Characteristics of Cancer Patients Who Developed an Exercise Habit Through Supervised Exercise Therapy by Hospital-Based Physiotherapists: A Case–Control Study

Characteristics of Cancer Patients Who Developed an Exercise Habit Through Supervised Exercise Therapy by Hospital-Based Physiotherapists: A Case–Control Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Characteristics of Cancer Patients Who Developed an Exercise Habit Through Supervised Exercise Therapy by Hospital-Based Physiotherapists: A Case–Control Study Nobuya Ibara, Tetsuya Tsuji, Yoshio Tokuda, Eri Maniwa, Tatsuya Saito This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4505382/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose Exercise and physical activity are recommended for cancer survivors. This study aimed to identify the patient characteristics associated with behavioral changes and maintenance of exercise habits through supervised exercise therapy (SET) by licensed physiotherapists during outpatient care. Methods The participants in this case–control study were outpatients with cancer who underwent uninsured SET at the Matsue City Hospital Cancer Center from April 1, 2017, to April 1, 2021. Data were collected retrospectively from medical records. The participants were divided into two groups: a continuation group that continued SET for at least 24 weeks and showed sufficient behavioral change and a dropout group that dropped out of SET after less than 24 weeks and showed insufficient behavioral change. Statistical analysis was performed using logistic regression analysis, with patient characteristics as the independent variable and SET continuation as the dependent variable. Results A total of 54 participants (median age, 58 years), including 38 female participants, were included in this study. The most common type of cancer was breast cancer, most commonly Stage IV cancer, and 33 patients (61%) were undergoing treatment. The continuation group consisted of 27 patients (50%). Factors significantly associated with SET continuation were age (odds ratio [95% confidence interval], 1.07 [1.00–1.13]), treatment completion (4.29 [1.15–16.05]), and the QLQ-C30 dyspnea score (0.34 [0.12–0.99]). Conclusions Older age, treatment completion, and the absence of dyspnea were associated with SET continuation and maintenance of exercise habits in outpatients with cancer. Outpatient Cancer Supervised Exercise Behavioral Change Exercise Habits Figures Figure 1 Introduction Cancer survivors constitute a growing population due to advancements in early detection and therapeutic modalities [ 1 , 2 ]. Cancer survivors experience physical, psychological, and social challenges during and after treatment, including sequelae from treatment, the risk of recurrence, and comorbidities [ 3 , 4 ]. Exercise therapy has been reported to be beneficial for anxiety, depression, fatigue, quality of life (QoL), and physical function. The American College of Sports Medicine (ACSM) recommends that patients with cancer avoid inactivity and remain physically active during and after treatment to improve survival and reduce the adverse effects associated with cancer treatment [ 5 , 6 ]. Intervention studies in the United States involving patients with cancer have reported the creation of exercise programs and counseling to establish healthy lifestyle [ 1 , 7 , 8 ]. However, in an epidemiological study of the general adult population aged ≥ 18 years in the United States [ 9 ], only 25.3% followed the ACSM physical activity guidelines of 150 min/week of combined aerobic and strength training at moderate or high intensity [ 10 ]. A National Health Interview Survey conducted in the United States in 2018 [ 11 ] also indicated that cancer survivors were similarly inactive [ 12 ]. Thus, behavioral changes are necessary to improve physical activity in patients with cancer during and after treatment, and identification of the factors associated with exercise adherence is important in this regard. Behavioral changes are necessary for exercise to become a habit. The Transtheoretical Model of behavioral change (TTM) classifies the process from a state of indifference until habitualization of a behavior into five stages: precontemplation, contemplation, preparation, action, maintenance [ 13 ]. The maintenance stage is the final stage, and is defined as the stage in which a clear behavioral change lasts for at least 24 weeks [ 14 , 15 ]. A previous study on exercise adherence in patients with cancer reported that supervised exercise therapy (SET) was associated with higher exercise adherence than non-supervised exercise such as home-based exercise [ 16 ]. Adherence to SET in patients with cancer is also associated with treatment status, travel time, and convenience of access to fitness centers [ 17 , 18 ]. However, because the follow-up period of these previous studies was 12 weeks, the patients were not surveyed at 24 weeks, which represents the maintenance stage of TTM. In addition, the cost of the SET was not considered. This study aimed to identify the factors that contribute to exercise adherence in outpatients with cancer by comparing patients who had completed at least 24 weeks of SET and demonstrated behavioral changes with those who had dropped out of SET before the 24-week duration. Methods Study design and setting The participants in this case–control study were outpatients with cancer who underwent SET at Matsue City Hospital Cancer Center in Japan. The continuation group consisted of those who continued SET for more than 24 weeks, and the control group consisted of those who dropped out in less than 24 weeks or did not attend SET for more than 4 weeks. We retrospectively collected participant characteristics and physical function information during SET enrollment from the participants’ medical records. Inclusion and exclusion criteria The case group consisted of 57 individuals of Japanese ethnicity enrolled in the SET at Matsue City Hospital Cancer Center from April 1, 2017, to April 1, 2021. The SET participants were recruited through Matsue City Hospital’s website, hospital posts, and referrals from health professionals. The inclusion criteria were as follows: (1) patients diagnosed with cancer and receiving treatment or follow-up outside the hospital, and (2) outpatients with cancer who enrolled for SET. Of the initially enrolled participants, those who 1) did not participate within 4 weeks of enrolling in the SET and 2) were denied permission from their respective attending physicians were excluded from the study. Steps before initiation of SET The participants’ physicians first evaluated whether the SET program was suitable for the participants. Next, the participants’ risk levels were rated as low, medium, and high according to the ACSM guidelines for stratifying clients before exercise testing and prescription [ 19 ]. Exercise stress testing was recommended for participants in the medium- and high-risk categories. Finally, SET program for each participant was designed on the basis of the results of the exercise stress test and the level of risk associated with exercise. SET programs Each SET program lasted one 1 h on weekdays between 9:00 a.m. and 5:00 p.m., and its frequency was at the discretion of the participants. The fee was 1,000 JPY (approximately 6.7 USD) for city residents and 2,000 JPY (approximately 13.3 USD) for those living outside the city (at the exchange rate on February 18,2024). SET was a one-on-one exercise program conducted by a physiotherapist. It was developed according to the exercise guidelines for patients with cancer for a total of 1 h [ 6 ], combining 20 min of aerobic exercise + 20 min of resistance training + 20 min of warm-up and cool-down exercises, such as stretching. The training machines were manufactured by Technogym Japan Co. Resistance training was performed on a cable machine with 1–3 sets of 8–10 different exercises, focusing on large muscle groups. The resistance training load was 10–20 repetition maximum. Aerobic exercise was performed on a treadmill, ergometer, recumbent bike, or cross-trainer. The intensity of aerobic exercise was set at the target heart rate (THR) for each participant. For participants who performed an exercise stress test, the THR was set to 60–80% of the maximal oxygen uptake. For participants who did not perform an exercise stress test, THR was set using the Karvonen formula calculation at an exercise intensity of 0.5–0.7 [ 20 ]. The target rating of perceived exertion for SET was set at 11–13 on the Borg scale [ 21 ]. Every 12 weeks, body composition analysis and evaluation of physical function were performed, and guidance was provided on the effectiveness of SET, adjustment of exercise load, and benefits of creation of an exercise habit. Primary endpoint The primary endpoint was the number of patients who continued SET for 24 weeks, and behavioral changes were monitored. This was because continued exercise (duration adherence) was part of exercise adherence [ 22 , 23 ], and to assess clear behavioral change, follow-up assessments were performed up to 24 weeks, which represented the maintenance phase of TTM [ 24 ]. Participants who continued SET for more than 24 weeks were defined as those (1) participating in SET at 12 and 24 weeks from the start of SET and (2) not pausing SET for more than 4 weeks. Secondary outcome Participant information (medical, physical function, QoL, social, and SET frequency) was collected from medical records at SET enrollment as baseline data. Medical information The medical information collected included information regarding cancer site and progression, treatment status, and the time from diagnosis to the initiation of SET. Cancer progression was classified as stage I–IV according to the Cancer Manual by the American Joint Committee on Cancer [ 25 ]. Treatment status was classified as current or completed, and current treatment was classified as chemotherapy or adjuvant therapy at baseline. If adjuvant therapy was completed during the follow-up period, participants were classified as undergoing current treatment. Completed treatment was defined when participants had completed cancer treatment, such as surgery or radiotherapy, and were being followed up. Body composition and physical function analyses Physical function evaluations included measurement of body mass index (BMI), lean body mass, and handgrip strength along with the 30-second chair-stand test (CS-30). Lean body mass was analyzed by bioelectrical impedance analysis with a body composition analyzer (ioi757; Sowa Medical, Japan). The handgrip strength test was conducted using a portable Grip-D digital grip strength meter (Takei Kiki Kogyo, Japan) to measure the right and left handgrip strength in kilograms. Participants were instructed to squeeze the instrument as hard as possible for 3 s in a standing position. Two sets with a 2-min rest between sets were completed for each hand, and the best score was recorded. Higher scores indicated greater strength. For the CS-30, the participants began the test seated in a chair and were asked to stand up and sit down as many times as they could for 30 s [ 26 ]. Higher repetitions indicated greater physical