Factors associated with physical activity in individuals with metastatic cancer: A UK cross-sectional survey.

Factors associated with physical activity in individuals with metastatic cancer: A UK cross-sectional survey. | 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 Factors associated with physical activity in individuals with metastatic cancer: A UK cross-sectional survey. Zainab Faatimah Haider, Samuel George Smith, Rebecca EA Walwyn, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4450026/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 28 Oct, 2024 Read the published version in Journal of Cancer Survivorship → Version 1 posted 9 You are reading this latest preprint version Abstract Purpose : Physical activity is safe and feasible for individuals with metastatic cancer and may support symptom management. We investigated the extent to which individuals with metastatic cancer are meeting moderate-vigorous physical activity (MVPA) guidelines, factors associated with meeting guidelines, and perceptions about physical activity and receiving physical activity advice. Methods: Data were from UK adults with metastatic breast, prostate, or colorectal cancer who completed the Healthy Lifestyle After Cancer survey (N=588). Self-reported clinical, demographic and physical activity (Godin Leisure-Time Exercise Questionnaire) data were collected. Logistic regression models assessed whether clinical and demographic factors were associated with meeting MVPA guidelines. Results : Most (59%) individuals with metastatic cancer were not meeting the World Health Organisation guidelines of 150 minutes of MVPA per week. Adjusting for cancer type, the odds of meeting MVPA guidelines were lower for unemployed individuals (OR=0.47, 95% CI=0.23-0.77) and ethnic minorities (OR=0.44, 95% CI=0.22-0.89), but higher for those with a university education (OR = 1.89 , 95% CI = 1.0-3.57). Most (63.5%) participants felt they should be doing more physical activity. However, 70.1% did not receive any physical activity advice or support, despite 73.6% wanting to receive it. Conclusion : People with metastatic cancer may need further support to address inadequate levels of physical activity. The differences observed between demographic sub-groups suggest this may be more beneficial for those less likely to engage in physical activity. Implications for Cancer Survivors: Individuals with metastatic cancer are likely to benefit from increased physical activity support, which considers the needs of diverse demographic groups. Physical Activity Metastatic Cancer Observational Study Physical Activity Support Ethnic Minority Introduction Around 20% of all cancer cases in the UK are diagnosed at the metastatic stage [ 1 ]. Improvements in treatment mean many individuals with metastatic cancer now live several years with the disease. However, compared with those diagnosed at earlier stages, people with metastatic cancer experience greater disease- and treatment-related challenges with their physical and psychological health [ 2 ], [ 3 ], [ 4 ], [ 5 ]. As life expectancy increases, there is a need to improve quality of life in individuals living with metastatic cancer. Physical activity (PA) could be an effective and affordable intervention for improving symptom management and quality of life for those with metastatic disease. Recent evidence suggests PA can reduce fatigue and improve muscle function, quality of sleep, patient autonomy, and psychological and social function for individuals with metastatic cancer [ 6 ], [ 7 ], [ 8 ], [ 9 ], [ 10 ]. Moderate-vigorous physical activity (MVPA), activity which causes an increase in heart and breathing rate [ 11 ], may also be associated with slower disease progression [ 12 ], [ 13 ] and improved survival [ 14 ], [ 15 ]. Systematic reviews of randomised controlled trials (RCTs) show PA is safe and feasible for this patient group, including those with bone metastases when supported by a trained professional [ 16 ], [ 17 ], [ 18 ], [ 19 ]. Existing studies have concluded levels of PA in people with metastatic cancer are low [ 20 ], [ 21 ], [ 22 ]. However, an integrative review (k = 18) in metastatic breast cancer highlighted that most of this literature relies on small, convenience samples (n = 20–231), with 39% of included studies given a poor quality rating [ 22 ]. We identified one large-scale US study which compared PA levels among metastatic and non-metastatic patients with colorectal cancer (n = 875)[ 23 ]. They reported median level of PA was significantly lower in the metastatic group (3.4 metabolic equivalent task-hours per week), compared with the non-metastatic group (4.6 hours). A recent European study (Netherlands, Spain, Germany, Poland, Sweden) of individuals with metastatic breast cancer (n = 420), showed patients self-reported a median of 33 (IQR: 0-120) and 0 (IQR: 0–45) minutes of moderate and vigorous intensity PA per week, respectively. This is significantly below the World Health Organisation (WHO) recommendation of 150 minutes of MVPA per week for adults with cancer [ 24 ]. Observational and qualitative studies suggest patients experience a range of physical, psychological and logistical barriers to keeping active and adhering to PA programmes [ 22 ], [ 25 ], [ 26 ]. Understanding the factors associated with PA in this group could help tailor and improve the effectiveness of future interventions [ 27 ]. In early-stage cancer survivors, individuals from lower income, ethnic minority and non-University educated backgrounds, those affected by overweight or who have a high number of comorbidities are less likely to be active [ 28 ], [ 29 ], [ 30 ], [ 31 ]. Some small studies have explored demographic and clinical factors associated with PA in metastatic cancer populations, but findings are inconsistent. Two studies (n = 24; n = 141) showed Body Max Index (BMI) was not associated with PA [ 32 ], [ 33 ], but another (n = 50) showed being under- or of normal weight was associated with higher PA [ 34 ]. Similarly one study (n = 63) showed older patients were more likely to adhere to a PA intervention [ 35 ], but others showed no significant relationships between age [ 33 ], [ 36 ], [ 37 ], or other demographic groups and levels of PA [ 10 ], [ 38 ]. To inform the development of inclusive and effective interventions, there is a need to understand patient attitudes to PA and receiving support. This can help researchers tailor interventions to an individual’s interests, or align them to perceived physical capabilities, which can influence engagement [ 6 ], [ 39 ]. People with advanced cancer often report a reduction in PA from before their diagnosis [ 40 ], [ 41 ], [ 42 ] and express an interest in increasing it after their diagnosis [ 35 ], [ 39 ], [ 43 ], [ 44 ]. Similarly, qualitative studies suggest strong interest in receiving PA advice and support from healthcare providers, as access to this or appropriate PA programmes appear limited [ 39 ], [ 41 ], [ 42 ], [ 45 ]. However, levels of interest and willingness to participate in PA may vary across groups. For example, one cross-European study showed Swedish participants with metastatic breast cancer, had more positive attitudes towards exercising compared with Polish participants [ 39 ]. This study did not assess the attitudes of UK participants with metastatic cancer. Differences may also exist for patients with different types of metastatic cancer, as there are unique challenges associated with each group. No study has compared perceptions across disease site. Additionally, it is not clear how common these perceptions are across the metastatic cancer population, as large-scale quantitative studies are lacking. Inconsistencies in barriers and preferences may result from the varied needs of people with advanced cancer, and a reliance on small convenience samples. Larger studies are required to build on existing data. Using data from the “Health and Lifestyle After Cancer” cohort study [ 46 ], we aimed to estimate for the first time, how many UK individuals with metastatic breast, prostate and colorectal cancer are meeting moderate-vigorous PA guidelines, and what clinical and demographic factors predict the likelihood of meeting guidelines. Additionally, we aimed to explore patient perceptions about their pre-diagnosis and current physical activity, and whether they had received, or were interested in receiving PA advice, overall and between disease sites. Methods Cross-sectional data from the "Health and Lifestyle After Cancer” survey were analysed [ 46 ]. Ethical approval was obtained through the National Research Ethics Service Committee South Central (Oxford B [14/SC/1369]). Sample In ten National Health Service (NHS) sites in London and Essex, research nurses sent surveys to 13,645 adults diagnosed with breast, prostate, or colorectal cancer between 2012–2015. Patients were identified by research nurses, and consequently the final sample included some patients diagnosed outside of these dates (range of most recent cancer diagnosis: 2001–2017). The response rate was 43% (N = 5,835). Participants were asked to report their most recent cancer type from breast, prostate or colorectal and were asked ‘Has this cancer spread to any other parts of your body?’ (“Yes”, “No”, “I don’t know” [coded as missing]). The present analysis was restricted to adults who selected yes to this question. Measures Moderate-Vigorous Physical Activity (MVPA) Participants reported how long they spent engaging in moderate (not exhausting) and strenuous (heart beats rapidly) physical activity in hours/minutes per week, using a measure adapted from the validated Godin Leisure-Time Exercise Questionnaire (LTEQ; [ 47 ]). The number of strenuous activity minutes was doubled and added to the number of moderate activity minutes to calculate an MVPA composite, measured in minutes per week. MVPA was coded into “meeting guidelines” and “not meeting guidelines” based on the WHO guidelines of 150 minutes of MVPA per week [ 24 ]. Physical Activity Perceptions : Participants reported which statement best described them at the time they completed the survey: “ I think I should be doing more physical activity ”, “I think I should be doing less physical activity ”, “ I don’t think I need to change my physical activity ” or “ Don’t know ” (coded as missing). To assess perceived physical activity change since diagnosis, participants reported whether the amount of physical activity they do now was “ more ”, “ about the same ”, or “ less ” than before their diagnosis. Physical Activity Advice Participants indicated whether they had received advice from a health care professional to increase their physical activity (“yes” or “no”), and also rated their interest in receiving physical activity information or advice on a 4-point scale from “ not at all interested” , to “ extremely interested ”. Clinical Factors BMI was calculated from participant reported height and weight (kg/m 2 ). Based on WHO guidelines (WHO, 1995), participants were categorised as “ underweight ” (BMI < 18.5), “ healthy weight ” (BMI ≥ 18.5 and < 25), “ overweight ” (BMI ≥ 25 and < 30), or “ obese ” (BMI ≥ 30). Total number of comorbidities was calculated based on the number of other health problems participants selected from a list of 15 conditions (e.g., diabetes, arthritis, angina, asthma, psychiatric illness), and providing details of any other condition. Similarly, for type of treatments, participants selected what treatments they had previously received (surgery, radiotherapy, chemotherapy, hormone therapy, active surveillance, biological therapy), and provided details of any other treatment, and these were summed. Finally, participants indicated the time since completing their main treatment which was coded as “s till having main treatment” , “ less than 1 year ”, “ more than 1 year ” or “ on active surveillance ”. Demographic Factors : Participants reported their current employment status and responses were recoded into: “w orking ” (Employed full-time, employed part-time, self-employed, voluntary work, studying), “n ot working ” (unemployed, retired, unable to work). Age was dichotomised based on the UK state pension age, into “ below retirement age” (< 67 years) and “ above retirement age ” (≥ 67 years). For ethnicity, participants reported which ethnic group best described them from a list of options or specified another ethnic group. Due to there being small numbers of respondents for some of the ethnic minority groups, responses were recoded into “w hite ” (1) and “n on-white ” (2). Participants selected what educational or professional qualifications they had obtained from a list of options (including “ no formal qualification ”) or specified another qualification. Responses were recoded into an ordinal scale, from “ none ”, “ GCSE/vocational ”, “ A-level ” or “d egree or above ”. Analysis The analysis protocol was preregistered on the Open Science Framework prior to data analysis ( https://osf.io/m7ktq/ ). All analyses were conducted in R [ 48 ]. Descriptive statistics were summarised for all variables. The frequency (%) of meeting MVPA guidelines was described, overall and across cancer type, and by clinical and demographic factors. Frequencies (%) of all measures of physical activity perceptions and advice, overall and across cancer type were also given. To assess whether clinical and demographic factors are associated with the probability