Recreational Physical Activity Levels Research Articles

Association between pre-diagnosis recreational physical activity and risk of breast cancer recurrence: the California Teachers Study.

Studies have reported inverse associations of pre-diagnosis recreational physical activity (RPA) level with all-cause and breast cancer (BCa)-specific mortality among BCa patients. However, the association between pre-diagnosis RPA level and BCa recurrence is unclear. We investigated the association between pre-diagnosis RPA level and risk of BCa recurrence in the California Teachers Study (CTS). Stage I-IIIb BCa survivors (n = 6,479) were followed with median of 7.4years, and 474 BCa recurrence cases were identified. Long-term (from high school to age at baseline questionnaire, or, age 55years, whichever was younger) and baseline (past 3 years reported at baseline questionnaire) pre-diagnosis RPA levels were converted to metabolic equivalent of task-hours per week (MET-hrs/wk). Multivariable Cox proportional hazards models estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for risk of BCa recurrence overall and by estrogen receptor (ER)/progesterone receptor (PR) status. Long-term RPA was not associated with BCa recurrence risk (ptrend = 0.99). The inverse association between baseline pre-diagnosis RPA level and BCa recurrence risk was marginally significant (≥26.0 vs. <3.4 MET-hrs/wk: HR = 0.79, 95% CI = 0.60-1.03; ptrend = 0.07). However, the association became non-significant after adjusting for post-diagnosis RPA (ptrend = 0.65). An inverse association between baseline pre-diagnosis RPA level and BCa recurrence risk was observed in ER-PR- cases (≥26.0 vs. <3.4 MET-hrs/wk: HR = 0.31, 95% CI = 0.13-0.72; ptrend = 0.04), but not in ER+ or PR+ cases (ptrend = 0.97). Our data indicates that the benefit of baseline RPA on BCa recurrence may differ by tumor characteristics. This information may be particularly important for populations at higher risk of ER-PR- BCa.

The Prevalence of Neck and Back Pain among Paramedics in Poland.

Neck Pain (NP) and low back pain (LBP) are ubiquitous musculoskeletal conditions and some of the major causes of disability worldwide. The aim of the study was to assess the incidence and risk factors of back pain among paramedics and their correlation with the nature of work, anthropometric features and the level of recreational physical activity. A group of 201 individuals (39 females (19.40%); 162 males (80.60%)), licensed to practice as paramedics in Poland completed a questionnaire containing the author's interview as well as the Neck Disability Index (NDI) questionnaire and the Revised Oswestry Disability Index (ODI). Among the examined paramedics, 92% of the subjects reported the presence of back pain in different parts of the spine (36% C; 17% Th; and 85% LBP). The pain intensity, determined by VAS, was on average 4.26 (SD 1.77). The level of disability, assessed by NDI, was 7.67 (SD 5.73) on average, while the ODI was 7.51 (5.90). Work-related spinal strain has a major impact on the intensity and incidence of spinal pain. Spinal pain in paramedics mainly occurs in the lower back.

High prevalence of medical conditions and unhealthy lifestyle behaviours in women with PCOS during preconception: findings from the Australian LongitudinalStudy on Women's Health.

What are the pre-existing medical conditions and lifestyle behaviours of women with and without PCOS during the preconception period? During the preconception period, medical conditions of obesity, depression, anxiety, and a history of infertility were more highly prevalent in women with than without PCOS, and more women with than without PCOS were engaged in unhealthylifestyle behaviours. Women with PCOS are predisposed to infertility and pregnancy complications. Optimizing preconception medical health and lifestyle behaviours can improve maternal and pregnancy outcomes but, to the best of our knowledge, no study has examined the preconception medical conditions and lifestyle behaviours of women with PCOS. This is a cross-sectional study on 942 women with PCOS and 7024 women without PCOS, aged 24-30 years from the Australian Longitudinal Study of Women's Health, an ongoing, national survey-based prospective cohort study. The current study analysed self-reported data from Survey 6 collected in 2019 of the cohort of women born between 1989 and 1995. Explored outcomes included BMI, pre-existing medical conditions, and modifiable lifestyle behaviours, including smoking, recreational drug use, alcohol intake, and physical activity level, during the preconception period. Differences between subgroups were tested using Student's t-test, χ2 test, or Fisher's exact test as appropriate. The associations of pregnancy intention with medical conditions and lifestyle behaviours were examined using logistic regression. Obesity, depression, anxiety, and infertility were highly prevalent in women actively planning for pregnancy. Among women with PCOS, the prevalence of obesity was 47.02%, followed by depression at 32.70%, anxiety at 39.62%, and infertility at 47.17%. Conversely among women without PCOS, the corresponding prevalence was lower, at 22.33% for obesity, 18.98% for depression, 23.93% for anxiety, and 16.42% for infertility. In women actively planning for pregnancy, only those without PCOS demonstrated a lower prevalence of unhealthy lifestyle behaviours compared to non-planning women. The prevalence of unhealthy lifestyle behaviours was similar in women with PCOS regardless of their pregnancy intentions. Multivariable logistic regressionrevealed that only moderate/high stress with motherhood/children (adjusted odds ratio (OR) 3.31, 95% CI 1.60-6.85) and history of infertility (adjusted OR 9.67, 95% CI 5.02-18.64) were significantly associated with active pregnancy planning in women with PCOS. The findings were based on self-reported data. The cohort of women surveyed may have a higher level of education than women in the community, therefore our findings may underestimate the true prevalence of pre-existing medical conditions and lifestyle challenges faced by the broader population. A higher proportion of women with than without PCOS had pre-existing medical conditions and engaged in potentially modifiable unhealthy lifestyle behaviours during preconception despite their risk for subfertility and pregnancy complications. Healthcare professionals play a pivotal role in guiding this high-risk group of women during this period, offering counselling, education, and support for the adoption of healthy lifestyles to improve fertility, pregnancy outcomes, and intergenerational health. C.T.T. holds a seed grant from the National Health and Medical Research Council (NHMRC) through the Centre of Research Excellence in Women's Health in Reproductive Life (CRE WHiRL) and Royal Australasian College of Physician Foundation Roger Bartop Research Establishment Fellowship. H.T. holds an NHMRC Medical Research Fellowship. C.L.H. holds an NHMRC CRE Health in Preconconception and Pregnancy Senior Postdoctoral Fellowship. A.E.J. holds a CRE WhiRL Early to Mid-career Fellowship. The authors have no conflicts of interest to declare. N/A.

