Mediators of Exercise Effects on HRQoL in Cancer Survivors after Chemotherapy

Kalter, Joeri; Kampshoff, Caroline S.; Chinapaw, Mai J. M.; Mechelen, Willem van; Galindo-Garré, Francisca; Schep, Goof; Leeuw, Irma M. Verdonck‐de; Brug, Johannes; Buffart, Laurien M.

doi:10.1249/mss.0000000000000976

Cited by 25 publications

(29 citation statements)

References 36 publications

(23 reference statements)

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“…The cluster physical fitness and health matches the results from previous quantitative studies that found improved physical fitness to mediate the exercise effects on QoL . In addition, previous studies suggested that psychological variables, such as self‐efficacy and distress, may mediate the exercise effect on QoL .…”

Section: Discussionsupporting

confidence: 86%

“…Several reviews and meta-analyses have demonstrated that exercise during or following cancer treatment has beneficial effects on QoL [7][8][9][10][11]. Previous studies indicated that these beneficial effects were mediated by improved physical fitness [12,13] and reduced fatigue [13][14][15]. Improved self-efficacy [12] and reduced distress [12,16] may also mediate the beneficial effects of exercise on QoL.…”

Section: Introductionmentioning

confidence: 99%

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How Does a Supervised Exercise Program Improve Quality of Life in Patients with Cancer? A Concept Mapping Study Examining Patients' Perspectives

Sweegers

Buffart

Veldhuizen³

et al. 2018

The Oncologist

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Background Previous systematic reviews and meta‐analyses demonstrated beneficial effects of exercise during or following cancer treatment on quality of life (QoL). Aiming to understand how exercise contributes to a patient's QoL, we examined patients' perspectives via a process called concept mapping. This unique method provides structure and objectivity to rich qualitative data. Methods Patients with cancer who were participating in an exercise program were invited to enroll. Eleven meetings with 3–10 patients were organized in which patients generated ideas in response to the question “How has participating in a supervised exercise program contributed positively to your QoL?” Next, patients individually clustered (based on similarity) and rated (based on importance) the ideas online. The online assessments were combined, and one concept map was created, visualizing clusters of ideas of how patients perceive that participating in a supervised exercise program improved their QoL. The research team labelled the clusters of ideas, and physiotherapists reflected on the clusters during semistructured interviews. Results Sixty patients attended the meetings; of these, one patient was not able to generate an idea in response to the statement. Forty‐four patients completed the online clustering and rating of ideas. The resulting concept map yielded six clusters: personalized care, coaching by a physiotherapist, social environment, self‐concept, coping, and physical fitness and health. Personalized care was rated as most important. Overall, physiotherapists recognized these clusters in practice. Conclusion Patients with cancer reported that participating in a supervised exercise program improved their physical fitness and influenced social, mental, and cognitive factors, resulting in improvements in QoL. These results can be used to increase the awareness of the importance of supervised exercise programs for the QoL of patients with cancer. Implications for Practice According to patients, a supervised exercise program contributes positively to their quality of life by improving physical fitness and health and providing personalized care, coaching by a physiotherapist, and improved social environment, self‐concept, and coping. This knowledge could help to increase physicians' and patients' awareness of the importance of an exercise program during or following cancer treatment, possibly improving referral, participation, and adherence rates to these programs. Furthermore, patients' perspectives may be used to improve supervised exercise programs, taking into account the importance of personalized care, the supervision of a physiotherapist, the social environment, self‐concept, and coping.

