Determinants and factors of physical activity and sedentary behaviors among post-treatment breast, colorectal, lung, and prostate cancer survivors living in France: Results from the DEFACTO study first phase.

OBJECTIVE: This study aimed to investigate the facilitators and barriers to adopting an active lifestyle among post-treatment cancer survivors in France. METHODS: Breast, colorectal, lung, and prostate cancer survivors were recruited. Participants completed a questionnaire covering sociodemographic and clinical factors, physical activity (PA) experiences, variables from the Transtheoretical model, types of motivation, knowledge of PA benefits, barriers to PA, and quality of life. We categorized participants into 4 profiles combining PA level and sedentary behaviors. RESULTS: One hundred and seventy-five participants were included. Ordinal logistic regression revealed that the active lifestyle of cancer survivors is influenced by their professional situation (OR, 3.99; 95%CI, 1.76-9.10 and OR, 3.14; 95%CI, 1.45-6.77), the use of self-liberation (OR, 0.41; 95%CI, 0.20-0.82), helping relationships processes of change (OR, 2.45; 95%CI, 1.20-5.00), and quality of life (OR, 1.11; 95%CI, 1.04-1.18). CONCLUSIONS: Identifying the factors associated with PA and sedentary behavior among cancer survivors in France will facilitate the adaptation of programs according to a whole-person approach. Semi-structured interviews will further enhance insights in this mixed-methods study. PRACTICE IMPLICATIONS: Interventions aimed at promoting an active lifestyle among cancer survivors should be customized based on professional situation, the utilization of experiential behavior change processes, and perceived quality of life.

[Barriers and facilitators to physical activity in oncology in Seine-Saint-Denis: A qualitative study using the socio-ecological approach]. / Barrières et facilitateurs à l'activité physique en oncologie en Seine-Saint-Denis : étude qualitative selon l'approche socio-écologique.

INTRODUCTION: Despite the undeniable benefits of physical activity during and beyond cancer treatments, patients do not always undertake and/or maintain it. The aim of the study is to identify, describe and understand the barriers and facilitators of physical activity practice among adults arriving at the end of treatment for solid cancer, in precarious situations, living in Seine-Saint-Denis. METHODS: The study was conducted using a descriptive qualitative phenomenological method involving semi-directed interviews with 23 participants during and beyond cancer. RESULTS: Multiple-level factors (micro, meso, macro) are involved in active behavior of patients. Three main facilitators were identified: perceived benefit, social support, and urban planning. Three barriers are identified: (1) physical and psychological disorders whether or not related to cancer and its treatment, (2) precariousness, organizational constraints, unfavorable social environment, (3) lack of coordination, lack of accurate and appropriate information, lack of realistic referral to physical activity offers. DISCUSSION: A diversity of representations, combinations of factors, and experiences are described. Getting people with cancer to engage in and maintain long-term physical activity is a complex task, requiring multidisciplinary action on all socio-ecological factors.

[Physical activity in the oncology care pathway: Expectations and perspectives]. / L'activité physique dans le parcours de soins en cancérologie : attentes et perspectives.

INTRODUCTION: Despite the benefits of an active lifestyle on health, there are still difficulties for patients, during and beyond cancer treatment, to initiate and maintain physical activity. A workshop was organized based on cooperation, coordination of the collective for and with the patient. METHODS: Ninety-six people - patients, relatives and professionals - were divided into five workgroups according to the cancer care continuum or according to specific clinical situations. Subgroups had to develop a common reflection around a representative fictive patient in order to (i) identify the factors that are in favor or not of physical activity practice, (ii) estimate at what extent it is possible to act on these factors, and (iii) to guide the fictive patient in the initiation and the maintenance of physical activity. Finally, the participants were asked to propose actions, strategies and tools to facilitate this process. The participants' writings and the moderators' summaries were collected and transcribed. RESULTS: Offers exist on the territory and their variety, plebiscited, is effective. However, their knowledge and the coordination allowing patients to access them must be reinforced through multidisciplinary network integrating patient-experts, training, digital technology use, and implementation research. DISCUSSION: The workshop has initiated a part of the conditions for collective empowerment which, if the process was created, could act on the structural determinants of patients' health.

First-Year Implementation of the EXercise for Cancer to Enhance Living Well (EXCEL) Study: Building Networks to Support Rural and Remote Community Access to Exercise Oncology Resources.

