Kristiann C. Heesch

Exercise and cancer rehabilitation: A systematic review

INTRODUCTION Cancer is increasingly being viewed as a chronic illness requiring long-term management, and there is a growing need for evidence-based rehabilitation interventions for cancer survivors. Previous reviews have evaluated the benefits of exercise interventions for patients undergoing cancer treatment and long-term survivors, but none have investigated the role of exercise during cancer rehabilitation, the period immediately following cancer treatment completion. This systematic review summarises the literature on the health effects of exercise during cancer rehabilitation and evaluates the methodological rigour of studies in this area to date. METHODS Relevant studies were identified through a systematic search of PubMed and Embase to April 2009. Data on study design, recruitment strategy, participants, exercise intervention, adherence rates, and outcomes were extracted. Methodological rigour was assessed using a structured rating system. RESULTS Ten studies were included. Breast cancer patients were the predominate patient group represented. Most interventions were aerobic or resistance-training exercise programmes, and exercise type, frequency, duration and intensity varied across studies. Improvements in physical functioning, strength, physical activity levels, quality of life, fatigue, immune function, haemoglobin concentrations, potential markers of recurrence, and body composition were reported. However, all studies were limited by incomplete reporting and methodological limitations. CONCLUSIONS Although the methodological limitations of studies in this new field must be acknowledged, initial evidence indicates that exercise is feasible and may provide physiological and psychological benefits for cancer survivors during the rehabilitation period. Future studies with rigorous study designs are now required to advance the field.

Perceived Barriers to Exercise and Stage of Exercise Adoption in Older Women of Different Racial/Ethnic Groups

ABSTRACT The purpose of this study was to determine whether barriers to exercise differ among racial/ethnic groups at the same stage of exercise adoption and adjacent stages within racial/ethnic groups. Questions about stage of exercise adoption and perceived barriers to exercise were administered to a cross sectional sample of 745 African American, 660 Hispanic, 738 Native American/Native Alaskan, and 769 Caucasian U.S. women aged 40 years and older. Correlations between rankings of barriers among racial/ethnic groups within the same stage ranged from .43 to .89. For each racial/ethnic group, significant differences existed between adjacent stages in the percentage of women reporting barriers to interfere with exercise (p < .10). Barriers were not similar enough among racial/ethnic groups to recommend that the same barriers be addressed for all races/ethnicities.

Freshman 15: Fact or fiction?

Objective: The objective of this study was to investigate changes in body weight, BMI, body composition, and fat distribution among freshman women during their 1st year of college.

Prospective association between physical activity and falls in community-dwelling older women

Objective: To explore associations between physical activity and the risk of falls and fractured bones in community-dwelling older women. Design, setting and participants: A prospective observational survey with three and six-year follow-ups. The sample included 8188 healthy, community-dwelling women, aged 70–75 years in 1996, who completed surveys as participants in the Australian Longitudinal Study on Women’s Health. Women who reported a recent serious injury from falling were excluded. Outcomes were reports of a fall to the ground, injury from a fall, and a fractured bone in 1999 and 2002. The main predictor variable was physical activity level in 1996, categorised on the basis of weekly frequency as none/very low, low, moderate, high and very high. Covariates were demographic and health-related variables. Logistic regression models were computed separately for each outcome in 1999 and 2002. Main results: In multivariable models, very high physical activity was associated with a decreased risk of reporting a fall in 1999 (odds ratio (OR) 0.67; 95% CI 0.47 to 0.95) and in 2002 (OR 0.64; 95% CI 0.43 to 0.96). High/very high physical activity was associated with a decreased risk of a fractured bone in 2002 (OR 0.53; 95% CI 0.34 to 0.83). No significant association was found between physical activity and injury from a fall. Conclusions: The results suggest that at least daily moderate to vigorous-intensity physical activity is required for the primary prevention of falls to the ground and fractured bones in women aged 70–75 years.

