Race, Age, and Obesity Disparities in Adult Physical Activity Levels in Breast Cancer Patients And Controls

Abstract

Physical activity has been shown to be inversely associated with breast cancer recurrence and survival. Although physical activity is known to decline with age, rates of change in physical activity have not been well characterized in breast cancer patients and subgroups with known disparities in breast cancer survival, especially in minorities, the elderly, and the obese. We evaluated moderate and strenuous physical activity from high school through diagnosis in 1,220 breast cancer patients, and from high school to recruitment in 935 controls. We compared the proportion of patients and controls meeting the American Cancer Society (ACS) guidelines for physical activity and differences in declines in level of physical activity by race, age, and obesity. At diagnosis, only 33.2% of breast cancer patients met the ACS physical activity guidelines. Only 13.2, 24.7, and 30.5% of African-American (AA), obese, and older (≥65 years) patients met the guidelines, respectively. Controls showed slightly higher rates, with 36.4% overall, 23.7% of AA, 29.0% of obese, and 32.4% of older women meeting the guidelines. AA patients were less likely to meet guidelines compared to White patients (p < 0.0001). Obese patients were less likely to meet guidelines compared to non-obese (p < 0.0001). We found that both moderate and strenuous physical activity declined after high school in patients and controls. AA patients reported steeper declines in strenuous (p = 0.0027), and total (p = 0.0009) physical activity compared to Whites. Obese patients reported steeper declines in total physical activity compared to non-obese (p = 0.022). Differences in average slopes of declines in physical activity were not observed by age. Our results suggest that strategies and programs to encourage women to maintain recommended levels of physical activity after high school are needed. Furthermore, breast cancer patients, particularly AA and obese patients, should be targeted to help reduce disparities.

Physical Functioning in Older Patients With Breast Cancer: A Prospective Cohort Study in the TEAM Trial

“…Furthermore, we observed a decrease in physical activity level 2 years after diagnosis compared with prediagnostic physical activity among postmenopausal patients with breast cancer. Our findings are in line with previous studies that examined physical activity among patients with breast cancer and reported a strong decline in physical activity immediately after diagnosis [15][16][17][18]. Only one study has examined physical recovery after surgery.…”

A Community-Based Exercise and Support Group Program Improves Quality of Life in African-American Breast Cancer Survivors: A Quantitative and Qualitative Analysis

“…Interestingly, a large, prospective multi-ethnic cohort study has recently shown that African-American BCa survivors that meet the recommended levels of physical activity have improved QoL [36]. As only a small percentage of African-American BCa survivors (only 12.3% in Northeast Ohio [11]) are meeting current exercise guidelines, programs encouraging physical activity at recommended levels will help improve QoL in African-American BCa survivors.…”

“…The Carolina Breast Cancer study found that African-American, compared to Caucasian women, are significantly less likely to meet national physical activity guidelines after diagnosis [10] and, the Sisters Network Inc. suggests that only 47% of African-American BCa survivors may be meeting these physical activity guidelines. Furthermore, in a recent evaluation of Northeast Ohio BCa survivors, we found steeper declines in physical activity levels after completing high school in African-American compared to Caucasian women and that only 12.3% percent of African-American BCa survivors were meeting exercise guidelines [11]. …”

Construct Validity of the Late-Life Function and Disability Instrument in African American Breast Cancer Survivors

“…However, the survival rates are not distributed uniformly among all cancer survivors, with the rates among African American women trailing behind those of other racial and ethnic groups significantly [2]. While poor screening habits and socio-demographic characteristics predispose minority women to lower survival rates [1], lifestyle characteristics (i.e., obesity, physical inactivity), and deficits in health-related quality of life may contribute equally to disparities in survival [3,4,5,6,7]. …”