Barriers to exercise-oncology programs remain for those living with and beyond cancer in rural and remote communities, including geographic isolation and access to programs. The EXercise for Cancer to Enhance Living Well (EXCEL) study was designed to support exercise-oncology implementation in rural and remote communities across Canada. The purpose of this analysis was to evaluate the first-year reach, adoption, and implementation of the EXCEL study. Reach outcomes included participant characteristics, study enrolment, and referral type (self vs. healthcare-provider [HCP] referral). Adoption outcomes included the number of clinical contacts, trained qualified exercise professionals (QEPs), and QEPs delivering EXCEL exercise classes. Implementation outcomes included retention, adherence, assessment completion rates, and adverse-event reporting. A total of 290 individuals living with cancer enrolled in EXCEL in year one, with an 81.4% retention to the study intervention. Most participants self-referred to EXCEL (75.8%). EXCEL's HCP network consisted of 163 clinical contacts, and the QEP network included 45 trained QEPs, 22 of whom delivered EXCEL classes. Adherence to the exercise intervention was 78.2%, and only one adverse event (mild) was reported. Fitness assessment and patient-reported outcome completion rates were above 85% pre- and post-intervention. EXCEL has developed HCP and QEP networks supporting exercise referral and online delivery, and the intervention is meeting feasibility markers. These implementation findings will inform the continued gathering of feedback across stakeholders to ensure that best evidence informs best practices.

Monitoring Breast Cancer Care Quality at National and Local Level Using the French National Cancer Cohort.

PURPOSE: The French National Cancer Institute has developed, in partnership with the French National Authority for Health, breast cancer-specific Care Quality, and Safety Indicators (BC QIs). With regard to the most common form of cancer, our aim is to support local and national quality initiatives, to improve BC pathways and outcomes, reduce heterogeneity of practice and regional inequities. In this study, we measure the BC QIs available in the French National medico-administrative cancer database, the French Cancer Cohort, for 2018. MATERIALS AND METHODS: BC QIs are developed according to the RAND method. QIs are based on good clinical practice and care pathway recommendations. QI computation should be automatable without any additional workload for data collection. They will be published annually for all stakeholders, and especially hospitals. RESULTS: Finally, ten feasible and pertinent QIs were selected. In France, BC care was found to be close to compliance with most QIs: proportion of patients undergoing biopsy prior to first treatment (94.5%), proportion of patients undergoing adjuvant radiotherapy after breast-conserving surgery for BC (94.5%), proportion of women undergoing radiotherapy within 12 weeks after surgery and without chemotherapy (86.2%), proportion of DCIS patients undergoing immediate breast reconstruction (54.3%) and proportion of women with NMIBC undergoing breast reintervention (14.4%). However, some are still far from their recommended rate. In particular, some QIs vary considerably from one region, or one patient, to another. CONCLUSION: Each result needs to be analyzed locally to find care quality leverage. This will strengthen transparency actions aimed at the public.

Effects of an Exercise and Nutritional Intervention on Circulating Biomarkers and Metabolomic Profiling During Adjuvant Treatment for Localized Breast Cancer: Results From the PASAPAS Feasibility Randomized Controlled Trial.

PURPOSE: Exercise has been shown to improve physical and psychological conditions during cancer therapy, but mechanisms remain poorly understood. The purpose of the present study was to report the results of cancer-related biomarkers and metabolomics outcomes from the PASAPAS feasibility study. METHODS: In the PASAPAS randomized controlled trial, 61 women beginning adjuvant chemotherapy for localized breast cancer were randomized in a 6-month program of weekly aerobic exercises associated with nutritional counseling versus usual care with nutritional counseling. In the present analysis of 58 women for whom blood samples were available, first, circulating levels of biomarkers (ie, insulin, insulin-like growth factor 1, estradiol, adiponectin, leptin, interleukin-6, and tumor necrosis factor α) were measured at baseline and 6-month follow-up. Changes in biomarkers were compared between exercisers (n = 40) and controls (n = 18) using mixed-effect models. Second, serum metabolites were studied using an untargeted 1H nuclear magnetic resonance spectroscopy, and orthogonal partial least squares analyses were performed to discriminate exercisers and controls at baseline and at 6 months. RESULTS: Over the 6-month intervention, no statistically significant differences were observed between exercisers and controls regarding changes in biomarkers and metabolomic profiles. CONCLUSION: The present analysis of the PASAPAS feasibility trial did not reveal any improvement in circulating biomarkers nor identified metabolic signatures in exercisers versus controls during adjuvant breast cancer treatment. Larger studies preferably in women with poor physical activity level to avoid ceiling effect, testing different doses and types of exercise on additional biological pathways, could allow to clarify the mechanisms mediating beneficial effects of physical exercise during cancer treatment. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01331772. Registered 8 April 2011, https://clinicaltrials.gov/ct2/show/NCT01331772?term=pasapas&rank=1.

