Authors Chipperfield K, Fletcher J, Millar J, Brooker J, Smith R, Frydenberg M, Oh T, Burney S.
Review Date August 2013
Citation Psycho-oncology. 2013 Jun 7. doi: 10.1002/pon.3310
Physical activity has been proposed as a behavioural intervention to improve health and well-being outcomes for patients with cancer. Physical activity has been associated with an improvement in overall Quality of Life (QoL) and health status in patients with cancer and cancer survivors. In numerous prostate cancer studies, results highlight the importance of physical activity in counteracting the negative side effects associated with prostate cancer treatment. Regular physical activity participation has also been demonstrated to provide improvements in QoL and psychosocial well-being. Importantly, research findings have established that physical activity can be safely tolerated in this patient group, with no reported effect on prostate-specific antigen levels, testosterone production or disease activity.
This study aimed to estimate the proportion of patients with prostate cancer meeting the National Physical Activity Guidelines of Australia (NPAGA) and determine sociodemographic and medical factors associated with meeting these guidelines. Secondary aims included examining physical activity levels by treatment type and domain (leisure, work, transport and domestic) and establishing a predictive model of the likelihood that men with prostate cancer would meet NPAGA.
A questionnaire was mailed to 638 men with prostate cancer attending for treatment at the Alfred, Cabrini or Latrobe Regional Hospitals during 2010 and 2011, with a response rate of 59%. Measures included International Physical Activity Questionnaire, Hospital Anxiety and Depression Scale, Functional Assessment of Cancer Therapy – Prostate and sociodemographic items. Data were collected over a 12-month period during 2010 and 2011.
Participant inclusion criteria was English speaking men aged 40 to 80 years, who had undergone radiotherapy between 9 and 30 months prior to the survey.
Physical activity was measured with the International Physical Activity Questionnaire (IPAQ), assessing four activity domains including work, transport, domestic and leisure time. It includes the frequency, intensity and duration of physical activity over the past 7 days.
Quality of life specific to prostate cancer and its treatment was measured using the 12-item prostate cancer subscale (PCS) of the Functional Assessment of Cancer Therapy – Prostate (FACT-P).
The Hospital Anxiety and Depression Scale (HADS) was used to assess symptoms of depression and anxiety, over the past 7 days.
Of 356 men with prostate cancer, less than half were meeting NPAGA (41.9%). Lower education and QoL, a higher number of comorbid conditions and symptoms of depression and anxiety were associated with decreased leisure-time physical activity. Patients treated with androgen deprivation therapy (ADT) were significantly less active than patients treated with radiotherapy only. Analyses indicated that the likelihood of meeting NPAGA was significantly lower with higher levels of depressive symptoms and lower levels of education.
A significant positive relationship was detected between leisure-time physical activity and QoL (p=<0.01). No relationships were found between leisure-time physical activity and time since diagnosis or age.
Meeting NPAGA is associated with higher QoL and psychosocial well-being in men with prostate cancer. These findings provide helpful information to target physical activity intervention programmes to prostate cancer survivors, suggesting that 150 minutes of moderate intensity leisure-time physical activity weekly is sufficient to improve QoL in this patient group.
Points to Note
- Due to the design of this cross-sectional study, changes in physical activity over time cannot be examined. Other longitudinal studies could provide further analyses of the physical activity and prostate cancer relationship.
- Structured physical activity regimes including resistance training elements are likely to improve QoL and survivorship outcomes in men receiving treatment for prostate cancer.
- Relationships between leisure time physical activity and comorbid conditions, depression, anxiety and QoL were significant and in the directions consistent with prior research. However, correlations were weak and should be interpreted with caution, suggesting that there are other variables associated with leisure-time physical activity not measured in the current study.
- An extensive review of the literature by the authors indicated that no prior studies had specifically examined the relationship between depression and physical activity in prostate cancer populations, and therefore, the present findings are novel.
- Participants receiving ADT were significantly less active in total physical activity compared with participants receiving radiotherapy only. However, statistically significant differences were not observed between treatment groups across individual physical activity domains (i.e. work, transport, leisure and domestic).
- With evidence suggesting that more severe treatment side-effects are linked to a reduced likelihood of physical activity participation, it is plausible that the additional adverse effects associated with ADT affect the ability of patients to participate in regular physical activity.
- Physical activity interventions need to include an education component emphasising the value, health benefits and optimal levels of physical activity for prostate cancer survivors.