Purpose: This study explored changes in physical activity (PA) and quality of life (QoL) in rural cancer survivors during the COVID-19 pandemic and differences in changes in physical activity and quality of life by perceived posttraumatic stress due to COVID-19.

Methods: Rural cancer survivors were recruited to the Partnering to Prevent and Control Cancer (PPCC) study in 2017-2018, and 219 cancer survivors completed questionnaires assessing physical activity and quality of life. In April 2020, PPCC participants with working email addresses were sent an e-invitation to complete an online questionnaire. Of the 195 contacted, 104 (53.3%) completed questionnaires assessing PA, QoL, and posttraumatic stress due to COVID-19. Paired samples t-tests were used to explore changes in PA and QoL from before to during the pandemic, and independent samples t-tests were used to explore differences in changes in PA and QoL by posttraumatic stress due to COVID-19 (normal/mild vs. moderate/severe).

Results: Rural cancer survivors who participated in PPCC and the follow-up survey (N=104) were mostly women (65.4%), in their 60s (M age=61.9±13.9 years), had overweight or obesity (66.0%), had completed college (63.4%), and were currently unemployed or retired (59.0%). Most participants were breast (26.0%) or prostate (26.0%) cancer survivors, and 93.5% were >12 weeks but <5 years post-treatment. Overall, participants reported decreases work-related, transportation, walking, and vigorous PA and increases in domestic, leisure-time, and moderate PA. Only changes in work-related PA were statistically significant (Δ=-723.8 MET-min/week, t=-2.4, p=.017), and there were no significant changes in QoL from before to during the COVID-19 pandemic. Over half (52.9%) of participants reported moderate to severe posttraumatic stress due to COVID-19. Participants who reported moderate/severe posttraumatic stress due to COVID-19 reported significant increases in walking (Δ=221.8 MET-min/week) and decreases in emotional wellbeing (Δ=-6.0) compared to those reporting normal/mild posttraumatic stress (Δ walking=-730.8, t=-2.1, p=.035; Δ emotional wellbeing=3.3, t=4.1, p<.001).

Conclusions: Rural cancer survivors reported moderate to severe posttraumatic stress related to COVID-19, which positively impacted their walking but negatively impacted their mental health. PA interventions that address psychosocial wellbeing are critically needed to reduce COVID-19 related distress among rural cancer survivors to promote health equity.

PURPOSE: Group-based physical activity (PA) programs delivered via videoconferencing present a viable and innovative way to help cancer survivors increase PA, connect with other participants, and may help expand reach to those living in remote or rural areas. This study describes the metro and non-metro status, and pre-program PA levels of cancer survivors enrolled in a videoconference-delivered PA program.

METHODS: Participants self-referred and enrolled in an 8-week program, consisting of circuit-style aerobic and resistance exercise sessions 1x/week, and discussion sessions which operationalize social cognitive theory informed behavior change techniques (e.g., goal setting, self-monitoring, etc.). All components would be delivered in real-time via Zoom in groups of 4-6 participants. To be eligible, participants had to have internet and a phone/computer with a front facing camera. Participant’s addresses were assigned a Rural-Urban Continuum Code. Pre-program PA was self-reported using the Godin-Leisure Time Exercise Questionnaire, which asks about average weekly frequency and duration of light, moderate and vigorous aerobic exercise, and moderate and vigorous resistance exercise done over the last month. Means, standard deviations, and median values were calculated for all PA variables, and differences in PA between metro and non-metro participants were examined using independent t-tests.

RESULTS: Participants (N=54) were M=59±10 years old, 96.3% female, and diagnosed with ovarian (58.8%), breast (31.4%) or other (9.8%) cancer. Most participants (75.5%) resided in a metro area vs 24.5% in non-metro, with only n=2 classified as rural (i.e., <2,500 population, not adjacent to a metro area). Pre-program resistance exercise was M=18.1±38.1, Median=0 mins/week. Moderate and vigorous aerobic exercise was M=138.4±178.1, Median=60 mins/week. Light aerobic exercise was M=106.1±133.9, Median=60 mins/week, and sitting time was M=8.0±3.5, Median=8 hours/day. There were no differences in PA between metro and non-metro participants (p>.05). 

CONCLUSION: Most participants resided in metropolitan areas, suggesting targeted recruitment and additional community engaged strategies may be needed to reach non-metro and rural cancer survivors. Pre-program PA levels were similar between metro and non-metro survivors, likely reflecting selection bias. Future studies will examine how rurality impacts cancer survivors’ PA engagement during and after completion of a videoconference-delivered PA program.

Purpose: Independent of physical activity (PA), high volumes of sedentary behaviour (SED) are associated with risk factors for chronic disease and poorer cancer-specific quality of life (QoL). Simultaneously increasing PA and decreasing SED may be an effective health promotion strategy especially during the COVID-19 pandemic. Given that prostate cancer survivors (PCS) may face several barriers to engaging in supervised programs, there is a need to develop and assess the efficacy of interventions that employ distance-based approaches for behaviour change. The primary aim of this study is to determine the effects of a 12-week intervention (Fitbit + behavioural counselling) vs. Fitbit-only control group in reducing SED among PCS. Secondary outcomes include PA, QoL, motivational outcomes, and patient satisfaction.

Methods: This two-arm, multi-site, randomized controlled trial will recruit inactive PCS (stage I-IV) across Canada who self-report performing >8 hours/day of SED. Participants will be randomized to the intervention (n=60; Fitbit and behavioural support) or active control group (n=60; Fitbit-only). The intervention employs the use of a FitBit® and a series of six behavioural support sessions (two group, four individual) to aid PCS in gradually increasing their daily step counts to 3,000 steps above their baseline values. The videoconference calls will incorporate behaviour change content in line with the multi-process action control (M-PAC) framework targeting motivational processes (perceived capability/opportunity, instrumental/affective attitudes), behavioural regulation (action planning, coping planning, social support, goal-setting), and reflexive processing (self-regulation, habit). The FitBit-only control condition will receive a FitBit and public health PA resources. The primary outcome is change in SED measured objectively using activPAL inclinometers. All secondary outcomes will be measured via self-report, except for PA which will be measuring using Fitbits. Data will be collected at baseline, post-intervention, and at 6-month post-intervention.

Discussion: With cancer survivorship being recognized as an essential cancer care component, greater efforts on maintaining QoL are needed. Reducing SED plays an important, yet often undervalued role in the health and well-being of PCS. This study will create a unique distance-based platform that can be used by clinical and community-based organizations as a low-cost, supportive care tool to improve health outcomes for PCS.