Utility of the theory of planned behavior for understanding exercise during breast cancer treatment

Better exercise adherence after treatment for cancer (BEAT Cancer) study: rationale, design, and methods

Most breast cancer survivors do not engage in regular physical activity. Our physical activity behavior change intervention for breast cancer survivors significantly improved physical activity and health outcomes post-intervention during a pilot, feasibility study. Testing in additional sites with a larger sample and longer follow-up is warranted to confirm program effectiveness short and longer term. Importantly, the pilot intervention resulted in changes in physical activity and social cognitive theory constructs, enhancing our potential for testing mechanisms mediating physical activity behavior change. Here, we report the rationale, design, and methods for a two-site, randomized controlled trial comparing the effects of the BEAT Cancer physical activity behavior change intervention to usual care on short and longer term physical activity adherence among breast cancer survivors. Secondary aims include examining social cognitive theory mechanisms of physical activity behavior change and health benefits of the intervention. Study recruitment goal is 256 breast cancer survivors with a history of ductal carcinoma in situ or Stage I, II, or IIIA disease who have completed primary cancer treatment. Outcome measures are obtained at baseline, 3 months (i.e., immediately post-intervention), 6 months, and 12 months and include physical activity, psychosocial factors, fatigue, sleep quality, lower extremity joint dysfunction, cardiorespiratory fitness, muscle strength, and waist-to-hip ratio. Confirming behavior change effectiveness, health effects, and underlying mechanisms of physical activity behavior change interventions will facilitate translation to community settings for improving the health and well-being of breast cancer survivors.

Predictors of follow-up exercise behavior 6 months after a randomized trial of supervised exercise training in lymphoma patients

OBJECTIVES

Supervised exercise is beneficial for lymphoma patients, but it needs to be maintained to optimize long-term benefits. Here, we report the predictors of follow-up exercise behavior 6 months after a randomized controlled trial in lymphoma patients.

METHODS

Lymphoma patients were randomly assigned to 12 weeks of supervised aerobic exercise (n = 60) or usual care (n = 62). At baseline and post-intervention, data were collected on demographic, medical, health-related fitness, quality of life, and motivational variables. At 6-month follow-up, participants were mailed a questionnaire that assessed exercise behavior and were categorized as meeting or not meeting public health exercise guidelines.

RESULTS

At 6-month follow-up, 110 participants (90.2%) responded, of which 61 (55.5%) were meeting public health exercise guidelines. In univariate analyses, 16 variables predicted 6-month follow-up exercise behavior. In a stepwise regression analysis, five variables entered the model and explained 38% (p < 0.001) of the variance including the following: accepting a post-intervention exercise prescription (β = 0.33; p < 0.001), achieving a higher peak power output at post-intervention (β = 0.28; p = 0.001), experiencing a larger positive change in perceived behavioral control (β = 0.18; p = 0.028), having Hodgkin lymphoma (β = 0.19; p = 0.025), and having a stronger post-intervention intention (β = 0.18; p = 0.034).

CONCLUSION

Exercise behavior in lymphoma patients 6 months after a randomized trial was predicted by a wide range of demographic, medical, health-related fitness, quality of life, and motivational variables. These findings may help facilitate the uptake of self-directed exercise after short-term supervised exercise in lymphoma patients.

Lessons learned in the trenches: facilitating exercise adherence among breast cancer survivors in a group setting

BACKGROUND

Improving effectiveness of group exercise counseling for breast cancer survivors is needed.

OBJECTIVE

The objective of this study was to describe clinical observations, with research and translation implications, derived during group exercise counseling for breast cancer survivors.

METHODS

While implementing group session components of an effective social cognitive theory-based exercise intervention, observations were made through verbal discussion with study staff, review of participant feedback, and prospective journaling by the group facilitator. The intervention has been implemented 11 times (ie, 63 survivors; 66 group sessions). Thematic consistency, application to intervention goals and design, and implications were reconciled between 2 investigators.

RESULTS

Breast cancer diagnosis was a strong source of commonality among group participants. Participant age, time since diagnosis, and expectation for group sessions (eg, group support vs health education) hindered group commonality. Barriers unique to the breast cancer experience were infrequent, but people-pleasing behavior was often identified as a barrier to adherence. Feeling at risk for cancer recurrence was a major concern. Some participants required referral for mental health evaluation for preexisting conditions (eg, depression). Although participants easily understood time management, application of other behavioral modification techniques was more difficult.

CONCLUSIONS

A breast cancer diagnosis alone is not sufficient for commonality among group members. Teaching time management and positive reframing is essential. Protocols for appropriate mental health referrals are needed.

IMPLICATIONS FOR PRACTICE

Our observations will assist group facilitators in enhancing group dynamics and addressing obstacles hindering counseling effectiveness. Moreover, our results suggest hypotheses related to enhancing behavior change in a group setting worthy of future study.

Design of the Steps to Health Study of Physical Activity in Survivors of Endometrial Cancer: Testing a Social Cognitive Theory Model

Physical activity has been shown to benefit cancer survivors' physical functioning, emotional well-being, and symptoms. Physical activity may be of particular benefit to survivors of endometrial cancer because they are more likely to be obese and sedentary than the general population, as these are risk factors for the disease, and thus experience a number of related co-morbid health problems. However, there is little research systematically studying mechanisms of physical activity adherence in cancer survivor populations. This paper describes the design of the Steps to Health study, which applies a Social Cognitive Theory-based model of endometrial cancer survivors' adoption and maintenance of exercise in the context of an intervention to increase walking or other moderate intensity cardiovascular activity. In Steps to Health we will test the influence of self-efficacy and outcome expectations on adherence to exercise recommendations, as well as studying the determinants of self-efficacy. Endometrial cancer survivors who are at least 6 months post-treatment are provided with an intervention involving print materials and telephone counseling, and complete assessments of fitness, activity, self-efficacy and outcome expectations, and determinants of self-efficacy every two months for a six month period. In addition to testing an innovative model, the Steps to Health study employs multiple assessment methods, including ecological momentary assessment, implicit tests of cognitive variables, and ambulatory monitoring of physical activity. The study results can be used to develop more effective interventions for increasing physical activity in sedentary cancer survivors by taking into account the full complement of sources of self-efficacy information and outcome expectations.

