Patterns and determinants of adherence to resistance and endurance training during cancer treatment in the Phys-Can RCT

Hannah L Brooke, Anne-Sophie Mazzoni, Laurien M Buffart, Sveinung Berntsen, Karin Nordin, Ingrid Demmelmaier, Hannah L Brooke, Anne-Sophie Mazzoni, Laurien M Buffart, Sveinung Berntsen, Karin Nordin, Ingrid Demmelmaier

Abstract

Background: Knowledge regarding adherence is necessary to improve the specificity of exercise interventions during cancer treatment. We aimed to determine adherence to resistance and endurance training interventions in parallel; identify subgroups with similar adherence characteristics; and examine determinants of these subgroups.

Methods: In the Phys-Can randomised controlled trial, participants (n = 577, 81% women, mean(SD) age 59(12) years, and 50% with BMI ≥ 25 kg/m2) starting (neo-) adjuvant treatment for breast, colorectal or prostate cancer were randomized to 6-month of high (HI) or low-to-moderate intensity (LMI) supervised, group-based resistance training and individual home-based endurance training, with or without behavior change support. Adherence was calculated as performed exercise volume as a proportion of prescribed exercise volume (0-100%), overall (HI and LMI groups) and for frequency, intensity, type and time (FITT principles) (HI group). Adherence to resistance training was plotted against adherence to endurance training overall and for each FITT principle. K-means cluster analysis was used to identify subgroups with similar adherence characteristics. Potential determinants of subgroup membership were examined using multinomial logistic regression.

Results: We found a positive curvilinear correlation between adherence to resistance and endurance training overall. A similar correlation was seen for adherence to frequency of resistance vs. endurance training in the HI group. In the HI group, adherence to resistance training intensity and time was > 80% for almost all participants. For endurance training adherence ranged from 0 to 100% for each of the FITT principles. Three clusters were identified, representing low, mixed, and high adherence to resistance and endurance training overall. Participants with higher age (Relative risk ratio [95% CI]; LMI: 0.86[0.77-0.96], HI: 0.83[0.74-0.93]), no behaviour change support (LMI: 0.11[0.02-0.56], HI: 0.20[0.05-0.85]), higher cardiorespiratory fitness (LMI: 0.81[0.69-0.94], HI: 0.80[0.69-0.92]), more fatigue (according to the reduced activity subscale of the MFI questionnaire) (LMI: 0.48[0.31-0.73], HI: 0.69[0.52-0.93]) or higher quality of life (LMI: 0.95[0.90-1.00], HI: 0.93[0.88-0.98]) were less likely to be in the low than the high adherence cluster whether randomised to LMI or HI training. Other determinants were specific to those randomised to LMI or HI training.

Conclusions: In an exercise intervention during cancer treatment, adherence to resistance and endurance training were positively correlated. Personalisation of interventions and additional support for some subgroups of participants may improve adherence. Trial registration NCT02473003 (clinicaltrials.gov, Registered 16/06/2015).

Keywords: Adherence; Cancer; Determinants; Endurance training; Exercise; FITT principles; Patterns; Resistance training.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
CONSORT flow chart showing flow of participants through to randomisation in the Phys-Can study. HI, high intensity; L-MI, low-to-moderate intensity, BCS; behaviour change support
Fig. 2
Fig. 2
The correlation between adherence to resistance training overall and adherence to endurance training overall. NB. Cubic splines were fitted with 5 cross-median knots to illustrate the relationship between overall adherence to resistance training and overall adherence to endurance training for each training intensity group
Fig. 3
Fig. 3
Correlation between adherence to resistance training and endurance training frequency FITT principles. Figure shows the correlation between adherence to resistance training and endurance training frequency (A), intensity (B), time (C), and type (D) (FITT principles) for participants randomised to high intensity training (n = 288). NB. Cubic splines were fitted with 5 cross-median knots to illustrate the relationship between adherence to prescribed frequency of resistance training and adherence to prescribed frequency of endurance training
Fig. 4
Fig. 4
Patterns of adherence to resistance and endurance training frequency, intensity, time, and type for participants randomised to high intensity training (n = 288). NB. Each’slice’ of the figure represents the proportion of participants with a specific combination of adherence levels for the four FITT principles, for example, 18.8% of participants had 0–25% adherence to all four FITT principles for resistance training, while 3.5% of participants had 0–25% adherence to the prescribed resistance training frequency but 75–100% adherence to the prescribed resistance training intensity, time and type. Blue segments represent 0–25% adherence, orange segments represent > 25–50% adherence, grey segments represent > 50–75% adherence, and yellow segments represent > 75–100% adherence
Fig. 5
Fig. 5
Adherence clusters based on overall adherence within each training intensity group. Orange points represent cluster 1, i.e. individuals within the low adherence to endurance training and/or resistance training; green points represent cluster 2, i.e. individuals with low-to-moderate adherence to endurance training and moderate-to-high adherence to resistance training; grey points represent cluster 3, i.e. individuals with high adherence to endurance training and moderate-to-high adherence to resistance training

