FLOOR AND STEP AEROBICS AS AN EXERCISE INTERVENTION TO ENHANCE COGNITION IN ...

133 Pages·2016·1.55 MB·English

FLOOR AND STEP AEROBICS AS AN EXERCISE INTERVENTION TO ENHANCE
COGNITION IN BREAST CANCER SURVIVORS

By

JULIE ANN-MICHELLE LARSEN

A dissertation submitted in partial fulfillment of
the requirements for the degree of

DOCTOR OF PHILOSOPHY

WASHINGTON STATE UNIVERSITY
Nutrition and Exercise Physiology

MAY 2016

© Copyright by JULIE ANN-MICHELLE LARSEN, 2016
All Rights Reserved
© Copyright by JULIE ANN-MICHELLE LARSEN, 2016
All Rights Reserved
To the Faculty of Washington State University:

The members of the Committee appointed to examine the dissertation of
JULIE ANN-MICHELLE LARSEN find it satisfactory and recommend that it be accepted.

_________________________________________
Judy Knuth, M.S., Co-Chair

_________________________________________
Kathryn E. Meier, Ph.D., Co-Chair

_________________________________________
Mel R. Haberman, Ph.D.

_________________________________________
Dennis Dyck, Ph.D.

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ACKNOWLEDGEMENTS

Thank you to the study participants who freely gave of their time to make this research happen. I
sincerely appreciate your willingness to attend classes regularly, and complete the pre/post
testing appointments. I would also like to thank all the local oncology clinics, individuals, and
businesses who supported these studies by referring participants and making brochures available.

Thank you to the College of Pharmacy and the Nutrition and Exercise Physiology program for
your continuous financial support, which made it possible for me to attend graduate school and
complete my degree in a timely manner. Thank you to the generous donors whose financial
contributions made this dissertation possible: Margaret Nicholson Schafer, James and Diann
Robbers, Margaret M. Hard, and Virginia Schafer.

Thank you to my research committee for your support and advice. I appreciate the time that you
spent sharing your expertise and reviewing documents. Thank you to Dr. Maureen Schmitter-
Edgecombe for your assistance with selecting a cognitive test battery. Thank you also to my
fellow graduate students, especially Alissa Underhill, Kari Jo Hilgendorf, and Aimee Bell.

Thank you to the many Nutrition and Exercise Physiology students at Washington State
University Spokane who assisted with various aspects of these studies: Nova Baker, Marilyn
Cellucci, Chris Covillo, Katie Forsell, Paige Fry, Lily Gay, Claire Godbout, Julie Hann, Char-
Lee Hansen, Angelina Masino, Nicole Moseley-Williams, Mackenzie Stults, Eleacia Walser,
Lauren Wampole, and Haley Willison. You were an enormous help and an encouragement.
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FLOOR AND STEP AEROBICS AS AN EXERCISE INTERVENTION TO ENHANCE
COGNITION IN BREAST CANCER SURVIVORS

Abstract

by Julie Ann-Michelle Larsen, Ph.D.
Washington State University
May 2016

Chairs: Judy Knuth and Kathryn E. Meier

Breast cancer survivors suffer from immediate and late adverse effects of treatment, which
reduce their quality of life. Regular exercise improves many health-related outcomes, but
relatively little research has been done to discover an effective treatment for cancer-induced
cognitive dysfunction. Aerobic exercise can enhance cognition in a variety of healthy and
clinical populations, demonstrating potential effectiveness in breast cancer survivors.

The purpose of this dissertation was to define an effective intervention for improving cognition
in recent breast cancer survivors. Exercise interventions were primarily considered because of
their potential to improve other outcomes while enhancing cognition. Specifically, a comparison
was made between floor/step aerobics (FSA) and treadmill walking (TMW). FSA provides
cognitive stimulation by requiring participants to follow oral directions, remember routines, and
frequently change movement patterns. Therefore, our first hypothesis was that although both
exercise modalities would improve cognition, participation in FSA would increase cognition to a
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greater extent than would TMW. We also wanted to ensure that the cognitively challenging FSA
routines did not diminish the fitness benefits of aerobic exercise when compared to doing an
equally intense TMW workout. A final factor under consideration was whether women strongly
preferred one exercise modality over another, because women are not likely to adhere to a poorly
accepted exercise program. The second hypothesis was that cardiorespiratory fitness would
improve similarly between groups and that FSA would provide greater satisfaction than would
TMW.