Nutrition and physical activity: French intergroup clinical practice guidelines for diagnosis, treatment and follow-up (SNFGE, FFCD, GERCOR, UNICANCER, SFCD, SFED, SFRO, ACHBT, AFC, SFP-APA, SFNCM, AFSOS).

This document is a summary of the French intergroup guidelines regarding the nutrition and physical activity (PA) management in digestive oncology. This collaborative work was produced under the auspices of all French medical and surgical societies involved in digestive oncology, nutrition and supportive care. It is based on published guidelines, recent literature review and expert opinions. Recommendations are graded according to the level of evidence. Malnutrition affects more than half of patients with digestive cancers and is often underdiagnosed. It has multiple negative consequences on survival, quality of life and risk of treatment complications. Consequently, in addition to anticancer treatments, supportive care including nutritional support and PA plays a central role in the management of digestive cancers. It is crucial to detect malnutrition (diagnostic criteria updated in 2019) early, to prevent it and to act against it at all stages of the cancer and at all times of the care pathway. In this context, we proposed recommendations for the evaluation and management in nutrition and PA in digestive oncology for each stage of the disease (perioperative setting, during radiation therapy, during systemic treatments, at the palliative phase, after cancer). Guidelines for nutrition and PA management aim at increasing awareness about malnutrition in oncology. They are continuously evolving and need to be regularly updated.

Nutrition and physical activity professional education in gastrointestinal oncology: a national multidisciplinary survey.

OBJECTIVES: Sarcopenia, present in more than 50% of digestive oncology patients, has a negative impact on clinical outcomes. Nutrition and adapted physical activity are two major interventions for the management of sarcopenia. However, young hepato-gastroenterologists, oncologists and surgeons in France have limited awareness on these topics. We aimed to evaluate the need for training programmes of physicians (residents and senior doctors) involved in digestive oncology on nutrition and adapted physical activity. METHODS: A 42-question survey was developed, by a working group of clinicians, dieticians and adapted physical activity teachers, to assess five areas related to demographics of respondents, nutrition practices, nutrition training, adapted physical activity practices and adapted physical activity training. The national survey was undertaken between April and July of 2019. RESULTS: 230 physicians participated in the survey; 34% were hepato-gastroenterologists, 31% were oncologists, 23% were surgeons and 40% were residents. Sixty-one per cent of participants had received training in nutrition and only 21% in adapted physical activity. Ninety per cent of the physicians expressed their desire for more effective training on these two topics. Disparities in clinical practices were observed between hepato-gastroenterologists, oncologists and surgeons. CONCLUSIONS: More initial and continuing training on nutrition and adapted physical activity is needed for French physicians in the current digestive oncology clinical practice.

[Effect of activities profile variations on health-related quality of life among breast cancer patients: Secondary exploratory analysis from PASAPAS study data]. / Effet de l'évolution du profil d'activité quotidienne sur la qualité de vie chez des femmes atteintes de cancers du sein : analyse exploratoire secondaire des données de l'étude PASAPAS.

INTRODUCTION: Lifestyle changes in breast cancer patients, by physical activity increasing, are becoming a main objective in supportive care. The objective of this study was to explore the impact of the daily activity profile evolution on the quality of life among this public. METHODS: Sixty patients (18 to 75 years) with non-metastatic breast cancer were randomized to a 2:1 ratio (physical activity intervention; control) in the PASAPAS randomized clinical trial. Multiple linear regression analyzes were computed to explain quality of life scores 6 months after the start of adjuvant therapy. Variables retained were the baseline quality of life scores, the anxiety trait, the randomization arm, the variations of time spent in different physical activity classes ([3-4 [MET, [4-6 [MET, ≥6 MET) and in sedentary behaviors. RESULTS: Only the decrease in time spent in sedentary behaviors really appeared as a predictor of the quality of physical life. Participation in the intervention group appeared as a predictor of quality of mental life. DISCUSSION: Results plead in favor of sedentary life style decrease as part of the objectives of care program for women with breast cancer. It also highlights the need of collective supervised sessions implemented by competent staff. This research also suggests that the dynamics of daily activity profile variations should be studied further in association to quality of life.