References

    1. Campbell KL, Winters-Stone KM, Wiskemann J, May AM, Schwartz AL, Courneya KS, et al. Exercise guidelines for cancer survivors: consensus statement from international multidisciplinary roundtable. Med Sci Sports Exerc. 2019;51(11):2375–2390. doi: 10.1249/MSS.0000000000002116.
    1. Meneses-Echavez JF, Gonzalez-Jimenez E, Ramirez-Velez R. Effects of supervised multimodal exercise interventions on cancer-related fatigue: systematic review and meta-analysis of randomized controlled trials. Biomed Res Int. 2015;2015:328636. doi: 10.1155/2015/328636.
    1. Gerritsen JK, Vincent AJ. Exercise improves quality of life in patients with cancer: a systematic review and meta-analysis of randomised controlled trials. Br J Sports Med. 2016;50(13):796–803. doi: 10.1136/bjsports-2015-094787.
    1. Neil-Sztramko SE, Medysky ME, Campbell KL, Bland KA, Winters-Stone KM. Attention to the principles of exercise training in exercise studies on prostate cancer survivors: a systematic review. BMC Cancer. 2019;19(1):321. doi: 10.1186/s12885-019-5520-9.
    1. Ormel HL, van der Schoot GGF, Sluiter WJ, Jalving M, Gietema JA, Walenkamp AME. Predictors of adherence to exercise interventions during and after cancer treatment: a systematic review. Psychooncology. 2018;27(3):713–724. doi: 10.1002/pon.4612.
    1. Neil-Sztramko SE, Winters-Stone KM, Bland KA, Campbell KL. Updated systematic review of exercise studies in breast cancer survivors: attention to the principles of exercise training. Br J Sports Med. 2019;53(8):504–512. doi: 10.1136/bjsports-2017-098389.
    1. Mazzoni AS, Brooke HL, Berntsen S, Nordin K, Demmelmaier I. Exercise adherence and effect of self-regulatory behavior change techniques in patients undergoing curative cancer treatment: secondary analysis from the phys-can randomized controlled trial. Integr Cancer Ther. 2020;19:1534735420946834. doi: 10.1177/1534735420946834.
    1. Kirkham AA, Bonsignore A, Bland KA, McKenzie DC, Gelmon KA, et al. Exercise prescription and adherence for breast cancer: one size does not FITT all. Med Sci Sports Exerc. 2018;50(2):177–86. doi: 10.1249/MSS.0000000000001446.
    1. Kampshoff CS, Jansen F, van Mechelen W, May AM, Brug J, Chinapaw MJ, et al. Determinants of exercise adherence and maintenance among cancer survivors: a systematic review. Int J Behav Nutr Phys Act. 2014;11:80. doi: 10.1186/1479-5868-11-80.
    1. Berntsen S, Aaronson NK, Buffart L, Borjeson S, Demmelmaier I, Hellbom M, et al. Design of a randomized controlled trial of physical training and cancer (Phys-Can)—the impact of exercise intensity on cancer related fatigue, quality of life and disease outcome. BMC Cancer. 2017;17(1):218. doi: 10.1186/s12885-017-3197-5.
    1. Demmelmaier I, Brooke HL, Henriksson A, Mazzoni AS, Bjorke ACH, Igelstrom H, et al. Does exercise intensity matter for fatigue during (neo-)adjuvant cancer treatment? The Phys-Can randomized clinical trial. Scand J Med Sci Sports. 2021;31(5):1144–1159. doi: 10.1111/sms.13930.
    1. Edvardsen E, Hansen BH, Holme IM, Dyrstad SM, Anderssen SA. Reference values for cardiorespiratory response and fitness on the treadmill in a 20- to 85-year-old population. Chest. 2013;144(1):241–248. doi: 10.1378/chest.12-1458.
    1. Smets EM, Garssen B, Bonke B, De Haes JC. The Multidimensional Fatigue Inventory (MFI) psychometric qualities of an instrument to assess fatigue. J Psychosom Res. 1995;39(3):315–325. doi: 10.1016/0022-3999(94)00125-O.
    1. Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, 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(5):365–376. doi: 10.1093/jnci/85.5.365.
    1. Makles A. Stata tip 110: How to get the optimal k-means cluster solution. Stata J. 2012;12(2):347–351. doi: 10.1177/1536867X1201200213.