Towards an Understanding of Change in Physical Activity from Pregnancy Through Postpartum

OBJECTIVE: The purpose of this paper was to describe the rationale, data collection, and proposed analyses for examination of mediators of change in physical activity from pregnancy to postpartum among a cohort of pregnant women. METHOD: The Pregnancy Infection and Nutrition 3 (PIN3) Study enrolled 2006 pregnant women into the cohort from 2001 to 2005. All women lived in central North Carolina upon enrollment. Physical activity was assessed using a self-reported one week recall, measured twice during pregnancy and once each at 3- and 12-months postpartum. On a subset of women, one-week accelerometer measures were also collected during the two postpartum time periods. Potential mediators (intrapersonal, interpersonal, community) were collected during pregnancy and postpartum through interviews and take home questionnaires. RESULTS: To assess mediation of physical activity among our cohort, we will first describe change in physical activity and the mediators, as well as their associations, through pregnancy into the postpartum period. Following this, the product of coefficients approach will be applied to examine whether each measure had indirect effects on change in physical activity. Each individual level mediator will be examined one at a time and across the time points in which it was available. The Sobel standard error approximation formula will be used to test for significance of the mediation effect. CONCLUSIONS: This study will provide evidence to develop appropriate interventions targeted at physical activity and will help focus efforts on the appropriate time periods between pregnancy and postpartum.

Design of the EXercise Intervention after Stem cell Transplantation (EXIST) study: a randomized controlled trial to evaluate the effectiveness and cost-effectiveness of an individualized high intensity physical exercise program on fitness and fatigue in patients with multiple myeloma or (non-) Hodgkin's lymphoma treated with high dose chemotherapy and autologous stem cell transplantation

Background

The use of high-dose chemotherapy combined with autologous stem cell transplantation has improved the outcome of hematologic malignancies. Nevertheless, this treatment can cause persistent fatigue and a reduced global quality of life, role and physical function. Physical exercise interventions may be beneficial for physical fitness, fatigue and quality of life. However, the trials conducted so far to test the effects of physical exercise interventions in this group of patients were of poor to moderate methodological quality and economic evaluations are lacking. Hence there is need for a rigorous, appropriately controlled assessment of the effectiveness of exercise programs in these patients. The aims of the present study are (1) to determine the effectiveness of an individualized high intensity strength and interval training program with respect to physiological and psychological health status in patients with multiple myeloma or (non-)Hodgkin's lymphoma who have recently undergone high dose chemotherapy followed by autologous stem cell transplantation; and (2) to evaluate the cost-effectiveness of this program.

Methods

A multicenter, prospective, single blind randomized controlled trial will be performed. We aim to recruit 120 patients within an inclusion period of 2 years at 7 hospitals in the Netherlands. The patients will be randomly assigned to one of two groups: (1) intervention plus usual care; or (2) usual care. The intervention consists of an 18-week individualized supervised high-intensity exercise program and counselling. The primary outcomes (cardiorespiratory fitness, muscle strength and fatigue) and secondary outcomes are assessed at baseline, at completion of the intervention and at 12 months follow-up.

Discussion

The strengths of this study include the solid trial design with clearly defined research groups and standardized outcome measures, the inclusion of an economic evaluation and the inclusion of both resistance and endurance exercise in the intervention program.

Trial registration

This study is registered at the Netherlands Trial Register (NTR2341)

Design of the Resistance and Endurance exercise After ChemoTherapy (REACT) study: a randomized controlled trial to evaluate the effectiveness and cost-effectiveness of exercise interventions after chemotherapy on physical fitness and fatigue

BACKGROUND

Preliminary studies suggest that physical exercise interventions can improve physical fitness, fatigue and quality of life in cancer patients after completion of chemotherapy. Additional research is needed to rigorously test the effects of exercise programmes among cancer patients and to determine optimal training intensity accordingly. The present paper presents the design of a randomized controlled trial evaluating the effectiveness and cost-effectiveness of a high intensity exercise programme compared to a low-to-moderate intensity exercise programme and a waiting list control group on physical fitness and fatigue as primary outcomes.

METHODS

After baseline measurements, cancer patients who completed chemotherapy are randomly assigned to either a 12-week high intensity exercise programme or a low-to-moderate intensity exercise programme. Next, patients from both groups are randomly assigned to immediate training or a waiting list (i.e. waiting list control group). After 12 weeks, patients of the waiting list control group start with the exercise programme they have been allocated to.Both interventions consist of equal bouts of resistance and endurance interval exercises with the same frequency and duration, but differ in training intensity. Additionally, patients of both exercise programmes are counselled to improve compliance and achieve and maintain an active lifestyle, tailored to their individual preferences and capabilities.Measurements will be performed at baseline (t = 0), 12 weeks after randomization (t = 1), and 64 weeks after randomization (t = 2). The primary outcome measures are cardiorespiratory fitness and muscle strength assessed by means of objective performance indicators, and self-reported fatigue. Secondary outcome measures include health-related quality of life, self-reported physical activity, daily functioning, body composition, mood and sleep disturbances, and return to work. In addition, compliance and satisfaction with the interventions will be evaluated. Potential moderation by pre- and post-illness lifestyle, health and exercise-related attitudes, beliefs and motivation will also be assessed. Finally, the cost-effectiveness of both exercise interventions will be evaluated.

DISCUSSION

This randomized controlled trial will be a rigorous test of effects of exercise programmes for cancer patients after chemotherapy, aiming to contribute to evidence-based practice in cancer rehabilitation programmes.

TRIAL REGISTRATION

This study is registered at the Netherlands Trial Register (NTR2153).

The cancer rehabilitation journey: barriers to and facilitators of exercise among patients with cancer-related fatigue

BACKGROUND

Despite the evidence to support exercise as an effective management strategy for patients with cancer-related fatigue (CRF), many of the general cancer population are sedentary.

OBJECTIVE

The aim of this study was to explore the barriers to and facilitators of exercise among a mixed sample of patients with CRF.

DESIGN

An exploratory, descriptive, qualitative design was used.

METHODS

Purposive sampling methods were used to recruit patients with CRF who were representative of the cancer trajectory, that is, survivors of cancer and patients in palliative care who were recently diagnosed and undergoing treatment. Focus group discussions were transcribed verbatim and analyzed using a grounded theory approach. Lower-level concepts were identified and ordered into subcategories. Related subcategories then were grouped to form the main categories, which were linked to the core category.

RESULTS

Five focus groups were conducted with 26 participants. Within the core category of the cancer rehabilitation journey were 3 main categories: (1) exercise barriers, (2) exercise facilitators, and (3) motivators of exercise. Exercise barriers were mainly related to treatment side effects, particularly fatigue. Fatigue was associated with additional barriers such as physical deconditioning, social isolation, and the difficulty of making exercise a routine. Environmental factors and the timing of exercise initiation also were barriers. Exercise facilitators included an exercise program being group-based, supervised, individually tailored, and gradually progressed. Exercise motivators were related to perceived exercise benefits.

CONCLUSIONS

Individuals with CRF have numerous barriers to exercise, both during and following treatment. The exercise facilitators identified in this study provide solutions to these barriers and may assist with the uptake and maintenance of exercise programs. These findings will aid physical therapists in designing appropriate exercise programs for patients with CRF.

