Effect of Exercise vs. Attention-Control on Depression Symptomatology in Ovarian Cancer Survivors: The Women's Activity and Lifestyle Study in Connecticut (WALC)

Background: With no effective screening tool, ovarian cancer survivors often suffer from unpleasant treatment-related side effects that influence quality of life. Increased physical activity has been associated with lower depression scores in ovarian cancer survivors. However, to date, no randomized controlled trial assessing the effect of exercise on depression has been conducted in this population. The Women’s Activity and Lifestyle Study in Connecticut (WALC) was a randomized trial examining the impact of exercise vs. attention-control on quality of life, body composition, and cancer biomarkers in ovarian cancer survivors. This analysis examined the effect of exercise on depression scores. Methods: We enrolled 144 physically inactive (< 90 minutes per week of exercise) ovarian cancer survivors who had been diagnosed within the past 4 years and completed initial chemotherapy into a six-month randomized controlled trial. Women randomized to the exercise intervention arm (n = 74) received 25 weekly phone calls from a certified cancer exercise trainer and were counseled on increasing their physical activity to 150 minutes per week of home-based aerobic exercise. Women randomized to the attention-control arm (n = 70) also received 25 weekly phone calls to discuss relevant health topics. Depression symptomatology was measured via the Center for Epidemiologic Studies Depression Scale (CES-D) at baseline and six-months. Student’s t-test and generalized linear models were used to compare changes in depression from baseline to six-months between the two arms. Results: All baseline characteristics were similar between the two arms. Adherence to both the exercise intervention and attendance to the weekly calls was outstanding with women on the exercise intervention arm exercising an average of 166 minutes per week and >70% of women on both arms attending > 20 calls. At baseline 39 women (27%) had a CES-D score greater than 16, indicating depressive symptomatology. CES-D scores decreased in women on the exercise intervention arm by an average of 2.2 ± 7.0 points (17% decrease) compared to an increase of 0.4 ± 5.6 points (4% increase) in women randomized to the attention-control arm (p = 0.02). A dose-response inverse relation of exercise with CES-D score was also observed (p < 0.01). Conclusions: Ovarian cancer ABSTRACT Background: With no effective screening tool, ovarian cancer survivors often suffer from unpleasant treatment-related side effects that influence quality of life. Increased physical activity has been associated with lower depression scores in ovarian cancer survivors. However, to date, no randomized controlled trial assessing the effect of exercise on depression has been conducted in this population. The Women’s Activity and Lifestyle Study in Connecticut (WALC) was a randomized trial examining the impact of exercise vs. attention-control on quality of life, body composition, and cancer biomarkers in ovarian cancer survivors. This analysis examined the effect of exercise on depression scores. Methods: We enrolled 144 physically inactive (< 90 minutes per week of exercise) ovarian cancer survivors who had been diagnosed within the past 4 years and completed initial chemotherapy into a six-month randomized controlled trial. Women randomized to the exercise intervention arm (n = 74) received 25 weekly phone calls from a certified cancer exercise trainer and were counseled on increasing their physical activity to 150 minutes per week of home-based aerobic exercise. Women randomized to the attention-control arm (n = 70) also received 25 weekly phone calls to discuss relevant health topics. Depression symptomatology was measured via the Center for Epidemiologic Studies Depression Scale (CES-D) at baseline and six-months. Student’s t-test and generalized linear models were used to compare changes in depression from baseline to six-months between the two arms. Results: All baseline characteristics were similar between the two arms. Adherence to both the exercise intervention and attendance to the weekly calls was outstanding with women on the exercise intervention arm exercising an average of 166 minutes per week and >70% of women on both arms attending > 20 calls. At baseline 39 women (27%) had a CES-D score greater than 16, indicating depressive symptomatology. CES-D scores decreased in women on the exercise intervention arm by an average of 2.2 ± 7.0 points (17% decrease) compared to an increase of 0.4 ± 5.6 points (4% increase) in women randomized to the attention-control arm (p = 0.02). A dose-response inverse relation of exercise with CES-D score was also observed (p < 0.01). Conclusions: Ovarian cancer analysis was performed using the intent-to-treat principle in order to assess significant differences in CES-D score between the baseline and six-month study visits. For those women who did not complete the six-month assessment of depressive symptomatology, the change in CES-D was imputed as 0. Potential covariates included baseline CES-D score, cancer stage, age, time since diagnosis, history of recurrence prior to enrollment, and recurrence of cancer during the study period. on a sub-group analysis randomized arm We examined the impact of exercise on depressive symptomatology by comparing the self-reported an of at 150 minutes of exercise per week and those that did not. Among all participants, we examined the impact of attendance to the weekly telephone calls on depressive symptomatology. Lastly, we performed a stratified analysis to evaluate effect modification by depressive symptomatology at baseline, cancer stage, age, cancer recurrence prior to enrollment and during the study period, attendance to weekly telephone calls, and exercise adherence. All statistical analysis was conducted using SAS, Version 9.3 (SAS, Cary, NC) with a two-sided 0.05 significance level.