Effectiveness of a therapeutic multiple-lifestyle intervention taking into account the periconceptional environment in the management of infertile couples: study design of a randomized controlled trial - the PEPCI study.

BACKGROUND: Infertility is defined as the inability to conceive after 12 months of unprotected intercourse. It affects approximately one in six couples seeking pregnancy in France or western countries. Many lifestyle factors of the couples' pre and peri-conceptional environment (weight, diet, alcohol, tobacco, coffee, drugs, physical activity, stress, sleep…) have been identified as risk factors for infertility in both males and females. The high prevalence rates of unhealthy diets and lifestyles in the reproductive population of industrialized countries are worrisome. Nevertheless, adoption of a healthy lifestyle may improve fertility but lifestyle changes are difficult to achieve and to maintain due notably to behavioral factors. METHODS: Consequently, we decided to propose an interventional study aimed at improving the quality of life of infertile couples before the start of assisted reproductive technology treatment. It is a randomized controlled multicentre trial. Both members of the couples are involved in an integrated global care program (PEPCI for "Parcours Environnement PériConceptionnel en Infertilité") vs. usual care. This global intervention not only considers diet and/or physical activity but follows a holistic approach, including a multidisciplinary assessment to address complete physical, psychological and social well-being. According to patient needs, this includes interventions on weight, exercise, diet, alcohol and drugs, mental and social health. DISCUSSION: The main objective of trial is to demonstrate that periconceptional multidisciplinary care has a positive impact on reproductive functions. We will also focus on feasibility, acceptance, compliance and conditions of success of a multifaceted lifestyle intervention. TRIAL REGISTRATION: The trial was registered at ClinicalTrials.gov, Identifier: NCT02961907 on November 11, 2016.

Cost-effectiveness of an exercise and nutritional intervention versus usual nutritional care during adjuvant treatment for localized breast cancer: the PASAPAS randomized controlled trial.

We undertook a cost-effectiveness analysis (CEA) to compare an exercise and nutritional program with the usual nutritional care concomitant to adjuvant chemotherapy in localized breast cancer patients. The CEA was designed as part of the interventional, controlled, randomized, single-center, open-label PASAPAS study. Breast cancer patients receiving first-line adjuvant chemotherapy at a French Comprehensive Cancer Center were randomized 2:1 to a 6-month exercise program of supervised indoor and outdoor group sessions in addition to usual nutritional care (exercise arm) or a usual nutritional care group receiving dietary and physical activity counseling (control arm). Costs were assessed from the French national insurance perspective (in Euros, 2012). Incremental cost-effectiveness ratios (ICERs) were calculated for four criteria: body mass index, waist circumference, body fat percentage, and estimated aerobic capacity. Uncertainty around the ICERs was captured by a probabilistic analysis using a non-parametric bootstrap method. The analysis was based on 60 patients enrolled between 2011 and 2013. Average intervention costs per participant were €412 in the exercise arm (n = 41) and €117 (n = 19) in the control arm. Total mean costs were €17,344 (standard deviation 9,928) and €20,615 (standard deviation 14,904), respectively, did not differ significantly (p = 0.51). The 6-month exercise program was deemed to be cost-effective compared with usual care for the estimated aerobic capacity. Multicenter randomized studies with long-term costs and outcomes should be done to provide additional evidence. Clinical trial: The PASAPAS study is registered under ClinicalTrials.gov. Trial registration ID: NCT01331772.

Using theory of change to develop an intervention theory for designing and evaluating behavior change SDApps for healthy eating and physical exercise: the OCAPREV theory.

