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, 2008;40:173-180)

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.Irwin et al., 2003, Cancer; 2004, Med Sci Sports Ex; Bellizzi et al., 2005, J Clin Oncol

Holmes et al., 2005, J Amer Med Assoc

(McNeely et al., 2006, Can Med Assoc J; Schmitz et al., 2005, Cancer Epi Bio Prev

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 minwk more PA and

60-90 minwk more brisk walking (d = .25 to .62).

• Combined approach yielded clinically

meaningful improvements in QoL and fatigue.

Exercise for health

• Core message was to engage in moderate PA on at

least 5 days of the week for 30 minutes.

Vallance et al., in press, Health Educ Behav

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%).

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%

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.

Change in self-reported PA

9

39

69

56

0

10

20

30

40

50

60

70

80

Min

ute

s/W

ee

k

SR PM PED COM

Group Assignment

*Baseline to 6 months f/u

+30 +60 +47

Change in self-reported brisk walking

-6

2936

41

-10

0

10

20

30

40

50

60

Min

ute

s/W

ee

k

SR PM PED COM

Group Assignment

*Baseline to 6 months f/u

+35 +42 +47

Conclusions

• INT groups reported 30-60 minwk more PA and 35-

50 minwk 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.

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.

Acknowledgements

• CCS/NCIC Sociobehavioral Cancer Research

Network.

• Co-investigators.

• Labmates and participants who contributed to

this research.

Questions?

377 randomized (23%)

1590 Northern Alberta breast cancersurvivors received a letter of invitation

96 allocatedto SR

94 allocatedto PM

85 followed upat posttest

81 followed upat posttest

94 allocatedto PED

88 followed upat posttest

Study flow

93 allocated to COM

84 followed upat posttest

1192 survivors excludedDid not respond (n=678)Interested but study full (n=310)

68 followed upat 6 months

62 followed upat 6 months

69 followed upat 6 months

67 followed upat 6 months

90%

71%

Change in self-reported PA

-23

-33

-22

-37

-50

-40

-30

-20

-10

0

10

Min

ute

s/W

ee

k

SR PM PED COM

Group Assignment

*Postintervention to 6 months f/u

Change in self-reported brisk walking

-8

-47

-57

-17

-70

-60

-50

-40

-30

-20

-10

0

10

Min

ute

s/W

ee

k

SR PM PED COM

Group Assignment

*Postintervention to 6 months f/u

Physical Activity and Cancer

(Courneya, 2001, Annals Behav Med)

Prescreening Screening Pretreatment Treatment Posttreatment Resumption

Diagnosis

Prediagnosis Postdiagnosis

Prevention Detection Coping

Rehabilitation

Palliation

Health Promotion

Survival