Change in Peak Oxygen Uptake Predicted by the Moderate 1-km Treadmill Walking Test After Walking Training in Outpatients With Cardiovascular Disease.

The purpose of this study was to determine the ability of the moderate 1-km treadmill walking test (1km-TWT) to predict changes in peak oxygen uptake (V˙O 2peak ) in patients with stable cardiovascular disease (CVD) during an exercise-based secondary prevention program. Sixty-four male outpatients with stable CVD (age 64 [41-85] yr) performed the 1km-TWT before and after an 8-wk walking training program. Patient V˙O 2peak was estimated using a sex-specific equation including age, body mass index, 1km-TWT performance time, and heart rate (V˙O 2peakEST ). Forty-one patients completed a maximal cardiopulmonary treadmill test (CPX) for direct V˙O 2peak determination (V˙O 2peakMEAS ). The training prescription consisted of moderate-to-high intensity supervised walking for 30-40 min/session, and an additional 2-4 times/wk of unsupervised home moderate walking sessions between 20-60 min at the end of the program. The walking intensity was based on the results of the 1km-TWT. Patients participated in an average of 14 of the 16 supervised sessions. An overall significant improvement in V˙O 2peakMEAS and weekly recreational physical activity levels were observed. No differences were observed between V˙O 2peakMEAS and V˙O 2peakEST . Compared with CPX results, the 1km-TWT underestimated the V˙O 2peak increase after the exercise intervention (mean difference -0.3 mL/kg/min, P > .05). The 1km-TWT provides a reasonably accurate and simple tool to predict changes in V˙O 2peak due to moderate walking training in male outpatients with CVD. These findings contribute to the growing body of evidence supporting the use of the 1km-TWT for exercise testing and training purposes in the context of cardiac rehabilitation/secondary prevention programs.

Adolescent Physical Activity and Breast Cancer Risk in Young Women: Findings From the ProF-SC Study

Study Purpose: The incidence of breast cancer (BC) in young women under age 40 years has increased substantially over time, underscoring the need for a better understanding of early life modifiers of risk. We examined the association of recreational physical activity (RPA) with BC risk before age 40 years, focusing on RPA during the adolescent window of susceptibility. Methods: We used data from the ProF-SC Study, which is enriched for young women at increased risk for BC. We conducted an ambidirectional cohort analysis that included women, aged ≤ 55 years at baseline, who were enrolled within 5 years of their first primary BC diagnosis or had no history of BC at baseline (n = 14,865). Women reported by baseline questionnaire their average levels of moderate and strenuous RPA during adolescence (12–17 years), which we converted to total metabolic equivalents per week (METs-per-week) and categorized into quartiles after adjusting for baseline age. We conducted attained age analyses until 40 years using multivariable Cox proportional hazards regression models adjusted for baseline sociodemographic and lifestyle factors. Follow-up started at age 18 years and ended at age at first invasive BC diagnosis, last follow-up, or 40 years, whichever came first. Results: There were 1,646 BC diagnoses before age 40 during 30,5594 person-years of follow-up. Being in the highest vs. lowest quartile of adolescent RPA was significantly associated with a 16% reduced risk of BC until age 40 before adjustment for baseline RPA (HR = 0.84, 95% CI = 0.73–0.97). This association was attenuated and no longer statistically significant after adjustment for baseline RPA (HR = 0.89, 95% CI = 0.77–1.04). We identified a statistically significant multiplicative interaction between adolescent and baseline RPA (interaction P value = 0.03). A one standard deviation increase in METs-per-week of baseline RPA was associated with a 5% reduced BC risk for women in the 10th percentile of adolescent RPA (HR = 0.95, 95% CI = 0.90–1.00) and an 11% reduced risk in the 90th percentile (HR = 0.89, 95% CI = 0.84–0.95). Conclusions: These findings suggest that adolescent physical activity might reduce breast cancer risk in young women and underscore the importance of maintain or increasing RPA levels across the lifecourse.