Dose–response relationships between physical activity, walking and health-related quality of life in mid-age and older women

Background Although physical activity is associated with health-related quality of life (HRQL), the nature of the dose–response relationship remains unclear. Objectives To examine the concurrent and prospective dose–response relationships between total physical activity (TPA) and (only) walking with HRQL in two age cohorts of women. Methods Participants were 10 698 women born in 1946–1951 and 7646 born in 1921–1926, who completed three mailed surveys for the Australian Longitudinal Study on Womens Health. They reported weekly TPA minutes (sum of walking, moderate and vigorous minutes). HRQL was measured with the Medical Outcomes Study Short-Form 36 Health Status Survey (SF-36). Linear mixed models, adjusted for socio-demographic and health-related variables, were used to examine associations between TPA level (none, very low, low, intermediate, sufficient, high and very high) and SF-36 scores. For women who reported walking as their only physical activity, associations between walking and SF-36 scores were also examined. Results Curvilinear trends were observed between TPA and walking with SF-36 scores. Concurrently, HRQL scores increased significantly with increasing TPA and walking, in both cohorts, with increases less marked above sufficient activity levels. Prospectively, associations were attenuated although significant and meaningful improvements in physical functioning and vitality were observed across most TPA and walking categories above the low category. Conclusion For women in their 50s–80s without clinical depression, greater amounts of TPA are associated with better current and future HRQL, particularly physical functioning and vitality. Even if walking is their only activity, women, particularly those in their 70s–80s, have better HRQL.

Experiences of Women in a Minimal Contact Pedometer-Based Intervention: A Qualitative Study

ABSTRACT Background: Minimal contact pedometer-based interventions are gaining in popularity as a cost-effective method of promoting physical activity. The experiences of women in these interventions, however, have not been adequately studied. Purpose: This study used focus groups to explore womens experiences in a minimal contact pedometer-based intervention. Methods: Participants were women aged 31 to 51 years who completed a 6-week minimal contact pedometer-based intervention. Before the intervention, all participants were inactive or irregularly active. For the intervention, participants wore pedometers, completed weekly logs of daily steps taken, created physical activity goals, and received weekly emails. Email messages contained strategies for increasing physical activity and served as reminders to wear the pedometer and submit the step logs. After the intervention, participants were invited to attend focus groups to discuss their experiences in the intervention. A generic qualitative research approach was used to analyze the data. Results: Wearing the pedometer helped participants set goals and motivated them to increase their physical activity. Submitting step logs made them accountable. They wanted more innovative tips in the emails for increasing physical activity. Discussion: Our results suggest that the effectiveness of minimal-contact interventions may be enhanced by including pedometers, step logs, and email reminders.

Sitting-Time, Physical Activity, and Depressive Symptoms in Mid-Aged Women

BACKGROUND Associations of sitting-time and physical activity with depression are unclear. PURPOSE To examine concurrent and prospective associations between both sitting-time and physical activity with prevalent depressive symptoms in mid-aged Australian women. METHODS Data were from 8950 women, aged 50-55 years in 2001, who completed mail surveys in 2001, 2004, 2007, and 2010. Depressive symptoms were assessed using the Center for Epidemiological Studies Depression questionnaire. Associations between sitting-time (≤ 4 hours/day, >4-7 hours/day, >7 hours/day) and physical activity (none, some, meeting guidelines) with depressive symptoms (symptoms/no symptoms) were examined in 2011 in concurrent and lagged mixed-effect logistic modeling. Both main effects and interaction models were developed. RESULTS In main effects modeling, women who sat >7 hours/day (OR=1.47, 95% CI=1.29, 1.67) and women who did no physical activity (OR=1.99, 95% CI=1.75, 2.27) were more likely to have depressive symptoms than women who sat ≤ 4 hours/day and who met physical activity guidelines, respectively. In interaction modeling, the likelihood of depressive symptoms in women who sat >7 hours/day and did no physical activity was triple that of women who sat ≤ 4 hours/day and met physical activity guidelines (OR 2.96, 95% CI=2.37, 3.69). In prospective main effects and interaction modeling, sitting-time was not associated with depressive symptoms, but women who did no physical activity were more likely than those who met physical activity guidelines to have future depressive symptoms (OR=1.26, 95% CI=1.08, 1.47). CONCLUSIONS Increasing physical activity to a level commensurate with guidelines can alleviate current depression symptoms and prevent future symptoms in mid-aged women. Reducing sitting-time may ameliorate current symptoms.