functioning. Quality of life QoL was defined using the Japanese version of the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 (version 3) Japanese version [ 27 ]. This questionnaire is designed to measure the physical, psychological, and social functions of patients with cancer. The questionnaire consisted of five functional scales (physical, role, cognitive, emotional, and social functioning) and nine symptom scales (fatigue, nausea and vomiting, pain, dyspnea, insomnia, appetite loss, constipation, diarrhea, and financial impact). All scales and single-item measures ranged from 0 to 100. Higher scores indicated higher response levels. Thus, a high score on the functional scale indicated a high or healthy level of functioning, while a high global health status/QoL score indicated a high QoL. In contrast, a high score for a symptom scale/item represented a high level of symptomatology/problems [ 28 ]. Social information Social information collected included information regarding employment status, exercise history, method of hospital transport, and distance to the hospital. Employment status was classified as employed or unemployed. The employed group included those who were employed or on leave at the time of SET enrollment. The unemployed group included participants who had retired or were not looking for work. Exercise history was surveyed over the past year. Hospital transportation was classified as either self-transportation or other transportation, with the former including participants who could transport themselves to the hospital at their own convenience (e.g., transportation in their car or walking) and the latter including participants who were transported to the hospital at the convenience of others or by public transportation. (e.g., commercial transport or being picked up by a family member). The distance to the hospital was measured from the participant’s house to the hospital and classified as more or less than 10 km. Frequency of SET The frequency of SET was classified as more than once a week vs. less than once a week, based on the average frequency of SET during the first 4 weeks. Statistical analysis Logistic regression analysis was performed using the forced-entry method to assess the factors affecting SET continuation for 24 weeks. Baseline characteristics for the continuation and dropout groups were summarized, compared using the chi-square test and Mann–Whitney U test, as appropriate. The Mann–Whitney U test was used for continuous variables (age, BMI, lean body mass, handgrip strength, and CS-30 and QLQ-C30 scores), while the chi-square test was used for categorical variables (medical information, social information, and frequency of SET). The independent variables were factors with a significance level of p < 0.05, based on the results of univariate analysis. The multicollinearity of independent variables was tested using the variance inflation factor (VIF). Multicollinearity was considered to be present when the VIF was > 10 [ 29 ]. If two independent variables had VIF ≥ 10, one of them was selected based on the clinical significance. A logistic regression analysis with the forced-entry method was performed with the dependent variable being SET continuation and the independent variables being factors of significance in the univariate analysis, after taking multicollinearity into consideration. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated. In addition, the cutoff value for continuous variables was calculated using receiver operating characteristic (ROC) analysis. All statistical analyses were performed using JMP ver. 15 (SAS Institute, Cary, NC, USA). Statistical significance was set at p < 0.05 with a two-sided test. Results Study population A total of 57 participants were initially enrolled in the SET, and 54 participants were analyzed, after excluding one participant who were denied permission to exercise by the attending physician and two participants who stopped participating in the SET within 4 weeks of enrollment. These 54 participants included 27 (50%) participants in the continuation group (i.e., continued SET for more than 24 weeks) and 27 (50%) participants in the dropout group (i.e., dropped out in less than 24 weeks or did not attend for more than 4 weeks) (Fig. 1 ). A total of 38 participants (70%) were female, and the median participant age was 58 years (interquartile range, 50.0–69.0 years). The most common cancer type was breast cancer, and the most common cancer stage was IV (Table 1 ). Table 1 Baseline characteristics of the study participants Variable Total (N = 54) Continuation group (n = 27) Dropout group (n = 27) p-value Demographics Age (years), median [IQR] a 58 [50.0–69.0] 61 [44.0–81.0] 53 [41.0–77.0] 0.048* Sex 0.37 Female 38 (70%) 21 (78%) 17 (63%) Male 16 (30%) 6 (22%) 10 (37%) Medical information Cancer site 0.95 Breast 19 (35%) 10 (37%) 9 (33%) Gastrointestinal cancer 17 (31%) 8 (30%) 9 (33%) Gynecological cancer 11 (20%) 6 (22%) 5 (19%) Others 7 (13%) 3 (11%) 4 (15%) Stage 0.95 I 12 (22%) 9 (33%) 3 (11%) II 9 (17%) 4 (15%) 5 (19%) III 4 (7%) 1 (4%) 3 (11%) IV 19 (35%) 6 (22%) 13 (48%) Undetermined/other 10 (19%) 7 (26%) 3 (11%) Treatment status 0.02* Current 33 (61%) 12 (44%) 21 (78%) Completed 21 (39%) 15 (56%) 6 (22%) Time from diagnosis to the start of SET 0.58 < 1 year 23 (43%) 13 (48%) 10 (37%) ≥ 1 year 31 (57%) 14 (52%) 17 (63%) Social information Employment status 0.17 Employed 32 (59%) 13 (48%) 19 (70%) Unemployed 22 (41%) 14 (52%) 8 (30%) Exercise history 1.00 Yes 31 (57%) 16 (59%) 15 (56%) No 23 (43%) 11 (41%) 12 (44%) Transport to the hospital 0.42 Self-transportation 47 (87%) 22 (81%) 25 (93%) Other transportation 7 (13%) 5 (19%) 2 (7%) Distance to hospital 0.76 < 10 km 40 (74%) 21 (78%) 19 (70%) ≥ 10 km以上 14 (26%) 6 (22%) 8 (30%) Frequency of SET 0.12 ≥ 1 time/week 40 (74%) 23 (85%) 17 (63%) < 1 time/week 14 (26%) 4 (15%) 10 (37%) a IQR: Interquartile range, [25th -75th percentile]; SET, supervised exercise therapy. p -Values were obtained using chi-square analyses for categorical variables and the Mann–Whitney U test for continuous variables. *Significant, p < 0.05 Comparison between the continuation and dropout groups A comparison of the baseline characteristics of the participants in the continuation and dropout groups (Table 1 ) showed that the median patient age was significantly higher in the continuation group (p = 0.048). Moreover, the continuation group included a significantly higher proportion of participants with completed treatment status (p = 0.02). Physical function did not differ significantly between the continuation and dropout groups (Table 2 ). The results of the EORTC QLQ-C30 are presented in Table 3 . The dyspnea score on the EORTC QLQ-C30 symptom scale was 0 (no shortness of breath at all) in the continuation group and 33.3 (a little shortness of breath) in the dropout group, indicating that the continuation group showed significantly fewer symptoms of shortness of breath (p = 0.045). The VIF results showed no multicollinearity in age, treatment status, or the QLQ-C30 dyspnea score. Table 2 Baseline physical function in both groups Variable, Measure Total (N = 54) Continuation group (n = 27) Dropout group (n = 27) p -value BMI, kg/m 2 22.5 [19.9–25.6] 22.6 [19.6–27.9] 22.4 [20.5–24.3] 0.74 Lean body mass, kg 41.9 [38.5–47.2] 42.0 [38.5–48.3] 41.1 [38.9–46.9] 0.97 Handgrip strength, kg 25.5 [21.4–32.0] 24.9 [14.0–22.0] 26.3 [20.9–32.1] 0.62 CS-30, reps 19.0 [14.0–22.0] 17.0 [14.0–22.0] 19.0 [15.0–22.0] 0.65 a BMI: Body Mass Index; CS-30: 30-s chair-stand test b Values are presented as median [25th -75th percentile] p -Values were obtained using the Mann–Whitney U test Table 3 Baseline EORTC QLQ-C30 scores in all participants Variable, score Total (N = 54) Continuation group (n = 27) Dropout group (n = 27) P-value Global health status and QoL score a 66.7 [50.0–83.3] 66.7 [41.7–83.3] 66.7 [50.0–83.3] 0.91 Functional scales a Physical 86.7 [80.0–93.3] 86.7 [80.0–93.3] 86.7 [80.0–86.7] 0.48 Role 83.3 [66.7–100] 83.3 [66.7–100] 83.3 [66.7–100] 0.45 Cognitive 83.3 [66.7–83.3] 66.7 [50.0–83.3] 83.3 [66.7–83.3] 0.28 Emotional 83.3 [66.7–91.7] 75.0 [66.7–91.7] 83.3 [75.0–100] 0.29 Social 83.3 [66.7–100] 83.3 [66.7–100] 83.3 [66.7–100] 0.91 Symptoms scales b Fatigue 83.3 [33.3–44.4] 33.3 [22.2–44.4] 33.3 [33.4–44.4] 0.61 Nausea and vomiting 0.0 [0.0–0.0] 0.0 [0.0–0.0] 0.0 [0.0–0.0] 0.21 Pain 16.7 [0.0–33.3] 16.7 [0.0–33.3] 16.7 [0.0–33.3] 0.67 Dyspnea 33.3 [0.0–33.3] 0.0 [0.0–33.3] 33.3 [0.0–33.3] 0.045* Insomnia 33.3 [0.0–33.3] 0.0 [0.0–33.3] 33.3 [0.0–33.3] 0.054 Appetite loss 0.0 [0.0–33.3] 0.0 [0.0–33.3] 0.0 [0.0–33.3] 0.19 Constipation 0.0 [0.0–33.3] 0.0 [0.0–33.3] 0.0 [0.0–33.3] 0.70 Diarrhea 0.0 [0.0–33.3] 0.0 [0.0–33.3] 0.0 [0.0–33.3] 0.93 Financial impact 33.3 [0.0–33.3] 0.0 [0.0–33.3] 33.3 [0.0–33.3] 0.11 a High score for the global health status/QoL represents a high QoL. b high score on a symptom scale/item represents a high level of symptomatology/problems. p -Values were obtained using Mann–Whitney U test *Significant, p < 0.05 Factors contributing to SET continuation and cutoff values In the logistic regression analysis, the factors associated with SET continuation included age, treatment status, and EORTC QLQ-C30 dyspnea score as independent variables (Table 4 ). The participant characteristics that significantly associated with SET continuation were age (OR = 1.07, 95% CI: 1.00-1.13, p = 0.04), treatment completion (OR = 4.29, 95% CI: 1.15–16.05, p = 0.03), and QLQ-C30 dyspnea score (OR = 0.34, 95% CI: 0.12–0.99, p = 0.03). Table 4 Logistic regression analysis with supervised exercise therapy continuation as the dependent variable Variables* Odds ratio 95% Confidence Interval p -value Treatment status Completed (vs. Current) 4.29 (1.15, 16.05) 0.03 Age per 1 year 1.07 (1.00, 1.13) 0.04 QLQ-C30 dyspnea score per 1 point 0.34 (0.12, 0.99) 0.03 *Only variables derived from predictive factors with a significance of < 0.05 in the univariate analysis were included. ROC analysis was performed to calculate the cutoff values for the SET continuation factors of age and QLQ-C30 dyspnea score. The cutoff age was 58 years, and the cutoff QLQ-C30 dyspnea score was 0 (i.e., no breathlessness at all). ROC analysis was performed based on the logistic regression analysis results, and it yielded an area under the curve value of 0.79, sensitivity of 0.85, and specificity of 0.74. Discussion This study aimed to identify the characteristics associated with behavioral changes and maintenance of exercise habits through SET continuation among cancer patient in outpatient care. Logistic regression analysis revealed that age, treatment status, and the QLQ-C30 dyspnea score were significantly associated with SET continuation. The novel finding was that factors significantly contributing to exercise adherence included baseline age ≥ 58 years, completion of treatment, and the absence of breathlessness symptoms at the start of SET. SET continuation rate The SET continuation rate in this study was 50% (27 participants), which was lower than the 70–92% continuation rate reported in previous studies [ 17 , 30 ]. The lower continuation rate in our study can be attributed