Evaluating Individual Level Change in Physical Function Response Following an Exercise Program for Cancer Survivors

Overview

Journal Support Care Cancer

Specialties Critical Care
Oncology

Date 2023 May 26

PMID 37233792

Authors

Heather J Leach

Ciaran M Fairman

Emma L Gomes

Ryan J Marker

Affiliations

Soon will be listed here.

Abstract

Purpose: Cancer survivors physical function response to exercise programs at the group level is well-established. However, to advance toward a more personalized approach in exercise oncology, a greater understanding of individual response is needed. This study utilized data from a well-established cancer-exercise program to evaluate the heterogeneity of physical function response and explore characteristics of participants who did vs. did not achieve a minimal clinically important difference (MCID).

Methods: Physical function measures (grip strength, 6-min walk test (6MWT), and sit-to-stand) were completed pre/post the 3-month program. Change scores for each participant and the proportion achieving the MCID for each physical function measure were calculated. The independent t-tests, Fisher's exact test, and decision tree analyses were used to explore differences in age, body mass index (BMI), treatment status, exercise session attendance, and baseline value between participants who achieved the MCID vs. those who did not.

Results: Participants (N = 250) were 55 ± 14 years old, majority female (69.2%), white (84.1%), and diagnosed with breast cancer (36.8%). Change in grip strength ranged from - 42.1 to + 47.0 lb, and 14.8% achieved the MCID. Change in 6MWT ranged from - 151 to + 252 m, and 59% achieved the MCID. Change in sit-to-stand ranged from - 13 to + 20 reps, and 63% achieved the MCID. Baseline grip strength, age, BMI, and exercise session attendance were related to achieving MCID.

Conclusions: Findings illustrate wide variability in the magnitude of cancer survivors' physical function response following an exercise program, and that a variety of factors predict response. Further investigation into the biological, behavioral, physiological, and genetic factors will inform tailoring of exercise interventions and programs to maximize the proportion of cancer survivors who can derive clinically meaningful benefits.

References

Basen-Engquist K, Alfano C, Maitin-Shepard M, Thomson C, Schmitz K, Pinto B . Agenda for Translating Physical Activity, Nutrition, and Weight Management Interventions for Cancer Survivors into Clinical and Community Practice. Obesity (Silver Spring). 2017; 25 Suppl 2:S9-S22. PMC: 5683412. DOI: 10.1002/oby.22031. View

Bohannon R . Minimal clinically important difference for grip strength: a systematic review. J Phys Ther Sci. 2019; 31(1):75-78. PMC: 6348186. DOI: 10.1589/jpts.31.75. View

Bohannon R, Crouch R . Minimal clinically important difference for change in 6-minute walk test distance of adults with pathology: a systematic review. J Eval Clin Pract. 2016; 23(2):377-381. DOI: 10.1111/jep.12629. View

Bouchard C, Rankinen T . Individual differences in response to regular physical activity. Med Sci Sports Exerc. 2001; 33(6 Suppl):S446-51; discussion S452-3. DOI: 10.1097/00005768-200106001-00013. View

Buffart L, Sweegers M, May A, Chinapaw M, VAN Vulpen J, Newton R . Targeting Exercise Interventions to Patients With Cancer in Need: An Individual Patient Data Meta-Analysis. J Natl Cancer Inst. 2018; 110(11):1190-1200. PMC: 6454466. DOI: 10.1093/jnci/djy161. View

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

Collins L, Murphy S, Strecher V . The multiphase optimization strategy (MOST) and the sequential multiple assignment randomized trial (SMART): new methods for more potent eHealth interventions. Am J Prev Med. 2007; 32(5 Suppl):S112-8. PMC: 2062525. DOI: 10.1016/j.amepre.2007.01.022. View

Covington K, Hidde M, Pergolotti M, Leach H . Community-based exercise programs for cancer survivors: a scoping review of practice-based evidence. Support Care Cancer. 2019; 27(12):4435-4450. DOI: 10.1007/s00520-019-05022-6. View

Fairman C, Nilsen T, Newton R, Taaffe D, Spry N, Joseph D . Reporting of Resistance Training Dose, Adherence, and Tolerance in Exercise Oncology. Med Sci Sports Exerc. 2019; 52(2):315-322. DOI: 10.1249/MSS.0000000000002127. View

10.

Fairman C, Zourdos M, Helms E, Focht B . A Scientific Rationale to Improve Resistance Training Prescription in Exercise Oncology. Sports Med. 2017; 47(8):1457-1465. DOI: 10.1007/s40279-017-0673-7. View

11.

Fishleder S, Petrescu-Prahova M, Harris J, Leroux B, Bennett K, Helfrich C . Predictors of Improvement in Physical Function in Older Adults in an Evidence-Based Physical Activity Program (EnhanceFitness). J Geriatr Phys Ther. 2018; 42(4):230-242. PMC: 6318072. DOI: 10.1519/JPT.0000000000000202. View

12.

Foley M, Hasson S . Effects of a Community-Based Multimodal Exercise Program on Health-Related Physical Fitness and Physical Function in Breast Cancer Survivors: A Pilot Study. Integr Cancer Ther. 2016; 15(4):446-454. PMC: 5739165. DOI: 10.1177/1534735416639716. View

13.

Irwin M, Cartmel B, Harrigan M, Li F, Sanft T, Shockro L . Effect of the LIVESTRONG at the YMCA exercise program on physical activity, fitness, quality of life, and fatigue in cancer survivors. Cancer. 2016; 123(7):1249-1258. PMC: 5360506. DOI: 10.1002/cncr.30456. View

14.

Labott B, Bucht H, Morat M, Morat T, Donath L . Effects of Exercise Training on Handgrip Strength in Older Adults: A Meta-Analytical Review. Gerontology. 2019; 65(6):686-698. DOI: 10.1159/000501203. View

15.

Marker R, Cox-Martin E, Jankowski C, Purcell W, Peters J . Evaluation of the effects of a clinically implemented exercise program on physical fitness, fatigue, and depression in cancer survivors. Support Care Cancer. 2017; 26(6):1861-1869. DOI: 10.1007/s00520-017-4019-7. View

16.

Ross L, Slentz C, Kraus W . Evaluating Individual Level Responses to Exercise for Health Outcomes in Overweight or Obese Adults. Front Physiol. 2019; 10:1401. PMC: 6867965. DOI: 10.3389/fphys.2019.01401. View

17.

Ross R, Goodpaster B, Koch L, Sarzynski M, Kohrt W, Johannsen N . Precision exercise medicine: understanding exercise response variability. Br J Sports Med. 2019; 53(18):1141-1153. PMC: 6818669. DOI: 10.1136/bjsports-2018-100328. View

18.

Santa Mina D, Au D, Brunet J, Jones J, Tomlinson G, Taback N . Effects of the community-based Wellspring Cancer Exercise Program on functional and psychosocial outcomes in cancer survivors. Curr Oncol. 2017; 24(5):284-294. PMC: 5659149. DOI: 10.3747/co.23.3585. View

19.

Santanasto A, Glynn N, Lovato L, Blair S, Fielding R, Gill T . Effect of Physical Activity versus Health Education on Physical Function, Grip Strength and Mobility. J Am Geriatr Soc. 2017; 65(7):1427-1433. PMC: 5507738. DOI: 10.1111/jgs.14804. View

20.

Schmidt K, Vogt L, Thiel C, Jager E, Banzer W . Validity of the six-minute walk test in cancer patients. Int J Sports Med. 2013; 34(7):631-6. DOI: 10.1055/s-0032-1323746. View