Accelerometer-derived physical activity and sedentary time by cancer type in the United States

Abstract

The 2003–2004 and 2005–2006 cycles of the National Health and Nutrition Examination Survey (NHANES) were among the first population-level studies to incorporate objectively measured physical activity and sedentary behavior, allowing for greater understanding of these behaviors. However, there has yet to be a comprehensive examination of these data in cancer survivors, including short- and long-term survivors of all cancer types. Therefore, the purpose of this analysis was to use these data to describe activity behaviors in short- and long-term cancer survivors of various types. A secondary aim was to compare activity patterns of cancer survivors to that of the general population. Cancer survivors (n = 508) and age-matched individuals not diagnosed with cancer (n = 1,016) were identified from a subsample of adults with activity measured by accelerometer. Physical activity and sedentary behavior were summarized across cancer type and demographics; multivariate regression was used to evaluate differences between survivors and those not diagnosed with cancer. On average, cancer survivors were 61.4 (95% CI: 59.6, 63.2) years of age; 57% were female. Physical activity and sedentary behavior patterns varied by cancer diagnosis, demographic variables, and time since diagnosis. Survivors performed 307 min/day of light-intensity physical activity (95% CI: 295, 319), 16 min/day of moderate-vigorous intensity activity (95% CI: 14, 17); only 8% met physical activity recommendations. These individuals also reported 519 (CI: 506, 532) minutes of sedentary time, with 86 (CI: 84, 88) breaks in sedentary behavior per day. Compared to non-cancer survivors, after adjustment for potential confounders, survivors performed less light-intensity activity (P = 0.01), were more sedentary (P = 0.01), and took fewer breaks in sedentary time (P = 0.04), though there were no differences in any other activity variables. These results suggest that cancer survivors are insufficiently active. Relative to adults of similar age not diagnosed with cancer, they engage in more sedentary time with fewer breaks. As such, sedentary behavior and light-intensity activity may be important intervention targets, particularly for those for whom moderate-to-vigorous activity is not well accepted.

Contrasting characteristics of daily physical activity in older adults by cancer history

“…Taking more activity breaks translates to spending more time in sedentary behaviors and increasing likelihood of taking fewer breaks in sedentary time. These findings are consistent with previous work from NHANES, suggesting that cancer survivors tend to take fewer breaks from their sedentary behavior, despite accumulating similar total daily sedentary time, translating to longer bouts of sedentary behavior compared to those with no cancer history (13). Additionally, BLSA cancer survivors had markedly lower employment rates and higher rates of smoking and comorbidities compared to those without cancer history; factors that warrant further investigation as possible contributors to the degradation of daily PA accrual.…”

“…Previous studies have primarily investigated differences in time spent at varying intensities of activity by cancer history, with a focus on meeting Federally-recommended PA guidelines (150 minutes/week in MVPA) (13,18,19). In general, these studies have suggested that cancer survivors largely do not reach recommended PA guidelines and are more likely to engage in light-intensity activities than moderate or vigorous intensity activities (13,18,20). Further, Thraen-Borowski and colleagues showed that total time spent in light-intensity activity was significantly lower while sedentary time was higher in those with cancer history than those with no cancer history (13).…”

“…Additionally, MVPA engagement is strongly associated with decreased mortality risk (12). Yet, only 8% of US cancer survivors met Federally-recommended levels of MVPA participation from 2003–2006, and, on average, they spent over 8 waking hours/day in sedentary behaviors (13). However, studies examining MVPA and sedentary time may be insensitive to volumes of light intensity activities or modifications in patterns of activity accumulation that may be informative to evaluating the onset and/or severity of fatigue, pain, and subsequent poor health outcomes (6).…”

A randomized dose‐response trial of aerobic exercise and health‐related quality of life in colon cancer survivors

“…Among colon cancer survivors, physical activity volume declines during cancer therapy and often does not return to pre‐diagnosis volumes after completing therapy . This may explain, in part, why up to 90% of colon cancer survivors do not engage in the recommended minimum volume of 150 min·wk −1 of physical activity . Cross‐sectional studies demonstrate that larger volumes of physical activity are correlated with higher physical and mental wellness, better sleep quality, lower fatigue, less worry about disease recurrence, and better bowel function .…”

Estimation of physical activity intensity cut‐points using accelerometry in breast cancer survivors and age‐matched controls

“…Accelerometers have been established as a valid measure of overall or lifestyle PA in cancer survivors, including BCS (Lynch et al, 2010(Lynch et al, , 2011Pfister et al, 2017;Phillips et al, 2015;Sabiston, Brunet, Vallance, & Meterissian, 2014;Thraen-Borowski, Gennuso, & Cadmus-Bertram, 2017;Vallance, Boyle, Courneya, & Lynch, 2014). Accelerometers have been established as a valid measure of overall or lifestyle PA in cancer survivors, including BCS (Lynch et al, 2010(Lynch et al, , 2011Pfister et al, 2017;Phillips et al, 2015;Sabiston, Brunet, Vallance, & Meterissian, 2014;Thraen-Borowski, Gennuso, & Cadmus-Bertram, 2017;Vallance, Boyle, Courneya, & Lynch, 2014).…”