BACKGROUND: Connected health devices and applications (referred to hereafter as "SDApps" - Smart devices and applications) are being portrayed as a new way for prevention, with the promise of accessibility, effectiveness and personalization. Many effectiveness evaluations (experimental designs) with strong internal validity exist. While effectiveness does appear to vary, the mechanisms used by these devices have not yet been thoroughly investigated. This article seeks to unpack this black box, and describes the process of elaboration of an intervention theory for healthy eating and physical activity SDApps. It includes a set of requirements relative to their impact on social health inequalities. METHODS: To build this theory, we drew on theory-driven approaches and in particular on the theory of change (ToC) method. To this end, we developed a cumulative and iterative process combining scientific data from the literature with knowledge from experts (researchers and practitioners) and from patients or users. It was a 3-step process, as follows: 1 - identifying the evidence base; 2 - developing the theory through design intervention and creating realistic expectations, including in our case specific work on social health inequalities (SHIs); 3 - modeling process and outcome. RESULTS: We produced an evidence-based theory according to the ToC model, based on scientific evidence and knowledge from experts and users. It sets out a causal pathway leveraging 11 key mechanisms - theoretical domains - with which 50 behavior change techniques can be used towards 3 ultimate goals: Capacity, Opportunity, Motivation - Behavior (COM-B). Furthermore, the theory specifically integrates requirements relative to the impact on SHIs. CONCLUSIONS: This theory is an aid to SDAapp design and evaluation and it can be used to consider the question of the possible impact of SDApps on the increase in inequalities. Firstly, it enables developers to adopt a more overarching and thorough approach to supporting behavior change, and secondly it encourages comprehensive and contributive evaluations of existing SDApps. Lastly, it allows health inequalities to be fully considered.

Sedentary behavior, physical inactivity and body composition in relation to idiopathic infertility among men and women.

BACKGROUND: Physical activity (PA) and sedentary behavior have inconsistent effects on fertility. High body mass index is associated with infertility but to our knowledge, very few studies have explored body composition in association to fertility. OBJECTIVE: To assess the association between physical inactivity, sedentary behavior, body composition and idiopathic infertility in French men and women. DESIGN: We conducted a case-control multicentric observational study. 159 infertile (79 men and 80 women) and 143 fertile (72 men and 71 women) were recorded in four fertility centers. MAIN OUTCOME MEASURES: Participants completed self-administered questionnaires on sociodemographic and lifestyle characteristics, dietary intake, physical activity and sedentary behavior. Anthropometrics were measured, and bioelectrical impedance analysis was used to estimate body composition. Multivariable logistic regression was used to analyze the association of fertility with PA level and sedentary behavior. RESULTS: In men, being physically inactive (Odd ratio [OR] 2.20; 95% confidence interval [CI], 1.06, 4.58) and having fat mass greater than the reference values for their age (OR 2.83; 95%CI, 1.31, 6.10) were positively associated with infertility. Sedentary behavior and fat-free mass were not related to infertility in men. In women, sedentary behavior (OR 3.61; 95%CI, 1.58, 8.24), high body fat (OR 3.16; 95%CI, 1.36, 7.37) and low fat-free mass (OR 2.65; 95%CI, 1.10, 6.37) were associated with infertility. PA level was not associated with fertility in women. CONCLUSIONS: This study suggests that sedentary behavior and physical inactivity would represent two independent risk factors associated with infertility. The various elements that make up physical activity (frequency, intensity, time, and type of exercise) and the interrupting time spent sitting should be considered. Body composition variation should be explored further in relation to the biological pathways involved in idiopathic infertility. Moreover, the improvement of lifestyle factors should be considered in infertility treatment.

Feasibility of an exercise and nutritional intervention for weight management during adjuvant treatment for localized breast cancer: the PASAPAS randomized controlled trial.

PURPOSE: Lack of physical activity (PA), weight gain, and overweight have been associated with increased risk of recurrence and mortality after breast cancer diagnosis. We evaluated the feasibility of implementing an individualized exercise program and nutritional counseling during adjuvant treatment of localized invasive breast cancer. METHODS: Sixty-one patients eligible for adjuvant chemotherapy were randomized 2:1 to receive a 6-month program of weekly aerobic exercises associated with nutritional counseling (n = 41) or usual care with nutritional counseling (n = 20, one withdrawal). The primary endpoints were the proportion of patients compliant with two weekly supervised sessions and their overall adherence (i.e., proportion of supervised and unsupervised sessions completed versus planned sessions). RESULTS: Ten percent of patients in the intervention group were compliant with the two weekly supervised sessions for 6 months, but the overall median adherence rate was 85% of supervised and non-supervised sessions completed. Non-adherence was mainly due to intrinsic reasons (medical, organizational, psychological barriers). Adherence was positively associated with education and baseline PA level and inversely associated with baseline weight and tumor grade. No statistically significant benefits were observed in the intervention group, even if overall PA level and body composition improved and anthropometrics were maintained over time (p < 0.05). CONCLUSIONS: Overall, there was good adherence with the 6-month exercise program during adjuvant treatment for breast cancer, despite poor compliance to twice-weekly supervised sessions. This study highlights the need for flexible exercise modalities and innovative experimental design to reach patients who would most adhere and benefit from intervention. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01331772. Registered 8 April 2011, https://clinicaltrials.gov/ct2/show/NCT01331772?term=pasapas&rank=1.

