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.
Higher levels of self-reported physical activity (PA) are associated with lower risk of breast cancer. To date, however, only one prospective study has examined the association between accelerometer-measured PA, an objective and more precise measure of PA, and incident breast cancer. PURPOSE: To examine the associations between accelerometer-measured total, light, and moderate-to-vigorous PA (MVPA) and incident breast cancer among postmenopausal women in the United States (US) Women's Health Accelerometry Collaboration (WHAC). METHODS: The WHAC comprised 21,091 women including 15,376 from the Women's Health Study [WHS; mean age 71.4±5.7 years; 95.2% non-Hispanic White] and 5,715 from the Women's Health Initiative Objective Physical Activity and Cardiovascular Health Study [OPACH; mean age 78.7±6.7 years; 50.0% non-Hispanic White]. All women wore an ActiGraph GT3X+ on the hip for ≥10 hours on ≥4 of 7 days during 2011-2015 and were followed for 5.9 average years to identify physician-adjudicated in situ (n=79) or invasive (n=491) breast cancers. Calibrated intensity cut points were used to define minutes per day of light and MVPA, which were summed to calculate total PA. Multivariable Cox regression estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for tertiles of wear time-standardized PA in association with incident in situ and invasive breast cancer, overall, by age (<75 or ≥75 years), and by cohort (WHS or OPACH). RESULTS: Overall, the highest (vs. lowest) tertiles of total, light, and MVPA were associated with breast cancer HRs (95% CIs) of 0.85 (0.68-1.04), 0.92 (0.75-1.13), and 0.81 (0.64-1.03), respectively. By age, HRs for MVPA were more pronounced among women <75 years (HR=0.73, 0.55-0.97) than among women ≥75 years (HR=1.18, 0.76-1.84; P Interaction =0.04). Associations did not differ significantly by cohort. CONCLUSION: Overall, no strong association was observed between accelerometer-measured PA and breast cancer. Among women ages <75 years, engaging in higher levels of MVPA, but not light PA, had an inverse association with breast cancer. Additional studies of accelerometer-measured PA and breast cancer by cancer characteristics such as stage at diagnosis and receptor status are needed.
COVID-19 public health recommendations have prohibited many older adults from attending in-person physical activity (PA) programs that improve physical function and promote functional independence. Most PA programs have shifted towards a video conference (VC) format, but this modality has been noted to “flatten” the social experience which is fundamental for lasting behavior change. Virtual reality (VR) is now designed for immersion and place-presence and may be better suited for instilling a feeling of social connection, which will likely improve physical function. The purpose of this study was to evaluate differences in physical function after a 4-week in-home VR or VC based PA intervention. Low-active adults (66.8±4.8 years) were randomized to VR (n=5) or VC (n=4) based PA counselling and instructed to find activities that were intrinsically motivating. VR participants were asked to select pre-approved available active games in addition to enjoyable real-world activities. ANCOVA models were used to explore group differences in six-minute walk distances across time. Results are reported using η^2 effect sizes based on the small sample size. After controlling for baseline values, the ANCOVA models revealed a moderate-to-large magnitude effect for distance traveled during the six-minute walk test (η^2=.10). Additionally, the VR group participants walked 42.63 meters further, which approaches a clinically meaningful difference. These promising early findings suggest there is value to exploring the impact of VR-delivered, group-mediated activity promotion on physical functioning in older adults. Future research should investigate aspects of VR that promote increased social connection and physical function in the older adult population.
To determine if (1) measured VO2P from BW and CANCER protocols differ and (2) if predictive VO2P equations for the BW are accurate for testing cardiovascular fitness in cancer survivors. METHODS: Thirty-four subjects participated in the study. Subjects completed the CANCER and BW protocols one week apart in randomized order. Measured VO2P was obtained from gas analysis using a research grade metabolic cart. Predicted VO2P was calculated using BW prediction equations from the completed BW gas analysis test. A paired samples t-test was used to test for significance (p < 0.05) for both comparisons. RESULTS: All subjects completed the CANCER protocol, but one subject could not complete the BW. No significant differences were found in VO2P values (mL•kg-1 •min-1) between CANCER (28.1 ± 0.65) and BW (26.3 ± 0.76) (p = 0.192). Significant differences were found between predicted and actual VO2P from the BW protocol (19.7 ± 1.33 vs. 26.3 ± 0.76, respectively) (p < 0.001). CONCLUSION: Data indicates if direct gas analysis is available, BW appropriately determines VO2P in cancer survivors. However, if direct gas analysis is unavailable, BW predictive VO2P equations significantly underestimate VO2P in cancer survivors. The CANCER protocol provides accurate VO2P values with or without a metabolic cart. Therefore, in a clinical setting where using direct gas analysis may not be practical, the CANCER protocol remains the current gold standard for assessing cardiovascular fitness in cancer survivors.
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