Employment status and adherence to physical activity guidelines among U.S. cancer survivors: An analysis of the National Health Interview Survey

Background: Physical activity (PA) is a critical, modifiable lifestyle factor that improves cancer survivorship outcomes, including reduced recurrence and lower mortality. However, many cancer survivors fail to meet recommended PA guidelines (150 min of aerobic PA and 2 days of strength training per week). Socioeconomic and structural factors such as employment status are key determinants of health behaviors. As many survivors return to work, the influence of employment on their ability to engage in PA is an understudied area. This study examined the relationship between employment and PA among U.S. adults including those with cancer. Methods: This cross-sectional study used pooled data from the 2020 and 2022 National Health Interview Survey (n=57,101), including cancer survivors. The independent variable was employment. The dependent variable, physical activity (PA) status, was categorized into four levels based on HHS guidelines (meeting both aerobic and strength, aerobic-only, strength-only, or neither). Multinomial logistic regression was used to calculate relative risk ratios for employment status across physical activity categories, adjusted for covariates. Results: Preliminary results using adjusted multinomial logistic regression showed that, relative to meeting neither criteria, employment was significantly associated with a 9% higher relative risk of meeting both aerobic and strength physical activity criteria (RRR = 1.09; 95% CI, 1.02-1.16). Employment status was not significantly associated with meeting strength-only (RRR = 1.05; 95% CI, 0.96-1.16) or aerobic-only criteria (RRR = 1.00; 95% CI, 0.95-1.06). For the distinct populations of U.S. citizens with cancer, employment was not significant for any of the physical activity categories. Conclusion: Preliminary findings suggest that while employment is associated with higher aerobic and muscle strengthening physical activity in the general population, this association does not hold true for cancer survivors. This suggests that returning to work may not offer the same PA benefit for survivors, potentially due to factors like persistent fatigue or other cancer-related symptoms. These results emphasize the need for targeted, low-cost physical activity interventions for non-working individuals and accessible workplace wellness programs designed specifically to mitigate PA barriers for working cancer survivors and improve long-term outcomes.