an individual is meeting MVPA guidelines, logistic regression models were fitted. Models were adjusted for disease site. Potential predictors (BMI, comorbidities, type of treatments received, time since treatment, current employment, highest education, ethnicity, received physical activity advice, disease site) were added into the model in one step. Odds ratios, and 95% confidence intervals were reported. To handle missing data, multiple imputation was used, with the R package mice [ 49 ]. A total of 35 imputations were conducted, which was based on the proportion of missing values [ 50 ], [ 51 ] and on convergence with a second imputed dataset. In exploratory analysis, we re-ran the logistic regression analysis while stratifying for disease site. This allowed us to explore whether the association between clinical and demographic factors, and the probability an individual is meeting MVPA guidelines, differs by type of primary cancer. Within prostate and colorectal cancer, the numbers of individuals receiving biological and hormone treatment were low (< 2) thus prior to analysis, we combined the five individual treatment variables (surgery, chemotherapy, radiotherapy, hormone treatment, biological therapy) to use the number of treatments received. No individuals with prostate cancer were classed as underweight for the BMI variable, so underweight and healthy weight were merged into one category (0), keeping the overweight (1) and obese (2) category as it was specified. Results The sample (N = 588/5835 = 10%) is described in Table 1 . Breast cancer was the most common cancer type (45.2%), and there was a slightly higher percentage of females (56.7%). The mean age was 63.8 years, and the majority were not working (65.8%) and white (89.9%). MVPA Levels Only 40.9% of individuals with metastatic cancer were meeting WHO guidelines of 150 minutes of weekly MVPA (Table 1 ). Those with metastatic prostate cancer were least likely to meet guidelines (31.1% meeting guidelines [prostate], 43.8% [breast] and 45.3% [colorectal]). In our study, participants above retirement age (below retirement = 49% [meeting guidelines] vs above retirement = 26.3%), not working (working = 56.1% vs not working = 31.2%), from an ethnic minority background (white = 42.7% vs ethnic minority = 27.1%), with no educational qualifications (university degree or above = 51.7% vs no qualifications = 24.3%), affected by obesity (healthy weight = 41.2% vs obese = 32.9%) and those with a greater number of comorbidities (0 comorbidities = 50.7% vs ≥ 3 comorbidities = 28%) were less likely to meet MVPA guidelines. In the multiple logistic regression analysis, the odds of meeting MVPA guidelines were lower for individuals who were unemployed, compared to employed individuals (OR = 0.49 ; 95% CI = 0.30–0.79 ) (Table 2 ). The odds were also lower for ethnic minorities than for white individuals (OR = 0.43 ; 95% CI = 0.21–0.87 ). Compared with those with no qualifications, individuals with a university education had greater odds of meeting MVPA guidelines (OR = 1.89, 95% CI = 1.0-3.57 ). We ran the logistic regression while stratifying for disease site to test whether these findings varied by cancer site (Online Resource 1). After stratifying, having a university education no longer predicted the odds of meeting MVPA guidelines for breast, prostate or colorectal cancer. The odds of meeting MVPA guidelines was lower for unemployed individuals compared with employed individuals among the breast cancer (OR = 0.44, 95% CI = 0.23–0.81 ) and prostate cancer (OR = 0.19, 95% CI = 0.06–0.65) subgroups. The odds were lower for ethnic minorities compared with white individuals (OR = 0.21, 95% CI = 0.07–0.59) for breast cancer only. No variables significantly predicted the odds of meeting guidelines for individuals with colorectal cancer. Perceptions and Advice Relating to Physical Activity Nearly two thirds (63.5%) of participants felt they should be doing more PA, with 1.6% believing they should be doing less. Individuals with metastatic breast cancer were more likely to feel they should be doing more PA (71.1%) compared with those with metastatic prostate (57.9%) and colorectal cancer (55.6%). Over half (53.3%) of participants believed they were less active now compared with before their cancer diagnosis. Only 12.5% believed they were more active. Percentages were similar across the three cancer types (Table 3 ). The majority (70.1%) of participants reported they did not receive any advice or support from a healthcare provider related to PA. This was slightly higher among those with colorectal cancer (75.2%) compared with breast (66.7%) and prostate (71.2%). Overall, 73.6% of participants expressed some interest in receiving advice to help increase their PA. Interest was generally higher among those with breast cancer with 79.4% overall reporting some interest. Interest was lowest among those with colorectal cancer, with 38% reporting they were not interested in receiving any advice (Table 4 ). Table 1 Descriptive Statistics and MVPA Activity Levels Note: MVPA data was missing from 149/558 (26.7%) survey respondents. Total ( n = 558 ) Meeting Guidelines ( n = 167 ) Not Meeting Guidelines ( n = 242 ) Mean (SD) N % N %* N % Cancer Type Breast 252 45.2 91 43.8 117 56.3 Prostate 155 27.8 33 31.1 73 68.9 Colorectal 151 27.1 43 45.3 52 54.7 Sex Male 241 43.3 57 36.3 100 63.7 Female 316 56.7 109 43.4 142 56.6 Age 63.8 (12.5) Below retirement 309 55.7 125 49.0 130 51.0 Above retirement 246 44.3 40 26.3 112 73.7 Employment Working 189 34.2 87 56.1 68 43.9 Not working 363 65.8 78 31.2 172 68.8 Highest Level of Education None 133 26.7 17 24.3 53 75.7 GCSE/vocational 135 27.1 44 44.9 54 55.1 A-level 64 12.8 18 31.0 40 69.0 Degree or above 167 33.5 76 51.7 71 48.3 Ethnicity White 499 89.9 153 42.7 205 57.3 Ethnic minority 56 10.1 13 27.1 35 72.9 BMI Underweight (BMI < 18.5) 5 0.9 2 66.7 1 33.3 Healthy weight (BMI ≥ 18.5 & < 25) 187 35.0 56 41.2 80 58.8 Overweight (BMI ≥ 25 & <30) 224 42.0 75 43.4 98 56.7 Obese ≥ 30 118 22.1 27 32.9 55 67.1 Time Since Treatment Still having main treatment 167 30.7 35 30.7 79 69.3 Less than 1 year 73 13.4 21 42.9 28 57.1 More than 1 year 276 50.7 103 47.3 115 52.8 Active surveillance 28 5.2 6 30.0 14 70.0 Treatment Received Surgery 357 65.6 125 44.8 154 55.2 Radiotherapy 320 58.6 104 41.8 145 58.2 Chemotherapy 374 68.8 116 41.4 164 58.6 Biological therapy 14 2.6 4 33.3 8 66.7 Hormone therapy 251 46.4 83 41.5 117 58.5 Comorbidities 1.25 (1.29) 0 178 31.9 70 50.7 68 49.3 1 197 35.5 56 38.4 90 61.6 2 108 19.4 27 36.0 48 64.0 ≥ 3 75 13.4 14 28.0 36 72.0 Note: MVPA data was missing from 149/558 (26.7%) survey respondents. Table 2 Logistic Regression Coefficients and Odds Ratios for Meeting MVPA Guidelines Coefficient Std Error p OR (95% CI) Cancer Type (ref: Breast) Prostate -0.13 0.41 .744 0.88 (0.39–1.96) Colorectal 0.49 0.36 .174 1.63 (0.80–3.33) BMI (ref: underweight) Healthy weight 0.01 0.31 .978 1.01 (0.54–1.87) Overweight -0.13 0.37 .735 0.88 (0.42–1.84) Obese -0.21 0.56 .705 0.81 (0.27–2.45) Comorbidities Number of Comorbidities -0.12 0.09 .22 0.89 (0.74–1.07) Time since treatment Less than 1 year 0.42 0.37 .253 1.52 (0.74–3.12) (ref: Still having treatment) More than 1 year 0.44 0.28 .121 1.56 (0.89–2.72) Active surveillance -0.04 0.54 .937 0.96 (0.33–2.79) Treatment Surgery 0.07 0.34 .834 1.07 (0.55–2.08) Radiotherapy -0.12 0.27 .664 0.89 (0.52–1.52) Chemotherapy -0.41 0.30 .172 0.66 (0.37–1.20) Hormone Therapy 0.39 0.28 .163 1.47 (0.85–2.55) Biological therapy -0.50 0.68 .468 0.61 (0.16–2.34) Employment (ref: Working) Not working -0.75** 0.24 .002 0.47 (0.29–0.77) Education (ref: No Qualifications) GCSE/Vocational 0.38 0.33 .251 1.47 (0.76–2.82) A level 0.03 0.39 .944 1.03 (0.48–2.21) University education 0.63 0.33 .055 1.88 (0.99–3.56) Ethnicity (ref: White) Ethnic Minority -0.83* 0.36 .023 0.44 (0.22–0.89) Note: ref = Reference category; 95% CI = Lower – Upper 95% Confidence Intervals. *Significant at p < .05; **Significant at p < .01. Table 3 Perceptions of Physical Activity Overall and by Cancer Type Total Breast Prostate Colorectal N % N % N % N % PA Present Should be doing more 309 63.45 162 71.1 77 57.9 70 55.6 Should be doing less 8 1.64 1 0.4 3 2.3 4 3.2 Don't need to change 170 34.91 65 28.5 53 39.9 52 41.3 N 487 228 133 126 PA change More 69 12.5 45 17.9 12 7.9 12 8.1 About the same 189 34.2 77 30.7 58 38.2 54 36.2 Less 294 53.3 129 51.4 82 54.0 83 55.7 N 552 251 152 149 Table 4 Physical Activity Advice Received and Interest Overall and by Cancer Type Total Breast Prostate Colorectal N % N % N % N % PA Advice Received Yes 155 29.9 80 33.3 42 28.8 33 24.8 No 364 70.1 160 66.7 104 71.2 100 75.2 N 519 240 146 133 Interest in PA Advice Not interested 127 26.5 48 20.6 33 26.2 46 38.0 A little interested 79 16.5 38 16.3 25 19.8 16 13.2 Somewhat interested 116 24.2 51 21.9 37 29.4 28 23.1 Very interested 158 32.9 96 41.2 31 24.6 31 25.6 N 480 233 126 121 Discussion In this UK observational study, over half of individuals living with metastatic breast, prostate and colorectal cancer were not meeting MVPA guidelines. The majority felt they needed to be doing more PA and expressed an interest in receiving PA advice, however, 70% of participants had not received any since their diagnosis. We identified potential educational and ethnic disparities in meeting MVPA guidelines, which should be considered alongside attempts to resolve inequalities across the cancer spectrum. The low estimates of MVPA suggest PA support for individuals living with metastatic cancer is needed. Our findings strengthen the previous evidence base estimating insufficient levels of PA, in smaller or non-UK samples [ 23 ]. Providing PA support which considers the reduced physical function and psychological challenges could be helpful at increasing PA for this patient group, but availability of this support appears to be limited. The majority of our sample reported not having received any PA advice post-diagnosis. Individuals with metastatic cancer have previously reported feeling insecure about their physical limitations and unsafe to perform exercises without supervision from a healthcare professional [ 40 ], [ 45 ]. Health care professionals themselves have indicated a need for further support in discussing PA recommendations for patients with metastatic cancer, given the complexities of the disease presentation [ 52 ], [ 53 ]. Despite perceiving PA as being beneficial, some physiotherapists have expressed uncertainty about prescribing it to metastatic patients with bone metastases, due to concerns about an increased risk of injury [ 52 ]. The International Bone Metastases Exercise Working Group (IBMEWG) recently released the first clinical exercise guidelines for people with bone metastases in 2022 [ 19 ], [ 54 ]. Further efforts are needed to ensure healthcare professionals are given the appropriate support and training to facilitate the rapid implementation of these guidelines. We also showed differences in the odds of meeting PA guidelines between different ethnicities, employment statuses and education levels. Similar disparities have been shown in those with early-stage cancer, with those from ethnic minority backgrounds and lower socioeconomic status less likely to be active [ 29 ], [ 30 ], [ 31 ], [ 55 ]. Underserved or disadvantaged demographic groups are likely to experience greater barriers to being physically active, such as a lack of advice, availability of support programs and financial support to attend programs [ 56 ], [ 57 ], [ 58 ]. A study with breast, prostate and colorectal cancer survivors (n = 1299), which included both metastatic and non-metastatic patients, found participants with a lower educational attainment and who were not employed reported a higher number of perceived structural barriers to PA [ 56 ]. Underserved demographic groups may need more, or different kinds of support, to increase their PA and researchers should actively involve these diverse communities when developing inclusive interventions. PA support may be more beneficial if it is sensitive to the needs of different subgroups [ 22 ], [ 40 ], [ 42 ], [ 59 ], [ 60 ]. In addition to demographic differences, individuals with metastatic cancer are heterogeneous in terms of tumour type, treatment plans, disease progression, symptom type and severity, and other individual contexts [ 61 ], [ 62 ]. In qualitative studies, individuals with metastatic cancer highlight preferences for support tailored to their varied abilities and needs, and sensitive to how this changes throughout their disease [ 26 ], [ 42 ], [ 45 ]. Exercise programmes that are based on the location of the bone metastases have been shown to be safe and efficacious for men with prostate cancer in small trials [ 63 ], [ 64 ]. Future research could explore further, cost-effective ways of tailoring PA for this population, for example by using adaptive intervention designs [ 65 ], [ 66 ]. After stratifying by disease site, the effect of highest education was no longer statistically significant for any of the cancer types, nor was ethnicity for individuals with colorectal cancer. This finding is likely to be explained by the smaller sample size for each patient group, and consequent lower statistical power to detect significant effects. However, ethnicity no longer predicted the odds of meeting MVPA guidelines for prostate and colorectal cancer, and employment was no