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Supportive Care in Cancer

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01-05-2018 | Original Article

Ease of walking associates with greater free-living physical activity and reduced depressive symptomology in breast cancer survivors: pilot randomized trial

Authors: Stephen J. Carter, Gary R. Hunter, Lyse A. Norian, Bulent Turan, Laura Q. Rogers

Published in: Supportive Care in Cancer | Issue 5/2018

Abstract

Purpose

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).

Methods

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.

Results

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).

Conclusions

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.

Siegel RL, Miller KD, Jemal A (2017) Cancer statistics, 2017. CA Cancer J Clin 67:7–30. https://doi.org/10.3322/caac.21387 CrossRefPubMed

Miller KD, Siegel RL, Lin CC, Mariotto AB, Kramer JL, Rowland JH, Stein KD, Alteri R, Jemal A (2016) Cancer treatment and survivorship statistics, 2016. CA Cancer J Clin 66:271–289. https://doi.org/10.3322/caac.21349 CrossRefPubMed

Knobf MT (2011) Clinical update: psychosocial responses in breast cancer survivors. Semin Oncol Nurs 27(3):e1–e14. https://doi.org/10.1016/j.soncn.2011.05.001 CrossRefPubMed

Rowland JH (2008) Cancer survivorship: rethinking the cancer control continuum. Semin Oncol Nurs 24(3):145–152. https://doi.org/10.1016/j.soncn.2008.05.002 CrossRefPubMed

Karakoyun-Celik O, Gorken I, Sahin S, Orcin E, Alanyali H, Kinay M (2010) Depression and anxiety levels in woman under follow-up for breast cancer: relationship to coping with cancer and quality of life. Med Oncol 27(1):108–113. https://doi.org/10.1007/s12032-009-9181-4 CrossRefPubMed

Serra MC, Goldberg AP, Ryan AS (2016) Increased depression and metabolic risk in postmenopausal breast cancer survivors. Diabetol Metab Syndr 8:44. eCollection 2016. https://doi.org/10.1186/s13098-016-0170-4 CrossRefPubMedCentralPubMed

Deimling GT, Arendt JA, Kypriotakis G, Bowman KF (2009) Functioning of older, long-term cancer survivors: the role of cancer and comorbidities. J Am Geriatr Soc 57(Suppl 2):S289–S292. https://doi.org/10.1111/j.1532-5415.2009.02515.x CrossRefPubMed

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. CrossRefPubMed

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 CrossRefPubMed

10.

Phillips SM, McAuley E (2015) Associations between self-reported post-diagnosis physical activity changes, body weight changes, and psychosocial well-being in breast cancer survivors. Support Care Cancer 23(1):159–167. https://doi.org/10.1007/s00520-014-2346-5. CrossRefPubMed

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 CrossRefPubMedCentralPubMed

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. CrossRefPubMedCentralPubMed

13.

Brock DW, Chandler-Laney PC, Alvarez JA, Gower BA, Gaesser GA, Hunter GR (2010) Perception of exercise difficulty predicts weight regain in formerly overweight women. Obesity (Silver Spring) 18(5):982–986. https://doi.org/10.1038/oby.2009.318. CrossRef

14.

Hartman MJ, Fields DA, Byrne NM, Hunter GR (2007) Resistance training improves metabolic economy during functional tasks in older adults. J Strength Cond Res 21(1):91–95. https://doi.org/10.1519/00124278-200702000-00017 CrossRefPubMed

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 CrossRef

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

17.

Peel JB, Sui X, Adams SA, Hebert JR, Hardin JW, Blair SN (2009) A prospective study of cardiorespiratory fitness and breast cancer mortality. Med Sci Sports Exerc 41(4):742–748. https://doi.org/10.1249/MSS.0b013e31818edac7 CrossRefPubMedCentralPubMed

18.

Schootman M, Aft R, Jeffe DB (2009) An evaluation of lower-body functional limitations among long-term survivors of 11 different types of cancers. Cancer 115(22):5329–5338. https://doi.org/10.1002/cncr.24606 CrossRefPubMedCentralPubMed

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 CrossRefPubMed

20.

American College of Sports Medicine (2010) ACSM’s guidelines for exercise testing and prescription. Lippincott, Williams, and Wilkins, Baltimore

21.

Tosti KP, Hackney AC, Battaglini CL, Evans ES, Groff D (2011) Exercise in patients with breast cancer and healthy controls: energy substrate oxidation and blood lactate responses. Integr Cancer Ther 10(1):6–15. https://doi.org/10.1177/1534735410387600 CrossRefPubMed

22.