The Correlation between the Level of Health-Improving and Recreational Physical Activity and Family Well-Being

Study purpose. The purpose of the study was to assess the correlation between the level of health-improving and recreational physical activity and family well-being.&#x0D; Materials and methods. Theoretical analysis of data from special scientific and methodological literature, generalization, systematization, sociological methods, and mathematical statistics. A research among parents was conducted using online surveying through completing an online questionnaire created with Google Forms. The study involved 106 married couples. The average age of the respondents was 35.1±4.2 years. The vast majority of the studied families (95.1%) had up to two children (preschool and school age).&#x0D; Results. The respondents were divided into two clusters according to their level of motor activity. Cluster 1 included families with a low level of physical activity, and cluster 2 included those with an average level of physical activity.Depending on the level of physical activity, statistically significant (p &lt; 0.05) differences were found between the families in terms of the following parameters: motivations for engaging in active leisure, amount of leisure time, level of knowledge and skills in organizing active leisure, reasons preventing participation in active leisure, etc. The families differed significantly (p &lt; 0.05) in 23 categorical parameters. It was found that the families with different levels of physical activity did not differ in their desire to engage in winter recreational activities. Reasons preventing participation in health-enhancing and recreational physical activity programs were identified. A comparative analysis of the current state of family well-being revealed statistically significant (p &lt; 0.05) differences in all studied parameters between the families with different levels of physical activity, i.e. the families with a proper level of physical activity had higher scores of satisfaction, well-being, and quality of life. Low indicators of family well-being indicated the rationale for such families to engage in active recreation and increase their level of health-enhancing and recreational physical activity.&#x0D; Conclusions. A relationship was identified between the level of health-enhancing and recreational physical activity and indicators of satisfaction, family well-being, and quality of life.

Twenty-four-hour time-use composition and cognitive function in older adults: Cross-sectional findings of the ACTIVate study.

Physical activity, sedentary behaviour and sleep are associated with cognitive function in older adults. However, these behaviours are not independent, but instead make up exclusive and exhaustive components of the 24-h day. Few studies have investigated associations between 24-h time-use composition and cognitive function in older adults. Of these, none have considered how the quality of sleep, or the context of physical activity and sedentary behaviour may impact these relationships. This study aims to understand how 24-h time-use composition is associated with cognitive function across a range of domains in healthy older adults, and whether the level of recreational physical activity, amount of television (TV) watching, or the quality of sleep impact these potential associations. 384 healthy older adults (age 65.5 ± 3.0 years, 68% female, 63% non-smokers, mean education = 16.5 ± 3.2 years) participated in this study across two Australian sites (Adelaide, n = 207; Newcastle, n = 177). Twenty-four-hour time-use composition was captured using triaxial accelerometry, measured continuously across 7 days. Total time spent watching TV per day was used to capture the context of sedentary behaviours, whilst total time spent in recreational physical activity was used to capture the context of physical activity (i.e., recreational accumulation of physical activity vs. other contexts). Sleep quality was measured using a single item extracted from the Pittsburgh Sleep Quality Index. Cognitive function was measured using a global cognition index (Addenbrooke's Cognitive Examination III) and four cognitive domain composite scores (derived from five tests of the Cambridge Neuropsychological Test Automated Battery: Paired Associates Learning; One Touch Stockings of Cambridge; Multitasking; Reaction Time; Verbal Recognition Memory). Pairwise correlations were used to describe independent relationships between time use variables and cognitive outcomes. Then, compositional data analysis regression methods were used to quantify associations between cognition and 24-h time-use composition. After adjusting for covariates and false discovery rate there were no significant associations between time-use composition and global cognition, long-term memory, short-term memory, executive function, or processing speed outcomes, and no significant interactions between TV watching time, recreational physical activity engagement or sleep quality and time-use composition for any cognitive outcomes. The findings highlight the importance of considering all activities across the 24-h day against cognitive function in older adults. Future studies should consider investigating these relationships longitudinally to uncover temporal effects.

