Date of Award

2017

Document Type

Thesis

Publisher

Edith Cowan University

Degree Name

Master of Science (Sports Science)

School

School of Medical and Health Sciences

First Supervisor

Professor Robert Newton

Second Supervisor

Dr Carolyn McIntyre

Third Supervisor

Professor Daniel Galvao

Abstract

Background: Advanced-stage ovarian cancer survivors (OCS) often experience a multitude of disease symptoms and treatment-related side-effects. Additionally, most OCS are older, have comorbidities, are overweight or obese, and report being insufficiently physically active. Ovarian cancer survivors may benefit from exercise oncology interventions to reduce symptom-burden, manage comorbidities, minimize functional decline and maximize health-related quality of life (HRQoL). However, current knowledge gaps regarding the physiological characteristics of OCS throughout the entire survivorship spectrum challenge the development of tailored exercise interventions.

Purpose: The overall purpose of this thesis was to provide a more comprehensive physiological and activity behavior profile of post-treatment advanced-stage OCS. Specifically, a cross-sectional research study was conducted to compare objectively measured activity behavior and physical function, body composition and musculoskeletal morphology, self-reported pelvic floor dysfunction (PFD) and HRQoL of OCS with age-matched controls. Associations between activity behavior, physiological characteristics, PFD and HRQoL for OCS were also investigated.

Methods: Twenty stage III-IV OCS and 20 age-matched controls underwent objective assessments of activity behavior (physical activity and sedentary time via 7-day accelerometry), physical function (400-meter walk to assess cardiorespiratory fitness, repeated chair rise to assess lower extremity function, 6-meter walking tests to assess gait speed and dynamic balance), muscle strength (1-repetition maximum chest press and single leg extension, and handgrip strength), body composition (dual-energy x-ray absorptiometry) and musculoskeletal morphology (peripheral quantitative computed tomography), and completed questionnaires assessing HRQoL (SF-36) and PFD (Australian Pelvic Floor Questionnaire). Results: Compared to controls, OCS spent more time/day in prolonged sedentary bouts (i.e., uninterrupted sedentary bouts of ≥30 min; p = 0.039), had lower cardiorespiratory fitness (p =0.041) and upper body strength (p = 0.023), had higher areal bone mineral content (p = 0.047) and volumetric trabecular density (p = 0.048), but were not different in other measures of body composition or musculoskeletal morphology (i.e., all p-values > 0.050). Compared to controls, OCS had equivalent self-reported PFD as indicated by combined bladder, bowel and pelvic organ prolapse symptoms (p = 0.277), but worse physical HRQoL indicated by a physical composite score (p = 0.013). Only 20% (n = 4) of OCS accrued ≥150 minutes/week moderate-and-vigorous physical activity (MVPA) in ≥10 min bouts. MVPA time/day in ≥10 min bouts was positively associated with cardiorespiratory fitness (p = 0.001), lower extremity function, (p = 0.019), muscle crosssectional area (p = 0.035), less PFD (p = 0.038) and physical HRQoL (p = 0.003). Decreased physical HRQoL was associated with less MVPA (p = 0.005), more sedentary time (p = 0.047), decreased objective physical function (p-values < 0.050) and greater PFD (p = 0.043).

Conclusion: Post-treatment advanced-stage OCS spent more time in prolonged sedentary bouts, had lower cardiorespiratory fitness, upper body strength and physical HRQoL compared to agematched controls. The decreased physical HRQoL of this sample of OCS compared to controls and its associations with modifiable factors such as MVPA, sedentary time, objective physical function and PFD highlights the need for ongoing supportive care and the importance of multidisciplinary interventions, including exercise oncology interventions, beyond the completion of first-line ovarian cancer treatment.

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