Determinants of adherence to physical activity guidelines among overweight and obese African American breast cancer survivors: implications for an intervention approach

Abstract

Objective Public health agencies encourage breast cancer survivors (BCSs) to follow their physical activity guidelines (PAGs). However, adherence to these guidelines is low. African American (AA) BCSs are more often overweight or obese and less likely than women of other races to report adherence to physical activity recommendations. This study examined socioeconomic, clinical, and psychosocial correlates with meeting PAGs. Design AA women diagnosed and treated for breast cancer and participating in a breast cancer support group (N = 193) completed a lifestyle assessment tool capturing demographic characteristics; breast cancer diagnosis and treatment history; health-related quality of life; weight history, including body mass index and post-diagnosis weight gain; and physical activity. Logistic regressions were used to determine if these covariates were associated with meeting [>8.3 metabolic equivalent task (MET) hr/wk]; partially meeting (4.15–8.3 MET hr/wk); or not meeting (<4.15 MET hr/wk) PAGs. Results Only 54% of AA BCSs reported meeting current PAGs. Participants reporting weight gain of ≤5 lbs post-diagnosis, and those who received surgical treatment for breast cancer were more likely to complete at least 8.3 MET hr/wk. Better physical functioning and lesser pain intensity were associated with meeting PAGs. Conclusion Several factors influence physical activity behaviors and are likely to be important in developing effective interventions to assist AA survivors manage their weight. It is essential that providers and breast cancer support groups that assist survivors to remain physically active and to manage their weight should be aware of these factors. These findings may help generate hypotheses for future research to undergird efforts to increase physical activity among African American BCSs.

Health Behaviors and Lifestyle Interventions in African American Breast Cancer Survivors: A Review

“…In the HEAL Study, only 24% of AA breast cancer survivors were compliant with guidelines (36, 64). Prior studies conducted in survivors recruited from community-based organizations have yielded higher compliance rates (65, 66). However, these rates may not be representative of AA breast cancer survivors nationwide.…”

“…Several studies have examined the relationship between physical activity and health-related quality of life in AA breast cancer survivors (35, 36). Physical activity has been associated consistently with physical function (35, 36, 65). In a sample of AA and Hispanic breast cancer survivors, Millet et al (67) found that those who were physically active had better health-related quality of life scores than those who were not.…”

The Augusta, Georgia Breast Cancer Survivor Study

“…There are currently about 2.5 million breast cancer survivors in the U.S. and the number is likely to continue to increase because of the aging of the population 1 . Several studies conducted over the past few decades have provided important information about health conditions and other challenges faced by women diagnosed with breast cancer and how they can improve their quality of life and reduce their risk of cancer recurrence 2 - 14 Women diagnosed with breast cancer and treated with surgery plus adjuvant therapy have a 5-10 year recurrence risk of 5% to 13% 15 , 16 .…”

“…Exercise can lower circulating levels of estrogen and potentially reduce tumor proliferation. Only about one-third of breast cancer survivors engage in the recommended level of physical activity and less than 18% to 37% consume the recommended amounts of fruits and vegetables 14 , 24 . Eating a healthy diet that includes adequate fruits and vegetables, whole grains, and little or no red meat protects against several chronic diseases.…”

“…Several studies have focused specifically on Hispanic American women 30 - 47 . Other studies have focused specifically on African American breast cancer survivors because of their higher risk of more deadly, “triple negative” tumors, poorer survival, and higher rates of obesity 12 , 14 , 24 , 48 - 52 . African American breast cancer survivors have been found to be more likely to be obese, less likely to engage in physical activity, and more likely to have decreased physical functioning than other groups of breast cancer survivors 17 .…”