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Physical activity trajectories following gynecological cancer: results from a prospective, longitudinal cohort study
  1. Steven Fleming1,
  2. Tamara Jones2,
  3. Monika Janda2,3,
  4. Dimitrios Vagenas2,
  5. Leigh Ward4,
  6. Hildegard Reul-Hirche5,
  7. Carolina Sandler2,6,
  8. Andreas Obermair7 and
  9. Sandra Hayes8
  1. 1College of Public Health, University of Kentucky, Lexington, Kentucky, USA
  2. 2Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia
  3. 3Centre for Health Services Research, The University of Queensland Faculty of Medicine, Brisbane, Queensland, Australia
  4. 4School of Chemistry and Molecular Biosciences, The University of Queensland, Saint Lucia, Queensland, Australia
  5. 5Physiotherapy Department, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
  6. 6School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
  7. 7Queensland Centre of Gynecological Research, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
  8. 8Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
  1. Correspondence to Tamara Jones, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, QLD 4059, Australia; tamara.jones{at}


Background Participating in physical activity after a diagnosis of cancer is associated with reduced morbidity and improved outcomes. However, declines in, and low levels of, physical activity are well documented in the broader cancer population, but with limited evidence following gynecological cancer.

Objective To describe physical activity levels from before and up to 2 years after gynecological cancer surgery; to explore the relationship between physical activity patterns and quality of life; and to describe characteristics associated with physical activity trajectories post-gynecological cancer.

Methods Women with gynecological cancer (n=408) participated in a prospective study that assessed physical activity and quality of life pre-surgery (baseline), at 6 weeks, and 3, 6, 9, 12, 15, 18 and 24 months post-surgery. Validated questionnaires were used to assess physical activity (Active Australia Survey) and quality of life outcomes (Functional Assessment of Cancer Therapy-General). Generalized estimating equation modeling, group-based trajectory analysis, and analysis of variance were used to identify physical activity levels over time, to categorize women into physical activity trajectory groups, and to assess the relationship between physical activity levels and quality of life, respectively.

Results Women had a mean±SD age of 60±11.4 years at diagnosis, with the majority diagnosed with endometrial cancer (n=235, 58%) or stage I disease (n=241, 59%). Most women (80%) started with and maintained low levels of physical activity (1–10 metabolic equivalent task hours per week), reported no physical activity throughout the follow-up period, or reduced physical activity levels over time. Only 19% of women maintained or doubled physical activity levels, so that by 24 months post-diagnosis they were engaging in sufficient levels of physical activity. Women with endometrial cancer (58% of the sample) were more likely to be overweight or obese and to report low levels of physical activity or none at all. Higher physical activity levels were associated with higher quality of life (p<0.05).

Conclusion The low baseline and surveillance levels of physical activity show that the vast majority of gynecological cancer survivors have the ability to improve their physical activity levels. Integration of physical activity advice and support into standard care could lead to gains in quality of life during gynecological cancer survivorship.

  • quality of life (PRO)/palliative care
  • postoperative period
  • miscellaneous
  • gynecology
  • gynecologic surgical procedures

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  • Contributors All authors have provided a substantial contribution to this work.

  • Funding This work was supported by project grants and fellowships from Cancer Council Australia, Cancer Australia, Greenslopes Hospital Research Foundation, Wesley Research Foundation, National Breast Cancer Foundation (SH), Cancer Council Queensland (SH) and the National Health and Medical Research Foundation (MJ).

  • Competing interests AO is the founder and managing director of SurgicalPerformance Pty Ltd, an Australian, private company that provides surgeons with a platform for collection of surgical outcome audit data; AO received travel grants from the O.R. Company (formerly Tyco Healthcare) and is a consultant for Covidien, NSW, Australia.

  • Patient consent for publication Not required.

  • Ethics approval All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. Deidentified participant data available from Tamara Jones upon reasonable request (see Corresponding author information).