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Article: Designing, analyzing, and interpreting observational studies of physical activity and cancer outcomes from a clinical oncology perspective.

Courneya, Kerry S / Friedenreich, Christine M

2023 Volume 13, Page(s) 1098278

Abstract: Observational studies may play an important role in evaluating physical activity (PA) as a cancer treatment; however, few studies have been designed, analyzed, or interpreted from a clinical oncology perspective. The purpose of the present paper is to ... ...

Abstract	Observational studies may play an important role in evaluating physical activity (PA) as a cancer treatment; however, few studies have been designed, analyzed, or interpreted from a clinical oncology perspective. The purpose of the present paper is to apply the Exercise as Cancer Treatment (EXACT) Framework to assess current observational studies of PA and cancer outcomes from a clinical oncology perspective and provide recommendations to improve their clinical utility. Recent systematic reviews and meta-analyses of over 130 observational studies have concluded that higher prediagnosis and postdiagnosis PA are associated with lower risks of cancer-specific and all-cause mortality. Most of these studies, however, have: (a) included cancer patients receiving heterogeneous treatment protocols, (b) provided minimal details about those cancer treatments, (c) assessed PA prediagnosis and/or postdiagnosis without reference to those cancer treatments, (d) reported mainly mortality outcomes, and (e) examined subgroups based on demographic and disease variables but not cancer treatments. As a result, current observational studies on PA and cancer outcomes have played a modest role in informing clinical exercise trials and clinical oncology practice. To improve their clinical utility, we recommend that future observational studies of PA and cancer outcomes: (a) recruit cancer patients receiving the same or similar first-line treatment protocols, (b) collect detailed data on all planned and unplanned cancer treatments beyond whether or not cancer treatments were received, (c) assess PA in relation to cancer treatments (i.e., before, during, between, after) rather than in relation to the cancer diagnosis (i.e., various time periods before and after diagnosis), (d) collect data on cancer-specific outcomes (e.g., disease response, progression, recurrence) in addition to mortality, (e) conduct subgroup analyses based on cancer treatments received in addition to demographic and disease variables, and (f) interpret mechanisms for any associations between PA and cancer-specific outcomes based on the clinical oncology scenario that is recapitulated rather than referencing generic mechanisms or discordant preclinical models. In conclusion, observational studies are well-suited to contribute important knowledge regarding the role of PA as a cancer treatment; however, modifications to study design and analysis are necessary if they are to inform clinical research and practice.
Language	English
Publishing date	2023-04-14
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2649216-7
ISSN	2234-943X
ISSN	2234-943X
DOI	10.3389/fonc.2023.1098278
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Article ; Online: Physical activity for cancer prehabilitation: A scoping review.

Yang, Lin / Alice, Azam / Friedenreich, Christine M

Critical reviews in oncology/hematology

2024 Volume 196, Page(s) 104319

Abstract: This scoping review aims to synthesize the current landscape of physical activity in cancer prehabilitation and identify knowledge gaps. We searched MEDLINE, EMBASE, SCOPUS and WEB OF SCIENCE for exercise interventions and observational studies that ... ...

Abstract	This scoping review aims to synthesize the current landscape of physical activity in cancer prehabilitation and identify knowledge gaps. We searched MEDLINE, EMBASE, SCOPUS and WEB OF SCIENCE for exercise interventions and observational studies that measured exercise or physical activity before cancer treatment from inception to January 20, 2023. Fifty-one articles from 44 unique studies were reviewed, including 32 intervention and 12 observational studies. Surgery is the only treatment modality that has been investigated. Included studies used heterogeneous exercise interventions and measures for physical activity. Colorectal and other gastrointestinal, lung, and urologic cancers are the most studied cancer types. Exercise intervention in cancer prehabilitation is highly feasible. The evidence for improved fitness, functional, psychosocial, and clinical outcomes is promising yet limited. Although research has increased recently, prehabilitation exercise remains a relatively under-investigated area in oncology. We have provided research directions towards an ideal cancer prehabilitation design in the real-world setting.
MeSH term(s)	Humans ; Preoperative Exercise ; Preoperative Care ; Exercise ; Neoplasms/surgery ; Exercise Therapy ; Postoperative Complications
Language	English
Publishing date	2024-03-08
Publishing country	Netherlands
Document type	Journal Article ; Review
ZDB-ID	605680-5
ISSN	1879-0461 ; 0737-9587 ; 1040-8428
ISSN (online)	1879-0461
ISSN	0737-9587 ; 1040-8428
DOI	10.1016/j.critrevonc.2024.104319
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Article ; Online: Physical Activity to Improve Lung Cancer Survival: Promising Evidence.