Physical Activity From Menarche-to-first Pregnancy And Risk Of Breast Cancer: The California Teachers Study

PURPOSE: Physical activity (PA) is associated with decreased breast cancer (BCa) risk. A longer menarche-to-first pregnancy window of susceptibility (WOS) is associated with increased BCa risk. Whether PA during the menarche-to-first pregnancy WOS offsets BCa risk is unclear. It is also unknown if differences in risk exist by BCa subtype. METHODS: We examined the prospective association between PA during the menarche-to-first pregnancy WOS and BCa risk in the California Teachers Study (N=78,940). Recreational PA levels from high school to current age, or, age 55, were recalled at cohort entry and converted to metabolic equivalent of task hours per week (MET-h/wk). We used multivariable Cox proportional hazards models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of incident invasive BCa for WOS and PA. RESULTS: 5,157 invasive BCa cases developed. The median length of follow-up was 21.6 years. Longer menarche-to-first pregnancy WOS (≥20 vs. <15 years) was associated with increased BCa risk (HR=1.23, 95% CI=1.13-1.34). Women with higher PA during menarche-to-first pregnancy WOS had decreased risk of invasive BCa (≥40 vs. <9 MET-h/wk: HR=0.89, 95% CI=0.83-0.97). The inverse association between PA during the menarche-to-first pregnancy WOS and BCa risk was strongest in triple-negative BCa (TNBC: ≥40 vs. <9 MET-h/wk: HR=0.53, 95% CI=0.32-0.87; luminal A-like: ≥40 vs. <9 MET-h/wk: HR=0.92, 95% CI=0.80-1.06; luminal B-like: ≥40 vs. <9 MET-h/wk: HR=0.84, 95% CI=0.52-1.36). Higher PA level during the menarche-to-first pregnancy WOS was associated with decreased BCa risk only among women with moderate (15-19 years) menarche-to-first pregnancy intervals (≥40 vs. <9 MET-h/wk: HR=0.80, 95% CI=0.69-0.92), but not women with short (<15 years; ≥40 vs. <9 MET-h/wk: HR=0.96, 95% CI=0.86-1,06) or long (≥20 years; ≥40 vs. <9 MET-h/wk: HR=0.93, 95% CI=0.74-1.17) intervals. CONCLUSION: PA during the menarche-to-first pregnancy WOS was associated with lower BCa risk in our cohort. Understanding the timing of PA over the life course in relationship to non-modifiable reproductive risk factors such as pregnancy maybe particularly important. Supported by NIH Grant U01 CA199277; P30 CA033572; P30 CA023100; UM1 CA164917; R01-CA077398; U54 CA155850; UL1 TR002014; UL1 TR000003; and KL2 TR002015.

P08-01 Demographic, social, and environmental factors predicting Danish children's greenspace use

BackgroundEvidence suggest that greenspace use can be associated with children's physical, mental, social health, and well-being (Tillmann et al., 2018; Mygind et al., 2019; Mygind et al., 2021). Greenspace can facilitate a wide range of low-cost activities and the availability of greenspace is frequently linked to increased levels of recreational physical activity. Accordingly, contemporary children's declining greenspace use prompts a need to understand the factors that affect frequency of use.MethodsAiming to determine to what extent demographic, environmental and social factors predict greenspace use for school-aged (6-15-year-old) children in Denmark, a national online survey was distributed to parents of 10.000 0-15-year-old children. From a total of 4772 responses a sub-sample of 3171 responses from parents of school-aged children was included in the analysis for this study. The aim was addressed by answering the following research questions: 1) How often do Danish children use greenspaces? 2) What demographic differences in greenspace use are present? 3) How do social and environmental factors predict greenspace use?ResultsResponses from the 3171 parents showed that 49.5% of the children used greenspace almost every day during the summer season. Multivariate binary logistic regression analysis showed that the number of types of greenspaces within walking or cycling distance from home was a strong predictor for daily use. Social factors (parental concern and encouragement) also predicted use, but less so. Geography and child age were the only demographic predictors for using greenspace almost every day.ConclusionsFindings from the present study suggest that providing opportunity for choosing between various types of greenspaces within walking or cycling distance might be an effective way to stimulate children's use of greenspace. Also, increased parental awareness of their role in children's outdoor spatial behaviours might further greenspace use among children.

Does fibromyalgia affect physical activity due to pain?

The aim of this case-control study was to evaluate the physical activity levels of patients with fibromyalgia syndrome (FMS) and to assess a possible relation between physical activity and FMS characteristics. Seventy patients with FMS and 50 age-gender-matched controls were included. Pain was evaluated using the visual analog scale. The Fibromyalgia Impact Questionnaire (FIQ) scoring system was used for the evaluation of the impact of FMS. Furthermore, for assessing the physical activity in our participants, we used the International Physical Activity Questionnaire (IPAQ). The Mann-Whitney U and Pearson's correlation tests were used for group comparisons and correlation analyses. The patients presented significantly less transportation-related, recreational, and total physical activity levels, besides reporting significantly less time spent walking and less time spent in vigorous activities than controls (p<0.05). Furthermore, there was a negative correlation between pain and the scores of self-reported moderate or vigorous physical activity (r=-0.41, p<0.01) in patients. However, we could not find any correlation between FIQ and IPAQ scores. Patients with FMS are physically less active than healthy individuals. This reduced activity seems to be associated with pain, but not with the impact of the disease. In the management of the patient with FMS, considering the patient's physical activity behavior negatively affected by pain may contribute to holistic approach to the patients.