Postpartum physical activity: measuring theory of planned behavior constructs

OBJECTIVES

To produce evidence for factor validity and longitudinal invariance of scales used to examine the theory of planned behavior applied to physical activity.

METHODS

Self-report questionnaires were administered at 3- (n = 267) and 12-months (n = 333) postpartum.

RESULTS

A single-factor model fit data from the normative beliefs, perceived behavioral control, and behavioral beliefs scales. Attitude and control beliefs were found to be multidimensional. Longitudinal invariance of all scales was supported.

CONCLUSIONS

Each scale had strong validity evidence. Future research using these measures will help identify areas for intervention and reveal how changes in these constructs influence physical activity.

Oncology and physical medicine and rehabilitation

INTRODUCTION

Cancer patients are living longer with deficiencies and functional impairments requiring often typically a care in physical medicine and rehabilitation (PMR).

OBJECTIVE

To examine the care of cancer patients in PMR.

METHOD

Investigation made with a questionnaire diffused from the e-mail listing of the Société Française de Médecine Physique et de Réadaptation.

RESULTS

Sixty-seven answers received. Fifty-seven centers take care of cancer patients. On average, 4% of cancer patients are hospitalised in PMR. Spinal cord injuries and hemiplegias are the most common impairments. Forty-two percent of the PMR units take the patients in all the stages of cancer treatment. Working relationships between PMR and oncology units are formalized only eight times out of 52. In case of health degradation, relationships with a palliative care unit are frequent but not generalized. Eighty-five percent of the centers think that PMR is not enough developed in oncology.

CONCLUSIONS

In spite of its limited character, this investigation shows that the PMR units take these patients. Situations where PMR has an important role in the follow-up of cancer patients are multiple and publications have showed its interest, especially on the limitations of activities. It is important to make better known the interest of PMR in oncology units but also to develop specific care within PMR units.

A randomized trial to increase physical activity in breast cancer survivors

PURPOSE

Interventions to increase physical activity among breast cancer survivors are needed to improve health and quality of life and possibly to reduce the risk of disease recurrence and early mortality. Therefore, we report the feasibility and preliminary outcomes of a pilot randomized trial designed to increase physical activity in sedentary breast cancer survivors receiving hormone therapy.

METHODS

Forty-one sedentary women on estrogen receptor modulators or aromatase inhibitors for stage I, II, or IIIA breast cancer were randomly assigned to receive a 12-wk multidisciplinary physical activity behavior change intervention or usual care.

RESULTS

Recruitment was 34%, intervention adherence was 99%, and complete follow-up data were obtained on 93%. Most participants (93%) were white with mean age of 53 +/- 9 yr. Differences favoring the intervention group were noted for accelerometer physical activity counts (mean difference = 72,103; 95% confidence interval (CI) = 25,383-119,000; effect size (d) = 1.02; P = 0.004), aerobic fitness (mean difference = 2.9; 95% CI = -0.1 to 5.8; d = 0.64; P = 0.058), back/leg muscle strength (mean difference = 12.3; 95% CI = 0.4-15.9; d = 0.81; P = 0.017), waist-to-hip ratio (mean difference = -0.05; 95% CI = -0.01 to -0.08; d = -0.77; P = 0.018), and social well-being (mean difference = 2.0; 95% CI = 0.3-3.8; d = 0.76; P = 0.03). However, the intervention group also reported a greater increase in joint stiffness (mean difference = 1.1; 95% CI = 0.1-2.2; d = 0.70; P = 0.04).

CONCLUSIONS

A behavior change intervention for breast cancer survivors based on the social cognitive theory is feasible and results in potentially meaningful improvements in physical activity and selected health outcomes. Confirmation in a larger study is warranted.

Understanding physical activity intentions among French Canadians with type 2 diabetes: an extension of Ajzen's theory of planned behaviour

BACKGROUND

Regular physical activity is considered a cornerstone for managing type 2 diabetes. However, in Canada, most individuals with type 2 diabetes do not meet national physical activity recommendations. When designing a theory-based intervention, one should first determine the key determinants of physical activity for this population. Unfortunately, there is a lack of information on this aspect among adults with type 2 diabetes. The purpose of this cross-sectional study is to fill this gap using an extended version of Ajzen's Theory of Planned Behavior (TPB) as reference.

METHODS

A total of 501 individuals with type 2 diabetes residing in the Province of Quebec (Canada) completed the study. Questionnaires were sent and returned by mail.

RESULTS

Multiple hierarchical regression analyses indicated that TPB variables explained 60% of the variance in intention. The addition of other psychosocial variables in the model added 7% of the explained variance. The final model included perceived behavioral control (beta = .38, p < .0001), moral norm (beta = .29, p < .0001), and attitude (beta = .14, p < .01).

CONCLUSION

The findings suggest that interventions aimed at individuals with type 2 diabetes should ensure that people have the necessary resources to overcome potential obstacles to behavioral performance. Interventions should also favor the development of feelings of personal responsibility to exercise and promote the advantages of exercising for individuals with type 2 diabetes.

The effects of subjective norms on behaviour in the theory of planned behaviour: a meta-analysis

A meta-analysis investigated the effects of perceived injunctive (IN) and descriptive (DN) norms on behaviour (BEH) within the theory of planned behaviour (TPB) in a sample of 196 studies. Two related correlation matrices (pairwise and listwise) were synthesized from the data and used to model the TPB relations with path analyses. Convergent evidence indicated that the relation between DN and BEH was stronger than the relation between IN and BEH. Evidence also suggested a significant direct relation between DN and BEH in the context of TPB. A suppressor effect of IN on DN in its relation with BEH was also noted. Moderator analyses indicated that the DN-BEH relation was stronger when there was more time between measures of cognition and behaviour, when behaviours were not socially approved, more socially motive and more pleasant; results were mixed in the case of the IN-BEH relation. Results imply that IN and DN are conceptually different constructs.

Theories underlying health promotion interventions among cancer survivors

OBJECTIVES

To review the theories that have been the basis for randomized controlled trials (RCTs) promoting health behavior change among adults diagnosed and treated for cancer.

DATA SOURCES

Electronic databases and recent review papers.

CONCLUSION

Several theories have been used in intervention development: Transtheoretical Model, Motivational Interviewing, Social Learning and Social Cognitive Theory, Theory of Planned Behavior, and Cognitive Behavioral Theory. There is support for the efficacy of some of these interventions. However, there has been limited assessment of theory-based constructs and examination of the mediational role of theoretical constructs in intervention efficacy.

IMPLICATIONS FOR NURSING PRACTICE

There is a need to apply theory in the development of interventions to assess the effects of the intervention on the constructs and to conduct mediational tests of these constructs.

