Postmenopausal Breast Cancer Survivors at Risk for Osteoporosis: Physical Activity, Vigor, and Vitality

Gloria Gross

Carol Ott

Ada M. Lindsey

Janice J. Twiss

Nancy Waltman

ONF 2002, 29(9), 1295-1300. DOI: 10.1188/02.ONF.1295-1300

Purpose/Objectives: To test a multicomponent intervention to prevent and treat osteoporosis in breast cancer survivors.

Design: Descriptive, correlational.

Setting: Midwestern urban and rural sites.

Sample: 27 postmenopausal breast cancer survivors between the ages of 42-65 who had completed treatment, except for tamoxifen, and were not candidates for hormone replacement therapy.

Methods: Bone mineral density (BMD) of the hip, spine, and forearm was measured using dual-energy x-ray absorptiometry. Physical activity was recorded using the Seven-Day Physical Activity Recall-Adapted, which classifies activities as light, moderate, hard, or very hard. Vigor was measured with the eight-item subscale of the Profile of Mood State based on the previous week. Vitality was measured using the four-question subscale of the Medical Outcomes Study 36-Item Short Form Health Survey.

Main Research Variables: Physical activity, vigor, vitality, and BMD.

Findings: More than half reported no very hard physical activity, and 37% reported no hard activity. The association of vigor with total metabolic equivalents for combined moderate, hard, and very hard activities was significant (r = 0.536, p = 0.007), as were the hours spent in the combined moderate to very hard activities. No relationship was found between vigor, vitality, or any level of activity and BMD.

Conclusions: Survivors reported high levels of perceived vigor and vitality but spent more time engaged in light versus hard or very hard activities. Positive correlations between higher levels of vitality and vigor with metabolic equivalents support the idea that activity promotes perceptions of energy and positive feelings.

Implications for Nursing: Breast cancer survivors are at risk for osteoporosis. Nurses should be aware of increased risk, recommend screening for bone health, and encourage physical activity.

Jump to a section

    References

    Ali, N.S., & Twibell, R. (1994). Barriers to osteoporosis prevention in perimenopausal and elderly women. Geriatric Nursing, 15, 201-206.

    Brandi, M.L. (1993). New treatment strategies: Ipriflavone, strontium, vitamin D metabolites, and analogs. American Journal of Medicine: Consensus Development Conference on Osteoporosis, 95(5A), 69S-74S.

    Cobleigh, M.A., Berris, R.F., Bush, T., Davidson, N.E., Robert, N.J., Sparano, J.A., et al. (1994). Estrogen replacement therapy in breast cancer survivors: A time for change. Breast Cancer Committees of Eastern Co-operative Oncology Group. JAMA, 272, 540-545.

    DeVita, V.T., Hellman, S., & Rosenberg, S.A. (1997). Principles and practice of oncology. Philadelphia: Lippincott-Raven.

    Ernst, E. (1998). Exercise for female osteoporosis. Sports Medicine, 25, 359-368.

    Gibaldi, M. (1997). Prevention and treatment of osteoporosis: Does the future belong to hormone replacement therapy? Journal of Clinical Pharmacology, 37, 1087-1099.

    Headley, J.A., Theriault, R.L., LeBlanc, A.D., Vassilopoulou-Sellin, R., & Hortobagyi, G.N. (1998). Pilot study of bone mineral density in breast cancer patients treated with adjuvant chemotherapy. Cancer Investigation, 16, 6-11.

    Heaney, R.P. (1993). Bone mass, nutrition, and other lifestyle factors. American Journal of Medicine: Consensus Development Conference on Osteoporosis, 95(5A), 29S-33S.

    Hellman, E.A., Williams, M.A., & Thalken, L. (1997). Construct validity of the modified 7-day activity interview used with older adults with cardiac problems. Rehabilitation Nursing Research, 5, 126-133.

    Jergas, M., & Genant, H.K. (1993). Current methods and recent advances in the diagnosis of osteoporosis. Arthritis and Rheumatism, 36, 1649-1662.

    Kanis, J.A. (1993). Treatment of symptomatic osteoporosis with fluoride. American Journal of Medicine: Consensus Development Conference on Osteoporosis, 95(5A), 53S-61S.

