Psychosocial health is associated with objectively assessed sedentary time and light intensity physical activity among lung cancer survivors

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Highlights

  • This study examines objectively assessed physical activity and sedentary time among lung cancer survivors.

  • Sedentary time and light intensity activity were significantly associated with psychosocial health.

  • Future studies may want to examine ways to facilitate a shift from sedentary time to light intensity activity.

Abstract

Statement of problem

Lung cancer survivors report among the highest levels of depression and anxiety compared to other tumor groups. To date, no studies have examined associations of accelerometer-assessed activity and sedentary time with psychosocial health outcomes among lung cancer survivors. The objective of this study was to determine associations of accelerometer-assessed light intensity physical activity, moderate-to-vigorous intensity physical activity (MVPA), and sedentary time with psychosocial health among lung cancer survivors.

Method

Lung cancer survivors in Southern Alberta completed a mailed survey that assessed measures of depressive symptoms (PHQ-9; Patient Health Questionnaire-9: range = 0-27), anxiety (State Anxiety Inventory: range = 10-40), satisfaction with life (SWL; Satisfaction With Life Scale: range = 5-35), and posttraumatic growth (PTG; Posttraumatic Growth Inventory: range = 0-105). Participants also wore an Actigraph® GT3X + accelerometer for seven days. Quantile regression was used to examine associations of depression, anxiety, SWL, and PTG with light intensity physical activity, MVPA, and sedentary time.

Results

A total of 127 lung cancer survivors participated for a 24% response rate. Total sedentary time min/day was associated with depressive symptoms at the 50th percentile (β = 0.02, 95% CI: 0.0–0.03), SWL at the 25th percentile (β = -0.04, 95% CI: -0.07-0.0) and 50th percentile (β = -0.03, 95% CI: -0.05 to -0.01). Total light-intensity physical activity mins/day was associated with SWL at the 25th (β = 0.04, 95% CI: 0.00–0.07) and 50th (β = 0.03, 95% CI: 0.0–0.05) percentiles, and depressive symptoms at the 50th percentile (β = -0.02, 95% CI: -0.03-0.00). Total MVPA min/day was not associated with any psychosocial health outcomes.

Conclusions

Sedentary time and light intensity physical activity were significantly associated with some psychosocial health outcomes. Reducing sedentary time and increasing light intensity physical activity may be a more appropriate recommendation for many lung cancer survivors given their older age, poorer functional status, and reduced pulmonary capacity.

Introduction

Lung cancer is the leading cause of cancer death for both men and women in the United States. Five-year survival rates remain low and survival has not improved significantly despite newer therapies (Wang et al., 2015). Depression and anxiety are common comorbidities among individuals diagnosed with lung cancer. Recent population-based estimates indicating lung cancer survivors report among the highest levels of depression and anxiety compared to other cancer groups (Jensen et al., 2017).

A small body of literature indicates regular and sustained moderate to vigorous physical activity (MVPA) is associated with better patient reported outcomes such as health-related quality of life and reduced fatigue among lung cancer survivors (Coups et al., 2009). However these studies have relied on self-reported estimates of physical activity, which may have a substantial impact on observed levels of physical activity given self-reported assessment of activity may be prone to recall error and over-reporting (Ainsworth et al., 2012). Our previous research reported lung cancer survivors spend the majority of their waking hours in sedentary pursuits (D'Silva et al., 2017) [behaviours that are performed in a seated or reclining posture and require very low energy expenditure (≤1.5 metabolic equivalents)].

To date, no studies have examined associations of accelerometer-assessed activity and sedentary time with psychosocial health outcomes in this population. The primary objective of this study was to determine the associations of objectively-assessed sedentary time, light intensity physical activity, and MVPA with psychosocial health outcomes including depression symptoms, anxiety symptoms, satisfaction with life, and post traumatic growth among lung cancer survivors.

Section snippets

Participants

The study was approved by the Health Research Ethics Board of Alberta and the Athabasca University Research Ethics Board. All lung cancer survivors were recruited from the Glans-Look Lung Cancer Database at the University of Calgary. The Glans-Look Database includes comprehensive medical information on all NSCLC patients diagnosed from 1999 to 2014 in Southern Alberta. Eligibility criteria for this study included (a) previous clinical and/or pathological diagnosis of NSCLC confirmed by chart

Participant characteristics

A total of 527 patients in the Glans-Look Registry satisfied the study eligibility requirements and were mailed a study invitation. Of these patients, 127 (24%) completed the study. Comparing the responders to those who did not respond, there were no significant differences in age, sex, or months since diagnosis.

Demographic and clinical characteristics of the sample are reported in Table 1. The mean age of the sample was 71 years (SD = 10.3) and 57% were female. The mean number of months since

Discussion

To our knowledge, this is the first study to examine associations of accelerometer-assessed light intensity and sedentary time among lung cancer survivors. We reported light intensity physical activity was significantly associated with SWL among survivors in the 50th percentile of SWL scores. Further, sedentary time was associated with depressive symptoms and SWL among survivors in the 50th percentile of the depressive symptom and SWL distributions. This suggests that associations appear

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