Movement Behaviors and the Role of Self‐Reported Symptoms and Well‐Being: A Dynamic Structural Equation Modeling Approach Among Head and Neck Cancer Patients

Aim This study aimed to identify individual variability in day‐to‐day physical activity (PA) and sedentary behavior (SB) as well as effects of pain, fatigue, and well‐being among patients with head and neck cancer (pwHNC) on both movement behaviors. Methods A total of 52 pwHNC (age ≥ 18 years, participation rate 73.2%) consented to wear an accelerometer during waking hours for seven consecutive days and to answer questionnaires. Applying a predefined accelerometer protocol resulted in a final analysis sample of 41 pwHNC. A dynamic structural equation modeling approach (DSEM) was employed that combines time series modeling and multilevel modeling. At the within‐person level , autoregressive and bidirectional relationships between PA and SB were analyzed. At the between‐person level , moderator effects of pain, fatigue, and well‐being on these relationships were analyzed. Results A proportion of 87.8% among the pwHNC were men, mean age 65.8 years, and 72.2% had finished curative care. The average accelerometer wear time was 710.2 ± 153.1 min/d. Of this time, an average of 461.3 ± 151.0 min/d was spent in SB and 248.9 ± 121.6 min/d in PA. At the within‐person level, PA and SB data showed no significant autoregressive relationships; that is, previous PA (or SB) did not predict PA (or SB) on the next day, respectively. No bidirectional relationships were found between PA and SB; that is, previous PA did not predict the next‐day SB and vice versa. At the between‐person level, neither fatigue, pain nor well‐being significantly changed the slope and path parameters of PA and SB. Conclusion This study serves as an example of how DSEM can be used to examine how different movement behaviors interact with each other. Presumably, there is a need for more long‐term assessment for the detection of consistency in the temporal information of movement behaviors in pwHNC. Trial Registration German Registry of Clinical Trials (DRKS00028062)