to three reasons. First, the follow-up period was 24 weeks, which was longer than the 12-week follow-up period in previous studies that were limited to the chemotherapy period [ 17 ]. Chemotherapy-induced adverse effects and lifestyle changes can affect adherence to exercise over longer periods. Second, participants who did not attend SET for more than 4 continuous weeks were classified into the dropout group. Several recent studies have classified all patients who were unable to continue exercise during the follow-up period as part of the dropout period [ 30 , 31 ]. However, no established criteria for pausing or resuming exercise during the follow-up period are currently available. In this study, to establish the reliability and validity of the dropout group, those who did not attend SET for more than 4 weeks were classified as the dropout group. As such, the lower SET continuation rate can be attributed to the stringent dropout criteria. Finally, SET costs and operations not covered by insurance may have caused financial difficulties, affecting the SET dropout rate. Additionally, SET operations were limited to weekdays from 9:00 am to 5:00 pm, which may have led to dropouts among employed participants or those returning to work. Participant characteristics related to SET continuation Age, treatment status, and the QLQ-C30 dyspnea score were significantly associated with SET continuation in outpatients with cancer. The American Thoracic Society defines dyspnea as a combination of physiological, psychological and environmental elements [ 32 ]. Thus, patients with cancer experience dyspnea symptoms not only because of physiological factors, such as adverse events from treatment or a history of respiratory disease, but also because of psychological factors, such as cancer notification or anxiety about returning to society. Furthermore, approximately 60% of patients with cancer reported that the reason they stopped exercising was shortness of breath [ 33 ]. We believe that the dropout rate is a direct result of increased shortness of breath with SET. In addition, most of the participants' cancer was at Stage IV, and their mental anxiety may have contributed to dropping out of the SET. Taken together, these results indicate that minor symptoms of shortness of breath in patients with cancer may cause them to drop out of SET; thus, designing an exercise program that is appropriate for the physical and emotional state of patients with cancer is of vital importance. Older age was a significant factor in SET continuation, which was supported by a previous study [ 34 ]. Older outpatients with cancer conceivably have more free time. In contrast, the barriers to SET continuation among younger outpatients with cancer included availability and employment and household responsibilities as well as the variety of treatment options. These findings highlight the need to provide exercise settings suited to the specific lifestyles of patients with cancer. Treatment completion was significantly associated with continued SET, which is supported by previous studies [ 10 , 35 – 37 ]. Cancer treatment is conceivably influenced by adverse events and lack of time. Based on these findings, outpatients undergoing cancer treatment should be monitored for changes in their physical status, and exercise programs should be planned accordingly. Relationship of SET continuation with distance and transport to the hospital A previous study reported that exercise adherence is related to the amount of time and effort required to reach the exercise location [ 38 ]. However, the results of this study showed no significant intergroup differences with regard to the distance to the hospital and transportation as factors for SET continuation; this could be attributed to the fact that this study recruited participants through an open recruitment process; hence, the participants were likely to be strongly motivated to exercise. In a previous study, high exercise motivation in patients with cancer showed an association with exercise adherence [ 39 ]. In addition, the fact that many participants were able to transport themselves to the hospital may have allowed them to continue SET. Limitations of the study and future prospects This study had three limitations. First, this was a case–control study conducted at a single institution. Participants were recruited from the public, which might have biased the study toward outpatients with cancer who were highly motivated to exercise and participants who had specific cancer types, stages, and social backgrounds. Therefore, the information needed to interpret the causal relationships between relevant factors and patient background characteristics is limited. Further studies are required to adjust for patient background characteristics to include a greater number of patients. Second, dyspnea was assessed using the QLQ-C30 symptom score, which is not specific to dyspnea. Future studies should include physiological and psychological assessments of dyspnea in patients with cancer and investigate their association with SET continuation. Third, the assessment of behavioral changes in exercise habits was based on the duration of SET continuation, which did not objectively assess changes in physical activity. Future studies should objectively assess physical activity using tools such as accelerometers and GPS. Despite these limitations, our findings support the hypothesis that hospital-based SET, even without insurance coverage, is necessary for promoting behavioral changes in exercise habits among patients with cancer. Conclusions Older age at the time of SET entry, treatment completion, and a lower QLQ-C30 dyspnea score (indicating no shortness of breath) were significantly associated with SET continuation. Notably, the QLQ-C30 dyspnea score was significantly associated with continuation of SET. To our knowledge, this is the first study to identify the patient characteristics required for behavioral changes to maintain exercise habits in outpatients with cancer undergoing hospital-based SET. Understanding the background and medical information of patients with cancer is crucial for maintaining exercise adherence and facilitating these behavioral changes. Declarations Ethics approval This study was approved by the Ethics Committee of Matsue City Hospital (date. Dec 12, 2020. No. 2A-0009) and was conducted in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments or comparable standards. Consent to participate Informed consent was obtained from all individual participants included in the study. Consent for publication The participants provided consent to the submission of the data to the journal. Competing interests The authors have no relevant financial or non-financial interests to disclose. Funding No funding was received for conducting this study. Author Contribution All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by N.I., T.T., Y.T., E.M. and T.S. The first draft of the manuscript was written by N.I. and all authors commented on previous versions of the manuscript. 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Ann Behav Med 40:150–163. https://doi.org/10.1007/s12160-010-9196-2 Cardinal B (1998) Interaction between stage of exercise and history of exercise relapse. J Hum Mov Stud 34:175–185 Prochaska JO, Marcus BH (1994) The transtheoretical model: Applications to exercise. In R. K. Dishman (Ed.), Advances in exercise adherence, Human Kinetics Publishers, Champaign, IL, pp 161–180. https://psycnet.apa.org/record/1994-98849-004 Stout NL, Baima J, Swisher AK, Winters-Stone KM, Welsh J (2017) A systematic review of exercise systematic reviews in the cancer literature (2005–2017). PM R 9:S347–S384. https://doi.org/10.1016/j.pmrj.2017.07.074 Courneya KS, Segal RJ, Gelmon K, Reid RD, Mackey JR, Friedenreich CM, Proulx C, Lane K, Ladha AB, Vallance JK, McKenzie DC (2008) Predictors of supervised exercise adherence during breast cancer chemotherapy. Med Sci Sports Exerc 40:1180–1187. https://doi.org/10.1249/MSS.0b013e318168da45 Ferri A, Gane EM, Smith MD, Pinkham EP, Gomersall SR, Johnston V (2021) Experiences of people with cancer who have participated in a hospital-based exercise program: a qualitative study. Support Care Cancer 29:1575–1583. https://doi.org/10.1007/s00520-020-05647-y Schmitz KH, Courneya KS, Matthews C, Demark-Wahnefried W, Galvão DA, Pinto BM, Irwin ML, Wolin KY, Segal RJ, Lucia A, et al. (2010) American College of Sports Medicine roundtable on exercise guidelines for cancer survivors Med Sci Sports Exerc 42: 1409–1426. https://doi.org/10.1249/MSS.0b013e3181e0c112 Karvonen MJ, Kentala E, Mustala O (1957) The effects of training on heart rate; a longitudinal study. Ann Med Exp Biol Fenn 35:307–315 Borg GAV (1982) Psychophysical bases of perceived exertion. Med Sci Sports Exerc 14:377–381. https://doi.org/10.1249/00005768-198205000-00012 Hawley-Hague H, Horne M, Campbell M, Demack S, Skelton DA, Todd C (2014) Multiple levels of influence on older adults’ attendance and adherence to community exercise classes. Gerontologist 54:599–610. https://doi.org/10.1093/geront/gnt075 Visek AJ, Olson EA, DiPietro L (2011) Factors predicting adherence to 9 months of supervised exercise in healthy older women. J Phys Act Health 8:104–110. https://doi.org/10.1123/jpah.8.1.104 Prochaska JO, Velicer WF (1997) The transtheoretical model of health behavior change. Am J Health Promot 12:38–48. https://doi.org/10.4278/0890-1171-12.1.38 American Joint Committee on Cancer (2002) AJCC cancer staging manual. Springer link. https://link.springer.com/book/10.1007/978-1-4757-3656-4 . Accessed 27 Jan 2022 Jones CJ, Rikli RE, Beam WC (1999) A 30-s Chair-Stand Test as a Measure of Lower Body Strength in Community-Residing Older Adults. Research Quarterly for Exercise and Sport 70:113–119. https://doi.org/10.1080/02701367.1999.10608028 Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, Filiberti A, Flechtner H, Fleishman SB, de Haes JC, Kaasa S (1993) The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85:365–376. https://doi.org/10.1093/jnci/85.5.365 Kyriaki M, Eleni T, Efi P, Ourania K, Vassilios S, Lambros V (2001) The EORTC core quality of life questionnaire (QLQ-C30, version 3.0) in terminally ill cancer patients under palliative care: validity and reliability in a Hellenic sample. Int J Cancer 94:135–139. https://doi.org/10.1002/ijc.1439 O’Brien RM (2007) A caution regarding rules of thumb for variance inflation factors. Qual Quant 41:673–690. https://doi.org/10.1007/s11135-006-9018-6 Courneya KS, Segal RJ, Mackey JR, Gelmon K, Reid RD, Friedenreich CM, Ladha AB, Proulx C, Vallance JK, Lane K, Yasui Y, McKenzie DC (2007) Effects of aerobic and resistance exercise in breast cancer patients receiving adjuvant chemotherapy: a multicenter randomized controlled trial. J Clin Oncol 25:4396–4404. https://doi.org/10.1200/JCO.2006.08.2024 Blanchard CM, Courneya KS, Stein K (2008) Cancer survivors’ adherence to lifestyle behavior recommendations and associations with health-related quality of life: results from the American Cancer Society’s SCS-II. J Clin Oncol 26:2198–2204. https://doi.org/10.1200/JCO.2007.14.6217 American Thoracic Society (1999) Dyspnea. Mechanisms, assessment, and management: a consensus statement. American Thoracic Society. Am J Respir Crit Care Med 159:321–340. https://doi.org/10.1164/ajrccm.159.1.ats898 Travers J, Dudgeon DJ, Amjadi K, McBride I, Dillon K, Laveneziana P, Ofir D, Webb KA, O'Donnell DE (2008) Mechanisms of exertional dyspnea in patients with cancer. J Appl Physiol 104:57–66. https://doi.org/10.1152/japplphysiol.00653.2007 Courneya KS, Stevinson C, McNeely ML, Sellar CM, Peddle CJ, Friedenreich CM, Mazurek A, Chua N, Tankel K, Basi S, Reiman T (2010) Predictors of adherence to supervised exercise in lymphoma patients participating in a randomized controlled trial. Ann Behav Med 40:30–39. https://doi.org/10.1007/s12160-010-9205-5 Irwin ML, McTiernan A, Bernstein L, Gilliland FD, Baumgartner R, Baumgartner K, Ballard-Barbash R (2004) Physical activity levels among breast cancer survivors. Med Sci Sports Exerc 36:1484–1491 Kirkham AA, Bonsignore A, Bland KA, McKenzie DC, Gelmon KA, VAN Patten CL, Campbell KL (2018) Exercise prescription and adherence for breast cancer: one size does not FITT all. Med Sci Sports Exerc 50:177–186. https://doi.org/10.1249/MSS.0000000000001446 Courneya KS, McKenzie DC, Reid RD, Mackey JR, Gelmon K, Friedenreich CM, Ladha AB, Proulx C, Lane K, Vallance JK, Segal RJ (2008) Barriers to supervised exercise training in a randomized controlled trial of breast cancer patients receiving chemotherapy. Ann Behav Med 35:116–122. https://doi.org/10.1007/s12160-007-9009-4 Chao D, Foy CG, Farmer D (2000) Exercise adherence among older adults: challenges and strategies. Control Clin Trials 21 Supplement:212S–217S. https://doi.org/10.1016/s0197-2456(00)00081-7 Husebø AM, Dyrstad SM, Søreide JA, Bru E (2013) Predicting exercise adherence in cancer patients and survivors: a systematic review and meta-analysis of motivational and behavioural factors. J Clin Nurs 22:4–21. https://doi.org/10.1111/j.1365-2702.2012.04322.x Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4505382","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":325871638,"identity":"5d3e53b7-6218-49ef-8064-bb9696e9b558","order_by":0,"name":"Nobuya Ibara","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4klEQVRIiWNgGAWjYBACNgkInQDEjA+ABA8fKVqYDUBa2Ahag6QFop2gFj7p5mcffu6wyTO4kfys8muOnQwbA/PDRzfwOUzmmPHM3jNpxQY30sxuy25LBjqMzdg4B69fEowZeNsOJ264kWB2W3IbM1ALD5s0fi3pnxn/grWkfyuW3FZPjJYcY2aILTlmjB+3HSZCi8yZYmbZtrRiyTNviqUZtx3nYWMm4Bf52e2bGd+22eTxHU/f+PHntmp7fvbmh4/xaUEAgQQGZh4Qg5ko5SDAf4CB8QfRqkfBKBgFo2AkAQDEbkWADWsq7AAAAABJRU5ErkJggg==","orcid":"","institution":"Matsue City Hospital","correspondingAuthor":true,"prefix":"","firstName":"Nobuya","middleName":"","lastName":"Ibara","suffix":""},{"id":325871639,"identity":"570a0548-ea4d-43f4-8747-3e725688c342","order_by":1,"name":"Tetsuya Tsuji","email":"","orcid":"","institution":"Keio University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Tetsuya","middleName":"","lastName":"Tsuji","suffix":""},{"id":325871640,"identity":"f34b8c6e-836a-4262-b874-120476f7f9a4","order_by":2,"name":"Yoshio Tokuda","email":"","orcid":"","institution":"Matsue City Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yoshio","middleName":"","lastName":"Tokuda","suffix":""},{"id":325871641,"identity":"4508a4a4-d311-44d6-8af2-a4279c7e3663","order_by":3,"name":"Eri Maniwa","email":"","orcid":"","institution":"Matsue City Hospital","correspondingAuthor":false,"prefix":"","firstName":"Eri","middleName":"","lastName":"Maniwa","suffix":""},{"id":325871642,"identity":"9420bc61-5a4d-420f-bc84-ffe46903a479","order_by":4,"name":"Tatsuya Saito","email":"","orcid":"","institution":"Matsue City Hospital","correspondingAuthor":false,"prefix":"","firstName":"Tatsuya","middleName":"","lastName":"Saito","suffix":""}],"badges":[],"createdAt":"2024-05-30 23:59:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4505382/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4505382/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":61347209,"identity":"d0febff2-18fe-44d6-9728-246d3e4e97bd","added_by":"auto","created_at":"2024-07-29 18:15:31","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":76316,"visible":true,"origin":"","legend":"\u003cp\u003eFlowchart of the patient-selection process\u003c/p\u003e","description":"","filename":"Fig.1Flowchartofthepatientselectionprocess.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4505382/v1/48206f251b82543f4f8c1606.jpg"},{"id":62957175,"identity":"fd18c51a-0e4c-405b-9a1d-b5e078f85a23","added_by":"auto","created_at":"2024-08-21 12:31:30","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1027976,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4505382/v1/253ed1d8-7244-43be-b567-3d1468c96cd3.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Characteristics of Cancer Patients Who Developed an Exercise Habit Through Supervised Exercise Therapy by Hospital-Based Physiotherapists: A Case–Control Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCancer survivors constitute a growing population due to advancements in early detection and therapeutic modalities [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Cancer survivors experience physical, psychological, and social challenges during and after treatment, including sequelae from treatment, the risk of recurrence, and comorbidities [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Exercise therapy has been reported to be beneficial for anxiety, depression, fatigue, quality of life (QoL), and physical function. The American College of Sports Medicine (ACSM) recommends that patients with cancer avoid inactivity and remain physically active during and after treatment to improve survival and reduce the adverse effects associated with cancer treatment [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Intervention studies in the United States involving patients with cancer have reported the creation of exercise programs and counseling to establish healthy lifestyle [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. However, in an epidemiological study of the general adult population aged\u0026thinsp;\u0026ge;\u0026thinsp;18 years in the United States [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], only 25.3% followed the ACSM physical activity guidelines of 150 min/week of combined aerobic and strength training at moderate or high intensity [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. A National Health Interview Survey conducted in the United States in 2018 [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] also indicated that cancer survivors were similarly inactive [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThus, behavioral changes are necessary to improve physical activity in patients with cancer during and after treatment, and identification of the factors associated with exercise adherence is important in this regard. Behavioral changes are necessary for exercise to become a habit. The Transtheoretical Model of behavioral change (TTM) classifies the process from a state of indifference until habitualization of a behavior into five stages: precontemplation, contemplation, preparation, action, maintenance [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. The maintenance stage is the final stage, and is defined as the stage in which a clear behavioral change lasts for at least 24 weeks [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eA previous study on exercise adherence in patients with cancer reported that supervised exercise therapy (SET) was associated with higher exercise adherence than non-supervised exercise such as home-based exercise [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Adherence to SET in patients with cancer is also associated with treatment status, travel time, and convenience of access to fitness centers [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. However, because the follow-up period of these previous studies was 12 weeks, the patients were not surveyed at 24 weeks, which represents the maintenance stage of TTM. In addition, the cost of the SET was not considered.\u003c/p\u003e \u003cp\u003eThis study aimed to identify the factors that contribute to exercise adherence in outpatients with cancer by comparing patients who had completed at least 24 weeks of SET and demonstrated behavioral changes with those who had dropped out of SET before the 24-week duration.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design and setting\u003c/h2\u003e \u003cp\u003e The participants in this case\u0026ndash;control study were outpatients with cancer who underwent SET at Matsue City Hospital Cancer Center in Japan. The continuation group consisted of those who continued SET for more than 24 weeks, and the control group consisted of those who dropped out in less than 24 weeks or did not attend SET for more than 4 weeks. We retrospectively collected participant characteristics and physical function information during SET enrollment from the participants\u0026rsquo; medical records.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eInclusion and exclusion criteria\u003c/h2\u003e \u003cp\u003eThe case group consisted of 57 individuals of Japanese ethnicity enrolled in the SET at Matsue City Hospital Cancer Center from April 1, 2017, to April 1, 2021. The SET participants were recruited through Matsue City Hospital\u0026rsquo;s website, hospital posts, and referrals from health professionals.\u003c/p\u003e \u003cp\u003eThe inclusion criteria were as follows: (1) patients diagnosed with cancer and receiving treatment or follow-up outside the hospital, and (2) outpatients with cancer who enrolled for SET.\u003c/p\u003e \u003cp\u003eOf the initially enrolled participants, those who 1) did not participate within 4 weeks of enrolling in the SET and 2) were denied permission from their respective attending physicians were excluded from the study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eSteps before initiation of SET\u003c/h2\u003e \u003cp\u003eThe participants\u0026rsquo; physicians first evaluated whether the SET program was suitable for the participants. Next, the participants\u0026rsquo; risk levels were rated as low, medium, and high according to the ACSM guidelines for stratifying clients before exercise testing and prescription [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Exercise stress testing was recommended for participants in the medium- and high-risk categories. Finally, SET program for each participant was designed on the basis of the results of the exercise stress test and the level of risk associated with exercise.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eSET programs\u003c/h2\u003e \u003cp\u003eEach SET program lasted one 1 h on weekdays between 9:00 a.m. and 5:00 p.m., and its frequency was at the discretion of the participants. The fee was 1,000 JPY (approximately 6.7 USD) for city residents and 2,000 JPY (approximately 13.3 USD) for those living outside the city (at the exchange rate on February 18,2024).\u003c/p\u003e \u003cp\u003eSET was a one-on-one exercise program conducted by a physiotherapist. It was developed according to the exercise guidelines for patients with cancer for a total of 1 h [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], combining 20 min of aerobic exercise\u0026thinsp;+\u0026thinsp;20 min of resistance training\u0026thinsp;+\u0026thinsp;20 min of warm-up and cool-down exercises, such as stretching.