A.D. Ezuma1, S.C. Ibeneme2,3, G. Fortwengel4, E. Ezeome5, H. Myezwa6, N. Lasebikan7, T.A. Ajidahun3, O. Onodugo8, A. Nnamani7, I. Okoye7
1University of Nigeria Teaching Hospital, Physiotherapy, Ituku/Ozalla, Enugu, Nigeria, 2University of Nigeria, Medical Rehabiliutation (Physiotherapy), Enugu, Nigeria, 3University of the Witwatersrand, Department of Physiotherapy, Johannesburg, South Africa, 4Hochschule Hannover University of Applied Sciences and Arts, Faculty III, Hannover, Germany, 5University of Nigeria Teaching Hospial, Surgical Oncology, Enugu, Nigeria, 6University of the Witwatersrand, Physiotherapy, Johannesburg, South Africa, 7University of Nigeria Teaching Hospital, Radiation Medicine, Ituku/Ozalla, Enugu, Nigeria, 8University of Nigeria Teaching Hospital, Medicine, Ituku/Ozalla, Enugu, Nigeria

Background: Globally, breast cancer is commonly found among women with 2 million new cases and 627,000 deaths in 2018. Modifiable risk factors associated with breast cancer include body composition indices especially waist-hip ratio - WHR ≥0.85 (which defines central adiposity), body mass index- BMI ≥30Kg/m2 (which defines obesity), percentage body fat mass -≥25Kg/m2 (which defines subcutaneous adiposity), and physical inactivity (defined as <600(MET-min/week or ≤7999 step counts/day). Physical inactivity promotes inflammatory micro-environment, oxidative stress,  adiposity and diminishes serum antioxidant (superoxide dismutase) concentration but is amenable to physical activity intervention. Therefore, a pedometer-based physical activity (walking) programme may improve body composition, physical activity level (PAL) and serum concentration of superoxide dismutase in breast cancer survivors, and likewise the prognosis of breast cancer recurrence. 

Purpose: To determine the effects of a six-week pedometer-based walking programme PAL, serum superoxide dismutase (antioxidant) concentration, and body composition in breast cancer survivors. 

Methods: This study is a single-blind randomized controlled trial involving 98 participants (of which only 80 completed it) from the Oncology Clinic, who were consecutively stratified according to their baseline physical activity level, and subsequently, by step count/day recorded with a fitbitCharge HR pedometer. The protocol is certified and registered according to the Pan African Clinical Trials Registry - Trial ID: PACTR202001542824141. The experimental group received an intervention programme based on the Trans-Theoretical Model to improve PA (walking) by setting biweekly targets of additional 1500 steps to the baseline value. The control group did not change their PA for the duration of the study. The independent variable is walking (pedometer step counts/day), while the dependent variables are PAL (MET-min/week), the serum concentration of superoxide dismutase (U/mgHb) and body composition - comprising WHR, BMI (Kg/M2) and percentage body fat (%). Data were collected with the short form of International Physical Activity Questionnaire at the baseline and 6th week, and on weekly basis from the Fitbit server/data centre, which receives transmitted data from the pedometer customised to each participant. Data were analysed using simple descriptive statistics, and independent t-test at p<0.05,one-tailed test.

Results: The majority of the breast cancer survivors were postmenopausal women (63.75%), had a surgery(88.75%), had chemotherapy(100%), never used oral contraceptives (75%) and were in stage III according to the Surveillance, Epidemiology and End Results (SEER) stage of disease classification (47.5%). The study attrition rate is 10.20% and adherence rate is 72.5%. A comparison of the pedometer group to control showed a significant increase with a large effect size for superoxide dismutase (p=0.0001, d= 1.01), PAL (p=0.006, d=0.85), and pedometer step count/day (p=0.0002, d=0.80). There was a significant decrease with a large effect size for WHR (p=0.002, d=1.13), and percentage body fat mass (p=0.01, d=0.72) unlike BMI (p=0.09, d=0.43).

Conclusion(s): Central and subcutaneous adiposity, PAL and serum concentration of superoxide dismutase, are significantly improved by a six-week pedometer-based walking programme in breast cancer survivors. The large effect size indicates that these findings are of clinical significance.  

Implications: A pedometer-based walking programme grounded in the trans-theoretical model could improve the prognosis of breast cancer recurrence in survivors. The probable translational benefits in breast cancer prevention should also be explored at the population level through public health action.

Funding, acknowledgements: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors

Keywords: Breast cancer survivors, pedometer-based physical activity lifestyle promotion, antioxidant level

Topic: Oncology, HIV & palliative care

Did this work require ethics approval? Yes
Institution: University of Nigeria
Committee: Health Research Ethics Committee
Ethics number: NHREC/05/01/2008B

All authors, affiliations and abstracts have been published as submitted.

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