Maintenance of physical activity in breast cancer survivors after a randomized trial

1
Maintenance of physical activity in breast cancer
survivors after a randomized trial
J Vallance1, KS Courneya2, RC Plotnikoff3, I
Dinu3, JR
Mackey4 1 Centre for Nursing and Health
Studies, Athabasca University 2 Faculty of
Physical Education and Recreation, University of
Alberta 3 School of Public Health,
University of Alberta 4 Department of Oncology,
University of Alberta, Cross Cancer Institute
(Vallance et al., Med Sci Sports Exerc,
200840173-180)
2
Background and Rationale

• Recent systematic reviews Cardiorespiratory
  fitness, QoL, fatigue.
• Post treatment PA associated with a 26 to 40
  risk reduction in breast cancer recurrence,
  breast cancer-specific mortality, and all-cause
  mortality.
• Majority of breast cancer survivors are still
  not meeting public health PA guidelines.

(McNeely et al., 2006, Can Med Assoc J Schmitz
et al., 2005, Cancer Epi Bio Prev
Holmes et al., 2005, J Amer Med Assoc
Irwin et al., 2003, Cancer 2004, Med Sci Sports
Ex Bellizzi et al., 2005, J Clin Oncol
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Activity Promotion Trial

• Compared breast cancer-specific PA print
  materials and step pedometers to a verbal public
  health recommendation for PA in breast cancer
  survivors.
• 12 weeks 40-60 min?wk more PA and
  60-90 min?wk more brisk walking (d .25
  to .62).
• Combined approach yielded clinically
  meaningful improvements in QoL and fatigue.

4
Exercise for health
Vallance et al., in press, Health Educ Behav

• Core message was to engage in moderate PA on at
  least 5 days of the week for 30 minutes.

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6 month follow-up assessment

• Mailed survey at 6 months post intervention.
• Godin Leisure Time Exercise Questionnaire.
• Modified Godin to assess brisk walking.
• QoL (FACT-Anemia).
• 266/377 (71) completed f/u assessment.
• Completers weighed less (3.5kg less), were more
  likely to be on Tamoxifen (51 vs 41), and more
  likely to be meeting PA guidelines at baseline
  (37 vs 26).

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Participants

• Mean age 58 years (Rg 30-90 years)
• Mean BMI 27.7 (5.6)
• Obese class I 20
• Months post-Dx 39 months (3 years)
• Postmenopausal 62
• Stage I or IIa 81

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Uptake of intervention materials

• PEDOMETER and COMBINED groups
• 40 wore pedometer during f/u (52/136).
• 80 felt pedometer helped them increase their
  activity (104/136).
• Pedometer was motivating (40).
• Knew how much they were doing (34).
• PRINT MATERIAL and COMBINED groups
• 60 read resource at least once during f/u.

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Change in self-reported PA
Baseline to 6 months f/u
30
60
47
9
Change in self-reported brisk walking
Baseline to 6 months f/u
35
42
47
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Conclusions

• INT groups reported 30-60 min?wk more PA and
  35-50 min?wk more brisk walking at 6 months f/u.
• Comparable to 3-month intervention effects
  (i.e., 40-60 more PA 60-90 min more brisk
  walking).
• Groups were not statistically superior to SR.
• Loss of power due to increase in variability.
• Maintained small to mod effect sizes (0.18 to
  0.38).
• Behavioral relevance of findings.

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Recommendations

• Examine ways of improving longer term adherence.
• Telephone support, frequent mailings, email.
• Motivated group of survivors.
• Preliminary support for INT tools in maintaining
  PA after distance-based behavior interventions.
• Distance-based trials and programs have the
  opportunity to benefit the greatest of
  survivors.

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Acknowledgements

• CCS/NCIC Sociobehavioral Cancer Research
  Network.
• Co-investigators.
• Labmates and participants who contributed to
  this research.

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Questions?
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Study flow
1590 Northern Alberta breast cancer survivors
received a letter of invitation
1192 survivors excluded Did not respond
(n678) Interested but study full (n310)
377 randomized (23)
96 allocated to SR
94 allocated to PM
94 allocated to PED
93 allocated to COM
90
85 followed up at posttest
81 followed up at posttest
88 followed up at posttest
84 followed up at posttest
71
68 followed up at 6 months
62 followed up at 6 months
69 followed up at 6 months
67 followed up at 6 months
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Change in self-reported PA
Postintervention to 6 months f/u
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Change in self-reported brisk walking
Postintervention to 6 months f/u
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Physical Activity and Cancer
Diagnosis
Health Promotion
Rehabilitation
Prevention
Detection
Coping
Survival
Palliation
Prescreening
Screening
Pretreatment
Treatment
Posttreatment
Resumption
Prediagnosis
Postdiagnosis
(Courneya, 2001, Annals Behav Med)