longer a predictor for colorectal cancer. There were some further differences for individuals with metastatic prostate cancer; a smaller proportion of prostate cancer survivors were meeting MVPA guidelines, and they were slightly more likely to feel they should be doing more PA, compared to breast and colorectal survivors. To our knowledge, this study is the first to compare levels of MVPA between different metastatic cancer types. Some studies in early cancer survivors show similar patterns, with higher rates of PA in breast cancer survivors compared to prostate cancer [ 67 ]. However, others have found opposite findings, with breast cancer survivors engaging in less activity compared to those with prostate and colorectal cancer [ 68 ], [ 69 ]. Differences between breast and prostate cancer could be associated with gender differences, but it is unclear if gender differences explains the differences between disease site, or vice versa. This suggests further research comparing across cancer types is required, as well as elucidating the role of gender within a metastatic clinical context to try and understand which groups may need more support. Limitations Our study had limitations. We used self-reported scales to assess PA. While a validated scale was used to assess MVPA (LTEQ: [ 47 ]), individuals may have overestimated their PA compared with accelerometer-assessed activity. Previous evidence from cancer survivors suggests PA is lower when assessed with an accelerometer than self-reported data [ 72 ], [ 73 ]. Participants also self-reported whether they had metastatic cancer, which was based on disease spread. We may have incorrectly included or excluded members of the wider study sample of cancer survivors, which would affect the generalisability of the study findings to the metastatic population However, previous studies suggest that many cancer survivors are not able to identify their cancer stage accurately [ 70 ], [ 71 ], therefore asking about spread, rather than cancer stage, may have helped us reach more eligible participants. Additionally, our sample were partly self-selecting, as completion of the survey was voluntary. It may be those who chose to complete a health behaviour survey were more likely to be active. Taken together, the proportion of individuals with metastatic cancer who are meeting PA guidelines may have been even lower than we estimate here. Our data were cross-sectional, and only associations with the likelihood of meeting MVPA guidelines were explored. Causality cannot be inferred. Finally, despite good representation of employment status, gender and educational attainment, only 10% of our sample were from non-White backgrounds. The decision to dichotomise ethnicity could ignore real cultural differences between groups [ 30 ], [ 55 ], [ 74 ]. Conclusion Overall, our study provides further evidence that physical activity levels in the metastatic cancer population are low and suggest further support is needed. Our analyses showed the majority of individuals with metastatic cancer in our study were not meeting MVPA guidelines and felt they should be doing more activity. We also showed most participants had not received any support or advice from healthcare providers, despite expressing an interest in receiving this. The recent publication of the first clinical exercise guidelines for individuals with bone metastases could help improve this support, provided healthcare staff are sufficiently trained to facilitate the implementation of this guidance. However, the differences in the odds of meeting MVPA guidelines between different demographic groups suggest support may be more needed in certain groups and diversity should be considered when developing accessible and inclusive interventions. Declarations Funding: ZFH is funded by an ESRC PhD studentship. The ‘Health and Lifestyle after Cancer’ survey was funded by Cancer Research UK (grant number C43975/A27498). Smith and Beeken acknowledge funding from a Yorkshire Cancer Research University Academic Fellowship (L389SS, L389RB). Smith is funded by a National Institute for Health Research NIHR Advanced Fellowship (NIHR300588). The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health and Social Care Research or the Department of Health and Social Care. The funders had no role in the study design, data collection, analysis, interpretation of data, and in the writing of this manuscript. Competing Interests: The authors have no relevant financial or non-financial interests to disclose. Author Contributions: All authors contributed to study conception and design. Material preparation, data collection and data cleaning were performed by PL, RJB and AF. Formal analysis was performed by ZFH and supported by all authors. The first draft of the manuscript was written by ZFH. All authors commented on draft versions and approved the final manuscript. Data Availability: This study’s methods, analysis plan and hypotheses were pre-registered on the Open Science Framework prior to data analysis ( https://osf.io/m7ktq/ ). Following publication, the study’s code will be uploaded to this OSF repository. The questionnaire and dataset used in this study is available on request. For the purpose of open access, the authors have applied a Creative Commons Attribution (CC BY) licence to any Author Accepted Manuscript version arising. Ethics Approval: This study was performed in line with the Declaration of Helsinki. We obtained ethical approval through the National Research Ethics Service Committee South Central—Oxford B (14/SC/1369). Consent to Participate: Participating hospitals posted letters of invitation, a paper survey and a link to an online version of the survey to eligible patients. Patients chose how they completed and returned the survey (postal or online). Completion of the survey was taken as informed consent. 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Sport Health Sci. , vol. 12, no. 6, pp. 664–673, Nov. 2023, 10.1016/j.jshs.2023.05.001 . Bryan SN, Tremblay MS, Pérez CE, Ardern CI, Katzmarzyk PT. ‘Physical Activity and Ethnicity’, Can. J. Public Health 2006 974, vol. 97, no. 4, pp. 271–276, Jul. 2006, 10.1007/BF03405602 . Additional Declarations No competing interests reported. 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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-4450026","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":307837556,"identity":"ddad37a4-c058-4075-a350-4b80c8952919","order_by":0,"name":"Zainab Faatimah Haider","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAzElEQVRIie3RsQrCMBCA4SuFZAnW8USwr5AiuFR8lhMhXXQXHKwU4mtVAvoMBYd26eomGQ24OTS6OeQjwyXwk0AAguAPjXh0amFZz0Zug+8zNpywOK4kqHrOfki4HrtkrX9IIh1ZuheaV5fGwioFVORNWqR+p8V1kwvYZCWq2pecZWbNTuN2MQWICbAovbcgkSlY+nhOLBy/TGoyxFC4BcYl/odVWUkm00LNcyFvbuhpMEn4uessmTThpmvs/uAGJQeTD9L7K0EQBME3XneRO4HtLpicAAAAAElFTkSuQmCC","orcid":"","institution":"University of Leeds, Leeds Institute of Health Sciences","correspondingAuthor":true,"prefix":"","firstName":"Zainab","middleName":"Faatimah","lastName":"Haider","suffix":""},{"id":307837558,"identity":"30cc9bd9-0930-4d64-86b4-51511f5541b2","order_by":1,"name":"Samuel George Smith","email":"","orcid":"","institution":"University of Leeds, Leeds Institute of Health Sciences","correspondingAuthor":false,"prefix":"","firstName":"Samuel","middleName":"George","lastName":"Smith","suffix":""},{"id":307837559,"identity":"607c0d4b-173e-4898-b360-d98f3969d8a9","order_by":2,"name":"Rebecca EA Walwyn","email":"","orcid":"","institution":"University of Leeds, Leeds Institute of Clinical Trials Research","correspondingAuthor":false,"prefix":"","firstName":"Rebecca","middleName":"EA","lastName":"Walwyn","suffix":""},{"id":307837560,"identity":"59815cce-ef5f-4443-a85d-582334e1c28e","order_by":3,"name":"Phillippa Lally","email":"","orcid":"","institution":"University of Surrey","correspondingAuthor":false,"prefix":"","firstName":"Phillippa","middleName":"","lastName":"Lally","suffix":""},{"id":307837561,"identity":"22ffa47e-30b1-485e-b956-a7358976f513","order_by":4,"name":"Abigail Fisher","email":"","orcid":"","institution":"University College London","correspondingAuthor":false,"prefix":"","firstName":"Abigail","middleName":"","lastName":"Fisher","suffix":""},{"id":307837564,"identity":"afa9489d-6210-4848-8ee8-894236692169","order_by":5,"name":"Rebecca J Beeken","email":"","orcid":"","institution":"University of Leeds, Leeds Institute of Health Sciences","correspondingAuthor":false,"prefix":"","firstName":"Rebecca","middleName":"J","lastName":"Beeken","suffix":""}],"badges":[],"createdAt":"2024-05-20 15:23:36","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4450026/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4450026/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s11764-024-01700-5","type":"published","date":"2024-10-28T16:13:18+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":68207158,"identity":"8f856d48-c5c2-47e4-af81-88cad20da94d","added_by":"auto","created_at":"2024-11-04 16:35:26","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1034910,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4450026/v1/618bbc35-b50e-474b-b7f8-d75c827b6e7d.pdf"},{"id":57622191,"identity":"74ffe159-b726-40da-8f84-56c02d33e513","added_by":"auto","created_at":"2024-06-03 13:13:38","extension":"docx","order_by":6,"title":"","display":"","copyAsset":false,"role":"supplement","size":42637,"visible":true,"origin":"","legend":"","description":"","filename":"JCSOnlineResources.docx","url":"https://assets-eu.researchsquare.com/files/rs-4450026/v1/c9330c0c33988f932ad83116.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Factors associated with physical activity in individuals with metastatic cancer: A UK cross-sectional survey.","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAround 20% of all cancer cases in the UK are diagnosed at the metastatic stage [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Improvements in treatment mean many individuals with metastatic cancer now live several years with the disease. However, compared with those diagnosed at earlier stages, people with metastatic cancer experience greater disease- and treatment-related challenges with their physical and psychological health [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. As life expectancy increases, there is a need to improve quality of life in individuals living with metastatic cancer.\u003c/p\u003e \u003cp\u003ePhysical activity (PA) could be an effective and affordable intervention for improving symptom management and quality of life for those with metastatic disease. Recent evidence suggests PA can reduce fatigue and improve muscle function, quality of sleep, patient autonomy, and psychological and social function for individuals with metastatic cancer [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Moderate-vigorous physical activity (MVPA), activity which causes an increase in heart and breathing rate [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], may also be associated with slower disease progression [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] and improved survival [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Systematic reviews of randomised controlled trials (RCTs) show PA is safe and feasible for this patient group, including those with bone metastases when supported by a trained professional [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eExisting studies have concluded levels of PA in people with metastatic cancer are low [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. However, an integrative review (k\u0026thinsp;=\u0026thinsp;18) in metastatic breast cancer highlighted that most of this literature relies on small, convenience samples (n\u0026thinsp;=\u0026thinsp;20\u0026ndash;231), with 39% of included studies given a poor quality rating [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. We identified one large-scale US study which compared PA levels among metastatic and non-metastatic patients with colorectal cancer (n\u0026thinsp;=\u0026thinsp;875)[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. They reported median level of PA was significantly lower in the metastatic group (3.4 metabolic equivalent task-hours per week), compared with the non-metastatic group (4.6 hours). A recent European study (Netherlands, Spain, Germany, Poland, Sweden) of individuals with metastatic breast cancer (n\u0026thinsp;=\u0026thinsp;420), showed patients self-reported a median of 33 (IQR: 0-120) and 0 (IQR: 0\u0026ndash;45) minutes of moderate and vigorous intensity PA per week, respectively. This is significantly below the World Health Organisation (WHO) recommendation of 150 minutes of MVPA per week for adults with cancer [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eObservational and qualitative studies suggest patients experience a range of physical, psychological and logistical barriers to keeping active and adhering to PA programmes [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Understanding the factors associated with PA in this group could help tailor and improve the effectiveness of future interventions [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. In early-stage cancer survivors, individuals from lower income, ethnic minority and non-University educated backgrounds, those affected by overweight or who have a high number of comorbidities are less likely to be active [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e], [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e], [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Some small studies have explored demographic and clinical factors associated with PA in metastatic cancer populations, but findings are inconsistent. Two studies (n\u0026thinsp;=\u0026thinsp;24; n\u0026thinsp;=\u0026thinsp;141) showed Body Max Index (BMI) was not associated with PA [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e], [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e], but another (n\u0026thinsp;=\u0026thinsp;50) showed being under- or of normal weight was associated with higher PA [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Similarly one study (n\u0026thinsp;=\u0026thinsp;63) showed older patients were more likely to adhere to a PA intervention [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e], but others showed no significant relationships between age [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e], [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e], [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e], or other demographic groups and levels of PA [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTo inform the development of inclusive and effective interventions, there is a need to understand patient attitudes to PA and receiving support. This can help researchers tailor interventions to an individual\u0026rsquo;s interests, or align them to perceived physical capabilities, which can influence engagement [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. People with advanced cancer often report a reduction in PA from before their diagnosis [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e], [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e], [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e] and express an interest in increasing it after their diagnosis [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e], [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e], [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e], [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. Similarly, qualitative studies suggest strong interest in receiving PA advice and support from healthcare providers, as access to this or appropriate PA programmes appear limited [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e], [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e], [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e], [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. However, levels of interest and willingness to participate in PA may vary across groups. For example, one cross-European study showed Swedish participants with metastatic breast cancer, had more positive attitudes towards exercising compared with Polish participants [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. This study did not assess the attitudes of UK participants with metastatic cancer. Differences may also exist for patients with different types of metastatic cancer, as there are unique challenges associated with each group. No study has compared perceptions across disease site. Additionally, it is not clear how common these perceptions are across the metastatic cancer population, as large-scale quantitative studies are lacking.\u003c/p\u003e \u003cp\u003eInconsistencies in barriers and preferences may result from the varied needs of people with advanced cancer, and a reliance on small convenience samples. Larger studies are required to build on existing data. Using data from the \u0026ldquo;Health and Lifestyle After Cancer\u0026rdquo; cohort study [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e], we aimed to estimate for the first time, how many UK individuals with metastatic breast, prostate and colorectal cancer are meeting moderate-vigorous PA guidelines, and what clinical and demographic factors predict the likelihood of meeting guidelines. Additionally, we aimed to explore patient perceptions about their pre-diagnosis and current physical activity, and whether they had received, or were interested in receiving PA advice, overall and between disease sites.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eCross-sectional data from the \"Health and Lifestyle After Cancer\u0026rdquo; survey were analysed [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. Ethical approval was obtained through the National Research Ethics Service Committee South Central (Oxford B [14/SC/1369]).\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSample\u003c/h2\u003e \u003cp\u003eIn ten National Health Service (NHS) sites in London and Essex, research nurses sent surveys to 13,645 adults diagnosed with breast, prostate, or colorectal cancer between 2012\u0026ndash;2015. Patients were identified by research nurses, and consequently the final sample included some patients diagnosed outside of these dates (range of most recent cancer diagnosis: 2001\u0026ndash;2017). The response rate was 43% (N\u0026thinsp;=\u0026thinsp;5,835). Participants were asked to report their most recent cancer type from breast, prostate or colorectal and were asked \u0026lsquo;Has this cancer spread to any other parts of your body?\u0026rsquo; (\u0026ldquo;Yes\u0026rdquo;, \u0026ldquo;No\u0026rdquo;, \u0026ldquo;I don\u0026rsquo;t know\u0026rdquo; [coded as missing]). The present analysis was restricted to adults who selected yes to this question.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eMeasures\u003c/h3\u003e\n\u003cp\u003e \u003cstrong\u003eModerate-Vigorous Physical Activity (MVPA)\u003c/strong\u003e \u003cp\u003eParticipants reported how long they spent engaging in moderate (not exhausting) and strenuous (heart beats rapidly) physical activity in hours/minutes per week, using a measure adapted from the validated Godin Leisure-Time Exercise Questionnaire (LTEQ; [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]). The number of strenuous activity minutes was doubled and added to the number of moderate activity minutes to calculate an MVPA composite, measured in minutes per week. MVPA was coded into \u0026ldquo;meeting guidelines\u0026rdquo; and \u0026ldquo;not meeting guidelines\u0026rdquo; based on the WHO guidelines of 150 minutes of MVPA per week [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003ePhysical Activity Perceptions\u003c/b\u003e: Participants reported which statement best described them at the time they completed the survey: \u0026ldquo;\u003cem\u003eI think I should be doing more physical activity\u003c/em\u003e\u0026rdquo;, \u0026ldquo;I \u003cem\u003ethink I should be doing less physical activity\u003c/em\u003e\u0026rdquo;, \u0026ldquo;\u003cem\u003eI don\u0026rsquo;t think I need to change my physical activity\u003c/em\u003e\u0026rdquo; or \u0026ldquo;\u003cem\u003eDon\u0026rsquo;t know\u003c/em\u003e\u0026rdquo; (coded as missing). To assess perceived physical activity change since diagnosis, participants reported whether the amount of physical activity they do now was \u0026ldquo;\u003cem\u003emore\u003c/em\u003e\u0026rdquo;, \u0026ldquo;\u003cem\u003eabout the same\u003c/em\u003e\u0026rdquo;, or \u0026ldquo;\u003cem\u003eless\u003c/em\u003e\u0026rdquo; than before their diagnosis.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003ePhysical Activity Advice\u003c/strong\u003e \u003cp\u003eParticipants indicated whether they had received advice from a health care professional to increase their physical activity (\u0026ldquo;yes\u0026rdquo; or \u0026ldquo;no\u0026rdquo;), and also rated their interest in receiving physical activity information or advice on a 4-point scale from \u0026ldquo;\u003cem\u003enot at all interested\u0026rdquo;\u003c/em\u003e, to \u0026ldquo;\u003cem\u003eextremely interested\u003c/em\u003e\u0026rdquo;.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eClinical Factors\u003c/strong\u003e \u003cp\u003eBMI was calculated from participant reported height and weight (kg/m\u003csup\u003e2\u003c/sup\u003e). Based on WHO guidelines (WHO, 1995), participants were categorised as \u0026ldquo;\u003cem\u003eunderweight\u003c/em\u003e\u0026rdquo; (BMI\u0026thinsp;\u0026lt;\u0026thinsp;18.5), \u0026ldquo;\u003cem\u003ehealthy weight\u003c/em\u003e\u0026rdquo; (BMI\u0026thinsp;\u0026ge;\u0026thinsp;18.5 and \u0026lt;\u0026thinsp;25), \u0026ldquo;\u003cem\u003eoverweight\u003c/em\u003e\u0026rdquo; (BMI\u0026thinsp;\u0026ge;\u0026thinsp;25 and \u0026lt;\u0026thinsp;30), or \u0026ldquo;\u003cem\u003eobese\u003c/em\u003e\u0026rdquo; (BMI\u0026thinsp;\u0026ge;\u0026thinsp;30). Total number of comorbidities was calculated based on the number of other health problems participants selected from a list of 15 conditions (e.g., diabetes, arthritis, angina, asthma, psychiatric illness), and providing details of any other condition. Similarly, for type of treatments, participants selected what treatments they had previously received (surgery, radiotherapy, chemotherapy, hormone therapy, active surveillance, biological therapy), and provided details of any other treatment, and these were summed. Finally, participants indicated the time since completing their main treatment which was coded as \u0026ldquo;s\u003cem\u003etill having main treatment\u0026rdquo;\u003c/em\u003e, \u0026ldquo;\u003cem\u003eless than 1 year\u003c/em\u003e\u0026rdquo;, \u0026ldquo;\u003cem\u003emore than 1 year\u003c/em\u003e\u0026rdquo; or \u0026ldquo;\u003cem\u003eon active surveillance\u003c/em\u003e\u0026rdquo;.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eDemographic Factors\u003c/b\u003e: Participants reported their current employment status and responses were recoded into: \u0026ldquo;w\u003cem\u003eorking\u003c/em\u003e\u0026rdquo; (Employed full-time, employed part-time, self-employed, voluntary work, studying), \u0026ldquo;n\u003cem\u003eot working\u003c/em\u003e\u0026rdquo; (unemployed, retired, unable to work). Age was dichotomised based on the UK state pension age, into \u0026ldquo;\u003cem\u003ebelow retirement age\u0026rdquo;\u003c/em\u003e (\u0026lt;\u0026thinsp;67 years) and \u0026ldquo;\u003cem\u003eabove retirement age\u003c/em\u003e\u0026rdquo; (\u0026ge;\u0026thinsp;67 years). For ethnicity, participants reported which ethnic group best described them from a list of options or specified another ethnic group. Due to there being small numbers of respondents for some of the ethnic minority groups, responses were recoded into \u0026ldquo;w\u003cem\u003ehite\u003c/em\u003e\u0026rdquo; (1) and \u0026ldquo;n\u003cem\u003eon-white\u003c/em\u003e\u0026rdquo; (2). Participants selected what educational or professional qualifications they had obtained from a list of options (including \u0026ldquo;\u003cem\u003eno formal qualification\u003c/em\u003e\u0026rdquo;) or specified another qualification. Responses were recoded into an ordinal scale, from \u0026ldquo;\u003cem\u003enone\u003c/em\u003e\u0026rdquo;, \u0026ldquo;\u003cem\u003eGCSE/vocational\u003c/em\u003e\u0026rdquo;, \u0026ldquo;\u003cem\u003eA-level\u003c/em\u003e\u0026rdquo; or \u0026ldquo;d\u003cem\u003eegree or above\u003c/em\u003e\u0026rdquo;.\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eAnalysis\u003c/h2\u003e \u003cp\u003eThe analysis protocol was preregistered on the Open Science Framework prior to data analysis (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://osf.io/m7ktq/\u003c/span\u003e\u003cspan address=\"https://osf.io/m7ktq/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e). All analyses were conducted in R [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDescriptive statistics were summarised for all variables. The frequency (%) of meeting MVPA guidelines was described, overall and across cancer type, and by clinical and demographic factors. Frequencies (%) of all measures of physical activity perceptions and advice, overall and across cancer type were also given.\u003c/p\u003e \u003cp\u003e To assess whether clinical and demographic factors are associated with the probability an individual is meeting MVPA guidelines, logistic regression models were fitted. Models were adjusted for disease site. Potential predictors (BMI, comorbidities, type of treatments received, time since treatment, current employment, highest education, ethnicity, received physical activity advice, disease site) were added into the model in one step. Odds ratios, and 95% confidence intervals were reported. To handle missing data, multiple imputation was used, with the R package \u003cem\u003emice\u003c/em\u003e [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]. A total of 35 imputations were conducted, which was based on the proportion of missing values [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e], [\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e] and on convergence with a second imputed dataset.\u003c/p\u003e \u003cp\u003eIn exploratory analysis, we re-ran the logistic regression analysis while stratifying for disease site. This allowed us to explore whether the association between clinical and demographic factors, and the probability an individual is meeting MVPA guidelines, differs by type of primary cancer. Within prostate and colorectal cancer, the numbers of individuals receiving biological and hormone treatment were low (\u0026lt;\u0026thinsp;2) thus prior to analysis, we combined the five individual treatment variables (surgery, chemotherapy, radiotherapy, hormone treatment, biological therapy) to use the number of treatments received. No individuals with prostate cancer were classed as underweight for the BMI variable, so underweight and healthy weight were merged into one category (0), keeping the overweight (1) and obese (2) category as it was specified.