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

A randomized trial of a lifestyle intervention in obese endometrial cancer survivors: quality of life outcomes and mediators of behavior change

BACKGROUND

To examine the effects of a 6 month lifestyle intervention on quality of life, depression, self-efficacy and eating behavior changes in overweight and obese endometrial cancer survivors.

METHODS

Early stage endometrial cancer survivors were randomized to intervention (n = 23) or usual care (n = 22) groups. Chi-square, Student's t-test and repeated measures analysis of variance were used in intent-to-treat analyses. Outcomes were also examined according to weight loss.

RESULTS

Morbidly obese patients had significantly lower self-efficacy, specifically when feeling physical discomfort. There was a significant improvement for self-efficacy related to social pressure (p = .03) and restraint (p = .02) in the LI group. There was a significant difference for emotional well-being quality of life (p = .02), self-efficacy related to negative emotions (p < .01), food availability (p = .03), and physical discomfort (p = .01) in women who lost weight as compared to women who gained weight. Improvement in restraint was also reported in women who lost weight (p < .01).

CONCLUSION

This pilot lifestyle intervention had no effect on quality of life or depression but did improve self-efficacy and some eating behaviors.

TRIAL REGISTRATION

http://www.clinicaltrials.gov; NCT00420979.

A framework for guiding health literacy research in populations with universal access to healthcare

At least one third of the US population suffers from limited health literacy, which has been linked to poorer health status, higher costs, and individuals who are socioeconomically disadvantaged. However, research and the development of theoretical frameworks to study health literacy have only recently begun to occur. The purpose of this article is to describe theoretical frameworks that have either been used or may be used to guide health literacy research and to identify implications for nursing research and practice related to an adaptation of a health literacy framework developed specifically for conducting research in populations with universal access to healthcare.

An international comparative study of professional development in research

In 2005, a group of researchers in China decided to compare the development of research in China with that of other countries. This article describes the process the authors used and the prevalent topics for trends and developments. Further ideas for their own professional development in research are defined.

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.

Women's experience of physical activity following breast cancer treatment

Physical activity is of great benefit to women treated for breast cancer and can even be vital. The aim of this qualitative study was to describe how women treated for breast cancer experience physical activity after surgery. Twelve women, strategically selected according to hospital, age and length of time since surgery, took part in a semi-structured interview. A qualitative method with a phenomenographic approach was used. The result indicates that the incentive to remain or return to a normal physical condition is an important motive for physical activity after breast cancer surgery. The experience of physical activity was, from the women's perspective, expressed in (i) compliance to instructions and need for support, (ii) struggle to get back to normal and fear of negative side-effects, (iii) a wish to stay normal and not allow limitations and (iv) getting control of the situation with new strategies. In conclusion, instructions and motivation are important in starting up and/or continuing physical activity after breast cancer treatment. While in considering the vital benefits of physical activity for breast cancer patients healthcare professionals, and in particular physiotherapists, must be aware of the need for information and the patients' motive for exercise and physical activity to be able to guide and encourage them individually. The professionals must also understand the need for empowerment for these women to take control over their lives and to allow the limitations that eventually occur.

Cancer fatigue: a review for psychiatrists

OBJECTIVE

Cancer-related fatigue (CRF) is a ubiquitous and debilitating phenomenon for patients both during and after treatment for cancer of all types. This review will outline the complex neurobiological mechanisms underlying CRF and their relevance to various treatment routes. It will cover aspects of screening, diagnosis and treatment, including both pharmacological and behavioral interventions for CRF. The goal of the article was not to perform a comprehensive literature review or meta-analysis, but rather to integrate clinically relevant information from different areas of research related to cancer fatigue, including etiology, diagnosis and management for a nonspecialist audience.

METHOD

The methodology used involved broadly surveying the literature available on Medline using such search terms as "cancer," "fatigue," "cytokine" and "depression," exploring relevant articles over the past 15 years and relevant citations from these articles and focusing on recent advances in the study of CRF.