Predictors of follow-up exercise behavior 6 months after a randomized trial of exercise training during breast cancer chemotherapy

PURPOSE

Exercise during breast cancer chemotherapy is beneficial but it needs to be maintained into survivorship to optimize long-term benefits. Here, we report the predictors of follow-up exercise behavior 6 months after a randomized exercise trial in breast cancer patients.

METHODS

Breast cancer patients (N = 242) initiating adjuvant chemotherapy were randomly assigned to usual care (n = 82), supervised resistance exercise (n = 82), or supervised aerobic exercise (n = 78) for the duration of their chemotherapy. At baseline and postintervention, data were collected on demographic, medical, behavioral, fitness, psychosocial, and motivational variables. At 6-month follow-up, participants were mailed a questionnaire that assessed exercise behavior over the past 6 months and were categorized as either meeting both aerobic and resistance exercise guidelines, either exercise guideline, or neither exercise guideline.

RESULTS

Two hundred one (83.1%) participants provided 6-month follow-up data with 85 (42.3%) meeting neither exercise guideline, 74 (36.8%) meeting either exercise guideline, and 42 (20.9%) meeting both exercise guidelines. In multivariate regression analysis, seven variables independently predicted the likelihood of meeting exercise guidelines at follow-up including higher pretrial exercise (beta = 0.23; P = 0.002), younger age (beta = -0.15; P = 0.028), breast conserving surgery (beta = 0.15; P = 0.033), strength improvements (beta = 0.15; P = 0.028), lower postintervention fatigue (beta = 0.13; P = 0.067), a more positive attitude (beta = 0.12; P = 0.086), and lower postintervention body mass index (beta = -0.11; P = 0.105).

CONCLUSION

Exercise behavior 6 months after a randomized trial was predicted by a wide range of demographic, medical, behavioral, fitness, psychosocial, and motivational variables. These findings may help facilitate the uptake of exercise behavior during the transition from breast cancer patient to survivor.

Analyzing theoretical mechanisms of physical activity behavior change in breast cancer survivors: results from the activity promotion (ACTION) trial

BACKGROUND

We previously reported that a physical activity (PA) behavior change intervention based on the theory of planned behavior (TPB) increased PA and quality of life in breast cancer survivors.

PURPOSE

To examine the effects of our interventions on TPB variables and to determine if PA at 12 weeks follow-up was mediated by TPB variables at 4 weeks.

METHODS

Breast cancer survivors (N = 377) were randomly assigned to receive either a standard public health recommendation for PA (SR group), a step pedometer alone, or one of two TPB-based behavior change interventions consisting of print materials (alone or combined with a step pedometer). For the purpose of this study, we compared the two TPB-based intervention groups (INT group) to the SR group.

RESULTS

Compared to the SR group, the INT group reported more favorable changes in instrumental attitude (mean difference = 0.13; 95% CI = -0.01 to 0.23; d = 0.19; p = 0.077), intention (mean difference = 0.33; 95% CI = 0.10 to 0.56; d = 0.33; p = 0.006), and planning (mean difference = 0.39; 95% CI = 0.04 to 0.73; d = 0.26; p = 0.027). Mediation analyses indicated that both planning and intention partially mediated the effects of the intervention on PA at 12 weeks.

CONCLUSIONS

Our TPB-based behavior change intervention resulted in small improvements in the TPB constructs that partially mediated the effects of our intervention on PA behavior. Additional research with the TPB is warranted.

Just how special are the physical activity cognitions in diseased populations? Preliminary evidence for integrated content in chronic disease prevention and rehabilitation

BACKGROUND

The extant literature is building on subdividing physical activity (PA) correlates and interventions by health condition (e.g., diabetes, cancer, etc.).

PURPOSE

The purpose of this study was to compare the mean values and correlations of a population sample divided by mutually exclusive health condition status ("nondiseased," cardiovascular disease and risk factors, cancer, diabetes, and arthritis) on theory of planned behavior beliefs and physical activity after adjusting for sociodemographic factors. The relationship between compounding health conditions/comorbidities and these beliefs with PA was also evaluated.

METHODS

Participants were a U.S. sample of 6,739 adults (M age = 49.65, SD = 16.04) who completed relevant social and medical demographics, measures of behavioral, normative, and control beliefs, and self-reported PA.

RESULTS

Mean analyses identified greater health barriers to PA for the arthritis population compared to the other groups (- .025), whereas physician norms and health barriers were higher for compounding health condition populations compared to the nondiseased group (- .025). Belief-behavior correlations, however, were not different across health conditions (- .19), and nondiseased and single disease populations had larger control belief-behavior correlations than those populations with compounding health conditions (- .19).

CONCLUSIONS

These data generally provide preliminary evidence for an integrated approach to PA promotion content in primary prevention and health rehabilitation with some possible tailoring in the areas of health barriers. This area of research will benefit from future studies that build off of these results.

Understanding physical activity in adolescent cancer survivors: an application of the theory of planned behavior

Notwithstanding the remarkable achievements in survival, there is a growing recognition that pediatric cancer survivors are faced with a variety of chronic health problems that may be exacerbated by maladaptive health behaviors. The purpose of the present study was to examine the utility of the theory of planned behavior (TPB) in understanding adolescent survivors' motivation to engage in physical activity. A group of adolescent cancer survivors recalled their beliefs, attitudes, norms, perceptions of control, intentions and post-treatment physical activity behaviors using a self-administered, mailed questionnaire in a retrospective design. Multiple regression analyses revealed that the TPB explained 29.1% of the variance in physical activity behavior, with the significant independent correlates being intention (beta=0.31,p=0.023) and self-efficacy (beta=0.42,p=0.04). For intention, 33.7% of the variance was explained by the TPB, with affective attitude (beta=0.32,p=0.016) and instrumental attitude (beta=0.31, p=0.037) making significant unique contributions. The present study has provided some of the first data toward understanding physical activity behavior in adolescent cancer survivors. Specifically, the results suggest that interventions designed to promote physical activity in this population should focus on the development of a positive attitude as well as fostering an enhanced sense of self-efficacy.

Physical activity correlates and barriers in head and neck cancer patients

PURPOSE

Our study purpose was to determine physical activity correlates and barriers among head and neck cancer patients.

MATERIALS AND METHODS

Fifty-nine (response rate = 91%) head and neck cancer patients from an academic oncology clinic enrolled in a cross-sectional study utilizing chart review and self-administered questionnaire.