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe sample (N\u0026thinsp;=\u0026thinsp;588/5835\u0026thinsp;=\u0026thinsp;10%) is described in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e. Breast cancer was the most common cancer type (45.2%), and there was a slightly higher percentage of females (56.7%). The mean age was 63.8 years, and the majority were not working (65.8%) and white (89.9%).\u003c/p\u003e\n\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\n\u003ch2\u003eMVPA Levels\u003c/h2\u003e\n\u003cp\u003eOnly 40.9% of individuals with metastatic cancer were meeting WHO guidelines of 150 minutes of weekly MVPA (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). Those with metastatic prostate cancer were least likely to meet guidelines (31.1% meeting guidelines [prostate], 43.8% [breast] and 45.3% [colorectal]). In our study, participants above retirement age (below retirement\u0026thinsp;=\u0026thinsp;49% [meeting guidelines] vs above retirement\u0026thinsp;=\u0026thinsp;26.3%), not working (working\u0026thinsp;=\u0026thinsp;56.1% vs not working\u0026thinsp;=\u0026thinsp;31.2%), from an ethnic minority background (white\u0026thinsp;=\u0026thinsp;42.7% vs ethnic minority\u0026thinsp;=\u0026thinsp;27.1%), with no educational qualifications (university degree or above =\u0026thinsp;51.7% vs no qualifications\u0026thinsp;=\u0026thinsp;24.3%), affected by obesity (healthy weight\u0026thinsp;=\u0026thinsp;41.2% vs obese\u0026thinsp;=\u0026thinsp;32.9%) and those with a greater number of comorbidities (0 comorbidities\u0026thinsp;=\u0026thinsp;50.7% vs\u0026thinsp;\u0026ge;\u0026thinsp;3 comorbidities\u0026thinsp;=\u0026thinsp;28%) were less likely to meet MVPA guidelines.\u003c/p\u003e\n\u003cp\u003eIn the multiple logistic regression analysis, the odds of meeting MVPA guidelines were lower for individuals who were unemployed, compared to employed individuals (OR\u0026thinsp;=\u0026thinsp;\u003cem\u003e0.49\u003c/em\u003e; 95% CI\u0026thinsp;=\u0026thinsp;\u003cem\u003e0.30\u0026ndash;0.79\u003c/em\u003e) (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e). The odds were also lower for ethnic minorities than for white individuals (OR\u0026thinsp;=\u0026thinsp;\u003cem\u003e0.43\u003c/em\u003e; 95% CI\u0026thinsp;=\u0026thinsp;\u003cem\u003e0.21\u0026ndash;0.87\u003c/em\u003e). Compared with those with no qualifications, individuals with a university education had greater odds of meeting MVPA guidelines (OR\u0026thinsp;=\u0026thinsp;\u003cem\u003e1.89, 95%\u003c/em\u003e CI\u0026thinsp;=\u0026thinsp;\u003cem\u003e1.0-3.57\u003c/em\u003e).\u003c/p\u003e\n\u003cp\u003eWe ran the logistic regression while stratifying for disease site to test whether these findings varied by cancer site (Online Resource 1). After stratifying, having a university education no longer predicted the odds of meeting MVPA guidelines for breast, prostate or colorectal cancer. The odds of meeting MVPA guidelines was lower for unemployed individuals compared with employed individuals among the breast cancer (OR\u0026thinsp;=\u0026thinsp;\u003cem\u003e0.44, 95%\u003c/em\u003e CI\u0026thinsp;=\u0026thinsp;\u003cem\u003e0.23\u0026ndash;0.81\u003c/em\u003e) and prostate cancer (OR\u0026thinsp;=\u0026thinsp;\u003cem\u003e0.19, 95%\u003c/em\u003e CI\u0026thinsp;=\u0026thinsp;\u003cem\u003e0.06\u0026ndash;0.65)\u003c/em\u003e subgroups. The odds were lower for ethnic minorities compared with white individuals (OR\u0026thinsp;=\u0026thinsp;\u003cem\u003e0.21, 95%\u003c/em\u003e CI\u0026thinsp;=\u0026thinsp;\u003cem\u003e0.07\u0026ndash;0.59)\u003c/em\u003e for breast cancer only. No variables significantly predicted the odds of meeting guidelines for individuals with colorectal cancer.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n\u003ch2\u003ePerceptions and Advice Relating to Physical Activity\u003c/h2\u003e\n\u003cp\u003eNearly two thirds (63.5%) of participants felt they should be doing more PA, with 1.6% believing they should be doing less. Individuals with metastatic breast cancer were more likely to feel they should be doing more PA (71.1%) compared with those with metastatic prostate (57.9%) and colorectal cancer (55.6%). Over half (53.3%) of participants believed they were less active now compared with before their cancer diagnosis. Only 12.5% believed they were more active. Percentages were similar across the three cancer types (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eThe majority (70.1%) of participants reported they did not receive any advice or support from a healthcare provider related to PA. This was slightly higher among those with colorectal cancer (75.2%) compared with breast (66.7%) and prostate (71.2%). Overall, 73.6% of participants expressed some interest in receiving advice to help increase their PA. Interest was generally higher among those with breast cancer with 79.4% overall reporting some interest. Interest was lowest among those with colorectal cancer, with 38% reporting they were not interested in receiving any advice (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eDescriptive Statistics and MVPA Activity Levels Note: MVPA data was missing from 149/558 (26.7%) survey respondents.\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eTotal (\u003cem\u003en\u0026thinsp;=\u0026thinsp;558\u003c/em\u003e)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eMeeting Guidelines (\u003cem\u003en\u0026thinsp;=\u0026thinsp;167\u003c/em\u003e)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eNot Meeting Guidelines (\u003cem\u003en\u0026thinsp;=\u0026thinsp;242\u003c/em\u003e)\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMean (SD)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eN\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eN\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e%*\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eN\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eCancer Type\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBreast\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e252\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e45.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e91\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e43.8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e117\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e56.3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eProstate\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e155\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e27.8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e33\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e31.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e73\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e68.9\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eColorectal\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e151\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e27.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e43\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e45.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e52\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e54.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e241\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e43.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e57\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e36.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e100\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e63.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFemale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e316\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e56.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e109\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e43.4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e142\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e56.6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e63.8 (12.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBelow retirement\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e309\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e55.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e125\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e49.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e130\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e51.0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAbove retirement\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e246\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e44.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e40\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e26.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e112\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e73.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eEmployment\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eWorking\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e189\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e34.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e87\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e56.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e68\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e43.9\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNot working\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e363\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e65.8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e78\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e31.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e172\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e68.8\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eHighest Level of Education\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e133\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e26.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e17\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e24.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e53\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e75.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eGCSE/vocational\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e135\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e27.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e44\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e44.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e54\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e55.1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eA-level\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e64\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12.8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e18\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e31.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e40\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e69.0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDegree or above\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e167\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e33.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e76\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e51.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e71\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e48.3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eEthnicity\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eWhite\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e499\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e89.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e153\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e42.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e205\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e57.3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eEthnic minority\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e56\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e27.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e35\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e72.9\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eBMI\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eUnderweight (BMI\u0026thinsp;\u0026lt;\u0026thinsp;18.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e66.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e33.3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHealthy weight (BMI\u0026thinsp;\u0026ge;\u0026thinsp;18.5 \u0026amp; \u0026lt; 25)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e187\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e35.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e56\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e41.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e80\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e58.8\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eOverweight (BMI\u0026thinsp;\u0026ge;\u0026thinsp;25 \u0026amp; \u0026lt;30)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e224\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e42.