Self-reported physical activity behaviour; exercise motivation and information among Danish adult cancer patients undergoing chemotherapy

Abstract

Background

Physical activity is considered an important and determining factor for the cancer patient's physical well-being and quality of life. However, cancer treatment may disrupt the practice of physical activity, and the prevention of sedentary lifestyles in cancer survivors is imperative.

Purpose

The current study aimed at investigating self-reported physical activity behaviour, exercise motivation and information in cancer patients undergoing chemotherapy.

Methods and sample

Using a cross-sectional design, 451 patients (18–65 years) completed a questionnaire assessing pre-illness and present physical activity; motivation and information received.

Results

Patients reported a significant decline in physical activity from pre-illness to the time in active treatment (p < 0.001). Amongst the respondents, 68% answered that they believed exercise to be beneficial; and 78% claimed not exercising as much as desired. Exercise barriers included fatigue (74%) and physical discomfort (45%). Present physical activity behaviour was associated with pre-illness physical activity behaviour (p < 0.001), exercise belief (p < 0.001), and diagnosis (p < 0.001). More patients <40 years than patients >40 years (OR 0.36, p < 0.001); more men than women (OR 2.12, p < 0.001); and more oncological than haematological patients (OR 0.41, p < 0.001) stated being informed about physical activity. Moreover patients who claimed to have been informed about exercise were more in agreement with being able to exercise while undergoing chemotherapy (OR 1.69, p = 0.023).

Conclusions

This study suggests that Danish adult cancer patients in chemotherapy experience a significant decline in physical activity behaviour. Results indicate a general positive interest in physical activity amongst the patients, which however may be only suboptimally exploited.

Introduction

Substantial increases in the number of cancer survivors mean that cancer must now be managed as a chronic disease, and that the community must adapt treatment for long- and short-term survivors including finding ways to modify the health behaviour of cancer survivors after diagnosis (Kuhn et al., 2005). Generally, cancer survivors who have undergone certain types of anti-neoplastic treatments are at an increased risk of developing secondary tumors, cardiovascular diseases, obesity and chronic fatigue (Demark-Wahnefried et al., 2006). These longer-term sequelae may be related to sedentary lifestyles and as such it becomes imperative, from a treatment standpoint, that physical activity as a health promoting strategy for cancer patients be fully researched and promoted.

An increasing number of cancer patients are offered chemotherapy to treat advanced stages of the disease and as adjuvant treatment after surgery or radiation (Cavalli et al., 2004). Thus, the use of chemotherapy in cancer treatment has become more prevalent while the treatment itself has advanced. The most common side-effects include fatigue, nausea and vomiting, diarrhoea, constipation, hair loss as well as muscle weakness and changes to the senses, which can be seen as significant stressors that may disrupt the practice of healthy behaviours, including exercise (Pinto et al., 2000). However, physical activity is considered an important and determining factor for the cancer patient's physical well-being and quality of life (Schmitz et al., 2005). From previous qualitative studies, we know that cancer patients of both genders and with different diagnosis may benefit from exercise during chemotherapy as a strategy to adjust their sense of physical debilitation (Adamsen et al., 2004). Furthermore recent observational studies indicate that physical activity could have a positive influence on survival following breast cancer (Holmes et al., 2005) and colon cancer (Meyerhardt et al., 2006).

However sedentary behaviour is commonly reported in cancer survivors (Pinto et al., 1998, Courneya and Friedenreich, 1997a, Courneya and Friedenreich, 1997b, Schwartz, 1998). Longitudinal studies confirm that the activity level of cancer patients one year following treatment lies substantially below the recommended activity level (Pinto et al., 2002). In a study by Pinto et al. (2002) the authors found that the average activity level in women who have completed a one-year treatment program for breast cancer was below the recommended level. Furthermore studies suggest that oncologist's recommendation to exercise and exercise discussions during cancer treatment consultations may increase exercise behaviour (Jones and Courneya, 2002a, Jones et al., 2004).

Apparently no European studies have yet highlighted the level and interest of physical activity amongst cancer patients undertaking chemotherapy across diagnoses. Although, physical activity is increasingly promoted in clinical populations, cancer patients undergoing treatment may remain an underserved and often neglected target group. The primary purpose of the present study was to examine past (pre-illness) and present (during active treatment) physical activity behaviour, exercise motivation and information amongst a representative sample of adult cancer patients receiving chemotherapy. A secondary purpose was to explore potential associations between selected background variables and (1) present physical activity behaviour and (2) information received regarding physical activity.