Objective Assessment of Physical Activity in Breast Cancer Survivors: Associations With Adiposity and Metabolic Parameters of Glucose and Insulin-Insights From NHANES

Abstract

Background: Physical activity (PA) is a modifiable lifestyle factor strongly linked to adiposity and metabolic health. Breast cancer survivors are at a higher risk of obesity-related metabolic complications, negatively impacting prognosis and quality of life. Therefore, updated objective assessments of PA and its effects on metabolic health are critical to improving survivorship care.

Aims: To analyze the most recent nationally representative sample of the US population where physical activity was objectively measured to identify associations between PA, adiposity measures, and metabolic health parameters among cancer survivors, specifically breast cancer survivors.

Methods and results: NHANES data from 2011 to 2014 is used to examine associations between PA, adiposity measures, and metabolic parameters in women aged 20 and older. PA is objectively measured using accelerometer data. Adiposity is assessed via sagittal abdominal diameter (SAD), waist circumference (WC), and body mass index (BMI), and the metabolic parameters are glucose and insulin. The analysis involved regressing the natural logarithms of SAD, WC, BMI, glucose, and insulin on moderate-to-vigorous and sedentary PA levels. The sample consisted of 4068 participants, including 397 with cancer diagnoses and 118 with breast cancer. Additionally, factors such as ethnicity, education, income, age, energy intake, diabetes, and smoking habits were considered. The associations between adiposity measures and excess daily sedentary PA are stronger for breast cancer survivors compared to all women and cancer survivors, with statistically significant results for SAD. SAD directly assesses visceral fat and is more closely linked to metabolic and cardiovascular risks. While moderate-to-vigorous PA is associated with decreased adiposity for all women, the decrease is less pronounced among cancer survivors. Daily moderate-to-vigorous PA has a significant and negative correlation with glucose and insulin levels, whereas sedentary PA has a positive correlation. The associations of PA with metabolic parameters in breast cancer survivors are similar to those in all women and cancer survivors.

Conclusion: This study provides an updated objective assessment of PA in breast cancer survivors using the most recent NHANES survey cycles, where this data was collected. The results confirm rising obesity rates among breast cancer survivors, highlighting the need for ongoing monitoring of adiposity. The results suggest that engaging in daily moderate-to-vigorous PA significantly lowers glucose and insulin levels, which are crucial for metabolic health. Given its modifiable nature, PA can be a valuable intervention for breast cancer patients, emphasizing the importance of its assessment. Implementing lifestyle changes that prioritize PA and targeted interventions to manage SAD is essential, as reducing sedentary behavior can lead to improved health outcomes with significant public health implications.

Keywords: NHANES; body mass index (BMI); breast cancer; cancer survivors; glucose and insulin metabolism parameters; machine learning; physical activity; sagittal abdominal diameter (SAD); waist circumference (WC).