Physical activity and cognition: longitudinal findings from the Thinking and Living with Cancer Study

Ashley L Artese; Xingtao Zhou; Danielle B Tometich; Brent J Small; Tim A Ahles; Jaeil Ahn; Traci N Bethea; Elizabeth C Breen; Harvey J Cohen; Martine Extermann; Deena Graham; Claudine Isaacs; Heather S L Jim; Brenna C McDonald; Zev M Nakamura; Sunita K Patel; Kelly E Rentscher; James C Root; Andrew J Saykin; Kathleen Van Dyk; Wanting Zhai; Judith E Carroll; Jeanne Mandelblatt

doi:10.1093/jnci/djae182

Physical activity and cognition: longitudinal findings from the Thinking and Living with Cancer Study

J Natl Cancer Inst. 2024 Dec 1;116(12):2009-2021. doi: 10.1093/jnci/djae182.

Authors

Ashley L Artese^{1

2}, Xingtao Zhou³, Danielle B Tometich⁴, Brent J Small⁵, Tim A Ahles⁶, Jaeil Ahn³, Traci N Bethea⁷, Elizabeth C Breen^{8

9}, Harvey J Cohen², Martine Extermann¹⁰, Deena Graham¹¹, Claudine Isaacs⁷, Heather S L Jim⁴, Brenna C McDonald¹², Zev M Nakamura¹³, Sunita K Patel¹⁴, Kelly E Rentscher¹⁵, James C Root⁶, Andrew J Saykin¹², Kathleen Van Dyk^{8

16}, Wanting Zhai³, Judith E Carroll^{8

9}, Jeanne Mandelblatt¹⁷

Affiliations

¹ Department of Exercise Science and Health Promotion, Charles E. Schmidt College of Science, Florida Atlantic University, Boca Raton, FL, USA.
² Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC, USA.
³ Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University, Washington, DC, USA.
⁴ Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA.
⁵ School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁶ Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
⁷ Lombardi Comprehensive Cancer Center, Department of Oncology, Georgetown University, Washington, DC, USA.
⁸ Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA.
⁹ Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, Los Angeles, CA, USA.
¹⁰ Senior Adult Oncology Program, Department of Oncology Sciences, Moffitt Cancer Center, University of South Florida, Tampa, FL, USA.
¹¹ John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, USA.
¹² Department of Radiology and Imaging Sciences, Melvin and Bren Simon Comprehensive Cancer Center, and Indiana Alzheimer's Disease Research Center, Indiana University School of Medicine, Indianapolis, IN, USA.
¹³ Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
¹⁴ Department of Population Sciences and Department of Supportive Care Medicine, City of Hope Comprehensive Cancer Center, Duarte, CA, USA.
¹⁵ Department of Psychiatry and Behavioral Medicine, MCW Cancer Center, Medical College of Wisconsin, Milwaukee, WI, USA.
¹⁶ Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA, USA.
¹⁷ Georgetown Lombardi Institute for Cancer and Aging Research, Lombardi Comprehensive Cancer Center, Department of Oncology, Georgetown University, Washington, DC, USA.

PMID: 39107910
PMCID: PMC11630529 (available on 2025-08-06)
DOI: 10.1093/jnci/djae182

Abstract

Background: Physical activity can improve cognition; however, little is known regarding the relationships between longitudinal objectively measured physical activity, cognition, and inflammation in older breast cancer survivors.

Methods: Older (aged 60 years and older) breast cancer survivors (n = 216) and frequency-matched noncancer control participants (n = 216) were assessed at baseline (presystemic therapy for survivors) and annually for up to 5 years. Assessments included hip-worn actigraphs worn for 7 days, neuropsychological tests, the Functional Assessment of Cancer Therapy-Cognitive Function perceived cognitive impairment subscale, and circulating levels of C-reactive protein and interleukin-6. Data were analyzed using linear mixed-effect, random-effect contemporaneous fluctuation, and multilevel mediation models, considering covariates; a P value less than .05 (2-sided) was considered statistically significant.

Results: Survivors had fewer minutes of moderate-to-vigorous physical activity than controls at 36-, 48-, and 60-month time points (P < .03). Fewer survivors met aerobic physical activity guidelines at 36 months than control participants (17.7% vs 33.0%, P = .030). When guidelines were met (vs not), Functional Assessment of Cancer Therapy-Cognitive Function perceived cognitive impairment scores were 2.1 (1.0) (P = .034) points higher. Higher moderate-to-vigorous physical activity and meeting aerobic guidelines were not related to objective neuropsychological performance. Moderate-to-vigorous physical activity was inversely associated with C-reactive protein and interleukin-6 (P < .001), but inflammation did not mediate physical activity effects on perceived cognition.

Conclusions: Older breast cancer survivors were less physically active than older noncancer controls, especially farther from baseline. Meeting aerobic guidelines was associated with better perceived cognition in survivors. Survivorship care should consider physical activity monitoring and referral to rehabilitation and supervised exercise programs to promote physical activity and improve recovery in older survivors.

MeSH terms

Aged
Breast Neoplasms* / blood
Breast Neoplasms* / psychology
Breast Neoplasms* / therapy
C-Reactive Protein / analysis
C-Reactive Protein / metabolism
Cancer Survivors* / psychology
Case-Control Studies
Cognition*
Cognitive Dysfunction / etiology
Exercise*
Female
Humans
Inflammation / blood
Interleukin-6 / blood
Longitudinal Studies
Middle Aged
Neuropsychological Tests

Substances

Interleukin-6
C-Reactive Protein

Abstract

MeSH terms

Substances

Grants and funding