Purpose: Physical activity (PA) significantly impacts the well-being of cancer survivors, but most PA research has focused on breast cancer survivors, leaving a significant knowledge gap on survivors of other cancers, such as prostate cancer. This study aims to investigate the effects of cancer treatments, including androgen deprivation therapy (ADT) and external beam radiation therapy (EBRT) on the PA patterns of men with non-metastatic prostate cancer (NMPC).

Methods: PA data from 65 NMPC men undergoing EBRT were analyzed. A cohort of participants (n=46 received prior ADT), while n=19 received EBRT alone (non-ADT group). Actical® devices were worn on the hip for four consecutive days, including one weekend day, during three time periods: Time 1 (pre-EBRT), Time 2 (mid-EBRT, days 16-22), and Time 3 (EBRT completion, days 32-44). Actigraphy data in 5-second epochs were collapsed to 1-minute means and cleaned for non-wear time. Only days with complete records and ≥10 hours wear time were included. PA variables included Total Activity Counts per day (TAC), daily mean Inactive Time (IT, < 100 CPM, including overnight rest), Light-Intensity Physical Activity (LIPA, >100 CPM & < 1535 CPM), and Moderate-to-Vigorous Physical Activity (MVPA, >1535 CPM). Covariates encompassed EBRT dose, age, body mass index (BMI), and demographics.

Results: ADT and non-ADT groups did not significantly differ in general demographic characteristics including age, BMI, race, marital status, and education. LIPA was significantly different between the ADT and non-ADT groups in time period 1 (ADT=11.82+0.55, non-ADT=13.04+0.62, p=0.037), and IT in time period 2 (ADT=1050.08+32.57, non-ADT=988.15+ 41.11, p=0.039). However, ADT and non-ADT groups did not significantly differ between time periods or overall for MVPA and TAC.

Conclusion: NMPC men on ADT exhibited reduced LIPA, which include activities like walking and low-intensity leisure activities, but engagement in more strenuous activities remained the same for both groups. Additionally, ADT men were more physically inactive with significantly higher IT at Time 2 compared to non-ADT men. These findings suggest potential side effects of ADT on physical functioning of these men. Understanding how cancer treatments impact PA can inform strategies to enhance quality of life and overall health of NMPC men.

Purpose: Physical activity (PA) engagement and adherence among cancer survivors is poor despite data demonstrating multiple physical, psychological, and emotional health benefits of PA. Little is known about cancer survivors’ perspectives on PA. The present study aims to assess the knowledge and perceived barriers and facilitators of PA among cancer survivors using the Theoretical Domains Framework (TDF).

Methods: A qualitative research design with a phenomenological approach was used. A purposive sample of twelve cancer survivors (two, each with colon, lung, and prostate cancers, and six with breast cancer) across Nebraska, USA, participated in a semi-structured interview conducted via Zoom or phone calls. Interviews were audio recorded, transcribed verbatim, and imported into qualitative software NVivo version 12. The responses were mapped using the TDF, where theory-driven deductive content analysis was used for data analysis.

Results/findings: The semi-structured interviews yielded several themes and subthemes on the perception, barriers, and facilitators of PA among cancer survivors. The first theme was related to beliefs about PA, which included perception and knowledge about PA and PA guidelines. The most commonly identified PA barriers included cancer-related symptoms (e.g., fatigue, pain, balance); psychosocial factors (lack of motivation, lack of confidence/skills, social support); and environmental/organizational barriers (unfavorable weather, lack of community resources, lack of PA information from oncology care providers, time constraints, and cost). Further, the reported facilitators mentioned by cancer survivors were self-efficacy/motivation, social support, perceived health benefits, and access to available resources.

Conclusions: The study findings suggested several barriers and facilitators that influenced the cancer survivors’ motivation and capability to engage in PA, which will help inform the future development of evidence-based interventions to increase PA engagement among cancer survivors.

Presenting Author: Xin Chen (the first author)
Corresponding Authors: Xin Chen (the first author), Anna Arthur (The last author)

Purpose: Nutrition and exercise are vital components of breast cancer (BC) care. This study aimed to investigate the facilitators associated with participating in nutrition and exercise intervention programming among people with a history of BC.
Methods: A cross-sectional survey was administered to participants who were 18 years or older and diagnosed with ductal carcinoma in situ (DCIS) or Stage I-IV BC from 2019 to 2021. Participants were recruited during routine oncology appointments at a Midwestern cancer center. Qualitative data from an open-ended question querying facilitators to participating in a combined exercise and nutrition intervention program was extracted and summarized. Descriptive analysis compared pre-COVID-19 (pre-COVID) and post-COVID-19 pandemic (post-COVID, March 2020 or later) subsets using Two-Proportions Z-Test.
Results: A total of 224 participants completed the survey. (pre-COVID: n=130; post-COVID: n=94).
Seventy percent of participants responded to the open-ended question regarding facilitators (pre-COVID: 84/130; post-COVID: 72/94). Awareness, timing of being notified, convenience (e.g., location, time of day), customization, program design, peer support, and an encouraging environment were the most stated facilitators. There was a significant increase in a desire for program customization/personalization as a facilitator from pre- to post-COVID (p<0.01). Although not statistically significant, offering peer support and creating an encouraging environment doubled as reported facilitators from pre- to post-COVID. A framework that grouped and summarized the reported facilitators was developed to help visualize program facilitating strategies.
Conclusion: Various facilitators related to participation in nutrition and exercise interventions were reported by a sample of individuals with a BC history, which may guide the development of future nutrition and exercise interventions for the post-COVID-19 era. Future research and intervention planning should incorporate strategies inspired by the reported facilitators, as relevant to basic operations, recruitment, design, participant-centered information, delivery and retention of nutrition and exercise programming.