Are Active Australia physical activity questions valid for older adults

OBJECTIVE The Active Australia Survey (AAS) is used for physical activity (PA) surveillance in the general Australian adult population, but its validity in older adults has not been evaluated. Our aim was to examine the convergent validity of the AAS questions in older adults. DESIGN The AAS was validated against pedometer step counts as an objective measure of PA, self-reported physical function, and a step-test to assess cardiorespiratory fitness. METHOD Participants were community-dwelling adults, aged 65-89 y, with the ability to walk 100 m. They completed a self-administered AAS and the step-test in one interview. One week earlier, they completed the Short Form-36 physical function subscale. Between these two interviews, they each wore a YAMAX Digiwalker SW200 pedometer and recorded daily steps. Using the AAS data, daily walking minutes and total PA minutes (walking, moderate-intensity PA and vigorous-intensity PA) were compared with the validity measures using Spearman rank-order correlations. Fifty-three adults completed the study. RESULTS Median daily walking minutes were 34.2 (interquartile range [IQR] 17.1, 60.0), and median daily total PA minutes were 68.6 (IQR 31.4, 113.6). Walking and total PA minutes were both moderately correlated with pedometer steps (Spearman correlation r=0.42, p=0.003, for each) but not with step-test seconds to completion (r=-0.11, p=0.44; r=-0.25, p=0.08, respectively). Total PA minutes were significantly correlated with physical function scores (r=0.39, p=0.004), but walking minutes were not (r=0.15, p=0.29). CONCLUSIONS This initial examination of the psychometric properties of the AAS for older adults suggests that this surveillance tool has acceptable convergent validity for ambulatory, community-dwelling older adults.

Lack of time for physical activity: Perception or reality for African American and Hispanic women?

ABSTRACT Lack of time is a well-known barrier to physical activity. It is not known, however, whether this barrier reflects actual time commitments. This study examined time commitments of women and assessed the relationship between time commitments and perceived lack of time for physical activity. Participants were 249 African American and Hispanic women, aged 45 to 70 years. These women devoted much of their time to their responsibilities as workers, housekeepers, mothers and wives. They also spent 28 hours per week in sedentary leisure-time activity. Actual time commitments did not predict perceived lack of time for physical activity. These findings can be used to address the mis-perceptions of women about time available to them for physical activity.

Changes in Women’s Physical Activity During the Transition to College

Abstract Background: Few studies have examined physical activity during the transition from high school to college. Purpose: To examine changes in physical activity and physical activity patterns among females during the transition from high school to college. Methods: Sixty-nine females (age 18.2±0.4 years; body mass index 21.8±2.6 kg/m2; 84% Caucasian) at a large university in the south central United States participated in this prospective longitudinal study. They completed a questionnaire at the beginning of their freshman and sophomore years of college, recalling their participation in physical activity during the previous 12 months. Results: Weekly time spent in moderate, vigorous, and moderateto-vigorous physical activity declined between high school and college (p<0.01). Physical activity participation also differed by semester (p<0.01), with a signifcant decline during the summer between high school and college (p<0.01), and an additional decrease during the first semester of college (p<0.01). Discussion: Participants’ physical activity signifcantly decreased from high school to college, with the largest decline occurring during the summer between high school and college. Translation to Health Education Practice: The transition from high school to college is a critical time to promote physical activity among women.