Abstract PO4-12-09: National Physical Activity Guidelines and It’s Association with Fatigue in Patients with Breast Cancer Pre- and Post-Chemotherapy in a Prospective, Nationwide Study
Authors: Mattick Lindsey , Sun Hongying , Mustian Karen , Peppone Luke , Williams AnnaLynn , Lin Po-Ju , Arana Evelyn , McGuire Jeremy , Curtis Amarinthia , Conlin Alison , Weiselberg Lora , Janelsins Michelle 
Published: May 2024

Abstract
Background: Cancer-related fatigue (CRF) is one of the most pervasive side effects of cancer and its treatment, reported by nearly 90% of patients. Physical activity (PA) during treatment may prevent or lessen CRF burden. Current aerobic PA guidelines for cancer patients recommend at least 150 minutes of moderate PA or 75 minutes of vigorous PA or some equivalent combination of moderate and vigorous PA (MVPA). Many patients have difficulty meeting these guidelines during treatment, however, meeting these guidelines may not be necessary to alleviate CRF. This study evaluated patterns of PA below the recommended guidelines and their association with CRF in cancer patients during treatment.
Methods: In a nationwide, prospective cohort study of patients with stage I-IIIC breast cancer (n=580) we assessed the relationship between self-reported PA (Aerobics Center Longitudinal Study PA) and CRF (Multidimensional Fatigue Symptom Inventory, MFSI) pre- and post-chemotherapy. Spearman correlations were utilized to evaluate the association of all PA (MET hr/wk) and MVPA (MET hr/wk) with overall CRF (total MFSI) and 5 CRF subdimensions (general, physical, emotional, mental CRF and vigor) at pre- and post-chemotherapy. ANCOVA estimated mean CRF score according to whether patients weekly MVPA (1) met 100% of the PA guidelines, (2) met 50%-99% of the PA guidelines (75-149 minutes), or (3) did not meet 50% of the PA guidelines (&lt; 75 minutes).
Results: Pre-chemotherapy, only 34% of participants met the PA guidelines, post-chemotherapy, only 21% of patients met the PA guidelines. At both time points, we observed small to moderate inverse correlations of MVPA with overall CRF and several subdimensions of CRF (Table 1; r = -0.11, -0.19). Pre-chemotherapy, those who did not meet 50% of the PA guidelines report significantly higher total CRF compared to those who met the PA guidelines (12.5 ± 1.2 vs 5.3 ± 1.5; p&lt; 0.001). However, those who met only 50%-99% of the PA guidelines, had comparable total CRF to those who fully met the PA guidelines (7.2 ± 2.2; p=0.474). A similar pattern was observed for the subdimensions general, mental, and physical CRF. Those who met 50% of the guidelines also had significantly lower vigor compared to those who met the guidelines (11.9 ± 0.3 vs 13.8 ± 0.4; p&lt; 0.001), while those who met 50%-99% of the guidelines had comparable vigor to those who fully met guidelines (13.1 ± 0.6; p=0.278). Post-chemotherapy CRF was higher among all patient’s, again there was no significant difference in total, general, physical CRF and vigor between those who met the PA guidelines and those who met 50%-99% of the PA guidelines.
Conclusions: All PA was consistently inversely associated with CRF pre- and post-chemotherapy for patients with breast cancer. Current minimum aerobic PA guidelines for patients with cancer are difficult to achieve during treatment. Lower doses of MVPA than the current PA guidelines suggest may provide equal benefit and represent a more achievable goal for patients with cancer.
Table 1: Spearman correlations of CRF and physical activity in patients with breast cancer pre- and post-chemotherapy.
Table 2: ANCOVA; Mean CRF score according to the PA guidelines.
Citation Format: Lindsey Mattick, Hongying Sun, Karen Mustian, Luke Peppone, AnnaLynn Williams, Po-Ju Lin, Evelyn Arana, Jeremy McGuire, Amarinthia Curtis, Alison Conlin, Lora Weiselberg, Michelle Janelsins. National Physical Activity Guidelines and It’s Association with Fatigue in Patients with Breast Cancer Pre- and Post-Chemotherapy in a Prospective, Nationwide Study [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-12-09.