Keywords: participation facilitators, nutrition, exercise, interventions, breast cancer

PURPOSE: Supervised exercise interventions have consistently been shown to improve quality of life (QoL), cancer-related fatigue (CRF), and depressive symptoms (DS) in people living with and beyond cancer. However, controlled research trials of exercise often exclude physically active individuals, possibly based on the assumption that this group has higher QoL and lower CRF and DS, and stands to benefit less from the intervention. The purpose of this study was to test this assumption by comparing QoL, CRF, and DS between survivors with self-reported high and low physical activity.
METHODS: A retrospective, cross-sectional analysis was performed on 56 participants initiating a clinical exercise oncology program. No exclusions were made on cancer diagnosis. Demographic information and questionnaires were collected upon enrollment and included measures of QoL (Functional Assessment of Cancer Treatment – General [FACT-G]), CRF (Functional Assessment of Chronic Illness Therapy – Fatigue [FACIT-Fatigue]), and DS (Center for Epidemiological Studies Depression scale [CES-D]). Self-reported moderate-to-vigorous physical activity (MVPA) was assessed by the Godin Leisure-Time Physical Activity questionnaire. An MVPA threshold of 100 min/wk was used to define high and low activity. Questionnaire scores were compared between high- and low-activity groups using Mann-Whitney U tests. Pearson correlation coefficients were calculated between scores and MVPA.
RESULTS: Participants were on average 58 (SD=14) years old and the majority were women (57%). Twenty participants (36%) met the definition of high activity. FACIT-Fatigue scores were significantly greater (less CRF) in participants with high vs low activity (37±11 vs 31±10, p=0.04). Other outcomes did not significantly differ between groups (high vs low activity; FACT-G: 76±21 vs 75±14, p=0.38; CES-D: 17±13 vs 15±8, p=0.87). MVPA was significantly correlated with FACIT-Fatigue (r=0.31, p=0.02) but not with FACT-G (r=0.13, p=0.34) or CES-D (r=-0.01, p=0.92).
CONCLUSIONS: QoL and DS did not significantly differ between participants with high and low self-reported physical activity. CRF was significantly lower in participants with high activity and moderately correlated with physical activity. This indicates that both groups have the potential to benefit from supervised exercise interventions and should be included in more clinical trials. Future work should investigate differences in responses to exercise interventions.

A Systematic Review of the Effects of Muscle-Strengthening Exercise on Recurrence and Mortality among Breast Cancer Survivors

Oliver W.A. Wilson, PhD (corresponding and presenting author)
Kaitlyn M. Wojcik, MPH, CPH
Dalya Kamil, BSc
Jessica Gorzelitz, PhD, M
Gisela Butera, Med, MLIS
Charles E. Matthews, PhD
Jinani Jayasekera, MS, PhD

AUTHOR AFFILIATIONS:
Oliver W.A. Wilson, Kaitlyn M. Wojcik, Dalya Kamil, and Jinani Jayasekera are in the Division of Intramural Research at the National Institute of on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA

Jessica Gorzelitz is in the Department of Health & Human Physiology, University of Iowa, Iowa City, IA, USA

Gisela Butera is in the Office of Research Services, National Institutes of Health Library, Bethesda, MD, USA

Charles E. Matthews is in the Metabolic Epidemiology Branch at the National Cancer Institute, National Institutes of Health, Bethesda, MD, USA

ABSTRACT
Purpose: To collate and critically evaluate empirical literature describing the association of muscle-strengthening exercise (MSE) with recurrence and/or mortality among breast cancer survivors.
Methods: We conducted a systematic review following the established Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. A search strategy for seven databases (MEDLINE via PubMed, PsycINFO, Embase, Scopus, Web of Science Core Collection, and Cochrane CENTRAL) was developed with the assistance of a librarian. Article quality was appraised using the Mixed Methods Appraisal Tool (MMAT). Data were analyzed and summarized descriptively.
Results: Initial searches retrieved 5,146 sources after removing duplicates. After title and abstract screening, a full-text review of 1,240 remaining sources was conducted. Five articles were identified and proceeded to extraction. All articles included data from North America. Two
were cross-sectional, two were prospective, and one was retrospective. MSE measurement differed across articles in relation to the description of the MSE (i.e., muscle-strengthening vs. strength training), examples of activities (e.g., sit ups or push-ups vs. calisthenics vs. circuit training) and exercise frequency (i.e., days vs. times per week). Variations in MSE measurement and analytical approaches prevented a meta-analysis. Four articles measured participation frequency, two measured duration, and one measured type of MSE. Three examined the association of MSE with recurrence, two with breast cancer-specific mortality, and three with all-cause mortality. Collectively, findings offer provisional evidence that suggests some MSE may lower the risk of recurrence and mortality among breast cancer survivors. Evidence was mixed as to whether additional MSE offers further benefits in reducing the risk of mortality. Associations may vary by race, weight status, and menopausal status.
Conclusions: Findings from the limited available evidence tentatively suggest that MSE may lower the risk of recurrence and mortality among breast cancer survivors. Greater consistency in measurement and analyses within MSE research may help generate findings more readily comparable across studies and applicable to inform clinical practice. More research is needed to improve understanding of the strength and differences of these relationships in underserved and underrepresented women.

