Special Attention to Physical Activity in Breast Cancer Patients during the First Wave of COVID-19 Pandemic in Italy: The DianaWeb Cohort

Valentina Natalucci, Milena Villarini, Rita Emili, Mattia Acito, Luciana Vallorani, Elena Barbieri, Anna Villarini, Valentina Natalucci, Milena Villarini, Rita Emili, Mattia Acito, Luciana Vallorani, Elena Barbieri, Anna Villarini

Abstract

Recent evidence highlights that physical activity (PA) is associated with decreased recurrence risk, improved survival and quality of life for breast cancer (BC) patients. Our study aimed to explore patterns of increased/decreased PA, and sedentary behaviors among BC women of the DianaWeb cohort during the first wave of COVID-19 pandemic, and examined the association with residential locations, work changes, different modality used to increase PA, and quality of life. The study analyzed the questionnaires completed by the 781 BC women (age 54.68 ± 8.75 years on both December 2019 and June 2020. Results showed a decrease of 22%, 57%, and 26% for walking activity, vigorous activity, and total PA, respectively. Sitting/lying time increased up to 54.2% of the subjects recruited. High quality of life was associated with lower odds of being sedentary (p = 0.003). Our findings suggest that innovative health management fostering compliance with current guidelines for PA and active behavior should be implemented, especially in unpredictable emergency conditions.

Keywords: COVID-19 pandemic; DianaWeb; breast cancer; epidemiology; health management; physical activity.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
(a) Proportion of total and domain-specific physical activity of women before and during COVID-19 home confinement; (b) Proportion of low active (MET < 600), moderate active (MET ≥ 600), and high active (MET ≥ 3000) women before and during COVID-19 home confinement. * Before vs. during quarantine, χ2 test, p < 0.05; Notes: IPAQ score is expressed as MET-min/week; PA = Physical Activity.
Figure 2
Figure 2
Proportion of self-reported physical activity modality of women before and during COVID-19 home confinement.

