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To document levels of and changes in physical activity before and after ovarian cancer diagnosis and explore associations with psychosocial outcomes.Of 1207 eligible Australian Ovarian Cancer Study (AOCS) participants, 798 participated in an additional prospective Quality of Life (QoL) Study which measured anxiety, depression and QoL at 3–6 monthly intervals for 2 years beginning 3–48 months after diagnosis. AOCS asked about physical activity before diagnosis and 530 women also completed a one-off lifestyle questionnaire 7–64 months after diagnosis which assessed activity during their first and, if relevant, second-to-third and fourth-to-sixth years following diagnosis. Analysis of variance was used to relate physical activity to psychosocial outcomes.Almost 40% of women decreased their physical activity in the first year after diagnosis. Approximately 25% still had lower levels after 2–3 and 4+years. Recent physical activity level was inversely associated with depression and positively associated with QoL (P<0.05). Also, women who maintained or increased their physical activity after diagnosis had better mean depression and QoL scores than women who decreased physical activity or remained inactive (P<0.05). Among women who received chemotherapy shortly prior to completing the lifestyle questionnaire, high versus low or medium physical activity was associated with significantly lower mean depression scores during both periods of treatment and non-treatment (P<0.05).Many women did not regain their pre-morbid physical activity levels several years after ovarian cancer diagnosis. Low physical activity may simply be a consequence of poor well-being but, alternatively, physical activity may improve psychosocial health of this group. Copyright © 2010 John Wiley & Sons, Ltd.