Impact and Determinants of Structural Barriers on Physical Activity in People with Cancer

Johanna Depenbusch, Joachim Wiskemann, Alexander Haussmann, Angeliki Tsiouris, Laura Schmidt, Nadine Ungar, Monika Sieverding, Karen Steindorf, Johanna Depenbusch, Joachim Wiskemann, Alexander Haussmann, Angeliki Tsiouris, Laura Schmidt, Nadine Ungar, Monika Sieverding, Karen Steindorf

Abstract

Background: A better understanding of the role of structural barriers for physical activity (PA) after a cancer diagnosis could help to increase PA among people with cancer. Thus, the present study aimed to identify determinants of structural barriers to PA in people with cancer and investigate the association between structural barriers and insufficient post-diagnosis PA, taking different PA change patterns into account.

Methods: A total of 1299 people with breast, prostate, or colorectal cancer completed a questionnaire assessing their socio-demographic and medical characteristics, pre- and post-diagnosis PA, and perceived PA impediment by seven structural barriers. Regression analyses were used to investigate determinants of the perception of structural barriers and to examine the association between structural barriers and insufficient post-diagnosis PA, also with regard to different pre-diagnosis PA levels.

Results: Overall 30-60% of participants indicated to feel impeded by structural barriers. The analyses revealed a younger age, higher BMI, lower educational level, no current work activity, co-morbidities, and lacking physicians' exercise counseling as significant determinants of the perception of structural barriers. Individuals reporting stronger impediments by structural barriers were significantly less likely to be meeting PA guidelines post-diagnosis, particularly those with sufficient pre-diagnosis PA levels.

Conclusions: The study highlights the need for tailored PA programs for people with cancer as well as for more guidance and support in overcoming structural barriers to improve PA behavior. The study has been registered under NCT02678832 at clinicaltrials.gov on February 10th 2016.

Keywords: Cancer; Exercise oncology; Impediment; Physical activity; Structural barriers.

Conflict of interest statement

The authors declare no competing interests.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Recruitment flow. Adapted and reprinted by permission from Springer Nature Customer Service Centre GmbH: Springer Nature, Supportive Care in Cancer, Steindorf et al., Change patterns and determinants of physical activity differ between breast, prostate and colorectal cancer patients, © 2019
Fig. 2
Fig. 2
Frequencies of participants perceiving impediment for physical activity (PA) by structural barriers

