Change patterns and determinants of physical activity differ between breast, prostate, and colorectal cancer patients

  • Karen SteindorfEmail author
  • Johanna Depenbusch
  • Alexander Haussmann
  • Angeliki Tsiouris
  • Laura Schmidt
  • Silke Hermann
  • Monika Sieverding
  • Joachim Wiskemann
  • Nadine Ungar
Original Article



The purpose of this study was to examine and compare pre- to post-diagnosis change patterns of physical activity (PA) among breast, prostate, and colorectal cancer patients. Moreover, the study aimed to investigate sociodemographic and medical determinants of post-diagnosis PA and to identify patient subgroups at increased risk of inactivity.


A total of 912 cancer patients (457 breast, 241 prostate, 214 colorectal cancer) completed a questionnaire assessing their pre- and post-diagnosis PA behavior, and sociodemographic and medical variables. Age-adjusted regression and classification tree analyses were used to investigate PA determinants and detect subgroups that were most likely to meet or not meet PA guidelines.


Across cancer types, we found that PA yet decreased from pre- to post-diagnosis, but that 54.1% of participants still reported to be meeting PA guidelines after the diagnosis. While post-diagnosis PA was strongly affected by previous PA behavior among individuals of all patient groups, other sociodemographic and medical determinants played different roles depending on cancer type. The results yielded that previously active, longer diagnosed patients with higher education levels were most likely to be meeting PA guidelines post-diagnosis, whereas specifically previously inactive prostate cancer patients had an increased likelihood of insufficient activity.


An encouragingly high number of cancer patients indicated sufficient PA levels. For those having difficulties to maintain or adopt PA post-diagnosis, interventions should be tailored to the specific characteristics of each cancer type, as different factors are associated with PA for each patient group.


Physical activity Breast cancer Prostate cancer Colorectal cancer Determinants Change patterns 



We thank Fiona Rupprecht, Lena Radke, Nina Immel, Sara Kuru, Sophie Madlinger, Elisa Ebler, and Xenia Peukert for their help in the recruitment, coding procedure, and data management.

Funding information

This study was part of the Momentum Project that has been supported by a grant from the German Cancer Aid (Grant No. 110512, 110551, and 111223).

Compliance with ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study. The authors declare that they have full control of all primary data and that they agree to allow the journal to review our data.


  1. 1.
    Demark-Wahnefried W, Rogers LQ, Alfano CM, Thomson CA, Courneya KS, Meyerhardt JA, Stout NL, Kvale E, Ganzer H, Ligibel JA (2015) Practical clinical interventions for diet, physical activity, and weight control in cancer survivors. CA Cancer J Clin 65(3):167–189. CrossRefPubMedGoogle Scholar
  2. 2.
    Buffart LM, Kalter J, Sweegers MG, Courneya KS, Newton RU, Aaronson NK, Jacobsen PB, May AM, Galvao DA, Chinapaw MJ, Steindorf K, Irwin ML, Stuiver MM, Hayes S, Griffith KA, Lucia A, Mesters I, van Weert E, Knoop H, Goedendorp MM, Mutrie N, Daley AJ, McConnachie A, Bohus M, Thorsen L, Schulz KH, Short CE, James EL, Plotnikoff RC, Arbane G, Schmidt ME, Potthoff K, van Beurden M, Oldenburg HS, Sonke GS, van Harten WH, Garrod R, Schmitz KH, Winters-Stone KM, Velthuis MJ, Taaffe DR, van Mechelen W, Kersten MJ, Nollet F, Wenzel J, Wiskemann J, Verdonck-de Leeuw IM, Brug J (2017) Effects and moderators of exercise on quality of life and physical function in patients with cancer: an individual patient data meta-analysis of 34 RCTs. Cancer Treat Rev 52:91–104. CrossRefPubMedGoogle Scholar
  3. 3.
    Segal R, Zwaal C, Green E, Tomasone JR, Loblaw A, Petrella T (2017) Exercise for people with cancer: a systematic review. Curr Oncol 24(4):e290–e315. CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Cormie P, Zopf EM, Zhang X, Schmitz KH (2017) The impact of exercise on cancer mortality, recurrence, and treatment-related adverse effects. Epidemiol Rev 39(1):71–92. CrossRefPubMedGoogle Scholar
  5. 5.
    Friedenreich CM, Neilson HK, Farris MS, Courneya KS (2016) Physical activity and cancer outcomes: a precision medicine approach. Clin Cancer Res 22(19):4766–4775. CrossRefPubMedGoogle Scholar
  6. 6.
    Friedenreich CM, Shaw E, Neilson HK, Brenner DR (2017) Epidemiology and biology of physical activity and cancer recurrence. J Mol Med (Berl) 95(10):1029–1041. CrossRefGoogle Scholar
  7. 7.
    Schmitz KH, Courneya KS, Matthews C, Demark-Wahnefried W, Galvão DA, Pinto BM, Irwin ML, Wolin KY, Segal RJ, Lucia A, Schneider CM, von Gruenigen VE, Schwartz AL (2010) American College of Sports Medicine roundtable on exercise guidelines for cancer survivors. Med Sci Sports Exerc 42(7):1409–1426. CrossRefPubMedGoogle Scholar
  8. 8.
    Bray F, Jemal A, Grey N, Ferlay J, Forman D (2012) Global cancer transitions according to the Human Development Index (2008-2030): a population-based study. Lancet Oncol 13(8):790–801. CrossRefPubMedGoogle Scholar
  9. 9.
    Allemani C, Matsuda T, Di Carlo V, Harewood R, Matz M, Niksic M, Bonaventure A, Valkov M, Johnson CJ, Esteve J, Ogunbiyi OJ, Azevedo ESG, Chen WQ, Eser S, Engholm G, Stiller CA, Monnereau A, Woods RR, Visser O, Lim GH, Aitken J, Weir HK, Coleman MP (2018) Global surveillance of trends in cancer survival 2000-14 (CONCORD-3): analysis of individual records for 37 513 025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries. Lancet 391(10125):1023–1075. CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Hawkins NA, Smith T, Zhao L, Rodriguez J, Berkowitz Z, Stein KD (2010) Health-related behavior change after cancer: results of the American cancer society’s studies of cancer survivors (SCS). J Cancer Surviv 4(1):20–32. CrossRefPubMedGoogle Scholar
  11. 11.
    Fassier P, Zelek L, Partula V, Srour B, Bachmann P, Touillaud M, Druesne-Pecollo N, Galan P, Cohen P, Hoarau H, Latino-Martel P, Menai M, Oppert JM, Hercberg S, Deschasaux M, Touvier M (2016) Variations of physical activity and sedentary behavior between before and after cancer diagnosis: Results from the prospective population-based NutriNet-Sante cohort. Medicine 95(40):e4629. CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Eng L, Pringle D, Su J, Shen X, Mahler M, Niu C, Charow R, Tiessen K, Lam C, Halytskyy O, Naik H, Hon H, Irwin M, Pat V, Gonos C, Chan C, Villeneuve J, Harland L, Shani RM, Brown MC, Selby P, Howell D, Xu W, Liu G, Alibhai SMH, Jones JM (2018) Patterns, perceptions, and perceived barriers to physical activity in adult cancer survivors. Support Care Cancer 26(11):3755–3763. CrossRefPubMedGoogle Scholar
  13. 13.
    Boyle T, Vallance JK, Ransom EK, Lynch BM (2016) How sedentary and physically active are breast cancer survivors, and which population subgroups have higher or lower levels of these behaviors? Support Care Cancer 24(5):2181–2190. CrossRefPubMedGoogle Scholar
  14. 14.
    Galvao DA, Newton RU, Gardiner RA, Girgis A, Lepore SJ, Stiller A, Occhipinti S, Chambers SK (2015) Compliance to exercise-oncology guidelines in prostate cancer survivors and associations with psychological distress, unmet supportive care needs, and quality of life. Psycho-oncology 24(10):1241–1249. CrossRefPubMedGoogle Scholar
  15. 15.
    Thraen-Borowski KM, Gennuso KP, Cadmus-Bertram L (2017) Accelerometer-derived physical activity and sedentary time by cancer type in the United States. PLoS One 12(8):e0182554. CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Vallance JK, Boyle T, Courneya KS, Lynch BM (2015) Accelerometer-assessed physical activity and sedentary time among colon cancer survivors: associations with psychological health outcomes. J Cancer Surviv 9(3):404–411. CrossRefPubMedGoogle Scholar
  17. 17.
    Buffart LM, Thong MS, Schep G, Chinapaw MJ, Brug J, van de Poll-Franse LV (2012) Self-reported physical activity: its correlates and relationship with health-related quality of life in a large cohort of colorectal cancer survivors. PLoS One 7(5):e36164. CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Ramirez-Parada K, Courneya KS, Muniz S, Sanchez C, Fernandez-Verdejo R (2019) Physical activity levels and preferences of patients with breast cancer receiving chemotherapy in Chile. Support Care Cancer 27(8):2941–2947. CrossRefPubMedGoogle Scholar
  19. 19.
    Speed-Andrews AE, Rhodes RE, Blanchard CM, Culos-Reed SN, Friedenreich CM, Belanger LJ, Courneya KS (2012) Medical, demographic and social cognitive correlates of physical activity in a population-based sample of colorectal cancer survivors. Eur J Cancer Care (Engl) 21(2):187–196. CrossRefGoogle Scholar
  20. 20.
    van Putten M, Husson O, Mols F, Luyer MDP, van de Poll-Franse LV, Ezendam NPM (2016) Correlates of physical activity among colorectal cancer survivors: results from the longitudinal population-based profiles registry. Support Care Cancer 24(2):573–583. CrossRefPubMedGoogle Scholar
  21. 21.
    Kampshoff CS, Stacey F, Short CE, van Mechelen W, Chinapaw MJ, Brug J, Plotnikoff R, James EL, Buffart LM (2016) Demographic, clinical, psychosocial, and environmental correlates of objectively assessed physical activity among breast cancer survivors. Support Care Cancer 24(8):3333–3342. CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Lynch BM, Boyle T, Winkler E, Occleston J, Courneya KS, Vallance JK (2016) Patterns and correlates of accelerometer-assessed physical activity and sedentary time among colon cancer survivors. Cancer Causes Control 27(1):59–68. CrossRefPubMedGoogle Scholar
  23. 23.
    Gjerset GM, Fossa SD, Courneya KS, Skovlund E, Thorsen L (2011) Exercise behavior in cancer survivors and associated factors. J Cancer Surviv 5(1):35–43. CrossRefPubMedGoogle Scholar
  24. 24.
    Schmidt ME, Wiskemann J, Ulrich CM, Schneeweiss A, Steindorf K (2017) Self-reported physical activity behavior of breast cancer survivors during and after adjuvant therapy: 12 months follow-up of two randomized exercise intervention trials. Acta Oncol 56(4):618–627. CrossRefPubMedGoogle Scholar
  25. 25.
    Hawkes AL, Patrao TA, Baade P, Lynch BM, Courneya KS (2015) Predictors of physical activity in colorectal cancer survivors after participation in a telephone-delivered multiple health behavior change intervention. J Cancer Surviv 9(1):40–49. CrossRefPubMedGoogle Scholar
  26. 26.
    Hackshaw-McGeagh LE, Penfold CM, Walsh E, Donovan JL, Hamdy FC, Neal DE, Jeffreys M, Martin RM, Lane JA, Protec TSG (2015) Physical activity, alcohol consumption, BMI and smoking status before and after prostate cancer diagnosis in the ProtecT trial: opportunities for lifestyle modification. Int J Cancer 137(6):1509–1515. CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    LeMasters TJ, Madhavan SS, Sambamoorthi U, Kurian S (2014) Health behaviors among breast, prostate, and colorectal cancer survivors: a US population-based case-control study, with comparisons by cancer type and gender. J Cancer Surviv 8(3):336–348. CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Forbes CC, Blanchard CM, Mummery WK, Courneya KS (2014) A comparison of physical activity correlates across breast, prostate and colorectal cancer survivors in Nova Scotia, Canada. Support Care Cancer 22(4):891–903. CrossRefPubMedGoogle Scholar
  29. 29.
    Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40(5):373–383CrossRefGoogle Scholar
  30. 30.
    Godin G (2011) The Godin-Shephard Leisure-Time Physical Activity Questionnaire. Health Fit J Can 4(1):18–22. CrossRefGoogle Scholar
  31. 31.
    Kass GV (1980) An exploratory technique for investigating large quantities of categorical data. J R Stat Soc: Ser C: Appl Stat 29(2):119–127. CrossRefGoogle Scholar
  32. 32.
    Stone CR, Courneya KS, McGregor SE, Li H, Friedenreich CM (2019) Determinants of changes in physical activity from pre-diagnosis to post-diagnosis in a cohort of prostate cancer survivors. Support Care Cancer 27(8):2819–2828. CrossRefPubMedGoogle Scholar
  33. 33.
    Haussmann A, Ungar N, Gabrian M, Tsiouris A, Sieverding M, Wiskemann J, Steindorf K (2018) Are healthcare professionals being left in the lurch? The role of structural barriers and information resources to promote physical activity to cancer patients. Support Care Cancer 26(12):4087–4096. CrossRefPubMedGoogle Scholar
  34. 34.
    Tarasenko YN, Miller EA, Chen C, Schoenberg NE (2017) Physical activity levels and counseling by health care providers in cancer survivors. Prev Med 99:211–217. CrossRefPubMedGoogle Scholar
  35. 35.
    Prochaska JJ, Coughlin SS, Lyons EJ (2017) Social media and mobile technology for cancer prevention and treatment. Am Soc Clin Oncol Educ Book 37:128–137. CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Chiu YC, Hsieh YL (2013) Communication online with fellow cancer patients: writing to be remembered, gain strength, and find survivors. J Health Psychol 18(12):1572–1581. CrossRefPubMedGoogle Scholar
  37. 37.
    Davis CE (1976) The effect of regression to the mean in epidemiologic and clinical studies. Am J Epidemiol 104(5):493–498. CrossRefPubMedGoogle Scholar
  38. 38.
    Moore SC, Lee IM, Weiderpass E, Campbell PT, Sampson JN, Kitahara CM, Keadle SK, Arem H, Berrington de Gonzalez A, Hartge P, Adami HO, Blair CK, Borch KB, Boyd E, Check DP, Fournier A, Freedman ND, Gunter M, Johannson M, Khaw KT, Linet MS, Orsini N, Park Y, Riboli E, Robien K, Schairer C, Sesso H, Spriggs M, Van Dusen R, Wolk A, Matthews CE, Patel AV (2016) Association of leisure-time physical activity with risk of 26 types of cancer in 1.44 million adults. JAMA Intern Med 176(6):816–825. CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Schuch F, Vancampfort D, Firth J, Rosenbaum S, Ward P, Reichert T, Bagatini NC, Bgeginski R, Stubbs B (2017) Physical activity and sedentary behavior in people with major depressive disorder: a systematic review and meta-analysis. J Affect Disord 210:139–150. CrossRefPubMedGoogle Scholar
  40. 40.
    Brunet J, Amireault S, Chaiton M, Sabiston CM (2014) Identification and prediction of physical activity trajectories in women treated for breast cancer. Ann Epidemiol 24(11):837–842. CrossRefPubMedGoogle Scholar
  41. 41.
    Heywood R, McCarthy AL, Skinner TL (2017) Safety and feasibility of exercise interventions in patients with advanced cancer: a systematic review. Support Care Cancer 25(10):3031–3050. CrossRefPubMedGoogle Scholar
  42. 42.
    Cornford P, Bellmunt J, Bolla M, Briers E, De Santis M, Gross T, Henry AM, Joniau S, Lam TB, Mason MD, van der Poel HG, van der Kwast TH, Rouviere O, Wiegel T, Mottet N (2017) EAU-ESTRO-SIOG guidelines on prostate cancer. Part II: treatment of relapsing, metastatic, and castration-resistant prostate cancer. Eur Urol 71(4):630–642. CrossRefPubMedGoogle Scholar
  43. 43.
    Liede A, Hallett DC, Hope K, Graham A, Arellano J, Shahinian VB (2016) International survey of androgen deprivation therapy (ADT) for non-metastatic prostate cancer in 19 countries. ESMO open 1(2):e000040. CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Haseen F, Murray LJ, Cardwell CR, O'Sullivan JM, Cantwell MM (2010) The effect of androgen deprivation therapy on body composition in men with prostate cancer: systematic review and meta-analysis. J Cancer Surviv 4(2):128–139. CrossRefPubMedGoogle Scholar
  45. 45.
    Jones LW, Alfano CM (2013) Exercise-oncology research: past, present, and future. Acta Oncol 52(2):195–215. CrossRefPubMedGoogle Scholar
  46. 46.
    Ungar N, Schmidt L, Gabrian M, Haussmann A, Tsiouris A, Sieverding M, Steindorf K, Wiskemann J (2019) Which self-management strategies do health care professionals recommend to their cancer patients? An experimental investigation of patient age and treatment phase. J Behav Med 42(2):342–352. CrossRefPubMedGoogle Scholar
  47. 47.
    Boyle T, Lynch BM, Courneya KS, Vallance JK (2015) Agreement between accelerometer-assessed and self-reported physical activity and sedentary time in colon cancer survivors. Support Care Cancer 23(4):1121–1126. CrossRefPubMedGoogle Scholar
  48. 48.
    Amireault S, Godin G, Lacombe J, Sabiston CM (2015) Validation of the Godin-Shephard Leisure-Time Physical Activity Questionnaire classification coding system using accelerometer assessment among breast cancer survivors. J Cancer Surviv 9(3):532–540. CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of Physical Activity, Prevention and CancerNational Center for Tumor Diseases (NCT) Heidelberg and German Cancer Research Center (DKFZ)HeidelbergGermany
  2. 2.Medical FacultyUniversity of HeidelbergHeidelbergGermany
  3. 3.Institute of PsychologyHeidelberg UniversityHeidelbergGermany
  4. 4.Division of Medical OncologyNational Center for Tumor Diseases (NCT) Heidelberg and University Clinic HeidelbergHeidelbergGermany
  5. 5.Department of Psychosomatic Medicine and Psychotherapy, University Medical Center MainzJohannes Gutenberg University MainzMainzGermany
  6. 6.Epidemiological Cancer Registry Baden-Württemberg, German Cancer Research Center (DKFZ)HeidelbergGermany

Personalised recommendations