Response to an exercise intervention after endometrial cancer: differences between obese and non-obese survivors

Abstract

Objective: The objective of this paper is to describe baseline differences between obese and non-obese endometrial cancer survivor in anthropometrics, exercise behavior, fitness, heart rate and blood pressure, and quality of life, and to analyze whether the effect of a home-based exercise intervention on these outcomes differed for obese and non-obese participants.

Methods: One hundred post-treatment Stage I-IIIa endometrial cancer survivors participated in a single arm 6month study in which they received a home-based exercise intervention. Cardiorespiratory fitness, anthropometrics, and exercise behavior were measured every two months, and quality of life (QOL) and psychological distress were measured at baseline and 6months.

Results: Adjusting for potential confounders, at baseline obese survivors had poorer cardiorespiratory fitness (p=.002), higher systolic blood pressure (p=.018), and lower physical functioning (p<.001) and ratings of general health (p=.002), and more pain (p=.037) and somatization (.002). Significant improvements were seen in exercise behavior, resting heart rate, systolic blood pressure, and multiple QOL domains over the course of the intervention. Obese survivors had less improvement in exercise behavior and cardiorespiratory fitness than non-obese survivors, but there were no differences with regard to improvements in QOL and stress.

Conclusions: Home based exercise interventions are beneficial to endometrial cancer survivors, including those whose BMI is in the obese range. While obese survivors have lower levels of physical activity and fitness, they experienced similar activity, fitness, quality of life and mental health benefits. Exercise should be encouraged in endometrial cancer survivors, including those who are obese.

Keywords: Cardiorespiratory fitness; Endometrial cancer; Exercise; Intervention; Obesity; Quality of life.

Figure 1. Adjusted¹ means for minutes of exercise per day, and percentage of participants meeting physical activity recommendations (≥150 minutes of moderate to vigorous intensity physical activity [MVPA] per week) by assessment time²

¹ Adjusted for age, education, race, time since diagnosis, disease stage, and treatment type (surgery, surgery plus radiation, or surgery plus other treatment). Adjusted means are based on a repeated measures model where observations are nested within individuals and assessment time. Time trend effects were not examined in this model. ²Minutes of activity was measured pre and post lab assessment for each assessment time. Participants were given recommendation for exercise after their baseline lab assessment. Hence, minutes of activity measured pre lab (true baseline) and post lab (during intervention period) are both considered in the model. Thus, five time points are considered for the minutes of activity repeated measures model (baseline pre lab, baseline post lab, month 2, month 4, and month 6).