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e75\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e43.4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e98\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e56.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eObese\u0026thinsp;\u0026ge;\u0026thinsp;30\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e118\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e22.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e27\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e32.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e55\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e67.1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eTime Since Treatment\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eStill having main treatment\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e167\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e30.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e35\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e30.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e79\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e69.3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eLess than 1 year\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e73\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13.4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e21\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e42.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e28\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e57.1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMore than 1 year\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e276\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e50.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e103\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e47.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e115\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e52.8\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eActive surveillance\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e28\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e30.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e14\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e70.0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eTreatment Received\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSurgery\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e357\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e65.6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e125\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e44.8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e154\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e55.2\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRadiotherapy\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e320\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e58.6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e104\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e41.8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e145\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e58.2\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eChemotherapy\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e374\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e68.8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e116\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e41.4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e164\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e58.6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBiological therapy\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e14\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e33.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e66.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHormone therapy\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e251\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e46.4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e83\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e41.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e117\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e58.5\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eComorbidities\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.25 (1.29)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e178\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e31.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e70\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e50.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e68\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e49.3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e197\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e35.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e56\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e38.4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e90\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e61.6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e108\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e19.4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e27\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e36.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e48\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e64.0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026ge;\u0026thinsp;3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e75\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13.4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e14\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e28.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e36\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e72.0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003cem\u003eNote: MVPA data was missing from 149/558 (26.7%) survey respondents.\u003c/em\u003e\u003cbr /\u003e\u003cbr /\u003e\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"char\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"char\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"char\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab3\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eLogistic Regression Coefficients and Odds Ratios for Meeting MVPA Guidelines\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eCoefficient\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eStd Error\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eOR (95% CI)\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eCancer Type (ref: Breast)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eProstate\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e-0.13\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.41\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e.744\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.88 (0.39\u0026ndash;1.96)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eColorectal\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.49\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.36\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e.174\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.63 (0.80\u0026ndash;3.33)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eBMI (ref: underweight)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHealthy weight\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.01\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.31\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e.978\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.01 (0.54\u0026ndash;1.87)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eOverweight\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e-0.13\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.37\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e.735\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.88 (0.42\u0026ndash;1.84)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eObese\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e-0.21\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.56\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e.705\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.81 (0.27\u0026ndash;2.45)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eComorbidities\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNumber of Comorbidities\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e-0.12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.09\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e.22\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.89 (0.74\u0026ndash;1.07)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eTime since treatment\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eLess than 1 year\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.42\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.37\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e.253\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.52 (0.74\u0026ndash;3.12)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e(ref: Still having treatment)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMore than 1 year\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.44\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.28\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e.121\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.56 (0.89\u0026ndash;2.72)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eActive surveillance\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e-0.04\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.54\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e.937\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.96 (0.33\u0026ndash;2.79)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eTreatment\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSurgery\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.07\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.34\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e.834\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.07 (0.55\u0026ndash;2.08)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRadiotherapy\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e-0.12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.27\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e.664\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.89 (0.52\u0026ndash;1.52)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eChemotherapy\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e-0.41\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.30\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e.172\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.66 (0.37\u0026ndash;1.20)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHormone Therapy\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.39\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.28\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e.163\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.47 (0.85\u0026ndash;2.55)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBiological therapy\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e-0.50\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.68\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e.468\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.61 (0.16\u0026ndash;2.34)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eEmployment (ref: Working)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNot working\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e-0.75**\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.24\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e.002\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.47 (0.29\u0026ndash;0.77)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eEducation (ref: No Qualifications)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eGCSE/Vocational\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.38\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.33\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e.251\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.47 (0.76\u0026ndash;2.82)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eA level\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.03\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.39\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e.944\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.03 (0.48\u0026ndash;2.21)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eUniversity education\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.63\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.33\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e.055\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.88 (0.99\u0026ndash;3.56)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eEthnicity (ref: White)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eEthnic Minority\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e-0.83*\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.36\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e.023\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.44 (0.22\u0026ndash;0.89)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cem\u003eNote: ref\u0026thinsp;=\u0026thinsp;Reference category; 95% CI\u0026thinsp;=\u0026thinsp;Lower \u0026ndash; Upper 95% Confidence Intervals. *Significant at p\u0026thinsp;\u0026lt;\u0026thinsp;.05; **Significant at p\u0026thinsp;\u0026lt;\u0026thinsp;.01.