Impact of Recreational Physical Activity And Body Composition On Insulin Resistance In Older Adult Population

Social support in old age has been linked to psychological wellbeing outcomes, such as depressive symptoms. However, insufficient attention has been paid to implications of social support for different domains of psychological wellbeing. In this study, we explored these associations among 797 older adults (mean age = 78.61 years) living in a retirement community in Florida from the ECRC study. Our findings show that measures of social support and connectedness have varying influences on psychological wellbeing. Loneliness was associated with lower life satisfaction (b=- -1.12, p<0.001) and higher depressive symptoms (b=3.52, p<0.001). Higher self-rated social support was associated with higher life satisfaction (b= 1.66, p<0.001) but did not predict depressive symptoms. Depressive symptoms, however, were significantly higher (b=-1.45) among individuals who reported that they don’t have anyone who they can turn to if they feel lonely and want to talk. Feeling lonely also predicted lower positive affects among these older adults (b=-0.65, p<0.001). Similarly, loneliness also predicted higher negative affects (b=1.28, p<0.001). Negative affects were also significantly higher among women (b=-1.15, p<0.001) but lower among those who were living alone (b=-1.06, p<0.001). Overall, our findings underscore the importance of social support and connectedness for psychological wellbeing in later life. This finding is consistent with prior research demonstrating significance of social support in later life for the overall psychological wellbeing of the older adults.

The Associations of Built Environment with Older People Recreational Walking and Physical Activity in a Chinese Small-Scale City of Yiwu.

Physical activity would bring in plenty of health benefits, especially recreational physical activity (RPA). Previous studies have suggested that built environment would affect older people’s recreational walking (RW) and RPA, but how the effects exist in a small-scale Chinese city remains unclear. Two hundred and fifty-two older participants were recruited in the city of Yiwu using cross-sectional survey of random samples in 2019. RW and RPA level of participants and perceived scores of built environments were collected using the International Physical Activity Questionnaire and Neighborhood Environment Walkability Scale, respectively. Linear regression analysis was conducted to investigate the association of built environment with older people’s RW and RPA. The results showed that two main factors affecting older people’s RW and RPA were residential density and aesthetics. Additionally, access to services was related to RW, and street connectivity was correlated with RPA. The associations of RW with built environment varied slightly with demographic variables included in the regression model. All the results suggested that lower residential density, better aesthetics environment, and higher street connectivity would motivate older people to engage more in RW and RPA. The better access to services encourages only RW, not RPA, in older people. These findings would be helpful for policy decision makers in the urban construction process in Yiwu. More studies are needed to enlarge the scientific evidence base about small-scale cities in China.

Seasonal variability of the vitamin D effect on physical fitness in adolescents

Studies investigating the relationship between vitamin D and physical fitness in youth have provided inconsistent findings. Recent evidence indicates that the expression of receptors and vitamin D-modulated genes in young subjects has a seasonal profile. Therefore, we investigated the role of vitamin D on physical fitness across seasons in a total of 977 male adolescents. Anthropometrics, lifestyle, dietary habits, biochemical profiles and physical fitness were studied. Multiple linear regression models, including pairwise interaction terms involving total 25-OH-vitamin D, were fitted. The interacting effect of season and total 25-OH-vitamin D had a significant influence on physical fitness performance (spring and total 25-OH-vitamin D: ß 0.19, SE 0.07, p = 0.007; summer and total 25-OH-vitamin D: ß 0.10, SE 0.06, p = 0.11; autumn and total 25-OH-vitamin D: ß 0.18, SE 0.07, p = 0.01), whereas the main effect of total 25-OH-vitamin D alone was not significant (p = 0.30). Body fat percentage, recreational physical activity level, time spent per day gaming/TV-watching, smoking, and hemoglobin levels were also related to the physical fitness performance score. Future studies should further explore the role of seasonal-dependent effects of vitamin D on health.

Alittle is better than none: the biggest gain of physical activity in patients with ischemic heart disease.

