Considering depression as a secondary outcome in the optimization of physical activity interventions for breast cancer survivors in the PACES trial: a factorial randomized controlled trial

Chad D Rethorst; Thomas J Carmody; Keith E Argenbright; Taryn L Mayes; Heidi A Hamann; Madhukar H Trivedi

doi:10.1186/s12966-023-01437-x

Considering depression as a secondary outcome in the optimization of physical activity interventions for breast cancer survivors in the PACES trial: a factorial randomized controlled trial

Int J Behav Nutr Phys Act. 2023 Apr 20;20(1):47. doi: 10.1186/s12966-023-01437-x.

Authors

Chad D Rethorst¹, Thomas J Carmody², Keith E Argenbright^{3

4}, Taryn L Mayes⁵, Heidi A Hamann⁶, Madhukar H Trivedi⁵

Affiliations

¹ Institute for Advancing Health Through Agriculture, Texas A&M Agrilife Research, 17360 Coit Road, Dallas, TX, 75252, USA. chad.rethorst@ag.tamu.edu.
² Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA.
³ Moncrief Cancer Institute, University of Texas Southwestern Medical Center, Dallas, TX Fort Worth, TX, USA.
⁴ Harold C. Simmons Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA.
⁵ Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA.
⁶ Department of Psychology, University of Arizona, Tucson, AZ, USA.

Abstract

Background: Depressive symptoms result in considerable burden for breast cancer survivors. Increased physical activity may reduce these burdens but existing evidence from physical activity interventions in equivocal. Furthermore, physical activity intervention strategies may differentially impact depressive symptoms, which should be considered in designing and optimizing behavioral interventions for breast cancer survivors.

Methods: The Physical Activity for Cancer Survivors (PACES) trial enrolled 336 participants breast cancer survivors, who were 3 months to 10 years post-treatment, and insufficiently active (< 150 min of moderate-to-vigorous physical activity per week). Participants were randomly assigned to a combination of 4 intervention strategies in a full-factorial design: 1) supervised exercise sessions, 2) facility access, 3) Active Living Every Day, and 4) Fitbit self-monitoring. Depressive symptoms were assessed at baseline, mid-intervention (3 months), and post-intervention (6 months) using the Quick Inventory for Depressive Symptoms. Change in depressive symptoms were analyzed using a linear mixed-effects model.

Results: Results from the linear mixed-effects model indicated that depressive symptoms decreased significantly across the entire study sample over the 6-month intervention (F = 4.09, p = 0.044). A significant ALED x time interaction indicated participants who received the ALED intervention experienced greater reductions in depressive symptoms (F = 5.29, p = 0.022). No other intervention strategy significantly impacted depressive symptoms.

Conclusions: The ALED intervention consists of strategies (i.e., goal setting, social support) that may have a beneficial impact on depressive symptoms above and beyond the effect of increased physical activity. Our findings highlight the need to consider secondary outcomes when designing and optimizing physical activity interventions.

Trial registration: ClinicalTrials.gov NCT03060941. Posted February 23, 2017.

Keywords: Behavioral interventions; Breast cancer survivors; Depression; Intervention optimization; Physical activity.

Publication types

Randomized Controlled Trial
Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

Breast Neoplasms* / therapy
Cancer Survivors*
Depression / therapy
Exercise
Female
Humans
Quality of Life
Survivors

Associated data

ClinicalTrials.gov/NCT03060941