RESULTS

The majority were men (83%) and white (92%) with mean age of 58 +/- 12.8 years and mean months since diagnosis of 18.6 +/- 51.9. The strongest bivariate correlates of physical activity included enjoyment (r = 0.41; p = 0.002), symptom index (r = -0.36; p = 0.006), alcohol use (r = 0.36; p = 0.007), task self-efficacy (r = 0.33; p = 0.013), perceived barriers (r = -0.27; p = 0.047), and comorbidity score (r = -0.27; p = 0.042). Stepwise regression demonstrated independent associations with physical activity for enjoyment (beta = 0.38; p = 0.002) and symptom index (beta = -0.33; p = 0.006; R (2) = 0.28). The most prevalent barriers significantly associated with physical activity included dry mouth or throat (r = -0.32; p = 0.016), fatigue (r = -0.27; p = 0.043), drainage in mouth or throat (r = -0.41; p = 0.002), difficulty eating (r = -0.32; p = 0.015), shortness of breath (r = -0.30; p = 0.024), and muscle weakness (r = -0.29; p = 0.033).

CONCLUSIONS

Our results showed that the strongest independent correlates of physical activity were social cognitive (i.e., enjoyment) and treatment-related (i.e., symptom index). Treatment-related activity barriers were frequent and significantly associated with reduced activity. Efforts to enhance exercise adherence in head and neck cancer patients should focus on optimizing enjoyment and managing treatment-related barriers.

Medical, demographic, and psychosocial correlates of exercise in colorectal cancer survivors: an application of self-determination theory

OBJECTIVES

The purpose of the present study was to evaluate medical, demographic, and psychosocial correlates of exercise in colorectal cancer survivors (CRC-S) using self-determination theory (SDT).

METHODS

Participants were 414 CRC-S who completed a mailed survey that assessed self-reported exercise, medical and demographic variables, and SDT constructs consisting of behavioral regulation for exercise, psychological needs satisfaction in exercise (PNSE), and perceived autonomy support (PAS).

RESULTS

CRC-S with less education were significantly less likely to meet exercise guidelines (21 vs 31%; p < 0.001). Path analysis indicated that SDT and education explained 16% of the variance in exercise behavior with identified regulation (beta = 0.17, p = 0.031), introjected regulation (beta = 0.14, p = 0.006), and education (beta = 0.16, p < 0.001) each making a significant independent contribution.

CONCLUSIONS

Few medical and demographic factors are correlates of regular exercise in CRC-S, but SDT provided a good understanding of exercise behavior in this population. Exercise behavior change interventions incorporating principles of SDT may have utility for promoting exercise and improving outcomes in this important population of cancer survivors.

Are beliefs elicited biased by question order? A theory of planned behaviour belief elicitation study about walking in the UK general population

OBJECTIVES

To elicit salient beliefs about walking for an average of 30 minutes per day, with the aims of investigating whether the order of Theory of Planned Behaviour (TPB) belief elicitation questions affects the number and types of beliefs elicited and whether affective and instrumental questions elicit different beliefs.

DESIGN

A 3 x 2 x 2 x 2 mixed factorial design was employed, with order of behavioural, normative and control questions, and affective and instrumental questions as between-subjects variables, and affective/instrumental and positive/negative questions as within-subjects variables.

METHOD

Quota sampling with regards to age and gender (N=180) was employed to obtain a sample that was broadly representative of the adult general population.

RESULTS

The order in which behavioural, normative and control beliefs were asked had little impact on the number or type of beliefs elicited. The affective/instrumental attitude distinction was supported. Few differences were apparent between older and younger respondents and between men and women.

CONCLUSION

TPB belief elicitation studies are not biased by order effects. Interventions to promote walking should consider targeting affective beliefs, e.g. stress relief, in addition to beliefs about health, which is the traditional focus of health campaigns. Given the similarities in beliefs across demographic groups, 'one size fits all' interventions to promote walking are appropriate.

Exercise beliefs of breast cancer survivors before and after participation in a randomized controlled trial

The purpose of this study was to examine the exercise beliefs of breast cancer survivors before and after participation in a randomized trial. Prior to randomization, 52 breast cancer survivors completed exercise belief measures based on the theory of planned behavior. After the trial, participants assigned to the exercise group (n = 24) completed the belief measures again. Results show that there was significant variability in the expected benefits of exercise prerandomization, ranging from 40% for a reduced risk of breast cancer recurrence to 94% for an improved energy level. Moreover, attitudes toward exercise and perceptions of control were higher in the exercise group after the exercise program. The findings are discussed in terms of the veracity of the exercise beliefs held by breast cancer survivors as well as the aspects of the program that may have contributed to the positive changes in exercise beliefs.

Using the theory of planned behavior to understand the determinants of exercise intention in patients diagnosed with primary brain cancer

The purpose of the present study was to examine the demographic, medical, and social cognitive determinants of exercise intentions in a institution-based cohort of primary brain tumor patients. Using a cross-sectional survey, 100 primary brain tumor patients completed a mailed survey that assessed medical and demographic characteristics, past exercise behavior using the Godin Leisure Time Exercise Questionnaire (GLTEQ), and social cognitive beliefs towards exercise using Aizen's theory of planned behavior (TPB; i.e. intention, perceived behavioral control, subjective norm, affective and instrumental attitude). Descriptive statistics indicated that participants had positive social cognitive beliefs towards exercise. In support of the tenets of the TPB, we found moderate to large (>0.40) positive correlations between the majority of TPB constructs. Moreover, the TPB constructs combined to explain 32% of the variance in exercise intentions with affective attitude (beta = 0.24; p = 0.020) and perceived behavioral control (beta = 0.36; p<0.001) being the most important determinants. Except past exercise behavior, medical and demographic variables were not consistently correlated with any TPB constructs. Finally, participant's gender and body mass index influenced the association between instrumental attitude and exercise intention with male and overweight/obese patients (> or =25 kg/m(2)) considering the health benefits of exercise to be more important than their female and normal weight (<25 kg/m(2)) counterparts. Information gained from this study suggests that the TPB is a useful framework to design and implement theoretically based interventions to promote exercise in primary brain cancer patients.

Randomized pilot test of a lifestyle physical activity intervention for breast cancer survivors

OBJECTIVE

This paper will report the results of a pilot test of a 6-month, 21-session intervention to increase breast cancer survivors' physical activity by teaching them to incorporate short periods of moderate activity into their daily routines (lifestyle intervention). The effect of the intervention on physical performance, quality of life, and physical activity are reported.

METHODS

Sixty breast cancer survivors were randomized to either a lifestyle intervention or a standard care control group. Physical performance, quality of life (Medical outcomes study short form-36 [SF-36]), and physical activity (7-day recall and motivation readiness), were assessed at baseline and 6 months.

RESULTS

The lifestyle group had significantly better performance in the 6-min walk task than the controls (p=0.005) at 6 months. The intervention had positive effects on the bodily pain (p=0.020) and general health (p=0.006) subscales from the SF-36. The lifestyle group had a greater motivational readiness for physical activity at 6-month than standard care, but no significant differences were seen between the two in terms of number of minutes of moderate or more intense physical activity or number of days on which they did > or =30 min of moderate or more intense activity.