Friedenreich, Christine M / Yang, Lin

JNCI cancer spectrum

2022 Volume 6, Issue 2

MeSH term(s)	Exercise ; Humans ; Lung Neoplasms/therapy
Language	English
Publishing date	2022-05-22
Publishing country	England
Document type	Journal Article ; Comment
ISSN	2515-5091
ISSN (online)	2515-5091
DOI	10.1093/jncics/pkac011
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Article ; Online: From evidence to implementation of lifestyle behaviour in cancer prevention and control: A Preventive Medicine Golden Jubilee Commentary.

Yang, Lin / Friedenreich, Christine M

Preventive medicine

2022 Volume 166, Page(s) 107342

Abstract: Preventive interventions targeting tobacco, alcohol, healthy diets and physical activity are key strategies to tackle the most pressing health challenges in modern society. A major gap remains in how to translate research evidence into population-level ... ...

Abstract	Preventive interventions targeting tobacco, alcohol, healthy diets and physical activity are key strategies to tackle the most pressing health challenges in modern society. A major gap remains in how to translate research evidence into population-level behaviour change to reduce the disease burden. We use the case for the role of physical activity-related behaviour and cancer to illustrate the iterative, multidirectional, and transdisciplinary nature of translational research. The issues we address in this context are generalizable and applicable to other behavioral risk factors and non-communicable diseases. There is now solid evidence that physical activity reduces cancer risk and improves outcomes after cancer diagnosis. Here we provide a framework for how to implement this knowledge into real-world settings. We provide the rationale for combining systems, causal and design thinking to develop interventions that can be implemented for this type of behaviour change. The proposed model is iterative, multidirectional and transdisciplinary. We identify major knowledge gaps in epidemiology and science of behaviour change on physical activity and cancer control and propose approaches to suggest priorities for future research.
MeSH term(s)	Humans ; Risk Factors ; Delivery of Health Care ; Life Style ; Exercise ; Neoplasms/prevention & control
Language	English
Publishing date	2022-11-09
Publishing country	United States
Document type	Journal Article
ZDB-ID	184600-0
ISSN	1096-0260 ; 0091-7435
ISSN (online)	1096-0260
ISSN	0091-7435
DOI	10.1016/j.ypmed.2022.107342
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Article ; Online: Re: Letter to the Editor: The population attributable risk of cancers for lack of physical activity in Canada by Michel D. Wissing.

Friedenreich, Christine M

Preventive medicine

2019 Volume 126, Page(s) 105761

MeSH term(s)	Canada ; Exercise ; Humans ; Neoplasms
Language	English
Publishing date	2019-06-30
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	184600-0
ISSN	1096-0260 ; 0091-7435
ISSN (online)	1096-0260
ISSN	0091-7435
DOI	10.1016/j.ypmed.2019.105761
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Article ; Online: Concerns Remain Regarding the Association of Sitting Time and Physical Activity With Cancer Survivorship-Reply.

Cao, Chao / Friedenreich, Christine M / Yang, Lin

JAMA oncology

2022 Volume 8, Issue 6, Page(s) 1

MeSH term(s)	Cancer Survivors ; Exercise ; Humans ; Neoplasms/therapy ; Risk Factors
Language	English
Publishing date	2022-04-28
Publishing country	United States
Document type	Journal Article ; Comment
ISSN	2374-2445
ISSN (online)	2374-2445
DOI	10.1001/jamaoncol.2022.0874
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Article ; Online: Association of Daily Sitting Time and Leisure-Time Physical Activity With Survival Among US Cancer Survivors.

Cao, Chao / Friedenreich, Christine M / Yang, Lin

JAMA oncology

2022 Volume 8, Issue 3, Page(s) 395–403

Abstract: Importance: Sedentary behaviors, particularly prolonged sitting and lack of physical activity, may influence survival after cancer.: Objective: To examine the independent and joint associations of daily sitting time and leisure-time physical activity ...

