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European Journal of Gynaecological Oncology  2020, Vol. 41 Issue (3): 343-351    DOI: 10.31083/j.ejgo.2020.03.5163
Original Research Previous articles | Next articles
Sustained effects of theory-based physical activity intervention for socioeconomically diverse obese endometrial cancer survivors: A Longitudinal analysis
A. Rossi1, 2(), C.E. Garber2, M. Ortiz3, V. Shankar4, D.Y. Kuo5, 6, N.S. Nevadunsky5, 6
1Division of Athletic Training, Health and Exercise Science, Long Island University Brooklyn. 1 University Plaza, Brooklyn, NY 11201, USA
2Department of Biobehavioral Sciences, Teachers College, Columbia University. 525 West 120th Street, New York, NY 10027, USA
3Department of Health and Nutrition Sciences, Brooklyn College. 2900 Bedford Ave, Brooklyn, NY 11210, USA
4Department of Epidemiology & Population Health, Albert Einstein College of Medicine 1300 Morris Park Avenue Bronx, NY 10461, USA
5Department of Obstetrics & Gynecology and Women's Health, Montefiore Medical Center 111 East 210th Street, Bronx, NY 10467, USA
6Albert Einstein Cancer Center, Albert Einstein College of Medicine 1300 Morris Park Avenue Bronx, NY 10461, USA
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Abstract  

Purpose of Investigation: Assess the sustained effects of a 12-week physical activity intervention on physical activity, physical function, waist circumference, and quality of life among urban, socioculturally diverse endometrial cancer survivors. Materials and Methods: Twenty-three obese women with a history of endometrial cancer within the previous five years with no evidence of cancer recurrence volunteered for a 12-week physical activity intervention based on social cognitive theory. Classes were offered 2x/week and included 30 minutes of behavioral counseling and 60 minutes of exercise. Pedometers were distributed, and participants were instructed to walk ≥ 90 min/week at home. A longitudinal analysis of baseline, post-intervention and 12-week follow-up response profile model was fitted using restricted maximum likelihood estimation approach. Results: Mean participant age was 64 ± 8 years, and BMI was 37 ± 6 kg?m-2. Seventy-eight percent of participants were non-white. Improvements in waist circumference (-4.8 cm, p = 0.009), and the six-minute walk test (13 m, p = 0.042) persisted 12 weeks after the completion of the intervention. Among the psychosocial variables, walking self-efficacy (p = 0.022), and outcome expectations (p = 0.040) also retained improvements at follow-up. Quality of life, assessed using the Functional Assessment of Cancer Therapy, improved post-intervention (p < 0.001), but this improvement was not sustained at follow-up (p = 0.14). Conclusion: This physical activity intervention led to meaningful sustained improvements in physical function, waist circumference and physical activity-related psychosocial variables. Replication of these results using controlled design with larger samples sizes should be conducted to confirm these findings and determine the long-term effectiveness of physical activity interventions.

Key words:  Exercise Therapy      Exercise      Quality of life      Cancer survivors     
Submitted:  18 February 2019      Accepted:  01 April 2019      Published:  15 June 2020     
Fund: Teachers College, Columbia University Vice President’s Student Research in Diversity Grant
*Corresponding Author(s):  A. Rossi     E-mail:  amerigo.rossi@liu.edu

Cite this article: 

A. Rossi, C.E. Garber, M. Ortiz, V. Shankar, D.Y. Kuo, N.S. Nevadunsky. Sustained effects of theory-based physical activity intervention for socioeconomically diverse obese endometrial cancer survivors: A Longitudinal analysis. European Journal of Gynaecological Oncology, 2020, 41(3): 343-351.

URL: 

https://ejgo.imrpress.com/EN/10.31083/j.ejgo.2020.03.5163     OR     https://ejgo.imrpress.com/EN/Y2020/V41/I3/343

