Determinants of exercise intention and behavior in survivors of breast and prostate cancer: an application of the theory of planned behavior

"The healthy me appears": palliative cancer patients' experiences of participation in a physical group exercise program

OBJECTIVE

Tentative results from a pilot study showed that patients with advanced cancer were willing and able to take part in a group exercise intervention. Limited knowledge exists, though, about the meaning and significance of such programs. The purpose of the present study was to understand the meaning of such an intervention for the individual participant and thereby to provide knowledge for shaping future clinical practice.

METHODS

Thirty-four palliative cancer patients with a life expectancy of less than 1 year completed a 6-week group exercise program. Five randomly selected individuals were interviewed 7 months after completion. Results from a self-report evaluation questionnaire identified relevant themes that formed the basis of an interview guide. These were addressed in a semistructured interview. Verbatim transcripts were analyzed with a phenomenological-hermeneutical approach.

RESULTS

Two main themes emerged from the interviews: (1) perceptions of the group and (2) a secure and caring setting for the group. Themes identified regarding perception of the group were a sense of belonging and commitment. Themes identified regarding a secure and caring setting for the group were a life-empowering group as a setting for enhancing coping, the qualifications of those who led the group, and a public gym as an unsuitable setting.

SIGNIFICANCE OF RESULTS

Our study indicates that an individually adjusted group exercise program, with competent leaders, can provide a setting to enhance psychological well-being in cancer patients with life expectancy below 1 year. Small sample size, however, limits the possibility to generalize the findings.

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.

Promoting Lifestyle Change Among Cancer Survivors: When Is the Teachable Moment?

There is mounting evidence that cancer survivors who adopt a healthy lifestyle—for example, by exercising, consuming a healthy diet, and not smoking—reap physical and emotional benefits. Depending on the behavior targeted, these benefits may include reduced fatigue, improved physical functioning, improved quality of life, and greater likelihood of disease-free survival. Given the advantages, cancer survivors should be urged to address any unhealthy behaviors. It remains unclear, however, when cancer survivors will be most receptive to advice from health care providers and others about their lifestyle behaviors. In other words, it is unclear if a “teachable moment” occurs shortly after the cancer diagnosis, during cancer treatment, or sometime after treatment has been completed. This review describes the reasons it has been difficult to identify the optimal time within the cancer trajectory to promote healthy lifestyle behaviors. Some strategies for clarifying the optimal timing are discussed. The review concludes by summarizing health behavior recommendations for cancer survivors outlined by an American Cancer Society expert panel.

The development of an Incontinence Treatment Motivation Questionnaire for patients undergoing pelvic floor physiotherapy in the treatment of stress incontinence

INTRODUCTION AND HYPOTHESIS

The aim of this paper is to develop a motivation questionnaire regarding perseverance in pelvic floor muscle training (PFMT) supervised by physiotherapists for stress urinary incontinence.

METHODS

Sixteen semi-structured interviews were conducted in women with stress urinary incontinence that revealed 15 common themes; 117 items were constructed and reviewed by continence advisors. Surviving items (n = 73) were administered to 210 women. Data were analysed for item properties, factor analysis was used to examine the questionnaire structure and tests of convergence/divergence used to check for sensitivity.

RESULTS

The Incontinence Treatment Motivation Questionnaire (ITMQ) comprises 18-items in five scales, assessing attitudes towards treatment (72.62% of explained variance; alpha = 0.87), reasons for not doing PFMT (55.73%; alpha = 0.74), living with incontinence (62.70% variance; alpha = 0.70), desire for treatment (65.37% variance; alpha = 0.74) and the effect of incontinence severity on PFMT (51.62% variance, alpha = 0.68). Scales were generally sensitive to known group differences.

CONCLUSIONS

This study represents the first effort to develop a motivation scale for PFMT. This validated Motivation Questionnaire is an instrument to test the impact of motivation upon cure, in PFMT.

Correlates of physical activity among lung cancer survivors

OBJECTIVE

Lung cancer survivors commonly experience impairments in quality of life, which may be improved through regular physical activity. However, little is known regarding correlates of physical activity in this survivor population. The current study addressed this research gap.

METHODS

The participants were 175 survivors of early-stage non-small cell lung cancer who completed surgical treatment from 1 to 6 years previously. Information regarding medical factors was obtained from chart records and from participant self-report. Participants also answered questions about demographic and social cognitive factors that may be associated with physical activity, which was assessed as reported engagement in moderate/strenuous activities and leisurely walking.

