Comparison between logbook-reported and objectively-assessed physical activity and sedentary time in breast cancer patients: an agreement study

Mazzoni et al. BMC Sports Science, Medicine and Rehabilitation (2017) 9:8 DOI 10.1186/s13102-017-0072-2 RESEARCH ARTICLE Open Access Comparison between logbook-reported and objectively-assessed physical activity and sedentary time in breast cancer patients: an agreement study Anne-Sophie Mazzoni1*, Karin Nordin1,2, Sveinung Berntsen1,2, Ingrid Demmelmaier1 and Helena Igelström1 Abstract Background: Increasing physical activity (PA) and decreasing sedentary time (ST) have important health effects among breast cancer patients, a growing population group. PA and sedentary behaviors are complex multidimensional behaviors and are challenging to monitor accurately. To date few studies have compared self-reports and objective measurement in assessing PA and ST in women undergoing breast cancer treatments. The aim of the present study was to compare self-reports and objective measures for assessing daily time spent in moderateintensity physical activity (MPA), vigorous-intensity physical activity (VPA) and ST in women undergoing breast cancer treatments. Methods: Baseline data from 65 women with breast cancer scheduled to undergo adjuvant treatment was included. Daily time spent in MPA, VPA and ST was assessed by a study-specific logbook and the SenseWear Armband mini (SWA). The level of agreement between the two measurement methods was then determined by performing Bland-Altman plots with limits of agreements, and calculating Spearman’s rank correlation coefficients. Results: The mean difference between the logbook and SWA with limits of agreement was 14 (±102) minutes for MPA, 1 (±21) minute for VPA and −196 (±408) minutes for ST, respectively. The logbook reported an average of 34 and 50% higher values than the SWA for MPA and VPA, as well as an average of 27% lower values for ST (P < 0.05). The Spearman’s rank correlation coefficients showed that the differences between the methods increased as the average amount of time spent in PA and ST increased (P < 0.01). Conclusions: The results imply that the two measurement methods have limited agreement and cannot be used interchangeably. Keywords: Activity monitor, Breast neoplasms, Exercise, Measurement accuracy, Sedentary lifestyle Background Breast cancer is a major and growing public health concern, affecting millions of women worldwide [1]. Globally, breast cancer incidence rates have been constantly increasing the previous two decades, making breast cancer one of the leading causes of disability and cancer deaths in women [1]. Current evidence supports that participating * Correspondence: 1 Department of Public Health and Caring Sciences, Section of lifestyle and rehabilitation in long term illness, Uppsala University, Box 564, BMC, Uppsala S-75122, Sweden Full list of author information is available at the end of the article in regular physical activity (PA; any bodily movement produced by skeletal muscles that increases energy expenditure above resting levels [2]), especially moderateintensity physical activity (MPA) and vigorous-intensity physical activity (VPA), both during and after treatment, provides many health benefits for breast cancer patients [3, 4]. For example, PA is positively associated with improved health-related quality of life, psychosocial wellbeing and physical function [4], as well as reduced risk of cancer recurrence and mortality [3]. Emerging evidence also suggests that sedentary behaviors (any waking activity characterized by low levels of energy expenditure while in © The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Mazzoni et al. BMC Sports Science, Medicine and Rehabilitation (2017) 9:8 a sitting or reclining posture [5]) may have negative health effects for these populations, such as impaired healthrelated quality of life [6] and increased mortality risk [7]. PA and sedentary behaviors are important outcomes in cancer research studies focusing on these behaviors. Accurate monitoring of time spent in PA and sedentary time (ST) is thus essential for many reasons, inter alia, to understand the relationship between these behaviors and different health outcomes, to describe dose–response relationships and finally, to evaluate the impact and efficacy of public health interventions [8]. However, PA and sedentary behaviors are challenging to measure accurately because of their complex multi-dimensional nature [9]. The most commonly used measurement methods are self-reports such as questionnaires [9] and diaries (or logbooks) [10] due to their convenience (e.g. inexpensive, easily administered and used in different clinical purposes) [9, 10] and their ability to provide contextual information about different aspects of PA and sedentary behaviors (e.g. mode of activities, PA and sedentary behavior patterns) [9, 11]. However, they have limitations [10, 12] including an increased risk for recall and response bias due to social desirability and cognitive demands of recall [10, 13]. These issues may be even greater among breast cancer patients undergoing cancer treatments and experiencing disease and treatment-related symptoms such as cognitive impairments [14–16]. On the other hand, objective methods such as physical activity monitors like the SenseWear Armband (SWA) are now more widely used in breast cancer studies [17, 18] despite their cost [9], intrusiveness [12] and inability to provide contextual information about PA and sedentary behaviors (e.g. mode of activities, behavior patterns) [9]. They have the capacity to estimate the number and length of activity bouts and breaks in ST [9] as well as to remove the issues of recall and response bias [12, 13]. In fact, both self-reports and physical activity monitors are reported to have advantages and limitations [9, 10] and it appears that no “gold standard” exists for recording PA and ST in everyday life [9, 10] in breast cancer patients. However, given the importance of accurate monitoring of PA and ST among breast cancer populations, it is essential to determine the precision of self-reports compared with objective assessments, in order to know which measurement methods are the most appropriate. It is thus important to evaluate agreement between different commonly used methods [19]. However, few studies have compared self-reports and objective measurement in assessing PA [19–21] and ST [19, 20] in cancer populations. These studies have been conducted among different cancer populations and prov (...truncated)