Abstract	Importance: Sedentary behaviors, particularly prolonged sitting and lack of physical activity, may influence survival after cancer. Objective: To examine the independent and joint associations of daily sitting time and leisure-time physical activity with mortality outcomes among cancer survivors. Design, setting, and participants: A prospective cohort of a nationally representative sample of cancer survivors, age 40 years or older (n = 1535; weighted population, 14 002 666), from the US National Health and Nutrition Examination Survey from 2007 to 2014. Participants were linked to mortality data from their interview and physical examination date through December 31, 2015. Daily sitting time and leisure-time physical activity (LTPA) were self-reported using the Global Physical Activity Questionnaire. Data analyses were performed from January 1 to May 1, 2021. Main outcomes and measures: All-cause, cancer-specific, and noncancer mortality. Results: Among 1535 cancer survivors (mean [SE] age, 65.1 [0.4] years; 828 [60.1%] females; 945 [83.1%] non-Hispanic White individuals), 950 (56.8%) reported LTPA of 0 minutes per week (min/wk) during the previous week (inactive); 226 (15.6%) reported LTPA of less than 150 min/wk (insufficiently active); 359 (27.6%) reported LTPA of 150 min/wk or more (active); 553 (35.4%) reported sitting for 6 to 8 hours per day (h/d); and 328 (24.9%) reported sitting for more than 8 h/d. Of note, 574 (35.8%) cancer survivors reported no LTPA with concurrent sitting of more than 6 h/d. During the follow-up period of up to 9 years (median, 4.5 years; 6980 person-years), there were 293 deaths (cancer, 114; heart diseases, 41; other causes, 138). Multivariable models showed that being physically active was associated with lower risks of all-cause (hazard ratio [HR], 0.34; 95% CI, 0.20-0.60) and cancer-specific (HR, 0.32; 95% CI, 0.15-0.70) mortality compared with inactivity. Sitting more than 8 h/d was associated with higher risks of all-cause (HR, 1.81; 95% CI, 1.05-3.14) and cancer-specific (HR, 2.27; 95% CI, 1.08-4.79) mortality compared with those sitting less than 4 h/d. In the joint analyses, prolonged sitting was associated with an increased risk of death among cancer survivors who were not sufficiently active. Specifically, inactive and insufficiently active survivors reported sitting more than 8 h/d had the highest overall (HR, 5.38; 95% CI, 2.99-9.67) and cancer-specific (HR, 4.71; 95% CI, 1.60-13.9) mortality risks. Conclusions and relevance: In this cohort study of a nationally representative sample of US cancer survivors, the combination of prolonged sitting with lack of physical activity was highly prevalent and was associated with the highest risks of death from all causes and cancer.
MeSH term(s)	Adult ; Aged ; Cancer Survivors ; Cohort Studies ; Exercise ; Female ; Humans ; Leisure Activities ; Neoplasms ; Nutrition Surveys ; Prospective Studies
Language	English
Publishing date	2022-05-26
Publishing country	United States
Document type	Journal Article
ISSN	2374-2445
ISSN (online)	2374-2445
DOI	10.1001/jamaoncol.2021.6590
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Article ; Online: An ecological analysis of walkability and housing affordability in Canada: Moderation by city size and neighbourhood property type composition.

Christie, Chelsea D / Friedenreich, Christine M / Vena, Jennifer E / Doiron, Dany / McCormack, Gavin R

PloS one

2023 Volume 18, Issue 5, Page(s) e0285397

Abstract: The neighbourhood built environment can support the physical activity of adults regardless of their individual-level socioeconomic status. However, physical activity supportive (walkable) neighbourhoods may not be accessible to those with lower incomes ... ...

Abstract	The neighbourhood built environment can support the physical activity of adults regardless of their individual-level socioeconomic status. However, physical activity supportive (walkable) neighbourhoods may not be accessible to those with lower incomes if homes in walkable neighbourhoods are too expensive. The objectives of this study were: 1) to estimate the associations between neighbourhood walkability and home values in Canadian cities, and 2) to test whether these associations differ by city size and residential property type composition within neighbourhoods. We linked built environment data from the 2016 Canadian Active Living Environments (Can-ALE) index with neighbourhood-level structural home characteristics and sociodemographic data from the 2016 Canadian census for 33,026 neighbourhoods across 31 Census Metropolitan Areas. We used multilevel linear regression models to estimate covariate-adjusted associations between neighbourhood walkability and natural-log median home values and tested city size and neighbourhood property type composition as moderators. There were no statistically significant associations between walkability and home values overall. The associations between neighbourhood walkability and home values were jointly moderated by city size and property type composition. For small and medium sized cities, within neighbourhoods containing a high proportion of detached homes, walkability was negatively associated with home values (b = -0.05, 95% CI: -0.10, -0.01; and, b = -0.04, 95% CI: -0.06, -0.02, for small and medium cities, respectively). However, for extra-large cities, within neighbourhoods containing a high proportion of detached homes, walkability was positively associated with home values (b = 0.06, 95% CI: 0.01, 0.10). Our findings suggest that, based on housing affordability, higher walkable neighbourhoods are likely accessible to lower income households that are situated in small and medium Canadian cities. In larger cities, however, municipal interventions (e.g., inclusionary zoning or targeted development of subsidized or social housing) may be needed to ensure equitable access to walkable neighbourhoods for lower income households.
MeSH term(s)	Cities ; Canada ; Housing ; Walking ; Exercise ; Residence Characteristics ; Environment Design
Language	English
Publishing date	2023-05-31
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0285397
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Article ; Online: Trends and cancer-specific patterns of physical activity, sleep duration, and daily sitting time among US cancer survivors, 1997-2018.

