Predictors of follow-up exercise behavior 6 months after a randomized trial of exercise training during breast cancer chemotherapy.

PURPOSE: Exercise during breast cancer chemotherapy is beneficial but it needs to be maintained into survivorship to optimize long-term benefits. Here, we report the predictors of follow-up exercise behavior 6 months after a randomized exercise trial in breast cancer patients. METHODS: Breast cancer patients (N = 242) initiating adjuvant chemotherapy were randomly assigned to usual care (n = 82), supervised resistance exercise (n = 82), or supervised aerobic exercise (n = 78) for the duration of their chemotherapy. At baseline and postintervention, data were collected on demographic, medical, behavioral, fitness, psychosocial, and motivational variables. At 6-month follow-up, participants were mailed a questionnaire that assessed exercise behavior over the past 6 months and were categorized as either meeting both aerobic and resistance exercise guidelines, either exercise guideline, or neither exercise guideline. RESULTS: Two hundred one (83.1%) participants provided 6-month follow-up data with 85 (42.3%) meeting neither exercise guideline, 74 (36.8%) meeting either exercise guideline, and 42 (20.9%) meeting both exercise guidelines. In multivariate regression analysis, seven variables independently predicted the likelihood of meeting exercise guidelines at follow-up including higher pretrial exercise (beta = 0.23; P = 0.002), younger age (beta = -0.15; P = 0.028), breast conserving surgery (beta = 0.15; P = 0.033), strength improvements (beta = 0.15; P = 0.028), lower postintervention fatigue (beta = 0.13; P = 0.067), a more positive attitude (beta = 0.12; P = 0.086), and lower postintervention body mass index (beta = -0.11; P = 0.105). CONCLUSION: Exercise behavior 6 months after a randomized trial was predicted by a wide range of demographic, medical, behavioral, fitness, psychosocial, and motivational variables. These findings may help facilitate the uptake of exercise behavior during the transition from breast cancer patient to survivor.

Physical activity preferences of ovarian cancer survivors.

OBJECTIVE: Regular physical activity is positively associated with quality of life in ovarian cancer survivors, but no data exist on how best to promote activity in this population. This study investigated the interests and preferences of ovarian cancer survivors with regard to physical activity participation. METHODS: A provincial, population-based postal survey of ovarian cancer survivors in Alberta, Canada, was performed including measures of self-reported physical activity, medical and demographic variables, and physical activity preferences. RESULTS: A total of 359 women participated (51.4% response rate). Over half expressed interest in participating in a physical activity program (53.8%), with a further 32.9% maybe interested. The most common preferences were for programs to be home-based (48.9%), start post-treatment (69.5%), and involve walking (62.7%). There were differences in preferences based on demographic, but not medical, factors. CONCLUSION: The majority of ovarian cancer survivors expressed interest in participating in physical activity programs; however, some preferences varied by demographic factors. Designing physical activity interventions according to these preferences may optimize adherence and outcomes in ovarian cancer survivors.

Physical activity in ovarian cancer survivors: associations with fatigue, sleep, and psychosocial functioning.

UNLABELLED: Physical activity has been associated with better health-related outcomes in several cancer survivor groups but very few data exist for women with ovarian cancer. The purpose of this study was to investigate the associations between physical activity and health-related outcomes in ovarian cancer survivors and to examine any dose-response relationship. PATIENTS AND METHODS: A cross-sectional postal survey of ovarian cancer survivors on and off treatment identified through the Alberta Cancer Registry was performed. Participants completed self-report measures of physical activity, cancer-related fatigue, peripheral neuropathy, depression, anxiety, and happiness, as well as demographic and medical variables. RESULTS: A total of 359 ovarian cancer survivors participated (51.4% response rate) of whom 31.1% were meeting the public health physical activity guidelines of the Centers for Disease Control and Prevention. Those meeting guidelines reported significantly lower fatigue than those not meeting guidelines (mean difference, 7.1; 95% confidence interval, 5.5-8.8; d = 0.87; P < 0.001). Meeting guidelines was also significantly inversely associated with peripheral neuropathy, depression, anxiety, sleep latency, use of sleep medication, and daytime dysfunction and was positively associated with happiness, sleep quality, and sleep efficiency. There was no evidence of a dose-response relationship beyond meeting or not meeting the guidelines for any variables. CONCLUSIONS: Ovarian cancer survivors who were meeting physical activity guidelines reported more favorable outcomes of fatigue, peripheral neuropathy, sleep, and psychosocial functioning.

