recommendations, which encourage patients to engage in at least 150 min of moderate or 75 min of vigorous intensity activity each week during treatment [10]. Unfortunately, physical activity often decreases after diagnosis, especially among women undergoing radiation or chemotherapy [11]. Given previous evidence of the concurrent relationships between physical activity, fatigue interference, depressive symptoms, and QOL post-surgically [9], understanding how changes in physical activity may influence these outcomes over time is relevant as women manage treatment-related symptoms.

In addition to physical activity, psychosocial interventions involving cognitive-behavioral, relaxation, and mindfulness techniques have shown efficacy in improving fatigue, depressive symptoms, and QoL in breast cancer [12], [13], [14]. Group-based cognitive-behavioral stress management (CBSM) has been particularly efficacious in reducing fatigue interference and depressed mood and improving QoL for women during breast cancer treatment [15], [16], [17]. As such, researchers have investigated whether an integrative approach combining physical activity and cognitive-behavioral techniques may attenuate treatment-related symptoms for women with non-metastatic breast cancer [18]. However, whether increased physical activity may be additionally beneficial for women who participate in CBSM has not been explored. Support for the additive effect of increased physical activity on psychosocial adjustment may encourage consistent promotion of physical activity among breast cancer patients.

The current study was a secondary analysis that aimed to (1) examine whether the relationships between physical activity and physical and psychosocial factors in the previously reported post-surgical cross-sectional study [9] are observed longitudinally during treatment, such that change in physical activity from pre- to post-intervention predicts changes in fatigue interference, clinician- and self-rated depressive symptoms, and functional QoL; (2) assess whether the influence of modified physical activity involvement on changes in depressive symptoms and functional QoL is mediated by change in fatigue interference; and (3) explore whether change in physical activity contributes additional benefit above and beyond CBSM. We hypothesized that an increase in physical activity would be associated with a reduction in fatigue interference, clinician- and self-rated depressive symptoms, and an increase in functional QoL, that the effect of increased physical activity on mood outcomes would be mediated by reduced fatigue interference, and that an increase in physical activity would be independently related to reduction in FRDI and improved QoL outcomes, above and beyond the effect of CBSM.

Section snippets

Participants

Participants were part of a larger, single center, single blind, randomized, parallel assignment efficacy trial, testing a CBSM intervention. A detailed description of the original study design is available elsewhere [16], [17]. Study approval was granted by the University of Miami's Institutional Review Board (National Institutes of Health Clinical Trial NCT01422551). Women diagnosed with non-metastatic stage 0-IIIb breast cancer were recruited through physician referrals and community

Participant characteristics

From a total screening sample of 502 women, 240 were consented and randomized to CBSM intervention (n = 120) or the 1-day psycho-educational control (n = 120). Women were an average of 50.3 (SD = 9.0) years old, with > 50% having completed college or advanced degrees, and 36.3% being a member of a racial or ethnic minority group. At baseline, women reported minimal use of medication for depression, anxiety, and/or sleep concerns (Table 1). The number of days elapsed from surgery to baseline assessment

Discussion

This study examined associations between change in physical activity and changes in FRDI, clinician- and self-rated depressive symptoms, and functional QoL from pre- to post-intervention in women undergoing treatment for non-metastatic breast cancer. Despite undergoing treatment, women increased moderate and vigorous intensity physical activity, with nearly 60% of women meeting the ACSM recommendation for moderate physical activity post-intervention. Consistent with our hypothesis, we observed

Disclosures

Michael Antoni Ph.D. reports receiving publication royalties from a book he co-authored on cognitive-behavioral stress management.

Acknowledgements

We would like to acknowledge our study participants, research coordinators, and project manager, Janny Rodriguez, M.A. The original trial was supported by a grant from the NCI/NIH (R01CA064710).

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