RESULTS

Participants reported an average of 77.7 min of moderate/strenuous weekly activity and 64.6% reported engaging in leisurely walking at least three times per week. Less leisurely walking was reported by older individuals (p=0.001) and those with a lower education level (p<0.001), who also reported less engagement in moderate/strenuous activities (p=0.004). Individuals with poorer pre-operative pulmonary function reported less moderate/strenuous physical activity (p=0.014) and the number of surgical complications was inversely associated with leisurely walking (p=0.003). Multiple social cognitive constructs were associated with moderate/strenuous activity and leisurely walking.

CONCLUSIONS

The study identified several lung cancer survivor subgroups who may be most in need of physical activity interventions. Identification of social cognitive correlates of physical activity provides valuable information regarding theory-guided constructs that should be targeted in future physical activity interventions for lung cancer survivors.

Exercise and quality of life: strengthening the connections

Exercise improves quality of life (QOL) in people with cancer. Most oncology healthcare providers recognize the statement to be true because the research literature provides strong support for the physical and psychological benefits of exercise. Because the terms exercise, QOL, and people with cancer have different meanings, the contextual connections in which they are used are important to understanding the relationship between exercise and QOL in people with cancer. This article explores the links between exercise and QOL in people with cancer and examines issues that impact the development, implementation, and evaluation of exercise programs for people with cancer. Issues related to exercise goal development, exercise prescription, exercise testing, exercise adherence, and methods to evaluate the efficacy of exercise in relation to QOL are discussed.

Exercise programming and counseling preferences in bladder cancer survivors: a population-based study

INTRODUCTION

Despite growing evidence of the benefits of exercise in cancer survivors, exercise participation rates are low. Understanding the unique exercise programming and counseling preferences of different cancer survivor groups may facilitate the delivery of optimal exercise programs in these growing populations. To date, no study has examined these preferences in bladder cancer survivors.

MATERIALS AND METHODS

Participants were 397 bladder cancer survivors who completed a mailed survey in the province of Alberta, Canada.

RESULTS

The majority of survivors indicated they would be interested (81.1%) and able (84.3%) to participate in an exercise program designed for bladder cancer survivors. We also found strong preferences for home-based exercise programming (53.7%), walking (81.1%), moderate intensity activity (61.7%) and unsupervised sessions (70.6%). Logistic regression analyses showed that older survivors were more likely to prefer to exercise at home (77 vs. 68%; OR = 4.21, 95% CI = 0.188-0.962, p = 0.040), do light intensity exercise (33 vs. 16%; OR = 4.50, 95% CI = 0.208-0.940, p = 0.034) and want unsupervised exercise sessions (75 vs. 62%; OR = 4.60, 95% CI = 1.07-4.08, p = 0.032). Body mass index, age, adjuvant therapy, marital status, income and education also influenced some exercise preferences.

CONCLUSIONS

These findings suggest that bladder cancer survivors are interested in receiving exercise counseling and have some consistent programming preferences including exercising at home, walking, and moderate intensity exercise. Many preferences were modified by demographic and medical factors.

IMPLICATIONS FOR CANCER SURVIVORS

Understanding the unique exercise preferences of bladder cancer survivors may be used to inform the design and delivery of exercise programs in this growing population.

A systematic review of physical activity in prostate cancer survivors: outcomes, prevalence, and determinants

INTRODUCTION

We reviewed physical activity (PA) studies in prostate cancer (PC) survivors investigating (a) the effects of PA on health outcomes, (b) the prevalence of PA, and (c) the determinants of PA.

MATERIALS AND METHODS

A systematic search of the literature identified nine studies on the outcomes of PA, six studies on the prevalence of PA, and four studies on the determinants of PA in PC survivors.

RESULTS

Results showed promising effects of PA on muscular fitness, physical functioning, fatigue, and health-related quality of life. The prevalence of PA varied widely from <30% to >70%, depending on the type of measure used. PA in PC survivors was predicted by motivational variables such as intentions, perceived behavioral control, and subjective norms.

CONCLUSION

Although preliminary research is promising, there remains a significant amount of research to be done on the role of PA in PC survivors. Moreover, future research would benefit from larger samples using randomized controlled trial methodology.

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.

Correlates of exercise motivation and behavior in a population-based sample of endometrial cancer survivors: an application of the Theory of Planned Behavior

Background

Despite evidence of the benefits of exercise in cancer survivors, exercise participation rates tend to decline after treatments. Few studies have examined the determinants of exercise in less common cancer sites. In this study, we examined medical, demographic, and social cognitive correlates of exercise in endometrial cancer survivors using the Theory of Planned Behavior (TPB).