References

    1. Demark-Wahnefried W, Rogers LQ, Alfano CM, et al. Practical clinical interventions for diet, physical activity, and weight control in cancer survivors. CA Cancer J Clin. 2015;65(3):167–189. doi: 10.3322/caac.21265.
    1. Buffart LM, Kalter J, Sweegers MG, et al. Effects and moderators of exercise on quality of life and physical function in patients with cancer: an individual patient data meta-analysis of 34 RCTs. Cancer Treat Rev. 2017;52:91–104. doi: 10.1016/j.ctrv.2016.11.010.
    1. Segal R, Zwaal C, Green E, Tomasone JR, Loblaw A, Petrella T. Exercise for people with cancer: a systematic review. Curr Oncol. 2017;24(4):e290–e315. doi: 10.3747/co.24.3619.
    1. Cormie P, Zopf EM, Zhang X, Schmitz KH. The impact of exercise on cancer mortality, recurrence, and treatment-related adverse effects. Epidemiol Rev. 2017;39(1):71–92. doi: 10.1093/epirev/mxx007.
    1. Patel AV, Friedenreich CM, Moore SC, et al. American College of Sports Medicine roundtable report on physical activity, sedentary behavior, and cancer prevention and control. Med Sci Sports Exerc. 2019;51(11):2391–2402. doi: 10.1249/MSS.0000000000002117.
    1. McTiernan A, Friedenreich CM, Katzmarzyk PT, et al. Physical activity in cancer prevention and survival: a systematic review. Med Sci Sports Exerc. 2019;51(6):1252–1261. doi: 10.1249/MSS.0000000000001937.
    1. Campbell KL, Winters-Stone KM, Wiskemann J, 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. Steindorf K, Depenbusch J, Haussmann A, et al. Change patterns and determinants of physical activity differ between breast, prostate, and colorectal cancer patients. Support Care Cancer. 2020;28(7):3207–3218. doi: 10.1007/s00520-019-05097-1.
    1. Eng L, Pringle D, Su J, et al. Patterns, perceptions, and perceived barriers to physical activity in adult cancer survivors. Support Care Cancer. 2018;26(11):3755–3763. doi: 10.1007/s00520-018-4239-5.
    1. Thraen-Borowski KM, Gennuso KP, Cadmus-Bertram L. Accelerometer-derived physical activity and sedentary time by cancer type in the United States. PloS One. 2017;12(8):e0182554.
    1. Hefferon K, Murphy H, McLeod J, Mutrie N, Campbell A. Understanding barriers to exercise implementation 5-year post-breast cancer diagnosis: a large-scale qualitative study. Health Educ Res. 2013;28(5):843–856. doi: 10.1093/her/cyt083.
    1. Fisher A, Wardle J, Beeken RJ, Croker H, Williams K, Grimmett C. Perceived barriers and benefits to physical activity in colorectal cancer patients. Support Care Cancer. 2016;24(2):903–910. doi: 10.1007/s00520-015-2860-0.
    1. Blaney JM, Lowe-Strong A, Rankin-Watt J, Campbell A, Gracey JH. Cancer survivors' exercise barriers, facilitators and preferences in the context of fatigue, quality of life and physical activity participation: a questionnaire-survey. Psychooncology. 2013;22(1):186–194. doi: 10.1002/pon.2072.
    1. Clifford BK, Mizrahi D, Sandler CX, et al. Barriers and facilitators of exercise experienced by cancer survivors: a mixed methods systematic review. Support Care Cancer. 2018;26(3):685–700. doi: 10.1007/s00520-017-3964-5.
    1. Romero SAD, Brown JC, Bauml JM, et al. Barriers to physical activity: a study of academic and community cancer survivors with pain. J Cancer Surviv. 2018;12(6):744–752. doi: 10.1007/s11764-018-0711-y.
    1. Ottenbacher AJ, Day RS, Taylor WC, et al. Exercise among breast and prostate cancer survivors–what are their barriers? J Cancer Surviv. 2011;5(4):413–419. doi: 10.1007/s11764-011-0184-8.
    1. Lynch BM, Owen N, Hawkes AL, Aitken JF. Perceived barriers to physical activity for colorectal cancer survivors. Support Care Cancer. 2010;18(6):729–734. doi: 10.1007/s00520-009-0705-4.
    1. Fernandez S, Franklin J, Amlani N, DeMilleVille C, Lawson D, Smith J. Physical activity and cancer: a cross-sectional study on the barriers and facilitators to exercise during cancer treatment. Can Oncol Nurs J. 2015;25(1):37–48. doi: 10.5737/236880762513742.
    1. Schmitz KH, Campbell AM, Stuiver MM, et al. Exercise is medicine in oncology: Engaging clinicians to help patients move through cancer. CA Cancer J Clin. 2019;69(6):468–484. doi: 10.3322/caac.21579.
    1. Estabrooks PA, Glasgow RE, Dzewaltowski DA. Physical activity promotion through primary care. JAMA. 2003;289(22):2913–2916. doi: 10.1001/jama.289.22.2913.
    1. Depenbusch J, Haussmann A, Tsiouris A, et al. The association between physicians' exercise counseling and physical activity in patients with cancer: Which roles do patients' satisfaction and previous physical activity levels play? Psychooncology. 2020;29(11):1856–1863. doi: 10.1002/pon.5506.
    1. Godin G. The Godin-Shephard Leisure-Time Physical Activity Questionnaire. Health Fit J Can. 2011;4(1):18–22.