SummaryBackground:There is a relationship between physical activity and health-related quality of life (HRQL) in healthy people and in patients with ischemic heart disease (IHD). The purpose of this study was to determine whether this relationship between sports or recreational physical activity levels and HRQL has a dose-response gradient in patients with IHD.Methods:Using one generic and three IHD-specific HRQL questionnaires, differences in HRQL scores (adjusted for confounders) were determined for physically a) inactive vs. active patients and b) inactive vs. patients being active 1–2, 3–5, or >5 times per week.Results:Data were provided by 6143 IHD-patients (angina: N = 2033; myocardial infarction: N = 2266; ischemic heart failure: N = 1844). Regardless of diagnosis or instrument used, when patients were dichotomized as either inactive or active, the latter reported throughout higher physical and emotional HRQL (all p < 0.001; d = 0.25–0.70). When categorized by physical activity levels, there was a positive HRQL dose-response gradient by increasing levels of physical activity that was most marked between inactive patients and those being active 1–2 times per week (63 82%). Conclusions: Using generic and IHD-specific HRQL questionnaires, there seems to be an overall dose-dependent gradient betweenincreasing levels of sports or recreational physical activity and higher HRQL in patients with angina, myocardial infarction, and ischemic heart failure. The greatest bang for the public health buck still lies on putting all the effort in changing sedentary lifestyle to at least a moderate active one (1–2 times per week), in particular in cardiac rehabilitation settings.

Prospective Cohort Study of Pre- and Postdiagnosis Physical Activity and Endometrial Cancer Survival.

PURPOSEThe aim of this study was to evaluate associations between pre- and postdiagnosis physical activity and survival in survivors of endometrial cancer by physical activity domain, intensity, dose (metabolic-equivalent task [MET]-hours/week/year), and change from pre- to postdiagnosis.METHODSWe conducted a prospective cohort study in Alberta, Canada, of 425 women who were diagnosed with histologically confirmed invasive endometrial cancer between 2002 and 2006 and observed to 2019. The interviewer-administered Lifetime Total Physical Activity Questionnaire recorded prediagnosis (assessed at a median of 4.4 months after diagnosis) and postdiagnosis physical activity (assessed at a median of 3.4 years after diagnosis). Associations between physical activity and overall and disease-free survival were assessed using Cox proportional hazards models adjusted for age, stage, grade, treatments, body mass index, menopausal status, hormone therapy use, family history of cancer, and comorbidities.RESULTSAfter a median follow-up of 14.5 years, there were 60 deaths, including 18 endometrial cancer deaths, and 80 disease-free survival events. Higher prediagnosis recreational physical activity was statistically significantly associated with improved disease-free survival (> 14 v ≤ 8 MET-hours/week/year; hazard ratio [HR], 0.54; 95% CI, 0.30 to 0.96; Ptrend = .04), but not overall survival (HR, 0.56; 95% CI, 0.29 to 1.07; Ptrend = .06). Higher postdiagnosis recreational physical activity (> 13 v ≤ 5 MET-hours/week/year) was strongly associated with both improved disease-free survival (HR, 0.33; 95% CI, 0.17 to 0.64; Ptrend = .001) and overall survival (HR, 0.33; 95% CI, 0.15 to 0.75; Ptrend = .007). Participants who maintained high recreational physical activity levels from pre- to postdiagnosis also had improved disease-free survival (HR, 0.35; 95% CI, 0.18 to 0.69) and overall survival (HR, 0.43; 95% CI, 0.20 to 0.94) compared with those who maintained low physical activity levels.CONCLUSIONRecreational physical activity, especially postdiagnosis, is associated with improved survival in survivors of endometrial cancer.

Changes in physical activity from pre-diagnosis to first five years post-diagnosis: A prospective cohort study in Chinese breast cancer patient.

e24121 Background: The diagnosis of cancer can motivate patients to change their physical activity habits. No data has reported level of physical activity before and after breast cancer diagnosis in Chinese women. Methods: In an on-going prospective cohort study which involved 1462 Chinese women with early-stage breast cancer, a validated modified Chinese Baecke questionnaire was used to assess physical activity at baseline, 18-, 36- and 60-month after diagnosis. At baseline, patients recalled their habitual physical activity in the preceding 12 months before cancer diagnosis. At 18-, 36- and 60-month follow-up, patients reported their habitual physical activity over the previous 12 months. The level of physical activity at post-diagnosis was defined as the average value assessed at 18-, 36- and 60-month follow-up. Results: Breast cancer patients significantly increased level of physical activity, with median value of 0.6, 5.3, 4.4 and 3.9 MET-hours/week at baseline, 18-, 36- and 60-month follow-up. The average level of physical activity at post-diagnosis was also significantly higher than that at pre-diagnosis ( P &lt; 0.001), with median value of 5.8 MET-hours/week. However, there was no significant difference between any two follow-ups at post-diagnosis. The proportions of participant who met the exercise recommendation (according to WCRF/AICR, 10 MET-hours/week) were low at pre- and post-diagnosis, being 20.7% and 35.1%, respectively. Compared to pre-diagnosis, most of the patients improved or had no change on level of recreational physical activity at post-diagnosis, with the respective proportion being 48.2% and 43.8%. Multivariate analysis showed that higher increase in physical activity after cancer diagnosis was observed among breast cancer patients who were married or cohabitation, unemployed (compared to full time) and had no comorbidity (compared to patients who had one comorbidity). Conclusions: Chinese breast cancer patients reported significant and long-term changes in physical activity after cancer diagnosis, which was in line with current recommendation. However, the proportion of patients who met the exercise recommendation for cancer survivors was still low. Empowering patients on the importance of durable high level of physical activity in breast cancer survivorship is warranted.

