Department of Family Medicine, Case Western Reserve University , Cleveland, OH , USA ; Department of Epidemiology and Biostatistics, Case Western Reserve University , Cleveland, OH , USA ; Case Comprehensive Cancer Center, Case Western Reserve University , Cleveland, OH , USA.
Case Comprehensive Cancer Center, Case Western Reserve University , Cleveland, OH , USA ; Department of Medicine, Case Western Reserve University , Cleveland, OH , USA.
Front Public Health. 2014 Sep 19;2:150. doi: 10.3389/fpubh.2014.00150. eCollection 2014.
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.
身体活动与乳腺癌复发和生存呈负相关。虽然已知随着年龄的增长身体活动会减少，但在乳腺癌患者和具有已知乳腺癌生存差异的亚组（尤其是少数族裔、老年人和肥胖者）中，身体活动的变化率尚未得到很好的描述。我们评估了 1220 名乳腺癌患者从高中到诊断时以及 935 名对照者从高中到入组时的中度和剧烈身体活动。我们比较了符合美国癌症协会（ACS）身体活动指南的患者和对照者的比例，以及按种族、年龄和肥胖程度划分的身体活动水平下降差异。在诊断时，只有 33.2%的乳腺癌患者符合 ACS 身体活动指南。分别只有 13.2%、24.7%和 30.5%的非裔美国人（AA）、肥胖和年龄≥65 岁的患者符合该指南。对照组的比例稍高，分别为 36.4%、23.7%、29.0%和 32.4%。与白人患者相比，AA 患者不太可能符合指南（p<0.0001）。与非肥胖患者相比，肥胖患者不太可能符合指南（p<0.0001）。我们发现，患者和对照组在高中毕业后身体活动的中高强度活动都有所减少。与白人患者相比，AA 患者报告剧烈（p=0.0027）和总（p=0.0009）身体活动减少更明显。与非肥胖患者相比，肥胖患者报告总身体活动减少更明显（p=0.022）。在身体活动减少的平均斜率方面，年龄没有差异。我们的研究结果表明，需要制定策略和方案，鼓励女性在高中毕业后保持推荐的身体活动水平。此外，应针对乳腺癌患者，特别是 AA 和肥胖患者，帮助减少差异。
