Patterns and determinants of adherence to resistance and endurance training during cancer treatment in the Phys-Can RCT

Abstract

Background: Knowledge regarding adherence is necessary to improve the specificity of exercise interventions during cancer treatment. We aimed to determine adherence to resistance and endurance training interventions in parallel; identify subgroups with similar adherence characteristics; and examine determinants of these subgroups.

Methods: In the Phys-Can randomised controlled trial, participants (n = 577, 81% women, mean(SD) age 59(12) years, and 50% with BMI ≥ 25 kg/m²) starting (neo-) adjuvant treatment for breast, colorectal or prostate cancer were randomized to 6-month of high (HI) or low-to-moderate intensity (LMI) supervised, group-based resistance training and individual home-based endurance training, with or without behavior change support. Adherence was calculated as performed exercise volume as a proportion of prescribed exercise volume (0-100%), overall (HI and LMI groups) and for frequency, intensity, type and time (FITT principles) (HI group). Adherence to resistance training was plotted against adherence to endurance training overall and for each FITT principle. K-means cluster analysis was used to identify subgroups with similar adherence characteristics. Potential determinants of subgroup membership were examined using multinomial logistic regression.

Results: We found a positive curvilinear correlation between adherence to resistance and endurance training overall. A similar correlation was seen for adherence to frequency of resistance vs. endurance training in the HI group. In the HI group, adherence to resistance training intensity and time was > 80% for almost all participants. For endurance training adherence ranged from 0 to 100% for each of the FITT principles. Three clusters were identified, representing low, mixed, and high adherence to resistance and endurance training overall. Participants with higher age (Relative risk ratio [95% CI]; LMI: 0.86[0.77-0.96], HI: 0.83[0.74-0.93]), no behaviour change support (LMI: 0.11[0.02-0.56], HI: 0.20[0.05-0.85]), higher cardiorespiratory fitness (LMI: 0.81[0.69-0.94], HI: 0.80[0.69-0.92]), more fatigue (according to the reduced activity subscale of the MFI questionnaire) (LMI: 0.48[0.31-0.73], HI: 0.69[0.52-0.93]) or higher quality of life (LMI: 0.95[0.90-1.00], HI: 0.93[0.88-0.98]) were less likely to be in the low than the high adherence cluster whether randomised to LMI or HI training. Other determinants were specific to those randomised to LMI or HI training.

Conclusions: In an exercise intervention during cancer treatment, adherence to resistance and endurance training were positively correlated. Personalisation of interventions and additional support for some subgroups of participants may improve adherence. Trial registration NCT02473003 (clinicaltrials.gov, Registered 16/06/2015).

Keywords: Adherence; Cancer; Determinants; Endurance training; Exercise; FITT principles; Patterns; Resistance training.

Fig. 1

CONSORT flow chart showing flow of participants through to randomisation in the Phys-Can study. HI, high intensity; L-MI, low-to-moderate intensity, BCS; behaviour change support

Fig. 2

The correlation between adherence to resistance training overall and adherence to endurance training overall. NB. Cubic splines were fitted with 5 cross-median knots to illustrate the relationship between overall adherence to resistance training and overall adherence to endurance training for each training intensity group

Fig. 3

Correlation between adherence to resistance training and endurance training frequency FITT principles. Figure shows the correlation between adherence to resistance training and endurance training frequency (A), intensity (B), time (C), and type (D) (FITT principles) for participants randomised to high intensity training (n = 288). NB. Cubic splines were fitted with 5 cross-median knots to illustrate the relationship between adherence to prescribed frequency of resistance training and adherence to prescribed frequency of endurance training

Fig. 4

Patterns of adherence to resistance and endurance training frequency, intensity, time, and type for participants randomised to high intensity training (n = 288). NB. Each’slice’ of the figure represents the proportion of participants with a specific combination of adherence levels for the four FITT principles, for example, 18.8% of participants had 0–25% adherence to all four FITT principles for resistance training, while 3.5% of participants had 0–25% adherence to the prescribed resistance training frequency but 75–100% adherence to the prescribed resistance training intensity, time and type. Blue segments represent 0–25% adherence, orange segments represent > 25–50% adherence, grey segments represent > 50–75% adherence, and yellow segments represent > 75–100% adherence

Fig. 5

Adherence clusters based on overall adherence within each training intensity group. Orange points represent cluster 1, i.e. individuals within the low adherence to endurance training and/or resistance training; green points represent cluster 2, i.e. individuals with low-to-moderate adherence to endurance training and moderate-to-high adherence to resistance training; grey points represent cluster 3, i.e. individuals with high adherence to endurance training and moderate-to-high adherence to resistance training