RESULTS

CRF occurs at high prevalence rates during and subsequent to cancer treatment. Multidisciplinary approaches are available for the assessment and management of fatigue including underlying contributory factors.

CONCLUSIONS

An increasing base for evidence is present to guide the management of CRF. Additional research is warranted to understand the neurobiological mechanisms, etiology and risk factors for fatigue.

Cultural beliefs and attitudes of Black and Hispanic college-age women toward exercise

The purpose of this study was to examine the cultural knowledge that informs exercise behaviors among Black and Hispanic college-age women. Focus groups were conducted among 26 Black or Hispanic female college students. Questions were based on constructs from social cognitive theory. Data were analyzed using content analysis. Latinas were found to be more likely to view vigorous exercise as "unfeminine" and cited family responsibilities as barriers. Black women enjoyed the competition and camaraderie of exercise, but felt pressure to conform to White standards of beauty. There appear to be distinct differences in the cultural beliefs that inform exercise behaviors among these women.

Exercise stage of change, barriers, expectations, values and preferences among breast cancer patients during treatment: a pilot study

With increasing evidence supporting physical activity benefits during breast cancer treatment, addressing exercise adherence with consideration of the unique exercise barriers, outcome expectations and preferences of cancer patients is needed. Our pilot study aimed to determine the following during breast cancer treatment: (1) exercise barriers, outcome expectations/values and associations with exercise stage of change and (2) exercise preferences. A cross-sectional survey was administered to 23 breast cancer patients during treatment. Participants were primarily aged 50-60 years (52%), Caucasian (91%), with stage I (30%), II (44%) or III (26%) disease. A total of 48% were receiving chemotherapy. In total, 50% were in the pre-contemplation/contemplation stage of change, with 34% in action/maintenance. Common exercise adherence barriers (i.e. lack of priority, self-discipline, procrastination and fatigue) demonstrated statistically significant negative associations with exercise. Frequent outcome expectations included improving heart/lungs, reducing disease risk, building muscle strength and losing weight. Important outcomes included improving state of mind, reducing fatigue and avoiding injury. Outcome expectations (i.e. less depression, boredom and nausea) were positively associated with exercise. The majority preferred walking (100%), moderate-intensity (61%), home-based (78%) exercise. Among breast cancer patients during treatment, exercise adherence barriers are general and disease specific. Outcome expectations are physical benefits, with the most important outcomes being psychological or avoidance of risk (i.e. injury).

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.

Exercise for women receiving adjuvant therapy for breast cancer

BACKGROUND

A huge clinical research database on adjuvant cancer treatment has verified improvements in breast cancer outcomes such as recurrence and mortality rates. On the other hand, adjuvant therapy with agents such as hormone therapy, chemotherapy and radiotherapy impacts on quality of life due to substantial short- and long-term side effects.

OBJECTIVES

To assess the effect of aerobic or resistance exercise interventions during adjuvant treatment for breast cancer on treatment-related side effects such as physical deterioration, fatigue, psychosocial distress and physiological, morphological and biological changes.

SEARCH STRATEGY

We searched the Cochrane Breast Cancer Specialised Register (16 July 2004) and the following electronic databases: MEDLINE (1966 to 2006), EMBASE (1988 to 2004), CINAHL (1982 to 2004), SPORTDiscus (1975 to 2004), PsycINFO (1872 to 2003), SIGLE (1880 to 2004), ProQuest Digital Dissertations (1861 to 2004) and Conference Papers Index (1973 to 2004). Furthermore, we screened references in relevant reviews and clinical trials and handsearched relevant journals.

SELECTION CRITERIA

We included randomised and non-randomised controlled trials that examined aerobic or resistance exercise, or both, in women undergoing adjuvant treatment for breast cancer.