    Karpf, D.B., Sharpiro, D.R., Seeman, E., Ensrud, K.E., Johnston, C.C., Adami, S., et al. (1997). Prevention of nonvertebral fractures by alendronate: A meta-analysis. Journal of the American Medical Society, 277, 1159-1164.

    Lindsay, R. (1993). Hormone replacement therapy for prevention and treatment of osteoporosis. American Journal of Medicine: Consensus Development Conference on Osteoporosis, 95(5A), 37S-39S.

    Lindsey, A.M., Gross, G.J., Twiss, J., Waltman, N., Ott, C., & Moore, T. (2002). Postmenopausal breast cancer survivors at risk for osteoporosis: Nutritional intake and body size. Cancer Nursing, 25, 50-56.

    Mahon, S. (1998). Osteoporosis: A concern for cancer survivors. Oncology Nursing Forum, 25, 843-852.

    McHorney, C.A., Ware, J.E., Lu, J.F., & Sherbourne, C.D. (1994). The MOS 36-Item Short-Form Health Survey (SF-36): III. Tests of data quality, scaling assumptions and reliability across diverse patient groups. Medical Care, 32, 40-66.

    McHorney, C.A., Ware, J.E., & Raczek, A.E. (1993). The MOS 36-Item Short-Form Health Survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Medical Care, 31, 247-263.

    McNair, D.M., Lorr, M., & Droppleman, L.F. (1992). EdITS manual for the Profile of Mood States. San Diego, CA: EdITS/Educational and Industrial Testing Service.

    Nguyen, T.V., Sambrook, P.N., & Eisman, J.A. (1998). Bone loss, physical activity, and weight change in elderly women: The Dubbo Osteoporosis Epidemiology Study. Journal of Bone and Mineral Research, 13, 1458-1467.

    Nowlis, V., & Green, R.F. (1957, July). The experimental analysis of mood. Paper presented at the International Congress of Psychology, Brussels, Belgium.

    Ott, C.D., Waltman, N., Gross, G.J., Lindsey, A.M., Twiss, J.J., Berg, K., et al. (2001, February). Home-based strength/weight training for bone health in postmenopausal breast cancer survivors. Abstract presented at the Sixth National Conference on Cancer Nursing Research, Orlando, FL.

    Papapoulos, S.E. (1993). The role of bisphosphonates in the prevention and treatment of osteoporosis. American Journal of Medicine: Consensus Development Conference on Osteoporosis, 95(5A), 48S-52S.

    Reginster, J.Y. (1993). Calcitonin for prevention and treatment of osteoporosis. American Journal of Medicine: Consensus Development Conference on Osteoporosis, 95(5A), 44S-47S.

    Sallis, J.F., Haskell, W.L., Wood, P.D., Fortmann, S.P., Rogers, T., Blair, S.N., et al. (1985). Physical activity assessment methodology in the five-city project. American Journal of Epidemiology, 121, 91-101.

    Scheiber, L.G., & Torregrosa, L. (1998). Evaluation and treatment of postmenopausal osteoporosis. Seminars in Arthritis and Rheumatism, 27, 245-261.

    Twiss, J.J., Waltman, N., Ott, C.D., Gross, G.J., Lindsey, A.M., & Moore, T.E. (2001). Bone mineral density in postmenopausal breast cancer survivors. Journal of the American Academy of Nurse Practitioners, 13, 276-284.

    Waltman, N., Gross, G.J., Ott, C.D., Lindsey, A.M., Twiss, J.J., Berg, K., et al. (2001, February). Prevention and treatment of osteoporosis in breast cancer survivors. Abstract presented at the Sixth National Conference on Cancer Nursing Research, Orlando, FL.

    Ware, J., & Sherbourne, C. (1992). The MOS 36-Item Short-Form Health Survey 1: Conceptual framework and item selection. Medical Care, 30, 473-483.

    Ware, J.E., Snow, K.K., Kosinski, M., & Gandek, B. (1993). SF-36 health survey: Manual and interpretation guide. Boston: Health Institute, New England Medical Center.