Methods

A mailed survey was completed by 354 endometrial cancer survivors (1 to 10 years postdiagnosis) residing in Alberta, Canada. The study was cross-sectional. Exercise behavior was assessed using the Godin Leisure Time Exercise Questionnaire and the TPB constructs were assessed with standard self-report scales. Multiple regression analyses were used to determine the independent associations of the TPB constructs with intention and behavior.

Results

Chi-square analyses indicated that marital status (p = .003), income level (p = .013), and body mass index (BMI) (p = .020) were associated with exercise. The TPB explained 34.1% of the variance in exercise behavior with intention (β = .38, p < .001) and self-efficacy (β = .18, p = .029) being independent correlates. For intention, 38.3% of the variance was explained by the TPB with self-efficacy (β = .34, p < .001) and affective attitude (β = .30, p < .001) being the independent correlates. The TPB mediated the associations of marital status and BMI with exercise but not income level. Age and BMI moderated the associations of the TPB with intention and behavior.

Conclusion

The TPB may be a useful framework for understanding exercise in endometrial cancer survivors. Exercise behavior change interventions based on the TPB should be tested in this growing population.

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.

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.

Correlates of physical activity level in breast cancer survivors participating in the Women’s Healthy Eating and Living (WHEL) Study

BACKGROUND

Physical activity levels among breast cancer survivors are typically low, and knowledge of the correlates of increased physical activity among cancer survivors is limited. The purpose of this study was to examine factors that are associated with physical activity or inactivity among breast cancer survivors.

METHODS

Data from 3088 women participating in the Women's Healthy Eating and Living (WHEL) Study, collected prior to randomization, were the focus of the current analyses. Self-reports of physical activity levels, quality of life, depression, and dietary intakes were collected. Pearson correlation analyses were employed to examine the associations among these variables, and multiple regression analyses were performed to examine the relationship between selected health behaviors and physical activity levels, after controlling for demographic, breast cancer-related, and psychosocial variables.

RESULTS

Demographic and psychosocial variables were related to physical activity levels (P < 0.001 for all). Cancer treatment type and cancer stage were correlated with survivors' physical activity levels (P < 0.01), but the associations were no longer significant after controlling for demographic variables. Physical activity levels were strongly associated with other health behaviors, especially dietary intakes (P < 0.001), even after controlling for demographic, cancer-related, and psychosocial factors.

CONCLUSION

Low physical activity levels in breast cancer survivors are associated with specific behavioral and other factors, which can be considered as indicators of women at higher risk. Findings of significant differences in physical activity levels based on demographic characteristics suggest the importance of promoting physical activity particularly among breast cancer survivors of ethnic minority or lower education levels.

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.

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.

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.

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.

Exercise motivation and adherence in cancer survivors after participation in a randomized controlled trial: an attribution theory perspective

The purpose of this study was to examine postprogram exercise motivation and adherence in cancer survivors who participated in the Group Psychotherapy and Home-Based Physical Exercise (GROUP-HOPE; Courneya, Friedenreich, Sela, Quinney, & Rhodes, 2002) trial. At the completion of the GROUP-HOPE trial, 46 of 51 (90%) participants in the exercise group completed measures of attribution theory constructs. A 5-week follow-up self-report of exercise was then completed by 30 (65%) participants. Correlational analyses indicated that program exercise, perceived success, expected success, and affective reactions were strong predictors of postprogram exercise. In multivariate stepwise regression analyses, program exercise and perceived success were the strongest predictors of postprogram exercise. Additionally, perceived success was more important than objective success in understanding the attribution process, and it interacted with personal control to influence expected success and negative affect. Finally, postprogram quality of life and changes in physical fitness were correlates of perceived success. We concluded that attribution theory may have utility for understanding postprogram exercise motivation and adherence in cancer survivors.

A comparison of physical activity of posttreatment breast cancer survivors and noncancer controls

The authors obtained data from 335 breast cancer survivors and 6,880 noncancer controls. They proposed (1) to determine whether, after treatment, the survivors were meeting the Center for Disease Control and Prevention/American College of Sports Medicine recommendations for physical activity and were similar to the controls in physical activity and (2) to compare the modes of activity of the 2 groups in frequency, min/session, and sessions/wk. Adjusted logistic regression analyses revealed that the breast cancer survivors engaged in as much moderate, vigorous, and combined physical activity as the noncancer controls did. However, chi-square analyses showed that survivors engaged in more yard work than the controls did, whereas independent-sample t tests showed that the frequency and the total min/wk of stretching were significantly higher in breast cancer survivors compared with noncancer controls. Findings from the study suggest that breast cancer survivors engage in as much physical activity as controls do, but that the groups differ in specific activities.