\u003c/em\u003e\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab4\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003ePerceptions of Physical Activity Overall and by Cancer Type\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eTotal\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eBreast\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eProstate\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eColorectal\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eN\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eN\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eN\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eN\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePA Present\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eShould be doing more\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e309\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e63.45\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e162\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e71.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e77\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e57.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e70\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e55.6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eShould be doing less\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.64\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3.2\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDon't need to change\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e170\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e34.91\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e65\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e28.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e53\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e39.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e52\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e41.3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eN\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e487\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e228\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e133\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e126\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePA change\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMore\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e69\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e45\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e17.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8.1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAbout the same\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e189\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e34.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e77\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e30.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e58\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e38.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e54\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e36.2\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eLess\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e294\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e53.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e129\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e51.4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e82\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e54.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e83\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e55.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eN\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e552\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e251\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e152\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e149\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab5\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003ePhysical Activity Advice Received and Interest Overall and by Cancer Type\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eTotal\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eBreast\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eProstate\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eColorectal\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eN\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eN\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eN\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eN\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003ePA Advice Received\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e155\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e29.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e80\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e33.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e42\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e28.8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e33\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e24.8\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e364\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e70.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e160\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e66.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e104\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e71.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e100\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e75.2\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eN\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e519\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e240\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e146\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e133\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eInterest in PA Advice\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNot interested\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e127\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e26.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e48\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e20.6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e33\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e26.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e46\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e38.0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eA little interested\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e79\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e16.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e38\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e16.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e25\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e19.8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e16\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13.2\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSomewhat interested\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e116\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e24.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e51\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e21.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e37\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e29.4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e28\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e23.1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eVery interested\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e158\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e32.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e96\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e41.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e31\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e24.6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e31\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e25.6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eN\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e480\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e233\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e126\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e121\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003e In this UK observational study, over half of individuals living with metastatic breast, prostate and colorectal cancer were not meeting MVPA guidelines. The majority felt they needed to be doing more PA and expressed an interest in receiving PA advice, however, 70% of participants had not received any since their diagnosis. We identified potential educational and ethnic disparities in meeting MVPA guidelines, which should be considered alongside attempts to resolve inequalities across the cancer spectrum. The low estimates of MVPA suggest PA support for individuals living with metastatic cancer is needed. Our findings strengthen the previous evidence base estimating insufficient levels of PA, in smaller or non-UK samples [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eProviding PA support which considers the reduced physical function and psychological challenges could be helpful at increasing PA for this patient group, but availability of this support appears to be limited. The majority of our sample reported not having received any PA advice post-diagnosis. Individuals with metastatic cancer have previously reported feeling insecure about their physical limitations and unsafe to perform exercises without supervision from a healthcare professional [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e], [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. Health care professionals themselves have indicated a need for further support in discussing PA recommendations for patients with metastatic cancer, given the complexities of the disease presentation [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e], [\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e]. Despite perceiving PA as being beneficial, some physiotherapists have expressed uncertainty about prescribing it to metastatic patients with bone metastases, due to concerns about an increased risk of injury [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]. The International Bone Metastases Exercise Working Group (IBMEWG) recently released the first clinical exercise guidelines for people with bone metastases in 2022 [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], [\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e]. Further efforts are needed to ensure healthcare professionals are given the appropriate support and training to facilitate the rapid implementation of these guidelines.\u003c/p\u003e \u003cp\u003e We also showed differences in the odds of meeting PA guidelines between different ethnicities, employment statuses and education levels. Similar disparities have been shown in those with early-stage cancer, with those from ethnic minority backgrounds and lower socioeconomic status less likely to be active [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e], [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e], [\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e]. Underserved or disadvantaged demographic groups are likely to experience greater barriers to being physically active, such as a lack of advice, availability of support programs and financial support to attend programs [\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e], [\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e], [\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e]. A study with breast, prostate and colorectal cancer survivors (n\u0026thinsp;=\u0026thinsp;1299), which included both metastatic and non-metastatic patients, found participants with a lower educational attainment and who were not employed reported a higher number of perceived structural barriers to PA [\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e]. Underserved demographic groups may need more, or different kinds of support, to increase their PA and researchers should actively involve these diverse communities when developing inclusive interventions.