Attendance and compliance with an exercise program during localized breast cancer treatment in a randomized controlled trial: The PACT study

Abstract

Purpose Maintaining high adherence rates (session attendance and compliance) in exercise programs during breast cancer treatment can be challenging. We aimed to identify adherence rates and predictors to an exercise program during adjuvant breast cancer treatment. Methods Ninety-two patients with localized breast cancer undergoing chemotherapy were randomly assigned to an 18-week supervised moderate-to-high intensity aerobic and resistance exercise program, including two 1-hour sessions/week. Additionally, participants were asked to be physically active for at least 30 minutes/day on at least three other days. We report median percentages for attendance, compliance with the prescribed duration and intensity of aerobic and muscle strength exercises, and the exercise advice given. Predictors included in univariate and multivariable linear regression models were demographical, tumor- and treatment-related factors, constructs of the theory of planned behavior, psychological and physical factors. Results Patients attended 83% (interquartile range: 69–91%) of the supervised sessions. Compliance with the duration of aerobic exercise, high-intensity aerobic exercise (cycling at the ventilatory threshold), muscle strength exercises and the exercise advice were 88%(64–97%), 50%(22–82%), 84%(65–94%) and 61%(33%–79%), respectively. Education, radiotherapy, BMI and physical fatigue were important predictors of adherence to supervised exercise. Beliefs about planned behaviors were important predictors, especially for compliance with the exercise advice. Conclusions Attendance to and compliance with an 18-week aerobic and strength exercise program were high. The lowest compliance was found for high-intensity supervised aerobic exercise. The identified predictors should be considered when designing or adapting exercise programs for patients with localized breast cancer to increase adherence. Trial registration Current Controlled Trials ISRCTN43801571 Dutch Trial Register NTR2138

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“…Again, this finding is consistent with trends in the general population, [59,60] as well as with a number of intervention studies that found that oncology patients with more education had higher rates of adherence with prescribed exercise regimens. [61][62][63] The complex relationship between education and health, often referred to as an education gradient, is partially explained by the idea that individuals with more years of education have higher incomes that provide increased access to resources (e.g., gym memberships); afford more time for health-related activities; and provide access to social networks that can amplify health behaviors like exercise. [60,64,65] This hypothesis is consistent with our findings that a significantly higher percentage of patients in the NoEx were less likely to be employed and reported a lower annual household income.…”

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“…It was expressed both as attendance and compliance rates. 19 Attendance rates were computed for each patient as the number of sessions completed, divided by the number of planned sessions attended. Compliance rates were defined in terms of the duration and prescribed intensity of the aerobic training and were rated as the percentage of sessions performed reaching the goal of 30 minutes training (compliance with duration) and the percentage performed at an intensity between 64% and 76% of maximal heart rate (compliance with prescribed intensity).…”

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“…Lastly, a large portion of our study sample (nearly 40%) had elementary education or was illiterate. Since educational level was found to be a significant predictor for exercise compliance in cancer patients [ 51 ], a low level of education in a large portion of the patients may reduce the exercise compliance in the present study. Further studies are needed to investigate exercise compliance across patients with different sociodemographic characteristics.…”