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. 2021 Sep;12(7):1059-1067.
doi: 10.1016/j.jgo.2021.04.007. Epub 2021 May 7.

Body image, physical activity and psychological health in older female cancer survivors

Xiaochen Zhang  1 , Michael L Pennell  2 , Brittany M Bernardo  1 , Justin Clark  3 , Jessica L Krok-Schoen  4 , Brian C Focht  5 , Tracy E Crane  6 , Aladdin H Shadyab  7 , Electra D Paskett  8
Affiliations

Body image, physical activity and psychological health in older female cancer survivors

Xiaochen Zhang et al. J Geriatr Oncol. 2021 Sep.

Abstract

Objectives: To determine the association of physical activity and body image with psychological health outcomes and whether body image mediates the association of physical activity with psychological health among older female cancer survivors.

Materials and methods: Data from the Women's Health Initiative (WHI) Life and Longevity after Cancer (LILAC) Study were used. Surveys assessed body image (appearance, attractiveness, scars), moderate-strenuous physical activity (min/week), and psychological health (depression, anxiety, distress). A mediation analysis was conducted to estimate the percentage of the total effect of physical activity on psychological health mediated by body image concerns.

Results: Among 4567 female cancer survivors aged 66-98 years, the average time since cancer diagnosis was 9.2 years. Approximately 50% reported no moderate-strenuous physical activity; 15% reported depressive symptoms, 6% reported anxiety, and 5% reported psychological distress; 3% had concerns with appearance, 20% had concerns with attractiveness, and 21% had concerns with scars. When unadjusted for body image concerns, every 30 min/week increase in physical activity was associated with lower risk of depressive symptoms (RR = 0.93, 95%CI: 0.90-0.96), anxiety (RR = 0.92, 95%CI: 0.87-0.97), and distress (RR = 0.92, 95%CI: 0.87-0.98). Body image concerns with appearance mediated 7%, 8.8%, and 14.5% of the association between physical activity and depressive symptoms, anxiety, and distress, respectively.

Conclusion: Older female cancer survivors reported body image concerns, which were associated with both physical activity and psychological health. Our findings suggest that interventions designed to address body image concerns in older female cancer survivors could serve to improve the benefit of physical activity on psychological health.

Keywords: Body image concerns; Cancer survivorship; Mediation effect; Physical activity; Psychological health.

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Conflict of interest statement

Declaration of Competing Interest Electra Paskett would like to disclose that she has grant funding from the Merck Foundation and Pfizer. All other authors report there are no conflicts of interest.

Figures

Figure 1.
Figure 1.
Directed acyclic graph based on the hypothesis that the associations between physical activity and psychological outcomes (A: depressive symptoms, B: anxiety, C: distress) are (partly) mediated through body image concerns regarding overall appearance, adjusted for baseline covariates. Arrow from physical activity to body image concern denotes the association between physical activity and body image concerns regarding overall appearance, with estimated relative risk (RR) adjusted for baseline covariates. Arrow from body image concerns to psychological outcomes denotes the association between body image concerns regarding overall appearance and psychological outcomes, with estimated relative risk (RR) adjusted for baseline covariates. Arrow from physical activity to psychological outcomes denotes the association between physical activity and psychological outcomes, with estimated relative risk (RRM) adjusted for mediator (body image concern) and baseline covariates. % Mediated: percentage mediated by body image concern regarding overall appearance
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