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A new study published in the Journal of Cancer Survivorship looked at the effect of behavioral graded activity on physical activity level, health-related quality of life, and symptom management in cancer patients and survivors.

“In this paper, we screened the literature for studies which had the goal of increasing daily activity levels in cancer patients and survivors,” study author Astrid Larousse told us. “Unfortunately, most individuals face barriers to become a more physically active person.”

Barriers can be cancer-related pain, and ignorance concerning how to do sport and its importance. For this reason, advising individuals to be more physical activity and start an exercise program without further support is not enough.

“We believe individuals need to be guided and informed throughout this process, and maladaptive thoughts about being physically active should be adjusted by their healthcare provider before starting an exercise program," Larousse told us. “The idea is that patients should have a behavioural change, therefore we are interested in the intervention known as ‘behavioural graded activity’. So, we screened the literature to summarise the evidence about this intervention.”

It is important to screen the literature systematically to avoid missing papers. Combining papers about one topic will strengthen the results of the studies. Researchers hoped to find long-term and favourable effects of behavioural-graded activity on debilitating symptoms (such as anxiety, pain, depression), physical activity and quality of life.

“Our experience is that numerous cancer patients and survivors have difficulties reaching the recommended amounts of physical activity levels provided in the guidelines,” Larousse told us. “It is advised to have at least 150 min of moderate-intensity aerobic activity and two days of muscles strengths training.”

According to previous literature, interventions with goal setting, graded activity and guidance on how to perform behaviour were the best manner to motivate individuals to remain active in the long term. The behavioural-graded activity is an intervention that combines all of these three aspects. The research team was interested to study the added value of this intervention.

“We hoped to find improvements for debilitating symptoms (such as anxiety, pain, depression), physical activity and quality of life in cancer patients and survivors,” Larousse told us. “Physical activity is important for a healthy body.”
During the EBCC-13th it has been mentioned several times that 40% of cancer could be prevented by a healthy lifestyle. Being physically active not only lowers cancer risk but also prevents a lot of other chronic diseases. The team felt that more research was needed to find the best intervention that maintains individuals, cancer patients and survivors physically active in the long-term.

“This paper is a systematic review with meta-analysis,” Larousse told us. “We screened the literature to summarize the evidence about this topic.”

It is important to screen the literature systematically to avoid missing papers. Combining papers and their effect about one topic strengthened the results of the studies.

“We found significant effects for cancer patients and survivors who had psychological support combined with behavioural graded activity compared to those who received nothing,” Larousse told us. “Medium to large improvements were found for anxiety, fatigue, depression, ability to manage everyday tasks, psychological distress, physical activity, quality of life, and social impairment.”

After a period between one to three months, only the effects on psychological distress remained statistically significant. When comparing cancer patients and survivors who had psychological support combined with behavioural graded activity with cancer patients and survivors who received the usual standard of care, the research team found significant medium improvements for anxiety, depression, fatigue and physical activity. After one to three months, the medium effects on anxiety, depression and fatigue remained significant.
No statistically significant effects were seen when comparing psychological therapies combined with behavioural-graded activity only, or psychological therapies only.

“The results went in the expected direction,” Larousse told us. “However, for pain non-significant effect was found when comparing psychological support combined with behavioural graded activity to no intervention.”

This was unexpected because various studies have already demonstrated a reduction in pain by being physically active. This result was based on two studies. More studies are needed to take stronger conclusions about pain. The research team faced the same problem for the long-term results/effects. Few studies reported long-term results. When comparing psychological support combined with behavioural graded activity to no intervention, the effect could only be observed on psychological distress in the long-term and was significant.

“The results of this study underline the importance of further studying non-drug interventions (such as psychological support and physical activity in the continuum of cancer care,” Larousse told us. “Physicians should switch towards a non-pharmacological intervention which is a less expensive treatment for society than any other drug treatment. On top of that being physically active not only helps with cancer's debilitating side-effect but also prevents cancer recurrence and other chronic diseases.”

The word should be spread to physicians to inform their patients about the importance of being physically active and if needed, Larousse further explained, refer the patients to the appropriate healthcare provider (psychologist, physical therapist,…) who will remove barriers and provide the perfect guidance.