Predictors of supervised exercise adherence during breast cancer chemotherapy.

PURPOSE: Exercise adherence is difficult during cancer treatments, but few studies have examined the predictors of such exercise. Here, we report the predictors of adherence to supervised exercise training during breast cancer chemotherapy. METHODS: Breast cancer patients (N = 242) initiating adjuvant chemotherapy in Edmonton, Ottawa, and Vancouver were randomly assigned to usual care (n = 82), supervised resistance exercise (n = 82), or supervised aerobic exercise (n = 78) for the duration of their chemotherapy. Baseline data on standard demographic, medical, behavioral, fitness, and psychosocial variables as well as motivational variables from the Theory of Planned Behavior were collected. Adherence was assessed by objective attendance records. RESULTS: Adherence to supervised exercise was 70.2%. Univariate analyses indicated significant or borderline significant associations between exercise adherence and location/center (r = 0.30; P < 0.001), V[spacing dot above]O2peak (r = 0.21; P = 0.008), muscular strength (r = 0.21; P = 0.008), percent body fat (r = -0.21; P = 0.012), disease stage (r = 0.17; P = 0.031), education (r = 0.15; P = 0.053), depression (r = -0.14; P = 0.073), and smoking (r = -0.14; P = 0.081). In multivariate analysis, location/center (beta = 0.28; P = 0.001), V[spacing dot above]O2peak ([beta] = 0.19; P = 0.016), disease stage (beta = 0.18; P = 0.015), and depression (beta = -0.16; P = 0.033) remained significant and explained 21% of the variance in exercise adherence. Participants in Vancouver, with higher aerobic fitness, more advanced disease stage, and lower depression, achieved better adherence. CONCLUSION: Adherence to supervised exercise training was predicted by unique aspects of the location/center, disease stage, aerobic fitness, and depression but not motivational variables. Location/center in our trial may have been a proxy for the amount of one-on-one attention received during supervised exercise. These findings may have implications for improving adherence during breast cancer chemotherapy.

Six-month follow-up of patient-rated outcomes in a randomized controlled trial of exercise training during breast cancer chemotherapy.

BACKGROUND: Few exercise trials in cancer patients have reported longer-term follow-up. Here, we report a 6-month follow-up of exercise behavior and patient-rated outcomes from an exercise trial in breast cancer patients. METHODS: Breast cancer patients initiating adjuvant chemotherapy (n = 242) were randomly assigned to usual care (n = 82), resistance exercise training (RET; n = 82), or aerobic exercise training (AET; n = 78) for the duration of their chemotherapy. At 6-month follow-up, participants were mailed a questionnaire that assessed quality of life, self-esteem, fatigue, anxiety, depression, and exercise behavior. RESULTS: Two hundred one (83.1%) participants provided 6-month follow-up data. Adjusted linear mixed-model analyses showed that, at 6-month follow-up, the RET group reported higher self-esteem [adjusted mean difference, 1.6; 95% confidence interval (95% CI), 0.1-3.2; P = 0.032] and the AET group reported lower anxiety (adjusted mean difference, -4.7; 95% CI, -0.0 to -9.3; P = 0.049) compared with the usual care group. Moreover, compared with participants reporting no regular exercise during the follow-up period, those reporting regular aerobic and resistance exercise also reported better patient-rated outcomes, including quality of life (adjusted mean difference, 9.5; 95% CI, 1.2-17.8; P = 0.025). CONCLUSIONS: Improvements in self-esteem observed with RET during breast cancer chemotherapy were maintained at 6-month follow-up whereas reductions in anxiety not observed with AET during breast cancer chemotherapy emerged at 6-month follow-up. Moreover, adopting a combined aerobic and resistance exercise program after breast cancer chemotherapy was associated with further improvements in patient-rated outcomes. Exercise training during breast cancer chemotherapy may result in some longer-term and late effects for selected patient-rated outcomes.