CONCLUSIONS

Despite the small sample size, the lifestyle intervention showed promise for improving physical functioning and quality of life and increasing physical activity, and should be tested in a larger randomized trial.

PRACTICE IMPLICATIONS

If the lifestyle approach is shown to be effective in a larger trial, it represents a highly feasible intervention that it can be delivered to cancer survivors by health care institutions or community organizations without dedicated exercise facilities and equipment.

The impact of supervised exercise intervention on short-term postprogram leisure time physical activity level in cancer patients undergoing chemotherapy: 1- and 3-month follow-up on the body & cancer project

BACKGROUND

Exercise is becoming an important component of cancer rehabilitation programs. A consistent finding across studies is that patients experience improved physical fitness and reduced fatigue. However, sustained physical activity is essential if the benefits are to be preserved over the course of cancer survivorship.

OBJECTIVE

This study examined self-reported short-term exercise adherence following a 6-week, supervised exercise program (muscle strength, cardiovascular fitness, relaxation, body awareness, and massage) in a heterogeneous group of 61 cancer patients (mean age 42.9 years, 82% oncological and 18% haematological) from the Body & Cancer Project.

METHODS

Semistructured interviews were used to quantitatively assess leisure time physical activity level 1 and 3 months after completion of the program. The study furthermore included 3-month follow-up assessment of psychological distress (Hospital Anxiety and Depression Scale-HADS). Patient statements were selected that best illustrated trends found in the statistical material.

RESULTS

There was a significant postprogram reduction in physical activity from 6 to 10 weeks and from 6 to 18 weeks. However, the patients (half of whom were still undergoing treatment at the time of follow-up) reported a higher physical activity level postprogram compared to their baseline levels. The analyses showed a positive association between the 3-month postprogram physical activity level and pre-illness physical activity level, treatment, and postprogram changes in depression.

SIGNIFICANCE OF RESEARCH

Given the significant decrease in postprogram PA level, especially in subjects still undergoing cancer treatment, the study suggests that continuous supervised programs may be required in order to encourage and support exercise adherence in this population. However, randomized clinical controlled trials and more follow-up studies are needed to establish the optimal program length and content for sustained exercise adherence in cancer patients.

Exercise use as complementary therapy among breast and prostate cancer survivors receiving active treatment: examination of exercise intention

BACKGROUND

Exercise is associated with an improved quality of life among cancer survivors. Previous research has highlighted the utility of the theory of planned behavior in understanding cancer survivors' intention to exercise. The purpose of this study was to extend the research on the theory of planned behavior in relation to exercise intention in breast cancer survivors and to provide preliminary evidence supporting its application with prostate cancer survivors during treatment.

METHODS

Participants consisted of 126 breast and 82 prostate cancer survivors receiving active treatment. Participants completed self-administered, mail-in questionnaires that assessed demographic and medical variables, past exercise, and the theory of planned behavior.

RESULTS

For breast cancer survivors, the results revealed that attitudes, subjective norm, and perceived behavioral control explained 66% of the variance in exercise intention with the instrumental component of attitude, subjective norm, and perceived behavioral control making significant unique contributions to intention. For prostate cancer survivors, attitudes, subjective norm, and perceived behavioral control explained 57% of the variance in exercise intention, with subjective norm and perceived behavioral control making significant unique contributions to intention.

CONCLUSIONS

The results provide further support that the theory of planned behavior is a useful framework for understanding determinants of exercise intention in breast cancer survivors undergoing active treatment and preliminary support for prostate cancer survivors undergoing active treatment. When designing exercise interventions, differences in breast and prostate cancer survivors' exercise intention merit consideration.

Development and Evaluation of a Theory-Based Physical Activity Guidebook for Breast Cancer Survivors

This study's objective was to develop and evaluate the suitability and appropriateness of a theory-based physical activity (PA) guidebook for breast cancer survivors. Guidebook content was constructed based on the theory of planned behavior (TPB) using salient exercise beliefs identified by breast cancer survivors in previous research. Expert judges completed the Maine Area Health Education Center's 18-item attribute checklist for evaluating written health information. Judges indicated that the PA guidebook achieved desirable attributes for the suitability and appropriateness of the guidebook. A subset of TPB expert judges completed items designed to determine the degree of match between the guidebook content and the respective TPB components. Mean item-content relevance ratings indicated at least a “very good match” between the PA guidebook content and the keyed TPB domains. Theoretically based PA information may be an effective strategy for increasing PA in breast cancer survivors at the population level.

Understanding the Determinants of Exercise Intentions in Multiple Myeloma Cancer Survivors

The purpose of this study was to examine the demographic, medical, and social cognitive determinants of exercise intentions in a population-based sample of multiple myeloma cancer survivors. Using a cross-sectional survey, 70 multiple myeloma cancer survivors completed a questionnaire that assessed their medical and demographic characteristics, past exercise behavior, and social cognitive exercise beliefs using the theory of planned behavior. Seventy participants provided valuable data. Descriptive statistics indicated that participants had quite positive instrumental attitude, intentions, and subjective norms and moderate levels of perceived behavioral control and affective attitudes for exercise. Forced entry multiple regression showed that the theory of planned behavior explained 43% of the variance in exercise intentions. Instrumental attitude and perceived behavioral control were both independent predictors of exercise intentions. No demographic or medical variable moderated the association between the theory of planned behavior constructs and exercise intentions. The results of the present investigation support the growing body of evidence confirming the utility of the theory of planned behavior to understand the salient determinants of exercise in cancer survivors. Knowledge gained from this study provides important information to oncology practitioners who are responsible for delivering supportive care interventions, including exercise, to patients diagnosed with multiple myeloma.

Active for Life After Cancer: a randomized trial examining a lifestyle physical activity program for prostate cancer patients

BACKGROUND

Active for Life After Cancer is a randomized trial evaluating the efficacy of a 6-month group-based lifestyle physical activity program (Lifestyle) for prostate cancer patients to improve quality of life (QOL) including physical and emotional functioning compared to a group-based Educational Support Program and a Standard Care Program (no group).

METHOD

A total of 134 prostate cancer patients receiving continuous androgen-ablation were randomly assigned to one of the three study conditions.

RESULTS

Results indicated no significant improvements in QOL at 6 or 12 months. Both group-based programs were positively received and yielded good attendance and retention. Lifestyle participants demonstrated significant improvements in most theoretical mediators proposed by the Transtheoretical Model and Social Cognitive Theory to affect physical activity. Despite these improvements, no significant changes were found for most physical activity measures.

CONCLUSIONS

Results suggest a lifestyle program focusing on cognitive-behavioral skills training alone is insufficient for promoting routine physical activity in these patients.