Cao, Chao / Patel, Alpa V / Liu, Raymond / Cao, Yin / Friedenreich, Christine M / Yang, Lin

Journal of the National Cancer Institute

2023 Volume 115, Issue 12, Page(s) 1563–1575

Abstract: Background: Physical activity, sufficient sleep, and limiting sedentary time may improve cancer survivorship.: Methods: Utilizing US nationally representative samples from the National Health Interview Survey 1997-2018 and the National Health and ... ...

Abstract	Background: Physical activity, sufficient sleep, and limiting sedentary time may improve cancer survivorship. Methods: Utilizing US nationally representative samples from the National Health Interview Survey 1997-2018 and the National Health and Nutrition Examination Survey 2007-2018, this study investigated the trends of meeting physical activity guidelines, insufficient sleep duration, and sitting time in US cancer survivors (n = 58 527) and noncancer adults (n = 640 109). Results: From 1997 to 2018, the prevalence of meeting physical activity guidelines was consistently lower in cancer survivors than in noncancer adults. Among cancer survivors, the prevalence of meeting physical activity guidelines increased from 34.9% (95% confidence interval [CI] = 33.1% to 36.8%) to 46.5% (95% CI = 45.0% to 48.1%) for aerobic (≥150 minutes per week at moderate intensity or 75 minutes per week at vigorous intensity), from 13.9% (95% CI = 12.8% to 15.1%) to 23.1% (95% CI = 21.8% to 24.4%) for muscle strengthening (≥2 days per week) activities, and from 9.5% (95% CI = 8.4% to 10.7%) to 17.9% (95% CI = 16.7% to 19.1%) for both combined (all Ptrend < .001). From 2004 to 2018, the prevalence of insufficient sleep duration (<7 hours per day) increased from 28.4% (95% CI = 26.3% to 30.5%) to 30.8% (95% CI = 29.3% to 32.2%) (Ptrend = .004). Daily sitting time increased from 6.09 hours per day (95% CI = 5.71 to 6.46 hours per day) in 2007-2008 to 7.36 hours per day (95% CI = 7.05 to 7.68 hours per day) in 2013-2014 and attenuated to 6.20 hours per day (95% CI = 5.74 to 6.65 hours per day) in 2017-2018. The pattern of physical activity, sleep, and sitting time varied by sex, race and ethnicity, body mass index, cancer type, and time since cancer diagnosis. Conclusions: More than half of US cancer survivors did not meet physical activity guidelines, and a large proportion had insufficient sleep duration and prolonged sitting time.
MeSH term(s)	Adult ; Humans ; Cancer Survivors ; Nutrition Surveys ; Sleep Duration ; Sitting Position ; Exercise ; Neoplasms/epidemiology
Language	English
Publishing date	2023-08-01
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	2992-0
ISSN	1460-2105 ; 0027-8874 ; 0198-0157
ISSN (online)	1460-2105
ISSN	0027-8874 ; 0198-0157
DOI	10.1093/jnci/djad146
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Article ; Online: Investigations of Malfunctions of the Vestibular System-Reply.

Cao, Chao / Friedenreich, Christine M / Yang, Lin

JAMA otolaryngology-- head & neck surgery

2021 Volume 147, Issue 8, Page(s) 775

MeSH term(s)	Equipment Failure ; Humans
Language	English
Publishing date	2021-07-01
Publishing country	United States
Document type	Journal Article ; Comment
ZDB-ID	2701825-8
ISSN	2168-619X ; 2168-6181
ISSN (online)	2168-619X
ISSN	2168-6181
DOI	10.1001/jamaoto.2021.1291
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