\u003c/p\u003e \u003cp\u003eThe training machines were manufactured by Technogym Japan Co. Resistance training was performed on a cable machine with 1\u0026ndash;3 sets of 8\u0026ndash;10 different exercises, focusing on large muscle groups. The resistance training load was 10\u0026ndash;20 repetition maximum. Aerobic exercise was performed on a treadmill, ergometer, recumbent bike, or cross-trainer. The intensity of aerobic exercise was set at the target heart rate (THR) for each participant. For participants who performed an exercise stress test, the THR was set to 60\u0026ndash;80% of the maximal oxygen uptake. For participants who did not perform an exercise stress test, THR was set using the Karvonen formula calculation at an exercise intensity of 0.5\u0026ndash;0.7 [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. The target rating of perceived exertion for SET was set at 11\u0026ndash;13 on the Borg scale [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Every 12 weeks, body composition analysis and evaluation of physical function were performed, and guidance was provided on the effectiveness of SET, adjustment of exercise load, and benefits of creation of an exercise habit.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003ePrimary endpoint\u003c/h2\u003e \u003cp\u003eThe primary endpoint was the number of patients who continued SET for 24 weeks, and behavioral changes were monitored. This was because continued exercise (duration adherence) was part of exercise adherence [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], and to assess clear behavioral change, follow-up assessments were performed up to 24 weeks, which represented the maintenance phase of TTM [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Participants who continued SET for more than 24 weeks were defined as those (1) participating in SET at 12 and 24 weeks from the start of SET and (2) not pausing SET for more than 4 weeks.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eSecondary outcome\u003c/h2\u003e \u003cp\u003eParticipant information (medical, physical function, QoL, social, and SET frequency) was collected from medical records at SET enrollment as baseline data.\u003c/p\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003ch2\u003eMedical information\u003c/h2\u003e \u003cp\u003eThe medical information collected included information regarding cancer site and progression, treatment status, and the time from diagnosis to the initiation of SET. Cancer progression was classified as stage I\u0026ndash;IV according to the Cancer Manual by the American Joint Committee on Cancer [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Treatment status was classified as current or completed, and current treatment was classified as chemotherapy or adjuvant therapy at baseline. If adjuvant therapy was completed during the follow-up period, participants were classified as undergoing current treatment. Completed treatment was defined when participants had completed cancer treatment, such as surgery or radiotherapy, and were being followed up.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e \u003ch2\u003eBody composition and physical function analyses\u003c/h2\u003e \u003cp\u003ePhysical function evaluations included measurement of body mass index (BMI), lean body mass, and handgrip strength along with the 30-second chair-stand test (CS-30). Lean body mass was analyzed by bioelectrical impedance analysis with a body composition analyzer (ioi757; Sowa Medical, Japan). The handgrip strength test was conducted using a portable Grip-D digital grip strength meter (Takei Kiki Kogyo, Japan) to measure the right and left handgrip strength in kilograms. Participants were instructed to squeeze the instrument as hard as possible for 3 s in a standing position. Two sets with a 2-min rest between sets were completed for each hand, and the best score was recorded. Higher scores indicated greater strength. For the CS-30, the participants began the test seated in a chair and were asked to stand up and sit down as many times as they could for 30 s [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Higher repetitions indicated greater physical functioning.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eQuality of life\u003c/h2\u003e \u003cp\u003eQoL was defined using the Japanese version of the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 (version 3) Japanese version [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. This questionnaire is designed to measure the physical, psychological, and social functions of patients with cancer. The questionnaire consisted of five functional scales (physical, role, cognitive, emotional, and social functioning) and nine symptom scales (fatigue, nausea and vomiting, pain, dyspnea, insomnia, appetite loss, constipation, diarrhea, and financial impact). All scales and single-item measures ranged from 0 to 100. Higher scores indicated higher response levels. Thus, a high score on the functional scale indicated a high or healthy level of functioning, while a high global health status/QoL score indicated a high QoL. In contrast, a high score for a symptom scale/item represented a high level of symptomatology/problems [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eSocial information\u003c/h2\u003e \u003cp\u003eSocial information collected included information regarding employment status, exercise history, method of hospital transport, and distance to the hospital. Employment status was classified as employed or unemployed. The employed group included those who were employed or on leave at the time of SET enrollment. The unemployed group included participants who had retired or were not looking for work. Exercise history was surveyed over the past year. Hospital transportation was classified as either self-transportation or other transportation, with the former including participants who could transport themselves to the hospital at their own convenience (e.g., transportation in their car or walking) and the latter including participants who were transported to the hospital at the convenience of others or by public transportation. (e.g., commercial transport or being picked up by a family member). The distance to the hospital was measured from the participant\u0026rsquo;s house to the hospital and classified as more or less than 10 km.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eFrequency of SET\u003c/h2\u003e \u003cp\u003eThe frequency of SET was classified as more than once a week vs. less than once a week, based on the average frequency of SET during the first 4 weeks.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eLogistic regression analysis was performed using the forced-entry method to assess the factors affecting SET continuation for 24 weeks. Baseline characteristics for the continuation and dropout groups were summarized, compared using the chi-square test and Mann\u0026ndash;Whitney U test, as appropriate. The Mann\u0026ndash;Whitney U test was used for continuous variables (age, BMI, lean body mass, handgrip strength, and CS-30 and QLQ-C30 scores), while the chi-square test was used for categorical variables (medical information, social information, and frequency of SET). The independent variables were factors with a significance level of p\u0026thinsp;\u0026lt;\u0026thinsp;0.05, based on the results of univariate analysis. The multicollinearity of independent variables was tested using the variance inflation factor (VIF). Multicollinearity was considered to be present when the VIF was \u0026gt;\u0026thinsp;10 [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. If two independent variables had VIF\u0026thinsp;\u0026ge;\u0026thinsp;10, one of them was selected based on the clinical significance.\u003c/p\u003e \u003cp\u003eA logistic regression analysis with the forced-entry method was performed with the dependent variable being SET continuation and the independent variables being factors of significance in the univariate analysis, after taking multicollinearity into consideration. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated. In addition, the cutoff value for continuous variables was calculated using receiver operating characteristic (ROC) analysis. All statistical analyses were performed using JMP ver. 15 (SAS Institute, Cary, NC, USA). Statistical significance was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 with a two-sided test.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eStudy population\u003c/h2\u003e \u003cp\u003eA total of 57 participants were initially enrolled in the SET, and 54 participants were analyzed, after excluding one participant who were denied permission to exercise by the attending physician and two participants who stopped participating in the SET within 4 weeks of enrollment. These 54 participants included 27 (50%) participants in the continuation group (i.e., continued SET for more than 24 weeks) and 27 (50%) participants in the dropout group (i.e., dropped out in less than 24 weeks or did not attend for more than 4 weeks) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). A total of 38 participants (70%) were female, and the median participant age was 58 years (interquartile range, 50.0\u0026ndash;69.0 years). The most common cancer type was breast cancer, and the most common cancer stage was IV (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline characteristics of the study participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eTotal (N\u0026thinsp;=\u0026thinsp;54)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eContinuation group (n\u0026thinsp;=\u0026thinsp;27)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eDropout group (n\u0026thinsp;=\u0026thinsp;27)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDemographics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years), median [IQR]\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e[50.0\u0026ndash;69.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e[44.0\u0026ndash;81.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e[41.0\u0026ndash;77.