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Self-reported physical comorbidities are not associated with muscle strengthening activity adherence in US cancer survivors from the National Health and Nutrition Examination Survey
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Self-reported physical comorbidities are not associated with muscle strengthening activity adherence in US cancer survivors from the National Health and Nutrition Examination Survey

Caleb F. Brandner
University of Iowa
Master of Science (MS), University of Iowa
Summer 2026
DOI: 10.25820/etd.008470
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2026.08.04 Brandner Thesis _FINAL1.21 MBDownloadView
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Abstract

Cancer Survivors (CS) represent a growing and aging US population facing disproportionately high comorbidity burden relative to age-matched non-cancer peers. Physical comorbidities such as arthritis, hypertension, diabetes, and cardiovascular disease may present physiological and symptomatic barriers to muscle-strengthening activity (MSA) adherence, yet population-level evidence examining this relationship is lacking. This study examined the association between physical comorbidity burden and MSA adherence among CS from a nationally representative sample of U.S. adults using data from four consecutive National Health and Nutrition Examination Survey (NHANES) cycles (1999-2006). The analytic sample comprised 968 adults with a self-reported cancer history, excluding non-melanoma skin cancers. MSA adherence was operationalized as reporting ≥8 sessions of MSA over the prior 30 days. The primary exposure was a continuous count of eight self-reported comorbidities (arthritis, asthma, emphysema, hypertension, diabetes, osteoporosis, myocardial infarction, and stroke). Survey-weighted logistic regression models estimated the association between comorbidity burden and MSA adherence, adjusting for age, sex, race and ethnicity, education, body mass index (BMI), smoking status, and moderate-to-vigorous physical activity (MVPA). An exploratory analysis examined whether associations differed by comorbidity cluster type (cardiometabolic, respiratory, and musculoskeletal). Of the analytic sample, 16.3% met the MSA adherence threshold, while 83.7% did not. Nearly half (42.7%) reported two or more comorbid conditions. Contrary to the study hypothesis, comorbidity count was not significantly associated with MSA guideline adherence across any model, from the unadjusted estimate through the fully adjusted model (OR = 1.21, 95% CI: 0.94-1.55). Cluster-specific analyses similarly demonstrated no associations with MSA adherence. MVPA co-participation had the strongest association with MSA adherence, with those meeting and exceeding aerobic guidelines demonstrating approximately five- and seven-fold greater odds of reaching MSA adherence relative to inactive participants, respectively. Obesity was independently associated with lower odds of MSA adherence (OR = 0.50, 95% CI: 0.29-0.86), as was current smoking (OR = 0.38, 95% CI: 0.17-0.84). These findings suggest that MSA non-adherence among U.S CS is not primarily associated with physical comorbidity burden but is instead associated with lower overall physical activity engagement, obesity, and current smoking, all of which reflect broader patterns of health behavior engagement. Future research should examine condition-specific barriers to MSA adherence and test interventions targeting the shared behavioral determinants of physical activity in this population.

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