Pradhan Kamnesh R, Stump Timothy E, Monahan Patrick, Champion Victoria
Department of Pediatric Hematology-Oncology, Indiana University School of Medicine, Indianapolis, IN, USA.
Psychooncology. 2015 Mar;24(3):325-32. doi: 10.1002/pon.3598. Epub 2014 Jun 17.
Although regular physical activity is associated with lower all-cause and disease-specific mortality among breast cancer survivors (BCS), most BCS do not meet its recommended guidelines. Attention function, a domain of cognition, is essential for daily tasks such as exercising, a form of planned physical activity. We tested the hypotheses that lower self-reported attention function in BCS would be associated with less exercise and higher body mass index (BMI) by comparing a group of 505 young BCS (45 years or younger at diagnosis and 3-8 years post-treatment) with 466 acquaintance controls (AC).
The groups were compared on self-reported physical and psychological outcomes. Mplus software was used to perform confirmatory structural equation modeling with a robust maximum likelihood estimator to evaluate hypothesized relationships among variables. The criteria for good model fit were having root mean square error of approximation (RMSEA) < 0.06, comparative fit index (CFI) > 0.95, and standardized root mean square residual (SRMR) < 0.08. Modification indices were used to better fit the model.
The final model demonstrated good fit, with RMSEA = 0.05, CFI = 0.98, and SRMR = 0.03. After controlling for demographics, parameter estimates revealed that, compared with AC, young BCS reported worse attention function (p < 0.001), more depressive symptoms (p < 0.001), and more fatigue (p < 0.001). Controlling for fatigue, depression, and anxiety, better attention function was associated with a greater likelihood of exercise in the past 3 months (p = 0.039), which in turn was associated with a lower BMI (p < 0.001).
The significant association between attention function and physical activity, if confirmed in a longitudinal study, will provide new targets for interventions aimed at improving physical activity and decreasing BMI among BCS.
尽管规律的体育活动与乳腺癌幸存者（BCS）全因死亡率和疾病特异性死亡率降低相关，但大多数BCS未达到推荐的指导方针。注意力功能作为认知的一个领域，对于诸如锻炼（一种有计划的体育活动形式）等日常任务至关重要。通过比较一组505名年轻BCS（诊断时年龄为45岁或以下且治疗后3 - 8年）与466名熟人对照（AC），我们检验了以下假设：BCS中自我报告的注意力功能较低与较少的锻炼及较高的体重指数（BMI）相关。
比较两组在自我报告的身体和心理结果方面的情况。使用Mplus软件，采用稳健最大似然估计器进行验证性结构方程建模，以评估变量之间的假设关系。良好模型拟合的标准为近似均方根误差（RMSEA）<0.06、比较拟合指数（CFI）>0.95以及标准化均方根残差（SRMR）<0.08。使用修正指数来更好地拟合模型。
最终模型显示拟合良好，RMSEA = 0.05，CFI = 0.98，SRMR = 0.03。在控制人口统计学因素后，参数估计显示，与AC相比，年轻BCS报告的注意力功能较差（p < 0.001）、抑郁症状更多（p < 0.001）以及疲劳更多（p < 0.001）。在控制疲劳、抑郁和焦虑后，更好的注意力功能与过去3个月内锻炼的可能性更大相关（p = 0.039），而这又与较低的BMI相关（p < 0.001）。
注意力功能与身体活动之间的显著关联若在纵向研究中得到证实，将为旨在改善BCS身体活动和降低BMI的干预措施提供新的靶点。