DATA COLLECTION AND ANALYSIS

Two authors independently extracted data and assessed methodological quality and adequacy of the training stimulus following a set of standardised criteria. Meta-analyses were performed for physical fitness, fatigue and weight gain using a random-effects model.

MAIN RESULTS

Nine trials involving 452 women met the inclusion criteria. Meta-analysis for cardiorespiratory fitness (involving 207 participants) suggested that exercise improves cardiorespiratory fitness (SMD 0.66, 95% CI 0.20 to 1.12). Meta-analysis for fatigue (317 participants) found statistically non-significant improvements for participants in the exercise intervention groups compared to control (non-exercising) groups (SMD -0.12, 95% CI -0.37 to 0.13); the same applied for the meta-analysis of weight gain (147 participants) (SMD -1.11, 95% CI -2.44 to 0.22). Evidence for other outcomes remains limited. Adverse effects (lymphedema and shoulder tendonitis) were observed in two trials. The results from non-randomised controlled trials are similar to those of randomised controlled trials and do not appear to produce any bias. This review is based on a small number of trials with a considerable degree of clinical heterogeneity regarding adjuvant cancer treatments and exercise interventions.

AUTHORS' CONCLUSIONS

Exercise during adjuvant treatment for breast cancer can be regarded as a supportive self-care intervention which results in improved physical fitness and thus the capacity for performing activities of daily life, which may otherwise be impaired due to inactivity during treatment. Improvements in fatigue were ambiguous and there was a lack of evidence for improvement with exercise for other treatment-related side effects. Since exercise interventions (for sedentary participants) require behaviour change, strategies for behaviour change should underpin these interventions. Furthermore, long-term evaluation is required due to possible long-term side effects.

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.

Exercise Preferences of Endometrial Cancer Survivors

Exercise has gained recognition as an effective supportive care intervention for cancer survivors, yet participation rates are low. Knowledge of the specific exercise counseling and programming preferences of cancer survivors may be useful for designing effective interventions. In this study, we examined the exercise preferences of 386 endometrial cancer survivors. Participants completed a questionnaire that included measures of past exercise behavior, exercise preferences, and medical and demographic information. Some key findings were as follows: (a) 76.9% of participants said they were interested or might be interested in doing an exercise program and (b) 81.7% felt they were able or likely able to actually do an exercise program. Participants also indicated that walking was their preferred activity (68.6%) and moderate exercise was their preferred intensity (61.1%). Logistic regression analyses showed that meeting public health guidelines for exercise, being overweight or obese, receiving adjuvant treatment, months since diagnosis, income, marital status, and level of education all influenced exercise preferences. These results suggest that endometrial cancer survivors have unique exercise preferences that are moderated by a number of demographic and medical variables. These findings may have implications for the design and implementation of clinical and population-based exercise interventions for endometrial cancer survivors.

Exercise preferences among a population-based sample of non-Hodgkin's lymphoma survivors

In the present study, we examined the exercise preferences of a population-based sample of non-Hodgkin's lymphoma (NHL) survivors. A secondary purpose was to explore the association between various demographic, medical, and exercise behaviour variables and elicited exercise preferences. Using a retrospective survey design, 431 NHL survivors residing in Alberta, Canada completed a mailed questionnaire designed to assess exercise preferences, past exercise behaviour, and various demographic variables. Overall, 77% of participants preferred or maybe preferred to receive exercise counselling at some point after their NHL diagnosis. An overwhelming majority indicated that they would possibly be interested (81%) and able (85%) to participate in an exercise programme designed for NHL survivors. The majority of participants (55%) listed walking as their preferred choice of exercise. Logistic regression analyses indicated that NHL survivors' exercise preferences were influenced by body mass index (BMI), exercise behaviour, and gender. Eliciting exercise preferences from the population in question yields important information for cancer care professionals designing exercise programmes for NHL survivors. Furthermore, tailoring exercise programmes to the preferences of NHL survivors may be one method to potentially enhance exercise adherence in this population both inside and outside of clinical trials.

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.