Roy JL, Hunter GR, Fernandez JR, McCarthy JP, Larson-Meyer DE, Blaudeau TE, Newcomer BR (2006) Cardiovascular factors explain genetic background differences in VO2max. Am J Hum Biol 18(4):454–460. https://doi.org/10.1002/ajhb.20509 CrossRefPubMed

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 CrossRefPubMed

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 CrossRefPubMed

25.

Physical Activity Guidelines Advisory Committee (2008) Physical activity guidelines advisory committee report, 2008 2008:A1-H14

26.

Welborn TA, Dhaliwal SS (2007) Preferred clinical measures of central obesity for predicting mortality. Eur J Clin Nutr 61(12):1373–1379. https://doi.org/10.1038/sj.ejcn.1602656 CrossRefPubMed

27.

Burgess C, Cornelius V, Love S, Graham J, Richards M, Ramirez A (2005) Depression and anxiety in women with early breast cancer: five year observational cohort study. BMJ 330(7493):702–700. https://doi.org/10.1136/bmj.38343.670868.D3 CrossRefPubMedCentralPubMed

28.

Zhu G, Zhang X, Wang Y, Xiong H, Zhao Y, Sun F (2016) Effects of exercise intervention in breast cancer survivors: a meta-analysis of 33 randomized controlled trails. Onco Targets Ther 9:2153–2168. https://doi.org/10.2147/OTT.S97864 CrossRefPubMedCentralPubMed

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

30.

Puhan MA, Frey M, Buchi S, Schunemann HJ (2008) The minimal important difference of the hospital anxiety and depression scale in patients with chronic obstructive pulmonary disease. Health Qual Life Outcomes 6:46. https://doi.org/10.1186/1477-7525-6-46 CrossRefPubMedCentralPubMed

31.

Dieli-Conwright CM, Orozco BZ (2015) Exercise after breast cancer treatment: current perspectives. Breast Cancer (Dove Med Press) 7:353–362. https://doi.org/10.2147/BCTT.S82039

32.

Rethorst CD, Wipfli BM, Landers DM (2009) The antidepressive effects of exercise: a meta-analysis of randomized trials. Sports Med 39(6):491–511. https://doi.org/10.2165/00007256-200939060-00004 CrossRefPubMed

33.

Shephard RJ (2009) Maximal oxygen intake and independence in old age. Br J Sports Med 43(5):342–346. https://doi.org/10.1136/bjsm.2007.044800 CrossRefPubMed

34.

Repka CP, Peterson BM, Brown JM, Lalonde TL, Schneider CM, Hayward R (2014) Cancer type does not affect exercise-mediated improvements in cardiorespiratory function and fatigue. Integr Cancer Ther 13(6):473–481. https://doi.org/10.1177/1534735414547108 CrossRefPubMed

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 CrossRefPubMed

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 CrossRefPubMedCentralPubMed

37.

Hunter GR, Fisher G, Neumeier WH, Carter SJ, Plaisance EP (2015) Exercise training and energy expenditure following weight loss. Med Sci Sports Exerc 47:1950–1957. https://doi.org/10.1249/MSS.0000000000000622 CrossRefPubMedCentralPubMed

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 CrossRef

39.

Guinan EM, Connolly EM, Healy LA, Carroll PA, Kennedy MJ, Hussey J (2014) The development of the metabolic syndrome and insulin resistance after adjuvant treatment for breast cancer. Cancer Nurs 37(5):355–362. https://doi.org/10.1097/NCC.0b013e3182a40e6d PubMed

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 CrossRefPubMed

42.

Courneya KS (2010) Efficacy, effectiveness, and behavior change trials in exercise research. Int J Behav Nutr Phys Act 7:81. https://doi.org/10.1186/1479-5868-7-81 CrossRefPubMedCentralPubMed

43.

Carter SJ, Herron RL, Rogers LQ, Hunter GR (2016) Is ‘high-intensity’ a bad word? J Physiother 62(3):175. https://doi.org/10.1016/j.jphys.2016.05.017 CrossRefPubMed

Title: Ease of walking associates with greater free-living physical activity and reduced depressive symptomology in breast cancer survivors: pilot randomized trial
Authors: Stephen J. Carter
Gary R. Hunter
Lyse A. Norian
Bulent Turan
Laura Q. Rogers
Publication date: 01-05-2018
Publisher: Springer Berlin Heidelberg
Published in: Supportive Care in Cancer / Issue 5/2018
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI: https://doi.org/10.1007/s00520-017-4015-y

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