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Maintenance of physical activity in breast cancer survivors after a randomized trial. J Vallance 1 , KS Courneya 2 , RC Plotnikoff 3 , I Dinu 3 , & JR Mackey 4 1 Centre for Nursing and Health Studies, Athabasca University

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


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maintenance of physical activity in breast cancer survivors after a randomized trial
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)

slide2

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

slide3

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.
slide4

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.
slide5

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%).
slide6

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%
slide7

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.
slide8

Change in self-reported PA

*Baseline to 6 months f/u

+30

+60

+47

slide9

Change in self-reported brisk walking

*Baseline to 6 months f/u

+35

+42

+47

slide10

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.
slide11

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.
slide12

Acknowledgements

  • CCS/NCIC Sociobehavioral Cancer Research Network.
  • Co-investigators.
  • Labmates and participants who contributed to this research.
slide14

Study flow

1590 Northern Alberta breast cancer

survivors received a letter of invitation

1192 survivors excluded

Did not respond (n=678)

Interested but study full (n=310)

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

slide15

Change in self-reported PA

*Postintervention to 6 months f/u

slide16

Change in self-reported brisk walking

*Postintervention to 6 months f/u

slide17

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)