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Exercise in African American and White Colorectal Cancer Survivors

A Mixed-Methods Approach

Ray, Andrew D., PT, PhD1; Masucci Twarozek, Annamaria, MPH2; Williams, Brian T., PhD3; Erwin, Deborah O., PhD4; Underwood, Willie III, MD, MSci, MPH5; Mahoney, Martin C., MD, PhD6

doi: 10.1097/01.REO.0000000000000125

Background: African American (AA) colorectal cancer (CRC) survivors tend to be more obese and less physically active than white survivors.

Purpose/Objective: To test the feasibility of an aerobic exercise program as well as explore perceptions about supervised exercise among AA CRC survivors.

Methods: A prospective supervised exercise intervention performed on a cycle ergometer 2 d/wk for 12 weeks. Peak (

O2peak) and submaximal exercise (Six-Minute Walk Test [6MWT]) along with questionnaires (36-Item Short Form Health Survey [SF-36], Memorial Sloan Kettering Cancer Center Bowel Function Instrument [BFI], Functional Assessment of Cancer Therapy–Colorectal (FACT-C) and Fatigue (FACIT-F), and Brief Symptom Inventory [BSI]). A second group of survivors participated in an interview evaluating perceptions regarding exercise.

Design: Prospective case series and qualitative interview.

Setting: Research university and academic medical center.

Patients: AA and white CRC survivors.

Results: Quantitative: A total of 237 letters were mailed to CRC survivors (112 whites, 126 AAs). From the letters, 25 whites and 15 AAs expressed interest; only 5 whites (4.5%) and 4 AAs (3.2%) enrolled. Two AA and 5 white survivors (7/9) finished the program. There was an improvement in peak exercise (P = .011) and quality of life (QOL) (SF-36 total, P = .035) posttraining. Qualitative: 30 CRC survivors (12 AAs and 18 whites) participated in qualitative interviews and selected comorbidity, motivation, and location as primary barriers to exercise.

Limitations: Small sample size.

Conclusions: Recruiting CRC survivors (regardless of race) into an exercise program is challenging; however, there are exercise and QOL benefits associated with participation. Barriers to exercise are similar between AA and white CRC survivors.

1Clinical Associate Professor, Department of Rehabilitation Science, State University at Buffalo, Buffalo NY

2Program Director, Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo NY

3Doctoral Student, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo NY

4Distinguished Professor of Oncology, Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo NY

5Associate Professor, Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo NY

6Professor of Oncology, Departments of Medicine & Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo NY

Correspondence: Andrew D. Ray, PT, PhD, Department of Rehabilitation, University at Buffalo, 501 Kimball Tower, 3435 Main St, Buffalo NY 14216 (

Grant Support: This study was supported, in part, by the Western New York Cancer Coalition (WNYC2) Center to Reduce Disparities grant: NIH/NCI/CRCHD U54CA153598-01.

The content is solely the responsibility of the authors and does not necessarily represent the official view of the National Institutes of Health.

The authors declare no conflicts of interest.

©2018 (C) Academy of Oncologic Physical Therapy, APTA
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