In order to test these two hypotheses, we conducted a study of healthy women, followed by a
study of breast cancer survivors. While we found few statistically significant differences between
groups, we demonstrated trends toward greater cognitive improvements among FSA participants
than among TMW participants. Women in FSA expressed slightly greater exercise modality
satisfaction than women in TMW. The groups experienced similar improvement in fitness
following the intervention. Overall, these results suggest that recent breast cancer survivors
should be encouraged to regularly participate in aerobic exercise, using a cognitively stimulating
modality. When frequency, intensity, and time of exercise are comparable, FSA will provide
similar or greater improvements in health-related quality of life outcomes than will traditional
exercise modalities.

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TABLE OF CONTENTS
PAGE
ACKNOWLEDGEMENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iii
ABSTRACT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iv
LIST OF TABLES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . viii
LIST OF FIGURES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix
LIST OF APPENDICES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . x
CHAPTERS
1. EFFECTS OF EXERCISE INTERVENTIONS ON HEALTH-RELATED OUTCOMES
IN BREAST CANCER SURVIVORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
a. Abstract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
b. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
c. Summary of Treatment Protocols . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
d. Breast Cancer Sequelae and Effects of Exercise . . . . . . . . . . . . . . . . . . . . . . . . . 6
e. Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
f. Hypotheses and Study Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
g. References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
2. DEVELOPMENT AND VALIDATION OF AEROBICS ROUTINES FOR EXERCISE
INTERVENTIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
a. Abstract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
b. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
c. Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
d. Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
e. Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
f. References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
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3. EFFECTS OF EXERCISE MODALITY ON COGNITION AND FITNESS IN
HEALTHY WOMEN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
a. Abstract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
b. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
c. Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
d. Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
e. Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
f. References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
4. EFFECTS OF EXERCISE MODALITY ON COGNITION AND FITNESS IN BREAST
CANCER SURVIVORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
a. Abstract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76
b. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
c. Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
d. Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84
e. Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90
f. References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
5. FINAL DISCUSSION AND FUTURE DIRECTIONS . . . . . . . . . . . . . . . . . . . . . . . . . 98

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LIST OF TABLES
Page
Table 3.1: Participant Demographics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
Table 4.1: Breast Cancer Survivor Demographics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
Table 4.2: Neuropsychological Assessment Battery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
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LIST OF FIGURES
Page
Figure 1.1: Benefits of Exercise for Breast Cancer Survivors . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Figure 1.2: Cognitive Reserve Theory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Figure 2.1: Exercise Modality Satisfaction among Healthy Women . . . . . . . . . . . . . . . . . . . . . 45
Figure 2.2: Frequency of Response Selection on Satisfaction Survey . . . . . . . . . . . . . . . . . . . . 46
Figure 2.3: Physical Activity Enjoyment Scale Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Figure 2.4: Intervention Effects on Shoulder Range of Motion . . . . . . . . . . . . . . . . . . . . . . . . . 48
Figure 3.1: Process of Recruitment and Attrition of Healthy Women . . . . . . . . . . . . . . . . . . . . 64
Figure 3.2: Effect of Exercise on Trail Making Test-A Results . . . . . . . . . . . . . . . . . . . . . . . . . 66
Figure 3.3: Effect of Exercise on Trail Making Test-B Results . . . . . . . . . . . . . . . . . . . . . . . . . 67
Figure 3.4: Effect of Interventions on Exercise Heart Rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
Figure 4.1: Process of Recruitment and Attrition of Breast Cancer Survivors . . . . . . . . . . . . . . 84
Figure 4.2: Effect of Exercise Modality on Composite Cognition . . . . . . . . . . . . . . . . . . . . . . . 85
Figure 4.3: Effect of Exercise Modality on Trail Making Test-A Results . . . . . . . . . . . . . . . . . 86
Figure 4.4: Effect of Exercise Modality on Verbal Fluency . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
Figure 4.5: Effect of Exercise Modality on Design Fluency . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88
Figure 4.6: Effect of Exercise Modality on Exercising Heart Rate . . . . . . . . . . . . . . . . . . . . . . . 89

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