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.048*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.37\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(70%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(78%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(63%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(30%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(22%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(37%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMedical information\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCancer site\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.95\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBreast\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(35%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(37%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(33%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGastrointestinal cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(31%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(30%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(33%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGynecological cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(20%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(22%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(19%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(13%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(11%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(15%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.95\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(22%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(33%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(11%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(17%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(15%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(19%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(11%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(35%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(22%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(48%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUndetermined/other\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(19%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(26%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(11%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTreatment status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.02*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCurrent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(61%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(44%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(78%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCompleted\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(39%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(56%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(22%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTime from diagnosis to the start of SET\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.58\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;1 year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(43%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(48%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(37%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;1 year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(57%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(52%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(63%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSocial information\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmployment status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.17\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(59%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(48%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(70%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(41%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(52%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(30%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExercise history\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(57%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(59%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(56%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(43%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(41%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(44%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTransport to the hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.42\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf-transportation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(87%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(81%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(93%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther transportation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(13%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(19%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDistance to hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.76\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;10 km\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(74%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(78%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(70%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;10 km以上\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(26%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(22%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(30%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFrequency of SET\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;1 time/week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(74%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(85%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(63%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;1 time/week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(26%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(15%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(37%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003csup\u003ea\u003c/sup\u003e IQR: Interquartile range, [25th -75th percentile]; SET, supervised exercise therapy.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003cem\u003ep\u003c/em\u003e-Values were obtained using chi-square analyses for categorical variables and the Mann\u0026ndash;Whitney U test for continuous variables.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e*Significant, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eComparison between the continuation and dropout groups\u003c/h2\u003e \u003cp\u003eA comparison of the baseline characteristics of the participants in the continuation and dropout groups (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) showed that the median patient age was significantly higher in the continuation group (p\u0026thinsp;=\u0026thinsp;0.048). Moreover, the continuation group included a significantly higher proportion of participants with completed treatment status (p\u0026thinsp;=\u0026thinsp;0.02). Physical function did not differ significantly between the continuation and dropout groups (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The results of the EORTC QLQ-C30 are presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. The dyspnea score on the EORTC QLQ-C30 symptom scale was 0 (no shortness of breath at all) in the continuation group and 33.3 (a little shortness of breath) in the dropout group, indicating that the continuation group showed significantly fewer symptoms of shortness of breath (p\u0026thinsp;=\u0026thinsp;0.045). The VIF results showed no multicollinearity in age, treatment status, or the QLQ-C30 dyspnea score.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline physical function in both groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable, Measure\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eTotal (N\u0026thinsp;=\u0026thinsp;54)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eContinuation group (n\u0026thinsp;=\u0026thinsp;27)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eDropout group (n\u0026thinsp;=\u0026thinsp;27)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI, kg/m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e[19.9\u0026ndash;25.6]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e22.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e[19.6\u0026ndash;27.9]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e22.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e[20.5\u0026ndash;24.3]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.74\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLean body mass, kg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e41.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e[38.5\u0026ndash;47.2]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e42.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e[38.5\u0026ndash;48.3]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e41.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e[38.9\u0026ndash;46.9]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.97\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHandgrip strength, kg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e[21.4\u0026ndash;32.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e[14.0\u0026ndash;22.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e26.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e[20.9\u0026ndash;32.1]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.62\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCS-30, reps\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e[14.0\u0026ndash;22.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e[14.0\u0026ndash;22.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e19.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e[15.0\u0026ndash;22.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.65\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003csup\u003ea\u003c/sup\u003eBMI: Body Mass Index; CS-30: 30-s chair-stand test\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003csup\u003eb\u003c/sup\u003eValues are presented as median [25th -75th percentile]\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003cem\u003ep\u003c/em\u003e-Values were obtained using the Mann\u0026ndash;Whitney U test\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline EORTC QLQ-C30 scores in all participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable, score\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eTotal (N\u0026thinsp;=\u0026thinsp;54)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eContinuation group (n\u0026thinsp;=\u0026thinsp;27)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eDropout group (n\u0026thinsp;=\u0026thinsp;27)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGlobal health status and QoL score\u003c/b\u003e \u003csup\u003e\u003cb\u003ea\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e66.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e[50.0\u0026ndash;83.3]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e66.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e[41.7\u0026ndash;83.3]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e66.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e[50.0\u0026ndash;83.3]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.91\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFunctional scales\u003c/b\u003e \u003csup\u003e\u003cb\u003ea\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhysical\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e86.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e[80.0\u0026ndash;93.3]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e86.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e[80.0\u0026ndash;93.3]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e86.