    1. Mazzoni AS, Carlsson M, Berntsen S, Nordin K, Demmelmaier I. "Finding my own motivation"—a mixed methods study of exercise and behaviour change support during oncological treatment. Int J Behav Med. 2019;26(5):499–511. doi: 10.1007/s12529-019-09809-z.
    1. Midtgaard J, Hammer NM, Andersen C, Larsen A, Bruun DM, Jarden M. Cancer survivors' experience of exercise-based cancer rehabilitation—a meta-synthesis of qualitative research. Acta Oncol. 2015;54(5):609–617. doi: 10.3109/0284186X.2014.995777.
    1. Browall M, Mijwel S, Rundqvist H, Wengstrom Y. Physical activity during and after adjuvant treatment for breast cancer: an integrative review of women's experiences. Integr Cancer Ther. 2018;17(1):16–30. doi: 10.1177/1534735416683807.
    1. Hwang CL, Yu CJ, Shih JY, Yang PC, Wu YT. Effects of exercise training on exercise capacity in patients with non-small cell lung cancer receiving targeted therapy. Support Care Cancer. 2012;20(12):3169–3177. doi: 10.1007/s00520-012-1452-5.
    1. Mijwel S, Backman M, Bolam KA, Jervaeus A, Sundberg CJ, Margolin S, et al. Adding high-intensity interval training to conventional training modalities: optimizing health-related outcomes during chemotherapy for breast cancer: the OptiTrain randomized controlled trial. Breast Cancer Res Treat. 2018;168(1):79–93. doi: 10.1007/s10549-017-4571-3.
    1. Arem H, Sorkin M, Cartmel B, Fiellin M, Capozza S, Harrigan M, et al. Exercise adherence in a randomized trial of exercise on aromatase inhibitor arthralgias in breast cancer survivors: the Hormones and Physical Exercise (HOPE) study. J Cancer Survivorship Res Practice. 2016;10(4):654–662. doi: 10.1007/s11764-015-0511-6.
    1. Shang J, Wenzel J, Krumm S, Griffith K, Stewart K. Who will drop out and who will drop in exercise adherence in a randomized clinical trial among patients receiving active cancer treatment. Cancer Nurs. 2012;35(4):312–22. doi: 10.1097/NCC.0b013e318236a3b3.
    1. Courneya KS, Segal RJ, Gelmon K, Reid RD, Mackey JR, Friedenreich CM, et al. Predictors of supervised exercise adherence during breast cancer chemotherapy. Med Sci Sports Exerc. 2008;40(6):1180–1187. doi: 10.1249/MSS.0b013e318168da45.
    1. Courneya KS, Segal RJ, Gelmon K, Mackey JR, Friedenreich CM, Yasui Y, et al. Predictors of adherence to different types and doses of supervised exercise during breast cancer chemotherapy. Int J Behav Nutr Phys Act. 2014;11:85. doi: 10.1186/s12966-014-0085-0.
    1. Swenson KK, Nissen MJ, Henly SJ. Physical activity in women receiving chemotherapy for breast cancer: adherence to a walking intervention. Oncol Nurs Forum. 2010;37(3):321–330. doi: 10.1188/10.ONF.321-330.
    1. Courneya KS, Segal RJ, Reid RD, Jones LW, Malone SC, Venner PM, et al. Three independent factors predicted adherence in a randomized controlled trial of resistance exercise training among prostate cancer survivors. J Clin Epidemiol. 2004;57(6):571–579. doi: 10.1016/j.jclinepi.2003.11.010.
    1. Courneya KS, Friedenreich CM, Quinney HA, Fields AL, Jones LW, Fairey AS. Predictors of adherence and contamination in a randomized trial of exercise in colorectal cancer survivors. Psychooncology. 2004;13(12):857–866. doi: 10.1002/pon.802.
    1. Courneya KS, Friedenreich CM, Quinney HA, Fields AL, Jones LW, Vallance JK, et al. A longitudinal study of exercise barriers in colorectal cancer survivors participating in a randomized controlled trial. Ann Behav Med. 2005;29(2):147–153. doi: 10.1207/s15324796abm2902_9.
    1. Kirkham AA, Bland KA, Zucker DS, Bovard J, Shenkier T, McKenzie DC, et al. "Chemotherapy-periodized" exercise to accommodate for cyclical variation in fatigue. Med Sci Sports Exerc. 2020;52(2):278–286. doi: 10.1249/MSS.0000000000002151.

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