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Section: Discussionsupporting

confidence: 86%

Section: Introductionmentioning

confidence: 99%

How Does a Supervised Exercise Program Improve Quality of Life in Patients with Cancer? A Concept Mapping Study Examining Patients' Perspectives

Sweegers

Buffart

Veldhuizen³

et al. 2018

The Oncologist

Self Cite

View full text Add to dashboard Cite

show abstract

“…Furthermore, the exercise-induced benefits on HRQoL were successfully maintained over time in both interventions, despite the return to baseline levels of fatigue. This indicates that besides fatigue, which is found to mediate the exercise effect on HRQoL [ 36 ], other factors also contribute to HRQoL.…”

Section: Discussionmentioning

confidence: 99%

Long-term effectiveness and cost-effectiveness of high versus low-to-moderate intensity resistance and endurance exercise interventions among cancer survivors

Kampshoff¹,

Dongen

Mechelen³

et al. 2018

J Cancer Surviv

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PurposeThis study aimed to evaluate the long-term effectiveness and cost-effectiveness of high intensity (HI) versus low-to-moderate intensity (LMI) exercise on physical fitness, fatigue, and health-related quality of life (HRQoL) in cancer survivors.MethodsTwo hundred seventy-seven cancer survivors participated in the Resistance and Endurance exercise After ChemoTherapy (REACT) study and were randomized to 12 weeks of HI (n = 139) or LMI exercise (n = 138) that had similar exercise types, durations, and frequencies, but different intensities. Measurements were performed at baseline (4–6 weeks after primary treatment), and 12 (i.e., short term) and 64 (i.e., longer term) weeks later. Outcomes included cardiorespiratory fitness, muscle strength, self-reported fatigue, HRQoL, quality-adjusted life years (QALYs) and societal costs. Linear mixed models were conducted to study (a) differences in effects between HI and LMI exercise at longer term, (b) within-group changes from short term to longer term, and (c) the cost-effectiveness from a societal perspective.ResultsAt longer term, intervention effects on role (β = 5.9, 95% CI = 0.5; 11.3) and social functioning (β = 5.7, 95%CI = 1.7; 9.6) were larger for HI compared to those for LMI exercise. No significant between-group differences were found for physical fitness and fatigue. Intervention-induced improvements in cardiorespiratory fitness and HRQoL were maintained between weeks 12 and 64, but not for fatigue. From a societal perspective, the probability that HI was cost-effective compared to LMI exercise was 0.91 at 20,000€/QALY and 0.95 at 52,000€/QALY gained, mostly due to significant lower healthcare costs in HI exrcise.ConclusionsAt longer term, we found larger intervention effects on role and social functioning for HI than for LMI exercise. Furthermore, HI exercise was cost-effective with regard to QALYs compared to LMI exercise.Trial registrationThis study is registered at the Netherlands Trial Register [NTR2153 [http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2153]] on the 5th of January 2010.Implications for Cancer SurvivorsExercise is recommended to be part of standard cancer care, and HI may be preferred over LMI exercise.

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“…There are multiple proposed mechanisms by which physical activity has been linked to physical and mental QoL. First, in prostate cancer exercise intervention studies, fatigue (56,57), cardiorespiratory fitness (57), walking speed (56), upper body strength (56), and lower body functional performance (58) has been identified as possible mediators between exercise intervention and different aspects of QoL. Furthermore, marital status, time since diagnosis, and use of bisphosphonates (58) have been described as moderators.…”

Section: Discussionmentioning

confidence: 99%

Associations of Postdiagnosis Physical Activity and Change from Prediagnosis Physical Activity with Quality of Life in Prostate Cancer Survivors

Farris

Kopciuk

Courneya

et al. 2017

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Mediators of Exercise Effects on HRQoL in Cancer Survivors after Chemotherapy

Abstract: Beneficial effects of exercise on global QoL and physical function in cancer survivors were mediated by increased cardiorespiratory fitness and subsequent reductions in fatigue.

Cited by 25 publications

References 36 publications

How Does a Supervised Exercise Program Improve Quality of Life in Patients with Cancer? A Concept Mapping Study Examining Patients' Perspectives

How Does a Supervised Exercise Program Improve Quality of Life in Patients with Cancer? A Concept Mapping Study Examining Patients' Perspectives

Long-term effectiveness and cost-effectiveness of high versus low-to-moderate intensity resistance and endurance exercise interventions among cancer survivors

Associations of Postdiagnosis Physical Activity and Change from Prediagnosis Physical Activity with Quality of Life in Prostate Cancer Survivors

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