\u003c/p\u003e \u003cp\u003ePA support may be more beneficial if it is sensitive to the needs of different subgroups [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e], [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e], [\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e], [\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e]. In addition to demographic differences, individuals with metastatic cancer are heterogeneous in terms of tumour type, treatment plans, disease progression, symptom type and severity, and other individual contexts [\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e], [\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e]. In qualitative studies, individuals with metastatic cancer highlight preferences for support tailored to their varied abilities and needs, and sensitive to how this changes throughout their disease [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e], [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. Exercise programmes that are based on the location of the bone metastases have been shown to be safe and efficacious for men with prostate cancer in small trials [\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e], [\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e]. Future research could explore further, cost-effective ways of tailoring PA for this population, for example by using adaptive intervention designs [\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e], [\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAfter stratifying by disease site, the effect of highest education was no longer statistically significant for any of the cancer types, nor was ethnicity for individuals with colorectal cancer. This finding is likely to be explained by the smaller sample size for each patient group, and consequent lower statistical power to detect significant effects. However, ethnicity no longer predicted the odds of meeting MVPA guidelines for prostate and colorectal cancer, and employment was no longer a predictor for colorectal cancer. There were some further differences for individuals with metastatic prostate cancer; a smaller proportion of prostate cancer survivors were meeting MVPA guidelines, and they were slightly more likely to feel they should be doing more PA, compared to breast and colorectal survivors. To our knowledge, this study is the first to compare levels of MVPA between different metastatic cancer types. Some studies in early cancer survivors show similar patterns, with higher rates of PA in breast cancer survivors compared to prostate cancer [\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e]. However, others have found opposite findings, with breast cancer survivors engaging in less activity compared to those with prostate and colorectal cancer [\u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e], [\u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e]. Differences between breast and prostate cancer could be associated with gender differences, but it is unclear if gender differences explains the differences between disease site, or vice versa. This suggests further research comparing across cancer types is required, as well as elucidating the role of gender within a metastatic clinical context to try and understand which groups may need more support.\u003c/p\u003e"},{"header":"Limitations","content":"\u003cp\u003eOur study had limitations. We used self-reported scales to assess PA. While a validated scale was used to assess MVPA (LTEQ: [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]), individuals may have overestimated their PA compared with accelerometer-assessed activity. Previous evidence from cancer survivors suggests PA is lower when assessed with an accelerometer than self-reported data [\u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e], [\u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e]. Participants also self-reported whether they had metastatic cancer, which was based on disease spread. We may have incorrectly included or excluded members of the wider study sample of cancer survivors, which would affect the generalisability of the study findings to the metastatic population However, previous studies suggest that many cancer survivors are not able to identify their cancer stage accurately [\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e], [\u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e], therefore asking about spread, rather than cancer stage, may have helped us reach more eligible participants. Additionally, our sample were partly self-selecting, as completion of the survey was voluntary. It may be those who chose to complete a health behaviour survey were more likely to be active. Taken together, the proportion of individuals with metastatic cancer who are meeting PA guidelines may have been even lower than we estimate here. Our data were cross-sectional, and only associations with the likelihood of meeting MVPA guidelines were explored. Causality cannot be inferred. Finally, despite good representation of employment status, gender and educational attainment, only 10% of our sample were from non-White backgrounds. The decision to dichotomise ethnicity could ignore real cultural differences between groups [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e], [\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e], [\u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e].\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eOverall, our study provides further evidence that physical activity levels in the metastatic cancer population are low and suggest further support is needed. Our analyses showed the majority of individuals with metastatic cancer in our study were not meeting MVPA guidelines and felt they should be doing more activity. We also showed most participants had not received any support or advice from healthcare providers, despite expressing an interest in receiving this. The recent publication of the first clinical exercise guidelines for individuals with bone metastases could help improve this support, provided healthcare staff are sufficiently trained to facilitate the implementation of this guidance. However, the differences in the odds of meeting MVPA guidelines between different demographic groups suggest support may be more needed in certain groups and diversity should be considered when developing accessible and inclusive interventions.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eZFH is funded by an ESRC PhD studentship. The \u0026lsquo;Health and Lifestyle after Cancer\u0026rsquo; survey was funded by Cancer Research UK (grant number C43975/A27498). Smith and Beeken acknowledge funding from a Yorkshire Cancer Research University Academic Fellowship (L389SS, L389RB). Smith is funded by a National Institute for Health Research NIHR Advanced Fellowship (NIHR300588). The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health and Social Care Research or the Department of Health and Social Care. The funders had no role in the study design, data collection, analysis, interpretation of data, and in the writing of this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests:\u0026nbsp;\u003c/strong\u003eThe authors have no relevant financial or non-financial interests to disclose.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions:\u0026nbsp;\u003c/strong\u003eAll authors contributed to study conception and design. Material preparation, data collection and data cleaning were performed by PL, RJB and AF. Formal analysis was performed by ZFH and supported by all authors. The first draft of the manuscript was written by ZFH. All authors commented on draft versions and approved the final manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability:\u0026nbsp;\u003c/strong\u003eThis study\u0026rsquo;s methods, analysis plan and hypotheses were pre-registered on the Open Science Framework prior to data analysis (\u003ca href=\"https://osf.io/m7ktq/\"\u003ehttps://osf.io/m7ktq/\u003c/a\u003e). Following publication, the study\u0026rsquo;s code will be uploaded to this OSF repository. The questionnaire and dataset used in this study is available on request.\u0026nbsp;For the purpose of open access, the authors have applied a Creative Commons Attribution (CC BY) licence to any Author Accepted Manuscript version arising.\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Approval:\u0026nbsp;\u003c/strong\u003eThis study was performed in line with the Declaration of Helsinki. We obtained ethical approval through the National Research Ethics Service Committee South Central\u0026mdash;Oxford B (14/SC/1369).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Participate:\u003c/strong\u003eParticipating hospitals posted letters of invitation, a paper survey and a link to an online version of the survey to eligible patients. Patients chose how they completed and returned the survey (postal or online). Completion of the survey was taken as informed consent.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eCancer Research UK. \u0026lsquo;Proportion of Cancer Cases by Stage at Diagnosis, England, 2018\u0026rsquo;, \u003cem\u003eEarly Diagn. Data Hub\u003c/em\u003e, 2018, Accessed: Aug. 10, 2022. [Online]. 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Public Health\u003c/em\u003e 2006 974, vol. 97, no. 4, pp. 271\u0026ndash;276, Jul. 2006, \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/BF03405602\u003c/span\u003e\u003cspan address=\"10.1007/BF03405602\" 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":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-cancer-survivorship","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jcsu","sideBox":"Learn more about [Journal of Cancer Survivorship](https://www.springer.com/journal/11764)","snPcode":"11764","submissionUrl":"https://submission.nature.com/new-submission/11764/3","title":"Journal of Cancer Survivorship","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Physical Activity, Metastatic Cancer, Observational Study, Physical Activity Support, Ethnic Minority","lastPublishedDoi":"10.21203/rs.3.rs-4450026/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4450026/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose\u003c/strong\u003e: Physical activity is safe and feasible for individuals with metastatic cancer and may support symptom management. We investigated the extent to which individuals with metastatic cancer are meeting moderate-vigorous physical activity (MVPA) guidelines, factors associated with meeting guidelines, and perceptions about physical activity and receiving physical activity advice.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e Data were from UK adults with metastatic breast, prostate, or colorectal cancer who completed the Healthy Lifestyle After Cancer survey (N=588). Self-reported clinical, demographic and physical activity (Godin Leisure-Time Exercise Questionnaire) data were collected. Logistic regression models assessed whether clinical and demographic factors were associated with meeting MVPA guidelines.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: Most (59%) individuals with metastatic cancer were not meeting the World Health Organisation guidelines of 150 minutes of MVPA per week. Adjusting for cancer type, the odds of meeting MVPA guidelines were lower for unemployed individuals (OR=0.47, 95% CI=0.23-0.77) and ethnic minorities (OR=0.44, 95% CI=0.22-0.89), but higher for those with a university education (OR = 1.89\u003cem\u003e, 95% \u003c/em\u003eCI = 1.0-3.57). Most (63.5%) participants felt they should be doing more physical activity. However, 70.1% did not receive any physical activity advice or support, despite 73.6% wanting to receive it.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: People with metastatic cancer may need further support to address inadequate levels of physical activity. The differences observed between demographic sub-groups suggest this may be more beneficial for those less likely to engage in physical activity.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eImplications for Cancer Survivors: \u003c/strong\u003eIndividuals with metastatic cancer are likely to benefit from increased physical activity support, which considers the needs of diverse demographic groups.\u003c/p\u003e","manuscriptTitle":"Factors associated with physical activity in individuals with metastatic cancer: A UK cross-sectional survey.","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-03 13:13:33","doi":"10.21203/rs.3.rs-4450026/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-08-21T07:18:25+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-08-20T19:32:41+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-08-09T14:15:29+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"14753272606244093526870013434610077988","date":"2024-07-31T13:08:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"7333946837500924560232753283136200968","date":"2024-07-29T10:09:09+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-05-23T16:23:34+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-05-21T19:57:18+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-05-21T19:57:17+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Cancer Survivorship","date":"2024-05-20T15:22:18+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-cancer-survivorship","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jcsu","sideBox":"Learn more about [Journal of Cancer Survivorship](https://www.springer.com/journal/11764)","snPcode":"11764","submissionUrl":"https://submission.nature.com/new-submission/11764/3","title":"Journal of Cancer Survivorship","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"9b879b15-4227-40b5-aea0-78c943863ced","owner":[],"postedDate":"June 3rd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-11-04T16:24:41+00:00","versionOfRecord":{"articleIdentity":"rs-4450026","link":"https://doi.org/10.1007/s11764-024-01700-5","journal":{"identity":"journal-of-cancer-survivorship","isVorOnly":false,"title":"Journal of Cancer Survivorship"},"publishedOn":"2024-10-28 16:13:18","publishedOnDateReadable":"October 28th, 2024"},"versionCreatedAt":"2024-06-03 13:13:33","video":"","vorDoi":"10.1007/s11764-024-01700-5","vorDoiUrl":"https://doi.org/10.1007/s11764-024-01700-5","workflowStages":[]},"version":"v1","identity":"rs-4450026","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4450026","identity":"rs-4450026","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}