The Effect of a 12-week Exercise Program on Physical Activity and Sedentary Behaviour following Esophageal Cancer Treatment

Abstract

Background: Emerging evidence indicates that increased sedentary behavior may exacerbate the negative side effects of esophageal cancer treatment. Objective data indicate that cancer survivors are approximately two-thirds of their waking time sedentary and that 70% do not meet moderate-to-vigorous physical activity recommendations. Interventions are needed to reduce sedentary behavior and encourage physical activity. Aim: To investigate the effect of a 12-week combined aerobic and resistance exercise program on physical activity and sedentary time in esophageal cancer patients following surgery with curative intent. And to explore potential characteristics that modify intervention effects. Methods: A multicenter randomized controlled trial was conducted in the Netherlands. 120 patients were randomly allocated (1:1) to either the exercise or usual care group. The intervention was a 12-week combined aerobic and resistance exercise program, compliant with the American College of Sports Medicine guidelines on exercise for cancer survivors. Outcomes were measured at baseline, 12 weeks and 24 weeks post baseline, using the GTX3+ Tri-Axis ActiGraph. A cutoff of <100 counts per minute was used to categorize sedentary time, Freedson cut points were used to differentiate light physical activity (100-1951 counts per minute) from moderate-to-vigorous physical activity (1952 counts per minute). Intention-to-treat Linear Mixed Models were used to detect within and between group differences. Results: Significant effects in sedentary time were found between groups at 24 weeks post baseline. Where the intervention group was on average 28.97 minutes (95% CI -54.09 - -3.84, 1.72) per day less sedentary than the control group. No significant differences between groups were found on light- and moderate-to-vigorous physical activity. Time since surgery was found to be a significant effect modifier. Patients included 0-5 months since surgery were less light physically active than patients included 6-12 months since surgery. Conclusion: Results of this study show very large effects of a 12-week combined aerobic and resistance exercise program on sedentary time in esophageal cancer patients following surgery with curative intent. No significant effects were found on light – and moderate-to-vigorous physical activity. Clinical Relevance: The PERFECT intervention should be offered to esophageal cancer patients after surgery with curative intent to encourage a less sedentary lifestyle.