Oncologists' opinions towards recommending exercise to patients with cancer: a Canadian national survey

RATIONALE

The goal of this study was to examine oncologists' attitudes towards recommending exercise to patients with cancer during treatment.

PATIENTS AND METHODS

Using a national survey, all 659 practicing medical and radiation oncologists in Canada were sent a brief questionnaire.

RESULTS

The response rate was 46% (281/610). The majority of oncologists agreed that exercise was beneficial (62.0%), important (55.8%) and safe (63.1%) for patients with cancer during treatment. Forty-three percent of oncologists reported that they tried to recommend exercise to their patients when appropriate. Moreover, oncologists actually reported recommending exercise to 28% of their patients during the past month. Analyses also indicated significant differences between oncologists, with younger, female, and medical oncologists generally having more favorable attitudes towards exercise for patients with cancer than their older, male, and radiation oncology counterparts.

CONCLUSIONS

Oncologists have a favorable attitude toward recommending exercise to patients with cancer although several important barriers may prevent oncologists from providing exercise advice to their patients. Further research is required evaluating the effectiveness of interventions and strategies designed to improve oncologists' confidence and ability to advise their patients on exercise during oncology consultations.

A longitudinal study of exercise barriers in colorectal cancer survivors participating in a randomized controlled trial

BACKGROUND

The Colorectal Cancer and Home-Based Physical Exercise (CAN-HOPE) trial compared the effects of a 16-week home-based exercise program to usual care on quality of life in colorectal cancer survivors.

PURPOSE

In this study, we report the weekly exercise barriers from the exercise group.

METHODS

Participants randomized to the exercise group (N = 69) were asked to report their exercise on a weekly basis by telephone. Those participants not achieving the minimum weekly exercise prescription (3 times per week of 30 min of moderate intensity exercise) were asked for a primary exercise barrier.

RESULTS

We obtained 1,073 (97.2%) weeks of adherence data out of a possible 1,104 (i.e., 69 x 16). Participants did not meet the minimum exercise prescription in 39.2% (421/1,073) of the weeks. We obtained an exercise barrier in 83.8% (353/421) of these cases. Overall, participants reported 37 different exercise barriers; the three most common were lack of time/too busy, nonspecific treatment side effects, and fatigue. The top 7 to 10 barriers accounted for 70% to 80% of all missed exercise weeks.

CONCLUSIONS

These findings may have utility for promoting exercise in this population both inside and outside of clinical trials.

Does the theory of planned behavior mediate the effects of an oncologist's recommendation to exercise in newly diagnosed breast cancer survivors? Results from a randomized controlled trial

This randomized trial examined the effects of 2 oncologist-based exercise interventions--recommendation only (RO) and recommendation plus referral (RR)--versus usual care (UC) on social-cognitive constructs from the theory of planned behavior (TPB). The authors also examined whether the TPB mediated the significant effect of the RO intervention on exercise and explained the null effect of the RR intervention. Independent t tests revealed that both interventions had significant effects on TPB constructs; however, only the RO intervention impacted perceived behavioral control (PBC). Path analyses indicated that PBC was the only construct with a direct effect on exercise and that it mediated the effect of the RO intervention on exercise and explained the null effect of the RR intervention.

Exercise barrier and task self-efficacy in breast cancer patients during treatment

Understanding exercise self-efficacy in breast cancer patients during treatment is important for enhancing physical activity adherence. Therefore, the primary study purpose was to determine, among breast cancer patients during treatment, the psychometric properties of scales to measure exercise barrier and task self-efficacy. The study also aimed to determine the following: (1) level of self-efficacy, (2) associations between barrier and task self-efficacy, and (3) associations between self-efficacy and patient age, race, and treatment type. Eighty-six female breast cancer patients recruited from a medical oncologist's office completed the scales once, and 46 repeated the scales 2 weeks later. The majority were Caucasian (95%), with 26% receiving chemotherapy, 64% hormonal therapy alone, and 5% radiation/other. The mean age was 59+/-14 years. The Cronbach's alpha for the nine-item barrier self-efficacy scale was 0.96, with a test-retest correlation of 0.89 (p<0.001). The Cronbach's alpha for the four-item task self-efficacy scale was 0.89, with a test-retest correlation of 0.83 (p<0.001). The mean barrier self-efficacy was slightly to moderately confident, with the lowest confidence reported in the ability to exercise when nauseated. The mean task self-efficacy was slightly to moderately confident, with the lowest confidence reported in the ability to jog for 10 min without stopping. Although no significant associations were found between self-efficacy and participant's race or treatment type, lower task self-efficacy was associated with older age (r=-0.36, p=0.001). Both self-efficacy scales demonstrated good internal consistency and test-retest reliability. Self-efficacy may be a useful target for physical activity interventions among breast cancer patients during treatment.

Social cognitive theory and physical activity during breast cancer treatment

PURPOSE/OBJECTIVES

To measure the association between physical activity and social cognitive theory constructs during breast cancer treatment.

DESIGN

Cross-sectional survey.

SETTING

Midwestern, academic oncology clinic.

SAMPLE

21 primarily Caucasian (90%) female patients with breast cancer undergoing treatment. 76% were > 50 years old; 76% had stage I or II disease. 17 completed the study.

METHODS

Survey (structured interview or self-administration), chart audit, pedometer, and seven-day physical activity recall.

MAIN RESEARCH VARIABLES

Steps per day, energy expenditure, self-efficacy, barriers, partners and role models, prior physical activity counseling, physical activity knowledge, pretreatment physical activity, outcome expectations and values, goals, reinforcement management, and emotional well-being.

FINDINGS

A higher average of steps per day was significantly associated with having an exercise role model and higher annual income. A higher daily energy expenditure (kilocalories per kilogram body weight per day) was significantly associated with higher barrier self-efficacy, higher task self-efficacy, having an exercise partner, having an exercise role model, higher physical activity enjoyment, and lower negative value score.

CONCLUSIONS

Social cognitive theory may provide a useful framework for understanding physical activity among patients with breast cancer during treatment, but correlation strength varies with physical activity measurement type.

IMPLICATIONS FOR NURSING

Social cognitive theory and physical activity during breast cancer treatment warrant additional study with larger sample sizes and multivariate analyses. Interventions to increase physical activity among patients with breast cancer may use social cognitive theory and assess theory constructs as potential mediators or moderators in intervention evaluation.