Associations in physical activity and sedentary behaviour among the immigrant and non-immigrant US population

BackgroundImmigrants are at a higher risk of poor mental and physical health. Regular participation in physical activity (PA) and low levels of sedentary time are beneficial for both these aspects...

Recreational Physical Activity Is Associated with Reduced Breast Cancer Risk in Adult Women at High Risk for Breast Cancer: A Cohort Study of Women Selected for Familial and Genetic Risk.

Although physical activity is associated with lower breast cancer risk for average-risk women, it is not known if this association applies to women at high familial/genetic risk. We examined the association of recreational physical activity (self-reported by questionnaire) with breast cancer risk using the Prospective Family Study Cohort, which is enriched with women who have a breast cancer family history (N = 15,550). We examined associations of adult and adolescent recreational physical activity (quintiles of age-adjusted total metabolic equivalents per week) with breast cancer risk using multivariable Cox proportional hazards regression, adjusted for demographics, lifestyle factors, and body mass index. We tested for multiplicative interactions of physical activity with predicted absolute breast cancer familial risk based on pedigree data and with BRCA1 and BRCA2 mutation status. Baseline recreational physical activity level in the highest four quintiles compared with the lowest quintile was associated with a 20% lower breast cancer risk (HR, 0.80; 95% confidence interval, 0.68-0.93). The association was not modified by familial risk or BRCA mutation status (P interactions >0.05). No overall association was found for adolescent recreational physical activity. Recreational physical activity in adulthood may lower breast cancer risk for women across the spectrum of familial risk. SIGNIFICANCE: These findings suggest that physical activity might reduce breast cancer risk by about 20% for women across the risk continuum, including women at higher-than-average risk due to their family history or genetic susceptibility.See related commentary by Niehoff et al., p. 23.

Characterization and Disease Management of Persons with Hemophilia A Treated with Emicizumab: A Survey Study of Hematologists in the US

Introduction Emicizumab (EMI) is a subcutaneously administered, bispecific, humanized monoclonal antibody that bridges activated factor IX (FIXa) and FX to restore the function of missing FVIIIa in persons with hemophilia A (PwHA). It was approved in the US for prophylaxis in PwHA with FVIII inhibitors in November 2017 and for PwHA without FVIII inhibitors in October 2018. In May 2019, an online survey of 50 board-certified hematologists (HEMs) was conducted with the objective of understanding the characteristics of PwHA who are being treated with EMI (PwHA-EMI) and assessing any changes in disease management of these individuals by HEMs. Methods Descriptive analysis was conducted on data collected from May 8 to May 20, 2019, through a 30-minute, online survey of 50 HEMs treating adult and pediatric PwHA with or without FVIII inhibitors in the US. These HEMs were required to have ≥2 years of experience post-residency and experience treating ≥3 PwHA per month with EMI. Results Of the 50 HEMs from 22 states who were surveyed in this study, 28% (n=14) primarily treated pediatric PwHA and 76% (n=38) practiced at federally funded hemophilia treatment centers. HEMs reported that the majority of their PwHA-EMI had severe HA, were previously treated, and did not have FVIII inhibitors. HEMs reported presence of inhibitors (40%, n=20) and high treatment burden with previous treatments (16%, n=8) as the top factors that were considered when initiating treatment with EMI. HEMs reported that they are testing less frequently for FVIII activity (52%, n=26) and inhibitors (28%, n=14) in PwHA-EMI. Most HEMs reported using multiple methods for breakthrough bleed recognition in their PwHA-EMI, such as advising them to call a healthcare provider (HCP) for diagnosis support (70%, n=35) and providing educational materials (68%, n=34). Further, 34% (n=17) reported a change in their guidance on bleed treatment in PwHA-EMI. Guidance varied by inhibitor status and type of bleed; these HEMs were more likely to recommend that their PwHA-EMI with FVIII inhibitors (65%, n=11/17) and without FVIII inhibitors (53%, n=9/17) call a HCP to discuss symptoms before treating the bleed. Also, 42% (n=21) of HEMs typically advised keeping 3-4 doses of bypassing agent or FVIII at hand in case of breakthrough bleed treatment in PwHA-EMI. A majority of HEMs (84%, n=42) reported that the recreational physical activity levels of their PwHA have remained the same or increased after starting EMI; 48% (n=24) of HEMs recommended that their patients have a gradual increase in these activities after starting EMI. Among HEMs who provided specific guidance on recreational physical activities (54%; n=27), most develop customized plans for their patients based on fitness goals (82%; n=22/27), disease severity (74%; n=20/27), and age (56%; n=15/27). For disease management support, 58% (n=29) of HEMs reported no change in the support they provide, even though EMI is a relatively new treatment. HEMs mainly attributed this to fewer bleeds in PwHA-EMI. For routine and follow-up care, 72% (n=36) and 56% (n=28) of HEMs, respectively, reported that their PwHA-EMI seek about the same levels of such care as they did prior to starting EMI, but 32% (n=16) of HEMs reported that their PwHA-EMI need less non-routine care after starting treatment with EMI. Breakthrough bleeds (22%, n=11) and trauma (20%, n=10) were reported as the top reasons for any non-routine care in PwHA-EMI. As for treatment adherence, 90% (n=45) of HEMs reported that their PwHA-EMI have similar or better adherence compared with those on other HA treatments. Lastly, 46% (n=23) of HEMs reported that their PwHA-EMI regularly experience insurance issues, including ones related to coverage for EMI and coverage for care and breakthrough bleed treatments while on EMI. Conclusions Based on the findings of this survey study, most HEMs have retained similar disease management support and practices for their PwHA-EMI. Although the frequency of routine care has not changed for most PwHA-EMI, HEMs indicated a reduction in the amount of non-routine care needed by these individuals. As EMI is prescribed and used over a longer period post approval, patient characteristics, treatment methods, and disease management practices should continue to be monitored to support HEMs' treatment and care of PwHA. Disclosures Owens: PRO Unlimited: Employment; Genentech, Inc.: Consultancy. Patel:Roche/Genentech: Equity Ownership; Genentech: Employment. Poulos:MedPanel, Inc.: Employment. Powers:MedPanel: Employment. Ko:Genentech, Inc.: Employment.