Understanding the determinants of exercise intentions in multiple myeloma cancer survivors: an application of the theory of planned behavior.

The purpose of this study was to examine the demographic, medical, and social cognitive determinants of exercise intentions in a population-based sample of multiple myeloma cancer survivors. Using a cross-sectional survey, 70 multiple myeloma cancer survivors completed a questionnaire that assessed their medical and demographic characteristics, past exercise behavior, and social cognitive exercise beliefs using the theory of planned behavior. Seventy participants provided valuable data. Descriptive statistics indicated that participants had quite positive instrumental attitude, intentions, and subjective norms and moderate levels of perceived behavioral control and affective attitudes for exercise. Forced entry multiple regression showed that the theory of planned behavior explained 43% of the variance in exercise intentions. Instrumental attitude and perceived behavioral control were both independent predictors of exercise intentions. No demographic or medical variable moderated the association between the theory of planned behavior constructs and exercise intentions. The results of the present investigation support the growing body of evidence confirming the utility of the theory of planned behavior to understand the salient determinants of exercise in cancer survivors. Knowledge gained from this study provides important information to oncology practitioners who are responsible for delivering supportive care interventions, including exercise, to patients diagnosed with multiple myeloma.

Phlegmasia Cerulea Dolens and May-Thurner Syndrome in the first trimester of Pregnancy.

Background Venous thromboembolism in pregnancy remains one of the leading causes of morbidity and mortality. Case A young, gravid patient presented with a cyanotic, edematous left lower extremity with no distal pulses palpable. She was emergently taken to the operating room and was found to have extensive iliofemoral thrombosis requiring femoral angioplasty and embolectomy with 43.7-rad intraoperative radiation exposure. Phlegmasia cerulea dolens and May-Thurner syndrome were diagnosed. Conclusion Timely diagnosis and prompt surgical management are necessary due to the limb-threatening nature of this condition. Despite maternal radiation exposure, the nature and extent of fetal effects depends upon radiation dose and gestational age.

A population-based study of the determinants of physical activity in ovarian cancer survivors.

BACKGROUND: Regular physical activity is associated with quality of life and other health-related outcomes in ovarian cancer survivors, but participation rates are low. This study investigated the determinants of physical activity in ovarian cancer survivors. METHODS: A population-based, cross-sectional, mailed survey of ovarian cancer survivors in Alberta, Canada, was performed. Measures included self-reported physical activity, medical and demographic factors, and social cognitive variables from the Theory of Planned Behavior. RESULTS: A total of 359 women participated (51.4% response rate), of whom 112 (31.1%) were meeting physical activity guidelines. Variables associated with meeting guidelines were younger age, higher education and income, being employed, lower body mass index, absence of arthritis, longer time since diagnosis, earlier disease stage, and being disease-free. Analysis of the Theory of Planned Behavior variables indicated that 36% of the variance in physical activity guidelines was explained, with intention being the sole independent correlate (?=.56; P < .001). CONCLUSION: Various demographic and medical factors can help identify ovarian cancer survivors at risk for physical inactivity. Interventions should attempt to increase physical activity intentions in this population by focusing on instrumental and affective attitudes as well as perceptions of control.

Barriers to supervised exercise training in a randomized controlled trial of breast cancer patients receiving chemotherapy.

