Purpose: To gain breast cancer survivors' perspectives on participation in a home-based physical activity intervention and the factors that contributed to their acceptance and adherence to physical activity. Methods: Semi-structured interviews were conducted with six women who had participated in a 12-week, home-based physical activity intervention using Polar A360® activity trackers. Additionally, 22 participants from the physical activity interventions provided scaled responses to barriers of physical activity on weeks 3, 6, 9, and 12. Interviews were transcribed verbatim. Thematic analysis was used for qualitative data. Results: Perceptions (n = 6) were categorized into three main themes including (i) Study Environment which consisted of three subthemes acrch versus fear of failure, power of results, and reminders of cancer and moving beyond. (ii) Influence of People encompassed two subthemes, i.e., personal relationships and self as a source of motivation; and (iii) Wearable Technology which was divided into two subthemes, i.e., objective insights into health and disconnect of person and technology. From the scaled responses, the most impactful barriers for participants within the intervention groups (n = 22) were "feeling busy," "lack of motivation," and "weather." Conclusion: Wearable technology was perceived largely as a facilitator to physical activity in the current study, but technologic difficulties created a barrier to physical activity adherence. Additionally, participants' perceptions of study design elements and social support influenced their acceptance and adherence to the home-based physical activity interventions and should be considered to inform the design and implementation of future studies.

Background: Metabolic syndrome has been previously associated with increased endometrial cancer risk, but the relationship with metabolic syndrome and endometrial cancer survival remains unclear. Objectives: To determine the associations between metabolic syndrome using the harmonized criteria with disease-free survival, overall survival, endometrial cancer-specific survival and time to recurrence among endometrial cancer survivors. Second, to determine the association between the number of metabolic syndrome components as well as each individual metabolic syndrome component with these prognostic outcomes. Methods: A prospective cohort of 540 endometrial cancer survivors diagnosed between 2002 and 2006 participated in the Alberta Endometrial Cancer Cohort and were followed until death or March 20, 2019. Baseline in-person interviews, direct anthropometric measurements and fasting blood samples were used to assess metabolic syndrome. Recurrence and survival data were obtained via medical chart abstraction and vital status updates. Results: Compared to endometrial cancer survivors without metabolic syndrome, survivors with metabolic syndrome had worse overall survival when assessed with the harmonized criteria. Of the individual metabolic syndrome components, only waist circumference was associated with recurrence and survival outcomes. Lifetime recreational physical activity prior to diagnosis was observed to modify the associations between metabolic syndrome and its components with overall survival and disease-free survival. Conclusion: The metabolic syndrome, especially waist circumference, was associated with worse overall and disease-free survival among endometrial cancer survivors. Future research should aim to confirm these results and improve our understanding of the role lifestyle factors iii such as physical activity have in the association between metabolic syndrome and endometrial cancer survivors' prognosis. iv Preface Chapter Four includes the main manuscript from this thesis which addresses the association between metabolic syndrome and its components defined by harmonized criteria with disease-free survival, overall survival, endometrial cancer-specific survival and recurrence among endometrial cancer survivors from the Alberta Endometrial Cancer Cohort Study. For this manuscript Renee Kokts-Porietis led the formal analysis and interpretation of data, as well as drafting, writing, reviewing and editing of the manuscript. All authors were involved in conceptualization and provided critical review of this manuscript. Kerry Courneya, Linda Cook and Christine Friedenreich were involved in the funding acquisition, methodology, investigation and project administration of the larger project. Finally, Jessica McNeil, Gregg Nelson and Christine Friedenreich provided supervision and guidance to Renee Kokts-Porietis at each stage of the project.

PURPOSE The aim of this study was to evaluate associations between pre- and postdiagnosis physical activity and survival in survivors of endometrial cancer by physical activity domain, intensity, dose (metabolic-equivalent task [MET]-hours/week/year), and change from pre- to postdiagnosis. METHODS We conducted a prospective cohort study in Alberta, Canada, of 425 women who were diagnosed with histologically confirmed invasive endometrial cancer between 2002 and 2006 and observed to 2019. The interviewer-administered Lifetime Total Physical Activity Questionnaire recorded prediagnosis (assessed at a median of 4.4 months after diagnosis) and postdiagnosis physical activity (assessed at a median of 3.4 years after diagnosis). Associations between physical activity and overall and disease-free survival were assessed using Cox proportional hazards models adjusted for age, stage, grade, treatments, body mass index, menopausal status, hormone therapy use, family history of cancer, and comorbidities. RESULTS After a median follow-up of 14.5 years, there were 60 deaths, including 18 endometrial cancer deaths, and 80 disease-free survival events. Higher prediagnosis recreational physical activity was statistically significantly associated with improved disease-free survival (> 14 v ≤ 8 MET-hours/week/year; hazard ratio [HR], 0.54; 95% CI, 0.30 to 0.96; Ptrend = .04), but not overall survival (HR, 0.56; 95% CI, 0.29 to 1.07; Ptrend = .06). Higher postdiagnosis recreational physical activity (> 13 v ≤ 5 MET-hours/week/year) was strongly associated with both improved disease-free survival (HR, 0.33; 95% CI, 0.17 to 0.64; Ptrend = .001) and overall survival (HR, 0.33; 95% CI, 0.15 to 0.75; Ptrend = .007). Participants who maintained high recreational physical activity levels from pre- to postdiagnosis also had improved disease-free survival (HR, 0.35; 95% CI, 0.18 to 0.69) and overall survival (HR, 0.43; 95% CI, 0.20 to 0.94) compared with those who maintained low physical activity levels. CONCLUSION Recreational physical activity, especially postdiagnosis, is associated with improved survival in survivors of endometrial cancer.