Implementation of optimized supportive care and hospital needs along the management of patients with advanced lung cancer.

BACKGROUND: Supportive care in cancer (SCC) have been recommended to be integrated in the management of patients with lung cancer all along the course of the disease. We took advantage of a pilot program of early implementation of optimized SCC, to report the feasibility such program in patients with advanced lung cancer, and correlate patient characteristics and outcomes with the actual use of optimized SCC. METHODS: This study is a retrospective analysis of all consecutive patients with lung cancer treated at our center between 2012 and 2016. Optimized SCC included the intervention of a nurse for the home-hospital network coordination, as well as socio-aesthetics, psychomotricity, art-therapy, adapted physical activity, and also establishment of at-home hospitalization. RESULTS: 309 patients were included. Median overall survival was 11.2 months. Unplanned hospitalizations occurred for 276 (89%) patients. The median duration of hospital stay was 19 days. Unplanned hospitalizations more frequently occurred within the first 3 months after the diagnosis of advanced cancer, and in the last 3 months before death. A short - less than 3 months - delay between diagnosis and unplanned hospitalization was associated with poor outcome. 272 (88%) patients received optimized SCC, within a median delay of 8 weeks after diagnosis. Intervention of the nurse for in- and out-patient network coordination was done for 143 (46%) patients, and at-home hospitalization was organized for 78 (25%) patients. The outcome of patients who received optimized SCC was numerically, but not significantly better (median overall survival of 11.8 vs. 6.9 months, p = 0.270). CONCLUSION: Our study provides landmark data to support an early integration of optimized SCC for patients with advanced lung cancer, that includes multimodal supportive care interventions along the course of the disease. This highlights the role of multidisciplinary teams to optimize the management of patients with advanced lung cancer.

[State of knowledge on sedentary behaviors]. / État des connaissances sur les comportements sédentaires.

Sedentary behaviors refer to any waking activity characterized by an energy expenditure ≤ 1.5 metabolic equivalent and a sitting or lying posture. Recent epidemiological data reported that in North America and Europe, citizens spend between 8 and 11 hours sitting per day. Sedentary behaviors and physical activity can coexist in the same person. It is possible to spend a lot of time sitting each day while completing recommendations for regular physical activity. Adverse health effects of sedentary behaviors are in part independent of the physical activity level. The physiological implications associated with sedentary behaviors are mainly metabolic. Regulary interrupting the sedentary behavior has favorable effects on health, regardless the total time spent sitting. Many interventional perspectives for reducing sedentary behaviors in France can be envisaged. Some countries have already launched interesting large-scale prevention programs.

Deterioration of Physical Activity Level and Metabolic Risk Factors After Early-Stage Breast Cancer Diagnosis.

BACKGROUND: In breast cancer patients, a lack of physical activity (PA) is 1 causative factor of weight gain during adjuvant treatment. It may increase the risk of treatment adverse effects, comorbidities, and deleterious long-term outcomes. OBJECTIVE: We aimed to describe the evolution of PA level and sedentary behavior in breast cancer patients between diagnosis and adjuvant chemotherapy onset following surgery and identify predictive factors associated with these changes early after breast cancer diagnosis. METHODS: Baseline data of 60 patients enrolled in a pilot randomized controlled trial of PA are presented. PA levels were estimated at adjuvant chemotherapy onset after surgery and retrospectively for the period at diagnosis. Height, weight, waist circumference, and bioelectrical impedance were measured at chemotherapy onset. Linear regression analysis evaluated factors associated with relative changes of PA level and sedentary behavior. RESULTS: Moderate PA decreased and sedentary behavior increased between diagnosis and chemotherapy onset. A grade III breast cancer was associated with a greater decrease in PA level. Conversely, keeping a professional occupation and adherence to nutritional guidelines were associated with maintained PA level. The majority (88%) of patients had excessive adiposity at chemotherapy onset. CONCLUSIONS: There was a significant deterioration of PA level between diagnosis and chemotherapy onset, and deleterious adiposity was present in most patients. IMPLICATIONS FOR PRACTICE: This study further emphasizes the need to motivate breast cancer patients toward engaging in a healthy lifestyle early after diagnosis and adhering to PA programs, which should be included in their clinical management.