BACKGROUND: Exercise adherence is a challenge for breast cancer patients receiving chemotherapy but few studies have identified the key barriers. PURPOSE: In this paper, we report the barriers to supervised exercise in breast cancer patients participating in a randomized controlled trial. METHODS: Breast cancer patients initiating adjuvant chemotherapy (N = 242) were randomly assigned to usual care (n = 82) or supervised resistance (n = 82) or aerobic (n = 78) exercise. Participants randomized to the two exercise groups (n = 160) were asked to provide a reason for each missed exercise session. RESULTS: The two exercise groups attended 70.2% (5,495/7,829) of their supervised exercise sessions and provided a reason for missing 89.5% (2,090/2,334) of their unattended sessions. The 2,090 reasons represented 36 different barriers. Feeling sick (12%), fatigue (11%), loss of interest (9%), vacation (7%), and nausea/vomiting (5%) accounted for the most missed exercise sessions. Disease/treatment-related barriers (19 of the 36 barriers) accounted for 53% (1,102/2,090) of all missed exercise sessions. Demographic and medical variables did not predict the types of exercise barriers reported. CONCLUSIONS: Barriers to supervised exercise in breast cancer patients receiving chemotherapy are varied but over half can be directly attributed to the disease and its treatments. Behavioral support programs need to focus on strategies to maintain exercise in the face of difficult treatment side effects.

Moderators of the effects of exercise training in breast cancer patients receiving chemotherapy: a randomized controlled trial.

BACKGROUND: Exercise training improves supportive care outcomes in patients with breast cancer who are receiving adjuvant therapy, but the responses are heterogeneous. In this study, the authors examined personal and clinical factors that may predict exercise training responses. METHODS: Breast cancer patients who were initiating adjuvant chemotherapy (N=242) were assigned randomly to receive usual care (UC) (n=82), resistance exercise training (RET) (n=82), or aerobic exercise training (AET) (n=78) for the duration of chemotherapy. Endpoints were quality of life (QoL), aerobic fitness, muscular strength, lean body mass, and body fat. Moderators were patient preference for group assignment, marital status, age, disease stage, and chemotherapy regimen. RESULTS: Adjusted linear mixed-model analyses demonstrated that patient preference moderated QoL response (P= .005). Patients who preferred RET improved QoL when they were assigned to receive RET compared with UC (mean difference, 16.5; 95% confidence interval [95% CI], 4.3-28.7; P= .008) or AET (mean difference, 11; 95% CI, -1.1-23.4; P= .076). Patients who had no preference had improved QoL when they were assigned to receive AET compared with RET (mean difference, 23; 95% CI, 4.9-41; P= .014). Marital status also moderated QoL response (P= .026), age moderated aerobic fitness response (P= .029), chemotherapy regimen moderated strength gain (P= .009), and disease stage moderated both lean body mass gain (P< .001) and fat loss (P= .059). Unmarried, younger patients who were receiving nontaxane-based therapies and had more advanced disease stage experienced better outcomes. The findings were not explained by differences in adherence. CONCLUSIONS: Patient preference, demographic variables, and medical variables moderated the effects of exercise training in breast cancer patients who were receiving chemotherapy. If replicated, these results may inform clinical practice.

Associations between physical activity and quality of life in ovarian cancer survivors.

OBJECTIVES: To estimate the prevalence of physical activity in ovarian cancer survivors and to determine if there is a dose-response relationship between physical activity and quality of life. METHODS: Ovarian cancer survivors identified from a Canadian provincial cancer registry were mailed a questionnaire measuring self-reported leisure time physical activity (Godin Leisure Time Exercise Questionnaire), cancer-specific quality of life (Functional Assessment of Cancer Therapy-Ovarian), and standard demographic and medical variables. RESULTS: Completed questionnaires were received from 359 (51.4%) participants. Analyses indicated that 31.1% were meeting public health physical activity guidelines (i.e., at least 60 min of strenuous or 150 min of moderate/strenuous physical activity per week). Comparisons using different volumes of physical activity showed support for the current guidelines. Specifically, participants meeting current physical activity guidelines reported significantly better quality of life than those not meeting guidelines [mean difference: 12.5; 95% CI: 9.1 to 16.0; p<0.001; d=0.75]. Disease status was the only variable to moderate this association. Adjusting for important demographic and medical variables did not alter the findings. CONCLUSIONS: Few ovarian cancer survivors are meeting public health physical activity guidelines, but those that are meeting guidelines report significantly and meaningfully better quality of life. Clinical trials investigating the causal effects of physical activity on quality of life in ovarian cancer survivors are warranted.

Effects of aerobic and resistance exercise in breast cancer patients receiving adjuvant chemotherapy: a multicenter randomized controlled trial.

PURPOSE: Breast cancer chemotherapy may cause unfavorable changes in physical functioning, body composition, psychosocial functioning, and quality of life (QOL). We evaluated the relative merits of aerobic and resistance exercise in blunting these effects. PATIENTS AND METHODS: We conducted a multicenter randomized controlled trial in Canada between 2003 and 2005 that randomly assigned 242 breast cancer patients initiating adjuvant chemotherapy to usual care (n = 82), supervised resistance exercise (n = 82), or supervised aerobic exercise (n = 78) for the duration of their chemotherapy (median, 17 weeks; 95% CI, 9 to 24 weeks). Our primary end point was cancer-specific QOL assessed by the Functional Assessment of Cancer Therapy-Anemia scale. Secondary end points were fatigue, psychosocial functioning, physical fitness, body composition, chemotherapy completion rate, and lymphedema. RESULTS: The follow-up assessment rate for our primary end point was 92.1%, and adherence to the supervised exercise was 70.2%. Unadjusted and adjusted mixed-model analyses indicated that aerobic exercise was superior to usual care for improving self-esteem (P = .015), aerobic fitness (P = .006), and percent body fat (adjusted P = .076). Resistance exercise was superior to usual care for improving self-esteem (P = .018), muscular strength (P < .001), lean body mass (P = .015), and chemotherapy completion rate (P = .033). Changes in cancer-specific QOL, fatigue, depression, and anxiety favored the exercise groups but did not reach statistical significance. Exercise did not cause lymphedema or adverse events. CONCLUSION: Neither aerobic nor resistance exercise significantly improved cancer-specific QOL in breast cancer patients receiving chemotherapy, but they did improve self-esteem, physical fitness, body composition, and chemotherapy completion rate without causing lymphedema or significant adverse events.

Effects of acute exercise on neutrophils in pediatric acute lymphoblastic leukemia survivors: a pilot study.

PURPOSE: This nonrandomized controlled trial was designed to investigate the effects of acute exercise on neutrophil count and function in children and adolescents receiving maintenance treatment for acute lymphoblastic leukemia (ALL) compared to matched controls. METHODS: Participants (n = 10; 4 ALL patients and 6 healthy matched controls) were males between the ages of 7 to 18 years. On visit 1, participants completed an incremental exercise test to volitional exhaustion on a treadmill to determine peak aerobic fitness (VO(2peak)). On visit 2, participants completed a 30-minute exercise session consisting of an intermittent run-walk on a treadmill at 70% to 85% of VO(2) peak with blood sampling completed at 5 time points: fasting, preexercise, postexercise, 1-hour postexercise, and 2-hour postexercise. RESULTS: A significant increase in absolute neutrophil count from preexercise to postexercise was observed in both groups (P = 0.011). Neutrophil oxidative capacity was significantly depressed in the ALL group at the basal level (P = 0.029), however, it increased in both groups after exercise and stimulation. CONCLUSIONS: This preliminary study suggests that 30 minutes of moderate intensity exercise in ALL patients receiving maintenance therapy provides a similar neutrophil response to that of healthy age and sex-matched controls.

Association between exercise and quality of life in multiple myeloma cancer survivors.

GOALS OF THE WORK: The goal of this study was to examine the association between exercise and quality of life (QOL) in multiple myeloma cancer survivors. PATIENTS AND METHODS: Using a retrospective design, 156 multiple myeloma cancer survivors were mailed a questionnaire that assessed self-reported exercise behavior over three periods (prediagnosis, active treatment, and off-treatment) and QOL. MAIN RESULTS: The response rate was 56% (88/ 156). Descriptive analyses indicated that 6.8% and 20.4% of survivors met national exercise guidelines during active and off-treatment periods, respectively. Exercise during active treatment and off-treatment were positively associated with overall QOL and all subdomains of QOL (all P<0.05) except physical wellbeing. CONCLUSIONS: A low percentage of multiple myeloma cancer survivors are exercising regularly either during active or off-treatment periods. Survivors who report more exercise during these periods also report higher QOL. These findings suggest that a randomized controlled trial is warranted.