Armbruster, S.D., Song, J., Gatus, L., Lu, K.H., & Basen-Engquist, K.M. (2018). Endometrial cancer survivors' sleep patterns before and after a physical activity intervention: A retrospective cohort analysis. Gynecologic Oncology, 149, 133–139.

DOI Link

Study Purpose

To determine baseline sleep characteristics of endometrial cancer survivors, the impact of demographic and treatment characteristics on sleep quality, the association of sleep quality with quality of life and stress levels, and the impact of physical activities on sleep.

Intervention Characteristics/Basic Study Process

Individualized exercise prescriptions based on baseline function. Adherence to the American College of Sports Medicine Guidelines requiring 30 minutes of moderate exercise five or more days per week or at least 20 minutes of rigorous exercise three or more days per week with telephone-based counseling sessions, printed materials, and pedometers. Decreasing frequency of counseling telephone calls from weekly to twice monthly to monthly over six months.

Sample Characteristics

  • N = 95   
  • AGE: 57.1 years (range = 25-76)
  • FEMALES: 100%
  • CURRENT TREATMENT: Radiation, other


  • SITE: Single site   
  • SETTING TYPE: Outpatient    
  • LOCATION: Houston, TX

Phase of Care and Clinical Applications

  • PHASE OF CARE: Transition phase after active treatment
  • APPLICATIONS: Elder care 

Study Design

Secondary analysis of Steps to Health, a single-arm cohort study.

Measurement Instruments/Methods

Sleep quality measured with the Pittsburgh Sleep Quality Index (PSQI). Physical activity measured with the Community Health Activities Model Program for Seniors (CHAMPS). Quality of life (QOL) measured with the SF-36.


At baseline, 61% of the sample had poor sleep quality (PSQI > 5). Obese survivors were more likely to have sleep disturbances than were their normal-weight counterparts (p = 0.029). At baseline, poor sleepers had higher stress levels than good sleepers (p = 0.002). Poor sleep quality was associated with lower health-related QOL: vitality (p = 0.001), bodily pain (p = 0.004), general health (p = 0.002), social functioning (p = 0.005), role limitations caused by emotional problems (p = 0.005), mental health (p = 0.002), and the mental component score (p = 0.003). Sleep quality improved in cancer survivors who increased their weekly total physical activity or moderate-vigorous intensity physical activities (MPVA) throughout the intervention (p = 0.004 and 0.05, respectively). Adjusting for covariates (e.g., age, time since diagnosis, obesity status, disease stage, treatment), improvement in sleep quality was associated with increased hours of total activity (p = 0.026).


Poor sleep quality was common in endometrial cancer survivors and an increase in physical activity was associated with improved sleep quality.


  • Small sample (< 100)
  • Risk of bias (no control group)

Nursing Implications

Sleep problems are common in women following treatment for endometrial cancer and are associated with stress and poor QOL. Increasing physical activity may improve sleep quality for these women.