References

    1. Wirtz P., Baumann F.T. Physical Activity, Exercise and Breast Cancer—What is the Evidence for Rehabilitation, Aftercare, and Survival? A Review. Breast Care. 2018;13:93–101.
    1. Cormie P., Zopf E.M., Zhang X., Schmitz K.H. The Impact of Exercise on Cancer Mortality, Re-currence, and Treatment-Related Adverse Effects. Epidemiol. Rev. 2017;39:71–92. doi: 10.1093/epirev/mxx007.
    1. Liu L., Shi Y., Li T., Qin Q., Yin J., Pang S., Nie S., Wei S. Leisure time physical activity and cancer risk: Evaluation of the WHO’s recommendation based on 126 high-quality epidemiological studies. Br. J. Sports Med. 2016;50:372–378. doi: 10.1136/bjsports-2015-094728.
    1. Vainshelboim B., Lima R.M., Myers J. Cardiorespiratory fitness and cancer in women: A prospective pilot study. J. Sport Health Sci. 2019;8:457–462. doi: 10.1016/j.jshs.2019.02.001.
    1. Adamo R., Klika R.J., Ballard T.M. How Does Physical Activity Prior to Breast Cancer Diagnosis Effect Rehabilitation Outcomes? Southern California Conferences for Undergraduate Research. [(accessed on 12 November 2016)];2016 Nov; Available online:
    1. Campbell K.L., Winters-Stone K.M., Wiskemann J., May A.M., Schwartz A.L., Courneya K.S., Zucker D.S., Matthews C.E., Ligibel J.A., Gerber L.H., et al. Exercise guidelines for cancer survivors: Consensus statement from international multidisciplinary roundtable. Med. Sci. Sports Exerc. 2019;51:2375–2390. doi: 10.1249/MSS.0000000000002116.
    1. Coletta A.M., Marquez G., Thomas P., Thoman W., Bevers T., Brewster A.M., Hawk E., Basen-Engquist K., Gilchrist S.C. Clinical factors associated with adherence to aerobic and resistance physical activity guidelines among cancer prevention patients and survivors. PLoS ONE. 2019;14:e0220814. doi: 10.1371/journal.pone.0220814.
    1. Gibney E. Coronavirus lockdowns have changed the way Earth moves. Nature. 2020;580:176–177. doi: 10.1038/d41586-020-00965-x.
    1. Lee I.M., Shiroma E.J., Lobelo F., Puska P., Blair S.N., Katzmarzyk P.T. Lancet Physical Activity Series Working Group. Effect of physical inactivity on major non-communicable diseases worldwide: An analysis of burden of disease and life expectancy. Lancet. 2012;380:219–229. doi: 10.1016/S0140-6736(12)61031-9.
    1. American Society of Clinical Oncology (ASCO) COVID-19 Clinical Oncology Frequently Asked Questions (FAQs) [(accessed on 12 March 2021)];2020 Available online: .
    1. Battershill P.M. Influenza pandemic planning for cancer patients. Curr. Oncol. 2006;13:119–120. doi: 10.3390/curroncol13040012.
    1. World Health Organization (WHO) Coronavirus Disease (COVID-19) Pandemic. [(accessed on 10 February 2021)];2020 Available online: .
    1. Violant-Holz V., Gallego-Jiménez M.G., González-González C.S., Muñoz-Violant S., Rodríguez M.J., Sansano-Nadal O., Guerra-Balic M. Psychological Health and Physical Activity Levels during the COVID-19 Pandemic: A Systematic Review. Int. J. Environ. Res. Public Health. 2020;17:9419. doi: 10.3390/ijerph17249419.
    1. . [(accessed on 10 February 2021)]; Available online: .
    1. Brunet J., Taran S., Burke S., Sabiston C.M. A qualitative exploration of barriers and motivators to physical activity participation in women treated for breast cancer. Disabil. Rehabil. 2013;35:2038–2045. doi: 10.3109/09638288.2013.802378.
    1. Gianfredi V., Nucci D., Balzarini M., Acito M., Moretti M., Villarini A., Villarini M. E-Coaching: The DianaWeb study to prevent breast cancer recurrences. Clin. Ter. 2020;170:e59–e65.
    1. Villarini M., Lanari C., Nucci D., Gianfredi V., Marzulli T., Berrino F., Borgo A., Bruno E., Gargano G., Moretti M., et al. Community-based participatory research to improve life quality and clinical outcomes of patients with breast cancer (DianaWeb in Umbria pilot study) BMJ Open. 2016;6:e009707. doi: 10.1136/bmjopen-2015-009707.
    1. Lee P.H., Macfarlane D.J., Lam T., Stewart S.M. Validity of the international physical activity questionnaire short form (IPAQ-SF): A systematic review. Int. J. Behav. Nutr. Phys. Act. 2011;8:115. doi: 10.1186/1479-5868-8-115.
    1. Craig C.L., Marshall A.L., Sjöström M., Bauman A.E., Booth M.L., Ainsworth B.E., Pratt M., Ekelund U., Yngve A., Sallis J.F., et al. International physical activity questionnaire: 12-country reliability and validity. Med. Sci. Sports Exerc. 2003;35:1381–1395. doi: 10.1249/01.MSS.0000078924.61453.FB.
