Physical Activity and Cognitive Function: A Comparison of Rural and Urban Breast Cancer Survivors

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2023 Apr 13

PMID 37053178

Authors

Lindsey L Page

Christina J Kahn

Joan Severson

Arthur F Kramer

Edward McAuley

Diane K Ehlers

Affiliations

Soon will be listed here.

Abstract

Purpose: Increasing evidence suggests rural breast cancer survivors (BCS) may experience greater burden in symptoms known to be associated with cancer-associated cognitive decline (CACD). Yet, little is known about CACD in rural BCS. This study (1) examined differences in cognitive function, moderate-to-vigorous physical activity (MVPA), and other CACD correlates and (2) tested the effects of MVPA on cognitive function in rural versus urban BCS.

Methods: Rural and urban BCS (N = 80), matched on age, education, and time since diagnosis from a larger study, completed cognitive tasks assessing processing speed (Trails-B, Mazes, Task-Switch) and working memory (spatial working memory) and questionnaires assessing subjective memory impairment (SMI), MVPA, and CACD correlates (i.e., sleep quality, fatigue, anxiety/depression). Some participants (n = 62) wore an accelerometer to objectively estimate MVPA. Multiple linear regression and multivariate analysis of covariance were used to test study aims.

Results: Rural BCS (n = 40, M = 61.1±8.4 years-old) performed significantly slower on Trails-B (p<0.01) compared with urban BCS (n = 40, M = 61.0±8.2 years-old) and engaged in less objectively-estimated daily MVPA (mean difference = 13.83±4.73 minutes; p = 0.01). No significant differences in SMI, self-reported MVPA, or CACD correlates were observed (all p>0.28). Regression models did not reveal a significant interaction between MVPA and cognitive performance (all p>0.1); however, estimated marginal means models indicated that the effect of MVPA on processing speed was evident only among rural BCS (Trails-B, p = 0.04; Mazes, p = 0.03).

Conclusions: Findings suggest rural BCS may suffer greater CACD and engage in less MVPA. Additional research is warranted to further examine CACD and more effectively promote MVPA in rural BCS.

References

Campbell K, Zadravec K, Bland K, Chesley E, Wolf F, Janelsins M . The Effect of Exercise on Cancer-Related Cognitive Impairment and Applications for Physical Therapy: Systematic Review of Randomized Controlled Trials. Phys Ther. 2020; 100(3):523-542. PMC: 8559683. DOI: 10.1093/ptj/pzz090. View

Henneghan A . Modifiable factors and cognitive dysfunction in breast cancer survivors: a mixed-method systematic review. Support Care Cancer. 2015; 24(1):481-497. DOI: 10.1007/s00520-015-2927-y. View

Cella D, Nichol M, Eton D, Nelson J, Mulani P . Estimating clinically meaningful changes for the Functional Assessment of Cancer Therapy--Prostate: results from a clinical trial of patients with metastatic hormone-refractory prostate cancer. Value Health. 2008; 12(1):124-9. DOI: 10.1111/j.1524-4733.2008.00409.x. View

Brady M, Cella D, Mo F, Bonomi A, Tulsky D, Lloyd S . Reliability and validity of the Functional Assessment of Cancer Therapy-Breast quality-of-life instrument. J Clin Oncol. 1997; 15(3):974-86. DOI: 10.1200/JCO.1997.15.3.974. View

Awh E, Jonides J, Reuter-Lorenz P . Rehearsal in spatial working memory. J Exp Psychol Hum Percept Perform. 1998; 24(3):780-90. DOI: 10.1037//0096-1523.24.3.780. View

Belasco E, Gong G, Pence B, Wilkes E . The impact of rural health care accessibility on cancer-related behaviors and outcomes. Appl Health Econ Health Policy. 2014; 12(4):461-70. DOI: 10.1007/s40258-014-0099-4. View