Purpose: Recent research has identified that there are subgroups of people with a stoma with different patterns of quality of life. Investigating whether factors such as physical activity and receipt or interest in physical activity advice are associated with membership of these groups could help us tailor future interventions. The aim of this study was to explore whether profiles derived from self-reported quality of life were associated with physical activity and receipt of, and interest in, advice from a healthcare professional in people with a stoma from colorectal cancer.
Methods: Secondary analysis of cross-sectional national survey data from England of 4487 people with a stoma from colorectal cancer who were diagnosed in 2010 and 2011 and still alive as of 2013. The survey included assessments of quality of life, and physical activity, and asked whether participants were interested in receiving physical activity advice. A three-step latent profile analysis was conducted to determine the optimum number of profiles. Multinomial regression explored factors associated with profile membership, including physical activity. Logistic regression examined whether profile membership was associated with interest in physical activity advice.
Results: Five profiles were identified; ‘consistently good quality of life’, ‘functional issues’, ‘functional and financial issues’, ‘low quality of life’ and ‘supported but struggling’. Individuals across all profiles with quality of life concerns were less likely to be physically active compared to the ‘consistently good quality of life’ profile. When compared to the ‘consistently good quality of life’ profile, all other profiles were more likely to report wanting advice on being physically active, with the strongest associations in the ‘low quality of life’ (OR=2.6, 95%CI:2.0; 3.5) and ‘functional and financial issues’ (OR=2.6, 95%CI:2.0; 3.4) profiles, after controlling for physical activity.
Conclusion: People with a stoma from colorectal cancer are not a homogenous group in terms of their quality of life. Participants in profiles with quality of life concerns are less active but more interested in receiving physical activity advice. Varying profiles suggest this advice could be tailored to specific groups.

Purpose: Cognitive impairments are reported as a chief quality of life (QoL) complaint in breast cancer (BC) patients. Women who have undergone adjuvant chemotherapy are at the highest risk for impairments in memory, attention, and processing speed. Cancer-related cognitive impairment (CRCI) is largely underdiagnosed and there are no proven treatments. Effective interventions are needed to mitigate the debilitating effects of CRCI. One such intervention may be exercise. The purpose of this study was to examine the effects of a remotely-delivered combined exercise regimen (aerobic + resistance training) vs. stretching/toning (active control) on cognitive function in an 8-week, randomized controlled trial (RCT) in BC patients following chemotherapy.

Methods: BC patients who had completed (neo) adjuvant chemotherapy within 48 months were recruited between February-July 2023 through community organizations across Canada. The combined exercise group underwent 30-min of unsupervised aerobic exercise 3x/wk; 30-min supervised, group-based resistance training class 2x/wk via Zoom + 1x/wk recorded class; and four group-based, bi-weekly behavioural counselling sessions (e.g., Multi-process Action Control Framework) via Zoom. The active control group received 30-min balance and flexibility class 2x/wk via Zoom + 1x/wk recorded class. BC patients completed objective cognitive function measures (NIH Toolbox remote cognitive battery) at baseline and post-intervention (i.e., 8 weeks). Separate analyses of covariance examined changes in cognitive function between groups.

Results: Patients (N=18; Mage=51.9±7.4 years) were randomized to the combined exercise (n=9) or active control (n=9) group and had a mean months since treatment of 12.6 ± 13.5. Adherence to the exercise classes and behavioural counselling sessions were 78.7% and 86.1%, respectively. Improvements in the Picture Sequence Memory Task (MDiff=5.33, p=0.53, ηp²=0.03), List Sorting Working Memory Test (MDiff=8.17, p=0.18, ηp²=0.12) and Auditory Verbal Learning (MDiff=3.22, p=0.21, ηp²=0.12) favored the combined exercise group, while the Oral Reading Recognition Test (MDiff= -9.65, p=0.14, ηp²=0.14) and Picture Vocabulary (MDiff= -2.48, p=0.07, ηp²=0.20) favored the active control group.

Conclusions: A supervised, remotely-delivered, combined exercise intervention may be effective for improving CRCI (i.e., memory) in BC patients. Larger RCTs are needed to demonstrate that exercise is an effective intervention strategy to enhance cognitive function and improve the QoL of BC patients.