May 12, 2009
Diet and exercise intervention helps older, overweight cancer survivors reduce functional decline
A home-based diet and exercise program reduced the rate of
functional decline among older, overweight long-term survivors of
colorectal, breast and prostate cancer, according to a study in the May
13 issue of JAMA.
"In 2008, the Centers for Medicare
& Medicaid Services declared mobility maintenance and functional
independence among at-risk older individuals as the sole priority in
aging research. Older cancer survivors represent an important target
because cancer and its treatment are associated with accelerated
functional decline," the authors write. The practice of healthy
lifestyle behaviors may reduce risk for disease and functional decline.
However, many older cancer survivors report poor lifestyle behaviors,
and few meet recommended health promotion guidelines. "Lifestyle
interventions may provide benefit, but it is unknown whether long-term
cancer survivors can modify their lifestyle behaviors sufficiently to
improve functional status."
Miriam C. Morey, Ph.D., of Duke
University, Durham, N.C., and colleagues conducted a randomized,
controlled trial that tested a home-based diet and exercise
intervention and its effect on functional decline among 641 older (age
65-91 years), overweight (BMI 25 or greater and less than 40) long-term
(5 years or greater) survivors of breast, prostate, and colorectal
cancer. The participants were randomly assigned to an intervention
group (n = 319) or delayed intervention (control) group (n = 322) in
Canada, the United Kingdom, and the United States. The 12-month
intervention consisted of a home-based program of telephone counseling
and mailed materials promoting exercise, improved diet quality, and
modest weight loss. Change in functional status was assessed using the
physical function subscale of the Medical Outcomes Study Short-Form 36
(SF-36) questionnaire (score range, 0-100; a high score indicates
better functioning). Other outcomes included changes in function on the
basic and advanced lower-extremity function (i.e., use of legs)
subscales of the Late Life Function and Disability Index (score range,
0-100), physical activity, body mass index and overall health-related
quality of life.
The average physical function score at the
beginning of the study was 75.7, which is comparable with the median
(midpoint) score for men and women age 65 years or older. For the SF-36
physical function subscale, the average function scores declined less
rapidly in the intervention group (average score change of -2.15) than
in the control group (average score change of −4.84). There was a
statistically significant difference between study groups in basic
lower-extremity function as function changed negligibly in the
intervention group, whereas the control group showed a decrease in
function.
There were significant differences between the
intervention and control groups for all targeted behaviors except
endurance exercise frequency. Duration of strength training exercise
and endurance exercise minutes increased in the intervention group and
remained stable in the control group. The average intake of fruits and
vegetables increased by 1.24 daily servings in the intervention group
and by 0.13 daily servings in the control group. The average
consumption of saturated fat decreased by 3.06 grams per day in the
intervention group and by only 1.07 grams per day in the control group.
Participants in the intervention group reported an average weight loss
of 4.5 pounds, which was more than twice that reported by the control
group (2.03 pounds).
Overall health-related quality of life
decreased in every subscale in the control group throughout the
12-month period. In the intervention group, decreases in subscale
scores were of lower magnitude and were sustained for overall health
and mental health.
"In conclusion, this study provides data on
a long overlooked, yet important faction in older long-term cancer
survivors. Long-term survivors of colorectal, breast, and prostate
cancer participating in a diet and exercise intervention reduced the
rate of self-reported physical function decline in comparison with a
group receiving no intervention," the researchers write. "Future
studies should not only assess the effect on health and well-being, but
also should address cost-related outcomes, especially given that the
economic burden associated with functional decline and loss of
independence is exceedingly high."
Contact: Lauren Shaftel Williams
lauren.shaftel@duke.edu
919-684-4966
SOURCE:
JAMA and Archives Journals