Mama S, Bhuiyan N, Foo W, Segel J, Bluethmann S, Winkels R . Rural-urban differences in meeting physical activity recommendations and health status in cancer survivors in central Pennsylvania. Support Care Cancer. 2020; 28(10):5013-5022. PMC: 7415488. DOI: 10.1007/s00520-020-05342-y. View

Ahles T, Root J . Cognitive Effects of Cancer and Cancer Treatments. Annu Rev Clin Psychol. 2018; 14:425-451. PMC: 9118140. DOI: 10.1146/annurev-clinpsy-050817-084903. View

Gray M, Judd S, Sloane R, Snyder D, Miller P, Demark-Wahnefried W . Rural-urban differences in health behaviors and outcomes among older, overweight, long-term cancer survivors in the RENEW randomized control trial. Cancer Causes Control. 2019; 30(4):301-309. PMC: 6459722. DOI: 10.1007/s10552-019-01141-x. View

10.

Rogers L, Markwell S, Verhulst S, McAuley E, Courneya K . Rural breast cancer survivors: exercise preferences and their determinants. Psychooncology. 2009; 18(4):412-21. DOI: 10.1002/pon.1497. View

11.

Clark R, Tahan A, Watson P, Severson J, Cohen N, Voss M . Aging affects spatial reconstruction more than spatial pattern separation performance even after extended practice. Hippocampus. 2017; 27(6):716-725. DOI: 10.1002/hipo.22727. View

12.

Hall S, Kaufman J, Ricketts T . Defining urban and rural areas in U.S. epidemiologic studies. J Urban Health. 2006; 83(2):162-75. PMC: 2527174. DOI: 10.1007/s11524-005-9016-3. View

13.

Weaver K, Geiger A, Lu L, Case L . Rural-urban disparities in health status among US cancer survivors. Cancer. 2012; 119(5):1050-7. PMC: 3679645. DOI: 10.1002/cncr.27840. View

14.

Yellen S, Cella D, Webster K, Blendowski C, Kaplan E . Measuring fatigue and other anemia-related symptoms with the Functional Assessment of Cancer Therapy (FACT) measurement system. J Pain Symptom Manage. 1997; 13(2):63-74. DOI: 10.1016/s0885-3924(96)00274-6. View

15.

Russ T, Batty G, Hearnshaw G, Fenton C, Starr J . Geographical variation in dementia: systematic review with meta-analysis. Int J Epidemiol. 2012; 41(4):1012-32. PMC: 3429875. DOI: 10.1093/ije/dys103. View

16.

Zelinski E, Gilewski M . A 10-item Rasch modeled memory self-efficacy scale. Aging Ment Health. 2004; 8(4):293-306. DOI: 10.1080/13607860410001709665. View

17.

Campbell K, Winters-Stone K, Wiskemann J, May A, Schwartz A, Courneya K . Exercise Guidelines for Cancer Survivors: Consensus Statement from International Multidisciplinary Roundtable. Med Sci Sports Exerc. 2019; 51(11):2375-2390. PMC: 8576825. DOI: 10.1249/MSS.0000000000002116. View

18.

Rubin L, Severson J, Marcotte T, Savin M, Best A, Johnson S . Tablet-Based Cognitive Impairment Screening for Adults With HIV Seeking Clinical Care: Observational Study. JMIR Ment Health. 2021; 8(9):e25660. PMC: 8461534. DOI: 10.2196/25660. View

19.

Weaver K, Palmer N, Lu L, Case L, Geiger A . Rural-urban differences in health behaviors and implications for health status among US cancer survivors. Cancer Causes Control. 2013; 24(8):1481-90. PMC: 3730816. DOI: 10.1007/s10552-013-0225-x. View

20.

Colcombe S, Erickson K, Raz N, Webb A, Cohen N, McAuley E . Aerobic fitness reduces brain tissue loss in aging humans. J Gerontol A Biol Sci Med Sci. 2003; 58(2):176-80. DOI: 10.1093/gerona/58.2.m176. View