The association of an exercise and rehabilitation clinical workflow algorithm on sedentary behavior and performance status from time of breast cancer diagnosis and throughout care.

[PURPOSE] Explore if a clinical workflow algorithm that connected Stage I-III newly diagnosed breast cancer (BC) patients to exercise and rehabilitation services from diagnosis throughout care associated with a lower percentage of time spent in sedentary behavior (SB)compared with standard of care (SOC). We also examined the relationship between SB and ECOG performance status scores, a measure of functional status.

[METHODS] This secondary data analysis from the Comprehensive Oncology Rehabilitation and Exercise (CORE) program was carried out among 51 BC survivors (CORE = 33, SOC = 18) with evaluable wrist-worn accelerometer data. Percentage of time in SB was assessed using wrist-worn specific cut-points (Montoye) and traditional cut-points (Freedson) three times during BC care: preoperative, first postoperative visit, and 24 weeks postoperative. Repeated measures analysis of covariance tests (RM-ANCOVA; adjusted for age, cancer stage, and number of postoperative treatments) with post-hoc comparisons evaluated SB over time within and between groups. Poisson regression evaluated associations between SB and ECOG.

[RESULTS] Participants were mostly white (76.5%), non-Hispanic (90.2%), with mean age 58.8 ± 12.3 years, diagnosed with Stage I BC (86.3%) and had a history of more than two adjuvant treatments (56.9%), with no significant differences between groups (p > 0.05). Proportion of time spent in SB (Montoye cut-points) was 73.95% (95% CI 70.60, 77.30) preoperatively; 77.79% (95% CI 74.23, 81.35) postoperatively; and 75.05% (95% CI 71.88, 78.22) 24 weeks postoperatively, although these time effect results did not reach statistical significance in the adjusted model. A time x group interaction was observed with Freedson cut-points (mean difference: 6.15%, 95% CI 0.42, 11.88). Between preoperative and 24 weeks postoperative timepoints, pairwise comparisons indicated that CORE intervention group participants exhibited a significant increase in percentage of time in SB (mean difference: 6.09%, 95% CI 0.24, 11.93). ECOG scores at each timepoint were not associated with SB (p > 0.05).

[CONCLUSION] CORE program participation was not associated with reduced SB. Strategies to reduce SB should be incorporated within programs aimed at increasing physical activity engagement.