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e[80.0\u0026ndash;86.7]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.48\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRole\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e83.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e[66.7\u0026ndash;100]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e83.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e[66.7\u0026ndash;100]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e83.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e[66.7\u0026ndash;100]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.45\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCognitive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e83.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e[66.7\u0026ndash;83.3]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e66.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e[50.0\u0026ndash;83.3]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e83.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e[66.7\u0026ndash;83.3]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.28\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmotional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e83.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e[66.7\u0026ndash;91.7]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e75.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e[66.7\u0026ndash;91.7]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e83.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e[75.0\u0026ndash;100]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.29\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e83.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e[66.7\u0026ndash;100]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e83.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e[66.7\u0026ndash;100]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e83.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e[66.7\u0026ndash;100]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.91\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSymptoms scales\u003c/b\u003e \u003csup\u003e\u003cb\u003eb\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFatigue\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e83.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e[33.3\u0026ndash;44.4]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e33.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e[22.2\u0026ndash;44.4]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e33.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e[33.4\u0026ndash;44.4]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.61\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNausea and vomiting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e[0.0\u0026ndash;0.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e[0.0\u0026ndash;0.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e[0.0\u0026ndash;0.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e[0.0\u0026ndash;33.3]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e[0.0\u0026ndash;33.3]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e16.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e[0.0\u0026ndash;33.3]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.67\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDyspnea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e33.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e[0.0\u0026ndash;33.3]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e[0.0\u0026ndash;33.3]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e33.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e[0.0\u0026ndash;33.3]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.045*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInsomnia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e33.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e[0.0\u0026ndash;33.3]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e[0.0\u0026ndash;33.3]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e33.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e[0.0\u0026ndash;33.3]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.054\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAppetite loss\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e[0.0\u0026ndash;33.3]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e[0.0\u0026ndash;33.3]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e[0.0\u0026ndash;33.3]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConstipation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e[0.0\u0026ndash;33.3]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e[0.0\u0026ndash;33.3]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e[0.0\u0026ndash;33.3]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.70\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiarrhea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e[0.0\u0026ndash;33.3]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e[0.0\u0026ndash;33.3]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e[0.0\u0026ndash;33.3]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFinancial impact\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e33.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e[0.0\u0026ndash;33.3]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e[0.0\u0026ndash;33.3]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e33.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e[0.0\u0026ndash;33.3]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003csup\u003ea\u003c/sup\u003e High score for the global health status/QoL represents a high QoL.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003csup\u003eb\u003c/sup\u003e high score on a symptom scale/item represents a high level of symptomatology/problems.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003cem\u003ep\u003c/em\u003e-Values were obtained using Mann\u0026ndash;Whitney U test\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e*Significant, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eFactors contributing to SET continuation and cutoff values\u003c/h2\u003e \u003cp\u003eIn the logistic regression analysis, the factors associated with SET continuation included age, treatment status, and EORTC QLQ-C30 dyspnea score as independent variables (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). The participant characteristics that significantly associated with SET continuation were age (OR\u0026thinsp;=\u0026thinsp;1.07, 95% CI: 1.00-1.13, p\u0026thinsp;=\u0026thinsp;0.04), treatment completion (OR\u0026thinsp;=\u0026thinsp;4.29, 95% CI: 1.15\u0026ndash;16.05, p\u0026thinsp;=\u0026thinsp;0.03), and QLQ-C30 dyspnea score (OR\u0026thinsp;=\u0026thinsp;0.34, 95% CI: 0.12\u0026ndash;0.99, p\u0026thinsp;=\u0026thinsp;0.03).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eLogistic regression analysis with supervised exercise therapy continuation as the dependent variable\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables*\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOdds ratio\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e95% Confidence Interval\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTreatment status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCompleted\u003c/p\u003e \u003cp\u003e(vs. Current)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e(1.15, 16.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eper 1 year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e(1.00, 1.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQLQ-C30 dyspnea score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eper 1 point\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e(0.12, 0.99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e*Only variables derived from predictive factors with a significance of \u0026lt;\u0026thinsp;0.05 in the univariate analysis were included.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eROC analysis was performed to calculate the cutoff values for the SET continuation factors of age and QLQ-C30 dyspnea score. The cutoff age was 58 years, and the cutoff QLQ-C30 dyspnea score was 0 (i.e., no breathlessness at all). ROC analysis was performed based on the logistic regression analysis results, and it yielded an area under the curve value of 0.79, sensitivity of 0.85, and specificity of 0.74.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study aimed to identify the characteristics associated with behavioral changes and maintenance of exercise habits through SET continuation among cancer patient in outpatient care. Logistic regression analysis revealed that age, treatment status, and the QLQ-C30 dyspnea score were significantly associated with SET continuation. The novel finding was that factors significantly contributing to exercise adherence included baseline age\u0026thinsp;\u0026ge;\u0026thinsp;58 years, completion of treatment, and the absence of breathlessness symptoms at the start of SET.\u003c/p\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eSET continuation rate\u003c/h2\u003e \u003cp\u003eThe SET continuation rate in this study was 50% (27 participants), which was lower than the 70\u0026ndash;92% continuation rate reported in previous studies [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. The lower continuation rate in our study can be attributed to three reasons. First, the follow-up period was 24 weeks, which was longer than the 12-week follow-up period in previous studies that were limited to the chemotherapy period [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Chemotherapy-induced adverse effects and lifestyle changes can affect adherence to exercise over longer periods. Second, participants who did not attend SET for more than 4 continuous weeks were classified into the dropout group. Several recent studies have classified all patients who were unable to continue exercise during the follow-up period as part of the dropout period [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. However, no established criteria for pausing or resuming exercise during the follow-up period are currently available. In this study, to establish the reliability and validity of the dropout group, those who did not attend SET for more than 4 weeks were classified as the dropout group. As such, the lower SET continuation rate can be attributed to the stringent dropout criteria. Finally, SET costs and operations not covered by insurance may have caused financial difficulties, affecting the SET dropout rate. Additionally, SET operations were limited to weekdays from 9:00 am to 5:00 pm, which may have led to dropouts among employed participants or those returning to work.