Predictors of adherence and contamination in a randomized trial of exercise in colorectal cancer survivors

The purpose of this study was to examine predictors of exercise adherence (i.e. exercise in the intervention group) and exercise contamination (i.e. exercise in the control group) in a randomized controlled trial of home-based exercise in colorectal cancer survivors. At baseline, 102 participants completed measures of the theory of planned behavior, personality, past exercise, exercise stage of change, physical fitness, and medical/demographics and then were randomly assigned in a 2:1 ratio to an exercise (n=69) or control (n=33) group. Exercise was monitored weekly for 16 weeks using self-reports by telephone. Ninety-three (91%) participants completed the trial. Adherence was 76% in the exercise group and contamination was 52% in the control group. Hierarchical stepwise regression analyses indicated that baseline exercise stage of change (beta=0.35; p=0.001), employment status (beta=-0.28; p=0.010), treatment protocol (beta=-0.26; p=0.018), and perceived behavioral control (beta=0.20; p=0.055) explained 39.6% of the variance in exercise adherence. Intentions (beta=0.36; p=0.049) and baseline exercise stage of change (beta=0.30; p=0.095) explained 29.9% of the variance in exercise contamination. These findings may have implications for conducting clinical trials of exercise in colorectal cancer survivors and for promoting exercise to colorectal cancer survivors outside of clinical trials.

Exploring social cognitive theory constructs for promoting exercise among breast cancer patients

Physical activity during breast cancer treatment can significantly reduce treatment-related fatigue and improve quality of life. Unfortunately, the majority of women with breast cancer either do not exercise at all or exercise below recommended levels. Little is known about how to enhance physical activity among breast cancer patients. The social cognitive theory, a useful framework for the design of physical activity interventions, has not been studied among breast cancer patients. Our study purpose was to explore physical activity knowledge, attitudes, and behaviors among breast cancer patients during adjuvant therapy utilizing social cognitive theory constructs in preparation for a larger, survey study and future intervention research. Twelve breast cancer patients attended 1 of 3 focus group sessions. Focus group questions were based on the social cognitive theory constructs of self-efficacy, environment, behavioral capability, expectations, expectancies, self-control and performance, observational learning, and reinforcement. The focus group participants generally felt confident in their ability to exercise during treatment if fatigue, time management, and social networking were addressed. The majority of participants had not been given information related to exercise by their physicians during treatment. The participants felt that exercise was more beneficial than harmful during treatment, with the 2 most important benefits identified as reduced fatigue and the potential for improved survival. The use of reinforcements by participants was minimal. The participants consistently expressed the desire for education and guidance by knowledgeable staff during an exercise program. Walking was the most acceptable exercise modality. Social cognitive theory may be a useful framework for future study of exercise behavior among breast cancer patients and measurement of constructs related to this theory should be included in such studies. Future exercise intervention studies should consider the unique barriers and program preferences of breast cancer patients while focusing on self-efficacy, outcome expectations/ expectancies, observational learning, and reinforcements.

Breast cancer survivors involved in vigorous team physical activity: psychosocial correlates of maintenance participation

Physical activity is increasingly being promoted as a means to achieve both physical and psychological benefits for cancer survivors. For women with breast cancer, one sport growing in popularity is dragon boating. The purpose of the present investigation was to examine the psychosocial correlates of dragon boat participation over the course of a season. Six crews completed the baseline (early-season) assessment (n = 109) and late-season assessments (n = 56). The self-report questionnaire completed at both time points included an assessment of the theory of planned behaviour variables, quality of life, cohesion, and physical activity levels. A prospective examination of the TPB variables revealed attitude at early season as the only significant predictor of behavioural intentions 12 weeks later at late season (R2 adjusted = 0.27, p < 0.001). Overall, the group environment was cohesive at a level similar to that for female sport teams among the asymptomatic population. As well, participants' health-related quality of life was similar to normal, healthy women of similar age for both mental and physical health.

Effects of an oncologist's recommendation to exercise on self-reported exercise behavior in newly diagnosed breast cancer survivors: a single-blind, randomized controlled trial

BACKGROUND

Increased attention has focused on exercise as a quality of life intervention for breast cancer survivors during and after adjuvant therapy.

PURPOSE

Our objective was to examine the effects of an oncologist's recommendation to exercise on self-reported exercise behavior in newly diagnosed breast cancer survivors attending their first adjuvant therapy consultation.

METHODS

Using a single-blinded, 3-armed, randomized controlled trial, 450 breast cancer survivors were randomly assigned to receive an oncologist exercise recommendation only, an oncologist exercise recommendation plus referral to an exercise specialist, or usual care. The primary outcome was self-reported total exercise (in metabolic equivalent [MET] hours per week) at 5 weeks postconsultation.

RESULTS

The follow-up assessment rate was 73% (329 of 450). Intention-to-treat analysis based on participants with follow-up data indicated a significant difference in total exercise in favor of the recommendation-only group over the usual care group (mean difference, 3.4 MET hr per week; 95% confidence interval [CI], 0.7-6.1 MET hr per week; p = .011). There was no significant difference between the recommendation-plus-referral group and the usual care group (mean difference, 1.5 MET hr per week; 95% CI, -1.0 to 4.0 MET hr per week; p = .244). Ancillary "on-treatment" analyzes showed that participants who recalled an exercise recommendation reported significantly more total exercise than participants who did not recall an exercise recommendation (mean difference, 4.1 MET hr per week: 95% CI, 1.9-6.4 MET hr per week; p < .001).

CONCLUSIONS

Our findings suggest that an oncologist recommendation may increase exercise behavior in newly diagnosed breast cancer survivors, particularly if it is recalled 1 week after the recommendation.

Three independent factors predicted adherence in a randomized controlled trial of resistance exercise training among prostate cancer survivors

OBJECTIVE

To examine predictors of adherence in a randomized controlled trial of resistance exercise training (RET) in prostate cancer survivors receiving androgen deprivation therapy.

STUDY DESIGN AND SETTING

A randomized controlled trial conducted at fitness centers in Ottawa and Edmonton, Canada. Prostate cancer survivors (n=155) completed measures of social cognitive variables, quality of life (QOL), behavior, and fitness before being randomized to either an exercise (n=82) or control (n=73) group. The exercise group was asked to perform supervised RET three times per week for 12 weeks.

RESULTS

The exercise group attended 28.2 of the 36 (78.3%) RET sessions. Univariate analyses revealed eight different significant (Ps <.05) predictors of exercise adherence including exercise stage of change, intention, age, QOL, fatigue, subjective norm, leg-press test, and perceived behavioral control. A multivariate analysis indicated that there were three independent predictors of adherence that explained 20.4% of the variance: exercise stage of change (beta=0.26; P=.013), age (beta=-0.22; P=.037), and intention (beta=0.19; P=.073).

CONCLUSION

Exercise adherence in the trial was very good but not optimal. Adherence was predicted by variables from many different categories including social cognitive, QOL, behavioral, fitness, and demographic. These findings may have important implications for maximizing adherence during clinical trials of exercise in prostate cancer survivors.