Abstract 961: Joint associations of physical activity and body mass index and the risk of excess body fatness-related cancer

Abstract Background: Consistent evidence has linked excess body fatness (EBF), typically measured in large epidemiologic studies using body mass index (BMI), with a higher risk of 13 types of cancer. Whether physical activity mitigates any of the excess risk associated with EBF is unclear—as few studies have examined the joint association between BMI and physical activity. Methods: We examined the joint association of BMI and physical activity on the risk of 12 of the 13 EBF-related cancers (excluding meningioma and including esophagus [adenocarcinoma], gastric cardia, colon and rectum, liver, gallbladder, pancreas, postmenopausal breast, corpus uteri, ovary, kidney [renal cell], thyroid, and multiple myeloma) among 70,658 men and 72,209 postmenopausal women (median age: 63 years) without a history of cancer at study entry in the Cancer Prevention Study II Nutrition Cohort (1992-2013). Multivariable Cox proportional hazards models were used to calculate hazard ratios (HR) and 95% confidence intervals (CI) for the individual and joint associations between BMI (kg/m2) and recreational physical activity (MET-hours/week) at study entry and first cancer incidence. Results: Between 1992-2013, 3,860 men and 9,001 women were diagnosed with an EBF-related cancer. Compared to normal weight (BMI 18.5-&amp;lt;25 kg/m2), overweight (25-&amp;lt;30 kg/m2) was associated with a modest increased risk of EBF-related cancer (men: HR 1.12; 95% CI: 1.04, 1.21; women: HR 1.13; 95% CI: 1.08, 1.19) and obesity (≥30 kg/m2) with a stronger risk (men: HR 1.48; 95% CI: 1.34, 1.63; women: HR 1.48; 95% CI: 1.40, 1.57). Higher levels of physical activity (&amp;gt;15 vs. &amp;gt;0-&amp;lt;7.5 MET-hrs/wk) were associated with a lower risk for EBF-related cancer among women (HR: 0.90; 95% CI: 0.85-0.95) but less so among men (HR: 0.96; 95% CI: 0.88, 1.04). Among women, there was no evidence of interaction between physical activity and BMI for the risk of EBF-related cancer (P-interaction=0.59); however, there was suggestive evidence that the excess risk associated with overweight was modestly mitigated by the highest level of physical activity (HR: 1.00; 95% CI: 0.91, 1.10). Among men, there was some evidence of an interaction between BMI and physical activity on risk (P-interaction=0.06) with the higher risk associated with overweight limited to those who were inactive (HR: 1.27; 95% CI: 1.08, 1.49). However, risk was higher for obese men irrespective of physical activity level. Conclusion: Our results suggest that higher levels of recreational physical activity may offset a small amount of the increased risk of EBF-related cancer among overweight men and women. However, physical activity does not appear to mitigate the strong effect of obesity (BMI ≥30 kg/m2) on risk of EBF-related cancers, thus reinforcing the importance of maintaining a healthy body weight even if physically active. Citation Format: Maret L. Maliniak, Susan M. Gapstur, Lauren E. McCullough, Erika Rees-Punia, Mia M. Gaudet, Caroline Y. Um, Mark A. Guinter, Elizabeth A. Fallon, Alpa V. Patel. Joint associations of physical activity and body mass index and the risk of excess body fatness-related cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 961.