Physician Role in Physical Activity for African-American Males Undergoing Radical Prostatectomy for Prostate Cancer

Purpose Physical activity is recognized as a complementary therapy to improve physical and physiological functions among prostate cancer survivors. Little is known about communication between health providers and African-American prostate cancer patients, a high risk population, regarding the health benefits of regular physical activity on their prognosis and recovery. This study explores African-American prostate cancer survivors’ experiences with physical activity prescription from their physicians. Methods Three focus group interviews were conducted with 12 African-American prostate cancer survivors in May 2014 in St. Louis, MO. Participants’ ages ranged from 49 to 79 years, had completed radical prostatectomy, and their time out of surgery varied from 7 to 31 months. Results Emerged themes included physician role on prescribing physical activity, patients’ perceived barriers to engaging in physical activity, perception of normalcy following surgery, and specific resources survivors’ sought during treatment. Of the 12 men who participated, 8 men (67%) expressed that their physicians did not recommend physical activity for them. Although some participants revealed they were aware of the importance of sustained physical activity on their prognosis and recovery, some expressed concerns that urinary dysfunction, incontinence, and family commitments prevented them from engaging in active lifestyles. Conclusions Transitioning from post radical prostatectomy treatment to normal life was an important concern to survivors. These findings highlight the importance of physical activity communication and prescription for prostate cancer patients

One-year urinary and sexual outcome trajectories among prostate cancer patients treated by radical prostatectomy: A prospective study

BACKGROUND: To examine one-year trajectories of urinary and sexual outcomes, and correlates of these trajectories, among prostate cancer patients treated by radical prostatectomy (RP). METHODS: Study participants were recruited from 2011 to 2014 at two US institutions. Self-reported urinary and sexual outcomes were measured at baseline before surgery, and 5 weeks, 6 months and 12 months after surgery, using the modified Expanded Prostate Cancer Index Composite-50 (EPIC-50). Changes in EPIC-50 scores from baseline were categorized as improved (beyond baseline), maintained, or impaired (below baseline), using previously-reported minimum clinically important differences. RESULTS: Of the 426 eligible participants who completed the baseline survey, 395 provided data on at least one EPIC-50 sub-scale at 5 weeks and 12 months, and were analyzed. Although all mean EPIC-50 scores declined markedly 5 weeks after surgery and then recovered to near (incontinence-related outcomes) or below (sexual outcomes) baseline levels by 12 months post-surgery, some men experienced improvement beyond their baseline levels on each sub-scale (3.3-51% depending on the sub-scale). Having benign prostatic hyperplasia (BPH) at baseline (prostate size ≥ 40 g; an International Prostate Symptom Index Score ≥ 8; or using BPH medications) was associated with post-surgical improvements in voiding dysfunction-related bother at 5 weeks (OR = 3.9, 95% CI: 2.1-7.2) and 12 months (OR = 3.3, 95% CI: 2.0-5.7); and in sexual bother at 5 weeks (OR = 5.7, 95% CI:1.7-19.3) and 12 months (OR = 3.0, 95% CI: 1.2-7.1). CONCLUSIONS: Our findings provide additional support for considering baseline BPH symptoms when selecting the best therapy for early-stage prostate cancer

Physical activity modifies the association between depression and cognitive function in older adults

Objective: To examine the effects of gender and physical activity on the interplay between depression and cognitive function in late adulthood. Method: Data on physical activity, depressive symptoms, two measures of cognitive function (the Animal Fluency Test (AFT) and the Digital Symbol Substitution Test (DSST)), and other demographic characteristics were extracted from 2,604 adults aged ≥ 60 years participating in the National Health and Nutrition Examination Survey (2011-2014). Gender-specific multiple linear regressions examined the relationship between depressive symptoms and cognitive function in the overall sample and stratified by level of leisure-time physical activity. Results: Sample included 1327 women and 1277 men (mean age 69.0 years), Women with moderate to severe depressive symptoms had a 1.7 (95% CI: 0.5 to 2.9) point lower score on the AFT than those with none or minimal depressive symptoms. No such association was observed in men. In the stratified analyses, lower AFT test scores only persisted among women who were inactive. With respective to the DSST, lower test scores were observed in in both men (-7.2, 95% CI: -13.1 to -1.3) and women (-6.4, 95% CI: -11.8 to -1.1) with moderate to severe depressive symptoms. In the stratified analyses, this association persisted in those who were insufficiently active, but attenuated to null among those engaged in sufficient physical activity. Conclusions: Moderate-to-vigorous physical activity modifies the depression-cognition relationship and preserves cognition function. Engaging in sufficient (150 min/week) leisure-time physical activity at moderate-to-vigorous intensity may protect those with depressive symptoms from cognitive decline in older age

Levels and patterns of self-reported and objectively-measured free-living physical activity among prostate cancer survivors: a prospective cohort study

Background: No prior study has measured or compared self-reported and objectively-measured physical activity trajectories in prostate cancer survivors before and after treatment. Methods: Clinically-localized prostate cancer patients treated with radical prostatectomy were recruited from 2011-2014. Of the 350 participants enrolled at the main site, 310 provided self-reported physical activity at baseline before radical prostatectomy, and 5 weeks, 6 months, and 12 months post-radical prostatectomy. A subset of participants (n=81) provided objectively-measured physical activity at all study time points by wearing an accelerometer for seven days each. Changes in activity over time were compared using Friedman’s test. Agreement between self-reported and objective measures was evaluated using Spearman’s rank correlation coefficient. Results: Self-reported moderate-to-vigorous physical activity was high at baseline (median=32.1 minutes/day), followed by a decline at 5 weeks (15.0 minutes/day) and a recovery at 6 and 12 months (32.1-47.1 minutes/day). In contrast, objectively-measured moderate-to-vigorous physical activity was low at all four time points (median=0.0-5.2 minutes/day), with no overall change across study assessments (global p=0.29). Self-reported moderate-to-vigorous physical activity tended to be more closely related to objectively-measured light intensity physical activity (rho=0.29-0.42) than to objectively-measured moderate-to-vigorous physical activity (rho=0.07-0.27, p=0.009-0.32). Conclusions: In our population of prostate cancer survivors with critically low moderate-to-vigorous physical activity levels, self-reported measures greatly overestimated moderate-to-vigorous physical activity and may have been more reflective of light intensity physical activity. As cancer survivor guidelines were derived from self-reported data, our findings may imply that intensities of physical activity below moderate, such as light intensity, still have health benefits