Relationship Between Cancer Related Fatigue, Physical Activity Related Health Competence, and Leisure Time Physical Activity in Cancer Patients and Survivors

Abstract

Background: A large body of evidence supports the positive effects of leisure time physical activity (LTPA) and exercise on cancer survivors. However, only a fraction of survivors manages to attain international PA recommendations. This can be attributed to several external and internal barriers toward PA those patients seem to encounter, with cancer related fatigue (CRF) being the most reported internal barrier. Nevertheless, self-efficacy and knowledge about the utilization of LTPA can serve as facilitators of PA, which also correspond to certain constituents of physical activity related health competence (PAHCO). Since PAHCO is not investigated in cancer survivors we investigated if PAHCO can mediate the negative relationship between CRF and LTPA.Methods: We surveyed 398 cancer survivors with different cancer types and therapy status. The patients completed the EORTC QLQ-FA12 (EORTC FA12) to assess CRF, the PAHCO questionnaire to assess PAHCO and the SQUASH to assess LTPA. We followed a two-step structural equation modeling approach. The first step established the measurement model, in the second step we fitted the mediation model. Since 163 patients chose not to answer the SQUASH, the mediation model was only fitted to the data of the remaining 235 participants.Results: The proposed measurement model of the PAHCO offered an excellent fit. We found small to moderate positive associations between the PAHCO dimensions and the LTPA, and negative moderate relationships between the PAHCO and the EORTC FA12 dimensions. We did not observe a relationship between the EORTC FA12 dimensions and the LTPA (p > 0.05). The hypothesized mediation models did not display an appropriate fit.Conclusion: The PAHCO confirmed its factorial validity; furthermore, it appears to have a positive relationship to LTPA. Therefore, integrating psycho-educational aspects can be beneficial in order to increase the PAHCO in exercise interventions. Because of the cross-sectional character of this study, causal conclusions are not suitable, therefore the longitudinal relationships of LTPA, CRF, and PAHCO require further investigation.

Physical activity-related health competence and symptom burden for exercise prescription in patients with multiple myeloma: a latent profile analysis

“…Regarding the positive association of PAHCO and PA, our results are in accordance with our previous study in cancer patients, in which small to moderate positive associations between PAHCO dimensions and PA could be observed [ 26 ]. Further, the highest amount of PA was observed by individuals with high levels of self-regulation competence [ 21 ].…”

“…This finding corresponds with the low CC displayed in our analysis in P-profiles two and three, which incorporates 54% of the sample. Comparing the PAHCO levels to our cohort of 398 mixed cancer patients from the USA, our German MM patients have lower levels of MR (75 vs 67), a comparable level of CC (67 vs 67), and a higher level of SC (44 vs 67) [ 26 ].…”

“…All items were answered on a four-stage Likert scale with possible responses ranging from “disagree completely” (1) to “agree completely” (4). McDonald’s omega was good for all three dimensions with 0.94 for MR, 0.93 for CC, and 0.92 for SC in cancer patients [ 26 ]. The original PAHCO questionnaire was developed and validated on two German samples, one sample includes oncological patients during rehabilitation period [ 25 ].…”

“…It is based on health literacy models [ 24 ] and is grounded on a pragmatic understanding of competence and contains the three sub-competences: movement competence (movement-related requirements of PA, e.g., motor skills and abilities), control competence (CC, describes the degree a person is capable of utilizing their knowledge regarding exercise, e.g., control physical load), and PA-specific self-regulation competence (SC, motivational and volitional abilities, e.g., self-control) [ 23 , 25 ]. It could be shown that the individual competence was linked to the regular amount of leisure time PA in a mixed sample of cancer patients [ 26 ]. Furthermore, the CC was directly related to physical fitness [ 25 ].…”

Could nutrition status predict fatigue one week before in patients with nasopharynx cancer undergoing radiotherapy?

“…There is evidence that the muscle of smokers are weaker and less fatigue‐resistant than those of nonsmokers 48 . Patients with high‐intensity physical activity at baseline reported less cognitive fatigue due to improved physical function and endurance to fatigue 49–51 . The results indicated that lifestyles may play an important role in the development of fatigue and should be considered in further intervention studies.…”