    1. Aaronson N.K., Ahmedzai S., Bergman B., Bullinger M., Cull A., Duez N.J., Filiberti A., Flechtner H., Fleishman S.B., de Haes J.C., et al. The European Organization for Research and Treatment of Cancer QLQ-C30: A quality-of-life instrument for use in international clinical trials in oncology. J. Natl. Cancer Inst. 1993;85:365–376. doi: 10.1093/jnci/85.5.365.
    1. Cheng H.L. A simple, easy-to-use spreadsheet for automatic scoring of the International Physical Activity Questionnaire (IPAQ) Short Form. ResearchGate. 2016 doi: 10.13140/RG.2.2.21067.80165.
    1. World Health Organization. [(accessed on 4 March 2021)]; Available online: .
    1. Villarini A., Villarini M., Gargano G., Moretti M., Berrino F. DianaWeb: Un progetto dimostrativo per migliorare la prognosi in donne con carcinoma mammario attraverso gli stili di vita [DianaWeb: A demonstration project to improve breast cancer prognosis through lifestyles] Epidemiol. Prev. 2015;39:402–405.
    1. Chen P., Mao L., Nassis G.P., Harmer P., Ainsworth B.E., Li F. Coronavirus disease (COVID-19): The need to maintain regular physical activity while taking precautions. J. Sport Health Sci. 2020;9:103–104. doi: 10.1016/j.jshs.2020.02.001.
    1. Narici M., De Vito G., Franchi M., Paoli A., Moro T., Marcolin G., Grassi B., Baldassarre G., Zuccarelli L., Biolo G., et al. Impact of sedentarism due to the COVID-19 home confinement on neuromuscular, cardiovascular and metabolic health: Physiological and pathophysiological implications and recommendations for physical and nutritional countermeasures. Eur. J. Sport Sci. 2020;12:1–22. doi: 10.1080/17461391.2020.1761076.
    1. Luciano F., Cenacchi V., Vegro V., Pavei G. COVID-19 lockdown: Physical activity, sedentary behaviour and sleep in Italian medicine students. Eur. J. Sport Sci. 2020;6:1–10. doi: 10.1080/17461391.2020.1842910.
    1. Kanera I.M., Bolman C.A., Mesters I., Willems R.A., Beaulen A.A., Lechner L. Prevalence and correlates of healthy lifestyle behaviors among early cancer survivors. BMC Cancer. 2016;5:4. doi: 10.1186/s12885-015-2019-x.
    1. Trinh L., Amireault S., Lacombe J., Sabiston C.M. Physical and psychological health among breast cancer survivors: Interactions with sedentary behavior and physical activity. Psychooncology. 2015;24:1279–1285. doi: 10.1002/pon.3872.
    1. Newton R.U., Hart N.H., Clay T. Keeping Patients with Cancer Exercising in the Age of COVID-19. JCO Oncol. Pract. 2020;16:656–664. doi: 10.1200/OP.20.00210.
    1. Di Renzo L., Gualtieri P., Pivari F., Soldati L., Attinà A., Cinelli G., Leggeri C., Caparello G., Barrea L., Scerbo F., et al. Eating habits and lifestyle changes during COVID-19 lockdown: An Italian survey. J. Transl. Med. 2020;18:229. doi: 10.1186/s12967-020-02399-5.
    1. Meyer J., McDowell C., Lansing J., Brower C., Smith L., Tully M., Herring M. Changes in Physical Activity and Sedentary Behavior in Response to COVID-19 and Their Associations with Mental Health in 3052 US Adults. Int. J. Environ. Res. Public Health. 2020;17:6469. doi: 10.3390/ijerph17186469.
    1. Gurgel A.R.B., Mingroni-Netto P., Farah J.C., de Brito C.M.M., Levin A.S., Brum P.C. Determinants of Health and Physical Activity Levels Among Breast Cancer Survivors During the COVID-19 Pandemic: A Cross-Sectional Study. Front. Physiol. 2021;12:624169. doi: 10.3389/fphys.2021.624169.
    1. Kang D.W., Lee J., Suh S.H., Ligibel J., Courneya K.S., Jeon J.Y. Effects of Exercise on Insulin, IGF Axis, Adipocytokines, and Inflammatory Markers in Breast Cancer Survivors: A Systematic Review and Meta-analysis. Cancer Epidemiol. Biomark. Prev. Publ. Am. Assoc. Cancer Res. Am. Soc. Prev. Oncol. 2017;26:355–365. doi: 10.1158/1055-9965.EPI-16-0602.
    1. Newton R.U. Overwhelming research and clinical evidence of exercise medicine efficacy in cancer management-translation into practice is the challenge before us. Current oncology. 2018;25:117–118. doi: 10.3747/co.25.4101.
    1. Patsou E.D., Alexias G.D., Anagnostopoulos F.G., Karamouzis M.V. Effects of physical activity on depressive symptoms during breast cancer survivorship: A meta-analysis of randomised control trials. ESMO Open. 2017;2:e000271. doi: 10.1136/esmoopen-2017-000271.
    1. Spei M.E., Samoli E., Bravi F., La Vecchia C., Bamia C., Benetou V. Physical activity in breast cancer survivors: A systematic review and meta-analysis on overall and breast cancer survival. Breast. 2019;44:144–152. doi: 10.1016/j.breast.2019.02.001.
    1. Naughton M.J., Weaver K.E. Physical and mental health among cancer survivors: Considerations for long-term care and quality of life. N. C. Med. J. 2014;75:283–286. doi: 10.18043/ncm.75.4.283.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe