Exercise as it relates to Disease/Endometrial cancer survivors and its association with exercise, body weight and quality of life

This report is critique of the article "Associations among exercise, body weight, and quality of life in a population-based sample of endometrial cancer survivors"

What is the background to this research?
Endometrial cancer is a cancer of the uterus that begins in the layer of cells that form endometrium or the lining of the uterus. Often, the cancer is found early and can be overcome with treatments such as removal of the uterus, radiation therapy, chemotherapy and hormone therapy. Physical activity or exercise recommendations conclude that it is important to up keep regular physical activity, avoid inactivity and aim for 150 minutes of exercise per week A lack of exercise and excess body weight can have negative effects on quality of life (QoL). For cancer survivors, it can be an important part of their own person treatment in recovery from the disease. Research on endometrial cancer survivors has indicated the independent effect of exercise and decreased BMI on QoL.

Where is the research from?
The study was conducted in Alberta, Canada. The research that was conducted is important to share because the findings could prove valuable for other individuals that have survived different cancers as well as those who have suffered from endometrial cancer across all locations. The primary authors of the research include Kerry Courneya, a professor and research chair in physical activity and cancer, Kristina Karvinen and Kristin Campbell, an expert in the field of physical activity in health and chronic disease. There are numerous factors that could be a conflict of interest and bias approach, in which can affect the results substantially. Firstly, obtaining the full and correct details of each endometrial cancer survivor within the Alberta cancer registry will prove to be difficult and may have led to false information. Furthermore, seeking permission from each survivor’s oncologist or physician could impact the results by false or misleading information given about the individuals.

What kind of research was this?
The research conducted was an observational study that examined different lifestyle factors across the population sample, including exercise and body weight. By using mail delivered questionaries the researchers were able to grasp an understanding of how exercise, BMI and QoL impacted the endometrial cancer survivors. Similar studies that have been completed for other cancers survivors often use randomised control trials. This will mean there is a more likely chance the results will be valid and true as participants are not as subject to over or underestimating how much exercise they are doing

What did the research involve?
The research involved contacting, via questionnaire, survivors of endometrial cancer residing in Alberta. To be eligible, the participants needed to be over eighteen years or older, be able to give written consent in English, approved for contact by their primary oncologist and had historically confirmed endometrial cancer. All of the people that were requested to complete the study were diagnosed from November 1994 and June 2003. Their contact information was obtained from the Alberta Cancer Registry. A slightly modified Total Design Method was used. This consisted of a mail out of initial questionnaire with a reminder sent out two weeks later. After another four weeks, a second questionnaire was mailed out. The participants role was to complete the questionnaires as accurately as possible about their exercise, including intensity, duration and frequency, body weight and QoL. Using this method to collect data has many benefits and limitations. It is an easy, cost-effective way to gather information, however, results are likely to not be accurate due to participants over and underestimating their level of exercise and exercise intensity, time duration of exercise and accurate height and weight measurements. These limitations could have serious impacts of how precise results are.

What were the basic results?
The results of the investigation found that descriptive data indicated that 30% of survivors met exercise guidelines, however it should be noted that this result is likely to be an overestimate due to self-reports of weight and exercise. The hypothesis of the research found a consistent positive association between exercise guidelines and QoL. An important result is that 72% of the population-sample were overweight or obese and approximately 70% did not reach exercise guidelines. When interpreting the results, the researchers have noted that exercise and body weight were significant for both independent and clinically meaningful associations in QoL, however these observations would need further study and randomised controlled trials to be validated.

What conclusions can we take from this research?
This research was a great starting point to identify the associations between exercise, body weight and QoL in those who have survived endometrial cancer. Although this research has multiple strengths, such as using a large population sample and using established measures, there are also limitations that need to be factored in. These limitations include, the transparency of the study, overestimating, self-reporting, not identifying if there was any disease reoccurrence within the population sample and because it was an observational study, exercise, body weight and QoL cannot be determined. In other studies, exercise is seen as an effective intervention to improve QoL in other cancer patients, however, it is unknown if exercise has any impact on the chances of reoccurrence in cancer survivors.

Practical advice
This article lacks further research in recommendations for exercise, monitoring the progress of individuals exercise, encouraging exercise and a criterion for not exercising. However, although it is indirect, the study does prove that exercise and body weight have an impact on someone’s QoL, therefore indicating the advice to meet exercise guidelines in order to have a better QoL.

Further information/research
For any further information and resources on associations of exercise, weight and QoL in people that have survived endometrial cancer, there are multiple websites, articles and organisations. Recommendations for further information:

Exercise and Behaviour In Population Sample of Endometrial Cancer Survivors

Physical activity and obesity in endometrial cancer survivors

Endometrial Cancer – The Women’s Royal Hospital

Centres for Disease Control

American College of Sports Medicine