    1. Spittaels H, Verloigne M, Gidlow C, et al. Measuring physical activity-related environmental factors: reliability and predictive validity of the European environmental questionnaire ALPHA. Int J Behav Nutr Phys Act. 2010;7(1):48. doi: 10.1186/1479-5868-7-48.
    1. Avancini A, Tregnago D, Rigatti L, et al. Factors influencing physical activity in cancer patients during oncological treatments: a qualitative study. Integr Cancer Ther. 2020;19:1534735420971365. doi: 10.1177/1534735420971365.
    1. Blaney JM, Lowe-Strong A, Rankin J, Campbell A, Allen J, Gracey J. The cancer rehabilitation journey: barriers to and facilitators of exercise among patients with cancer-related fatigue. Phys Ther. 2010;90(8):1135–1147. doi: 10.2522/ptj.20090278.
    1. Elshahat S, Treanor C, Donnelly M. Factors influencing physical activity participation among people living with or beyond cancer: a systematic scoping review. Int J Behav Nutr Phys Act. 2021;18(1):50. doi: 10.1186/s12966-021-01116-9.
    1. Schmidt ME, Wiskemann J, Ulrich CM, Schneeweiss A, Steindorf K. Self-reported physical activity behavior of breast cancer survivors during and after adjuvant therapy: 12 months follow-up of two randomized exercise intervention trials. Acta Oncol. 2017;56(4):618–627. doi: 10.1080/0284186X.2016.1275776.
    1. Forbes CC, Blanchard CM, Mummery WK, Courneya KS. A comparison of physical activity correlates across breast, prostate and colorectal cancer survivors in Nova Scotia. Canada Support Care Cancer. 2014;22(4):891–903. doi: 10.1007/s00520-013-2045-7.
    1. Lynch BM, Boyle T, Winkler E, Occleston J, Courneya KS, Vallance JK. Patterns and correlates of accelerometer-assessed physical activity and sedentary time among colon cancer survivors. Cancer Causes Control. 2016;27(1):59–68. doi: 10.1007/s10552-015-0683-4.
    1. Kampshoff CS, Stacey F, Short CE, et al. Demographic, clinical, psychosocial, and environmental correlates of objectively assessed physical activity among breast cancer survivors. Support Care Cancer. 2016;24(8):3333–3342. doi: 10.1007/s00520-016-3148-8.
    1. Hardcastle SJ, Cohen PA. Effective physical activity promotion to survivors of cancer is likely to be home based and to require oncologist participation. J Clin Oncol. 2017;35(32):3635–3637. doi: 10.1200/JCO.2017.74.6032.
    1. O'Leary KA, Estabrooks CA, Olson K, Cumming C. Information acquisition for women facing surgical treatment for breast cancer: influencing factors and selected outcomes. Patient Educ Couns. 2007;69(1–3):5–19. doi: 10.1016/j.pec.2007.08.002.
    1. Haussmann A, Ungar N, Gabrian M, et al. Are healthcare professionals being left in the lurch? The role of structural barriers and information resources to promote physical activity to cancer patients. Support Care Cancer. 2018;26(12):4087–4096. doi: 10.1007/s00520-018-4279-x.
    1. Ligibel JA, Jones LW, Brewster AM, et al. Oncologists' attitudes and practice of addressing diet, physical activity, and weight management with patients with cancer: findings of an ASCO survey of the oncology workforce.v J Oncol Pract. 2019;15(6):e520-e528.
    1. Nadler M, Bainbridge D, Tomasone J, Cheifetz O, Juergens RA, Sussman J. Oncology care provider perspectives on exercise promotion in people with cancer: an examination of knowledge, practices, barriers, and facilitators. Support Care Cancer. 2017;25(7):2297–2304. doi: 10.1007/s00520-017-3640-9.
    1. Park JH, Lee J, Oh M, et al. The effect of oncologists' exercise recommendations on the level of exercise and quality of life in survivors of breast and colorectal cancer: a randomized controlled trial. Cancer. 2015;121(16):2740–2748. doi: 10.1002/cncr.29400.
    1. Huy C, Schmidt ME, Vrieling A, Chang-Claude J, Steindorf K. Physical activity in a German breast cancer patient cohort: one-year trends and characteristics associated with change in activity level. Eur J Cancer. 2012;48(3):297–304. doi: 10.1016/j.ejca.2011.08.005.
    1. Fassier P, Zelek L, Partula V, et al. Variations of physical activity and sedentary behavior between before and after cancer diagnosis: results from the prospective population-based NutriNet-Sante cohort. Medicine. 2016;95(40):e4629.
    1. Naik H, Qiu X, Brown MC, et al. Socioeconomic status and lifestyle behaviours in cancer survivors: smoking and physical activity. Curr Oncol. 2016;23(6):e546–e555. doi: 10.3747/co.23.3166.
    1. Haussmann A, Gabrian M, Ungar N, Jooß S, Wiskemann J, Sieverding M, Steindorf K. What hinders healthcare professionals in promoting physical activity towards cancer patients? The influencing role of healthcare professionals’ concerns, perceived patient characteristics and perceived structural factors. Eur J Cancer Care. 2018;27(4):e12853

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