Figure 1.  - Flow diagram for study participation

Table 1  - Characteristics of 23 Endometrial Cancer Survivors at Baseline
Age (years) 64 ± 8
Body Mass Index (kg·m-2) 37 ± 6
Time Since Cancer Diagnosis (months) 32 ± 19
Stage at Cancer Diagnosis
Stage I 18 (78%)
Stage II 1 (6%)
Stage III 2 (12%)
Stage IV 2 (12%)
Race/Ethnicity
Non-Hispanic Black 9 (39%)
Hispanic 8 (35%)
Non-Hispanic White 5 (22%)
Asian 1 (4%)
Education
High School Graduate or less 8 (35%)
Some College/College Graduate 8 (35%)
Some Graduate School or
Graduate Degree
7 (30%)
Employment Status
Retired 16 (70%)
Unemployed 2 (9%)
Employed 2 (9%)
On disability 2 (9%)
Homemaker 1 (4%)
Household Income
< $40,000 10 (43%)
$40,000 - 79,999 4 (17%)
$80,000 or more 7 (30%)
No Answer 2 (9%)
Table 2  - Model predicted means, standard error and p-values over time by cohort: Physical activity, waist circumferences, physical function and quality of life at baseline, immediately following (post-intervention) and 12 weeks after (follow-up) a physical activity intervention for 21 endometrial cancer survivors.
Outcome Measure
Group
Baseline
Post-intervention Follow-up Difference
between baseline
-post intervention
p-value*
Difference
between baseline
-Follow-up
p-value*
YPAS Summary Index
Imm. Intervention 27.3 ± 5.6 69.2 ± 6.6 47.8 ±7 .3 < 0.001 0.07
Del. Intervention 57.8 ± 6.6 58.5 ±7.2 44.4 ± 8.4 1.0 0.68
Log Waist Circumference?
Imm. Intervention 3.8 ± 0.03 3.7 ± 0.03 3.7 ± 0.03 < 0.001 0.009
Del. Intervention 3.8 ± 0.03 3.7 ± 0.03 3.8 ± 0.03
6 MWT (meters)
Imm. Intervention 428 ± 22 447 ± 23 438 ± 23 < 0.001 0.042
Del. Intervention 424 ± 26 447 ± 26 439 ± 26
Chair stands (repetitions)
Imm. Intervention 11.3 ± 0.8 13.8 ± 0.9 14.0 ± 0.9 0.002 0.001
Del. Intervention 12.6 ± 0.9 13.1 ± 1.0 12.7 ± 1.1 1.0 1.0
FACT-En
Imm. Intervention 141.8 ± 3.3 152.8 ± 3.6 148.5 ± 3.9 < 0.001 0.14
Del. Intervention 143.3 ± 3.8 154.4 ± 3.9 150.0 ± 4.2
FACT-G
Imm. Intervention 86.9 ± 2.2 92.6 ± 2.5 92.1 ± 2.7 0.014 0.11
Del. Intervention 89.6 ± 2.6 95.3 ± 2.7 94.8 ± 2.9
Physical Well Being
Imm. Intervention 22.6 ± 0.7 21.9 ± 0.8 22.4 ± 0.9 0.75 1.0
Del. Intervention 21.5 ± 0.7 20.8 ± 0.8 21.3 ± 0.8
Social Well Being
Imm. Intervention 22.5 ± 1.0 24.9 ± 1.1 24.5 ± 1.2 0.027 0.22
Del. Intervention 22.9 ± 1.1 25.2 ± 1.2 24.8 ± 1.3
Emotional Well Being
Imm. Intervention 19.9 ± 0.6 22.2 ± 0.6 20.9 ± 0.7 < 0.001 0.41
Del. Intervention 22.1 ± 0.6 24.3 ± 0.7 23.0 ± 0.7
Functional Well Being
Imm. Intervention 21.8 ± 0.9 23.5 ± 1.0 24.0 ± 1.1 0.050 0.06
Del. Intervention 23.2 ± 1.1 24.9 ± 1.1 25.4 ± 1.2
Endometrial Subscale
Imm. Intervention 55.0 ± 2.0 60.3 ± 2.1 56.5 ± 2.5 < 0.001 0.91
Del. Intervention 53.7 ± 2.3 59.0 ± 2.3 55.2 ± 2.5
Table 3  - Model predicted means, standard error and p-values over time by cohort for social cognitive theory health behavior change at baseline, immediately following (post-intervention) and 12 weeks after (follow-up) a physical activity intervention for 21 endometrial cancer survivors.
Outcome Measure
Group
Baseline
Post-intervention Follow-up Difference
between baseline
-post intervention
p-value*
Difference
between baseline
-Follow-up
p-value*
Walking self-efficacy (1-5)?
Imm. Intervention 2.4 ± 0.3 3.4 ± 0.4 3.4 ± 0.4 0.001 0.022
Del. Intervention 2.6 ± 0.4 3.7 ± 0.4 3.7 ± 0.4
Barrier self-efficacy (1-5)?
Imm. Intervention 3.2 ± 0.2 3.7 ± 0.3 3.2 ± 0.3 0.26 1.0
Del. Intervention 2.9 ± 0.3 3.4 ± 0.3 2.9 ± 0.3
Self-regulation (RAI) ?
Imm. Intervention 10.4 ± 1.7 14.2 ± 1.8 12.8 ± 1.8 0.002 0.11
Del. Intervention 9.4 ± 1.9 13.2 ± 2.0 11.8 ± 2.1
Outcome Expectations (1-5) ?
Imm. Intervention 3.5 ± 0.1 3.8 ± 0.2 3.8 ± 0.2 0.030 0.040
Del. Intervention 3.5 ± 0.2 3.8 ± 0.2 3.8 ± 0.2
Social Support (20-100) ?
Imm. Intervention 32.1 ± 3.2 31.8 ± 3.8 32.2 ± 3.8 1.0 1.0
Del. Intervention 43.1 ± 3.5 42.9 ± 3.8 43.3 ± 4.1
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