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eParticipant characteristics related to SET continuation\u003c/h2\u003e \u003cp\u003eAge, treatment status, and the QLQ-C30 dyspnea score were significantly associated with SET continuation in outpatients with cancer. The American Thoracic Society defines dyspnea as a combination of physiological, psychological and environmental elements [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Thus, patients with cancer experience dyspnea symptoms not only because of physiological factors, such as adverse events from treatment or a history of respiratory disease, but also because of psychological factors, such as cancer notification or anxiety about returning to society. Furthermore, approximately 60% of patients with cancer reported that the reason they stopped exercising was shortness of breath [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. We believe that the dropout rate is a direct result of increased shortness of breath with SET. In addition, most of the participants' cancer was at Stage IV, and their mental anxiety may have contributed to dropping out of the SET. Taken together, these results indicate that minor symptoms of shortness of breath in patients with cancer may cause them to drop out of SET; thus, designing an exercise program that is appropriate for the physical and emotional state of patients with cancer is of vital importance.\u003c/p\u003e \u003cp\u003eOlder age was a significant factor in SET continuation, which was supported by a previous study [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Older outpatients with cancer conceivably have more free time. In contrast, the barriers to SET continuation among younger outpatients with cancer included availability and employment and household responsibilities as well as the variety of treatment options. These findings highlight the need to provide exercise settings suited to the specific lifestyles of patients with cancer.\u003c/p\u003e \u003cp\u003eTreatment completion was significantly associated with continued SET, which is supported by previous studies [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan additionalcitationids=\"CR36\" citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. Cancer treatment is conceivably influenced by adverse events and lack of time. Based on these findings, outpatients undergoing cancer treatment should be monitored for changes in their physical status, and exercise programs should be planned accordingly.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eRelationship of SET continuation with distance and transport to the hospital\u003c/h2\u003e \u003cp\u003eA previous study reported that exercise adherence is related to the amount of time and effort required to reach the exercise location [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. However, the results of this study showed no significant intergroup differences with regard to the distance to the hospital and transportation as factors for SET continuation; this could be attributed to the fact that this study recruited participants through an open recruitment process; hence, the participants were likely to be strongly motivated to exercise. In a previous study, high exercise motivation in patients with cancer showed an association with exercise adherence [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. In addition, the fact that many participants were able to transport themselves to the hospital may have allowed them to continue SET.\u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003eLimitations of the study and future prospects\u003c/h2\u003e \u003cp\u003eThis study had three limitations. First, this was a case\u0026ndash;control study conducted at a single institution. Participants were recruited from the public, which might have biased the study toward outpatients with cancer who were highly motivated to exercise and participants who had specific cancer types, stages, and social backgrounds. Therefore, the information needed to interpret the causal relationships between relevant factors and patient background characteristics is limited. Further studies are required to adjust for patient background characteristics to include a greater number of patients. Second, dyspnea was assessed using the QLQ-C30 symptom score, which is not specific to dyspnea. Future studies should include physiological and psychological assessments of dyspnea in patients with cancer and investigate their association with SET continuation. Third, the assessment of behavioral changes in exercise habits was based on the duration of SET continuation, which did not objectively assess changes in physical activity. Future studies should objectively assess physical activity using tools such as accelerometers and GPS.\u003c/p\u003e \u003cp\u003eDespite these limitations, our findings support the hypothesis that hospital-based SET, even without insurance coverage, is necessary for promoting behavioral changes in exercise habits among patients with cancer.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eOlder age at the time of SET entry, treatment completion, and a lower QLQ-C30 dyspnea score (indicating no shortness of breath) were significantly associated with SET continuation. Notably, the QLQ-C30 dyspnea score was significantly associated with continuation of SET. To our knowledge, this is the first study to identify the patient characteristics required for behavioral changes to maintain exercise habits in outpatients with cancer undergoing hospital-based SET. Understanding the background and medical information of patients with cancer is crucial for maintaining exercise adherence and facilitating these behavioral changes.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eEthics approval\u003c/h2\u003e \u003cp\u003e This study was approved by the Ethics Committee of Matsue City Hospital (date. Dec 12, 2020. No. 2A-0009) and was conducted in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments or comparable standards.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent to participate\u003c/strong\u003e \u003cp\u003e Informed consent was obtained from all individual participants included in the study.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eThe participants provided consent to the submission of the data to the journal.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eCompeting interests\u003c/strong\u003e \u003cp\u003eThe authors have no relevant financial or non-financial interests to disclose.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eNo funding was received for conducting this study.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAll authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by N.I., T.T., Y.T., E.M. and T.S. The first draft of the manuscript was written by N.I. and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003e Dr. Ryo Takemura of the Clinical and Translational Research Center provided guidance for the statistical analysis. Yuri Obata, Javid Djalili, and Tomoyuki Kurosaki contributed to the translation of the paper.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eData are available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eShapiro CL (2018) Cancer survivorship. N Engl J Med 379:2438\u0026ndash;2450. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1056/NEJMra1712502\u003c/span\u003e\u003cspan address=\"10.1056/NEJMra1712502\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A (2018) Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 68:394\u0026ndash;424. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3322/caac.21492\u003c/span\u003e\u003cspan address=\"10.3322/caac.21492\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHewitt M, Greenfield S, Stovall E. (2005) From cancer patient to cancer survivor: lost in transition. National Academies. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://nap.nationalacademies.org/catalog/11468/from-cancer-patient-to-cancer-survivor-lost-in-transition\u003c/span\u003e\u003cspan address=\"https://nap.nationalacademies.org/catalog/11468/from-cancer-patient-to-cancer-survivor-lost-in-transition\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed 27 Jan 2022\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJefford M, Karahalios E, Pollard A, Baravelli C, Carey M, Franklin J, Aranda S, Schofield P. (2008) Survivorship issues following treatment completion\u0026ndash;results from focus groups with Australian cancer survivors and health professionals. 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J Clin Nurs 22:4\u0026ndash;21. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/j.1365-2702.2012.04322.x\u003c/span\u003e\u003cspan address=\"10.1111/j.1365-2702.2012.04322.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Outpatient, Cancer, Supervised Exercise, Behavioral Change, Exercise Habits","lastPublishedDoi":"10.21203/rs.3.rs-4505382/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4505382/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eExercise and physical activity are recommended for cancer survivors. This study aimed to identify the patient characteristics associated with behavioral changes and maintenance of exercise habits through supervised exercise therapy (SET) by licensed physiotherapists during outpatient care.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003e The participants in this case\u0026ndash;control study were outpatients with cancer who underwent uninsured SET at the Matsue City Hospital Cancer Center from April 1, 2017, to April 1, 2021. Data were collected retrospectively from medical records. The participants were divided into two groups: a continuation group that continued SET for at least 24 weeks and showed sufficient behavioral change and a dropout group that dropped out of SET after less than 24 weeks and showed insufficient behavioral change. Statistical analysis was performed using logistic regression analysis, with patient characteristics as the independent variable and SET continuation as the dependent variable.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 54 participants (median age, 58 years), including 38 female participants, were included in this study. The most common type of cancer was breast cancer, most commonly Stage IV cancer, and 33 patients (61%) were undergoing treatment. The continuation group consisted of 27 patients (50%). Factors significantly associated with SET continuation were age (odds ratio [95% confidence interval], 1.07 [1.00\u0026ndash;1.13]), treatment completion (4.29 [1.15\u0026ndash;16.05]), and the QLQ-C30 dyspnea score (0.34 [0.12\u0026ndash;0.99]).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eOlder age, treatment completion, and the absence of dyspnea were associated with SET continuation and maintenance of exercise habits in outpatients with cancer.\u003c/p\u003e","manuscriptTitle":"Characteristics of Cancer Patients Who Developed an Exercise Habit Through Supervised Exercise Therapy by Hospital-Based Physiotherapists: A Case–Control Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-29 18:15:26","doi":"10.21203/rs.3.rs-4505382/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"cbfdce17-492b-4688-9970-16ea830acd26","owner":[],"postedDate":"July 29th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-08-21T12:23:23+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-29 18:15:26","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4505382","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4505382","identity":"rs-4505382","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}