1
|
Hallsworth K, McCain MV, Fallen-Bailey R, Brown MC, Orange ST, Reeves HL. Is home-based, virtually delivered, group exercise feasible and acceptable for older patients with hepatocellular carcinoma? A non-randomised feasibility study (TELEX-Liver Cancer). BMJ Open 2024; 14:e082155. [PMID: 38866571 PMCID: PMC11177682 DOI: 10.1136/bmjopen-2023-082155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 05/20/2024] [Indexed: 06/14/2024] Open
Abstract
OBJECTIVES The study aimed to assess the feasibility, acceptability and safety of delivering a home-based telehealth exercise intervention to older patients with hepatocellular carcinoma (HCC). DESIGN Non-randomised feasibility study. SETTING Patients were recruited from UK outpatient liver cancer clinics. PARTICIPANTS Patients were aged ≥60 years with HCC, with post-treatment imaging reporting a complete response, partial response or stable disease. INTERVENTION AND DATA COLLECTION Patients were invited to attend synchronous online exercise sessions, twice weekly for 10 weeks. Physical function and patient-reported outcomes were assessed pre-intervention and post-intervention. Qualitative data were collected via semistructured interviews after intervention completion. PRIMARY OUTCOME MEASURES Recruitment, retention, exercise adherence and safety. RESULTS 40 patients were invited to participate and 19 (mean age 74 years) provided consent (recruitment rate 48%). Patients completed 76% of planned exercise sessions and 79% returned to the clinic for follow-up. Hand grip strength (95% CI 1.0 to 5.6), Liver Frailty Index (95% CI -0.46 to -0.23) and time taken to perform five sit-to-stands (95% CI -3.2 to -1.2) improved from pre-intervention to post-intervention. Patients reported that concerns they had relating to their cancer had improved following the intervention (95% CI 0.30 to 5.85). No adverse events occurred during exercise sessions.Qualitative data highlighted the importance of an instructor in real time to ensure that the sessions were achievable, tailored and well balanced, which helped to foster motivation and commitment within the group. Patients reported enjoying the exercise intervention, including the benefits of peer support and highlighted perceived benefits to both their physical and mental health. Patients felt that the online sessions overcame some of the barriers to exercise participation and preferred attending virtual sessions over face-to-face classes. CONCLUSIONS It is feasible, acceptable and safe to deliver supervised group exercise via videoconferencing to patients with HCC in their own homes. These findings will inform the design of a future, adequately powered randomised controlled trial to evaluate the efficacy of the intervention. TRIAL REGISTRATION NUMBER ISRCTN14411809.
Collapse
Affiliation(s)
- Kate Hallsworth
- NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne, UK
- The Liver Unit, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Misti V McCain
- NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Newcastle University Centre for Cancer, Newcastle upon Tyne, UK
| | | | - Morven C Brown
- Newcastle University Centre for Cancer, Newcastle upon Tyne, UK
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Samuel T Orange
- NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne, UK
- Newcastle University Centre for Cancer, Newcastle upon Tyne, UK
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- School of Biomedical, Nutritional and Sport Sciences, Faculty of Medical Sciences,Newcastle University, Newcastle upon Tyne, UK
| | - Helen L Reeves
- NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne, UK
- The Liver Unit, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Newcastle University Centre for Cancer, Newcastle upon Tyne, UK
| |
Collapse
|
2
|
Gell NM, Dittus K, Caefer J, Martin A, Bae M, Patel KV. Remotely delivered exercise to older rural cancer survivors: a randomized controlled pilot trial. J Cancer Surviv 2024; 18:596-605. [PMID: 36374436 PMCID: PMC9662104 DOI: 10.1007/s11764-022-01292-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 11/03/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE The study aimed to determine the feasibility of remotely delivered exercise (tele-exercise) for older, rural cancer survivors and to explore the effects of tele-exercise on physical function, physical activity, and patient-reported outcomes. METHODS Participants were rural cancer survivors age ≥ 60 years (79% female; mean age 70.4 ± 5.7) randomly assigned to the remotely delivered EnhanceFitness (tele-EF) exercise program, inclusive of aerobic, strength, and balance training and led by American Council on Exercise certified instructors for 1 h, 3 days/week for 16 weeks (n = 20) or to a waitlist control group (n = 19). We assessed feasibility, physical function, accelerometer-measured physical activity, and patient-reported outcomes at baseline and post intervention. RESULTS Among those screened as eligible, 44 (64%) consented to participate with 39 randomized after completing baseline measures. Attrition was equivalent between groups (n = 1, each) with 95% completing the study. The median class attendance rate was 86.9% (interquartile range: 79-94%). Compared to controls, tele-EF participants had statistically significant improvement in the five-time sit-to-stand test (- 3.4 vs. - 1.1 s, p = 0.03, effect size = 0.44), mean daily light physical activity (+ 38.5 vs 0.5 min, p = 0.03, effect size = 0.72) and step counts (+ 1977 vs. 33, p = 0.01, effect size = 0.96). There were no changes in self-efficacy for exercise, fatigue, or sleep disturbance between groups. CONCLUSIONS Findings indicate that tele-EF is feasible in older, rural cancer survivors and results in positive changes in physical function and physical activity. IMPLICATIONS FOR CANCER SURVIVORS Tele-EF addresses common barriers to exercise for older, rural cancer survivors, including limited accessible opportunities for professional instruction and supervision.
Collapse
Affiliation(s)
- Nancy M Gell
- Department of Rehabilitation and Movement Science, University of Vermont, 306B Rowell 106 Carrigan Drive, Burlington, VT, 05405, USA.
- University of Vermont Cancer Center, Burlington, VT, USA.
| | - Kim Dittus
- University of Vermont Cancer Center, Burlington, VT, USA
- Department of Medicine, University of Vermont Medical Center, Burlington, VT, USA
| | - Jacqueline Caefer
- Department of Physical Therapy Movement and Rehabilitation Sciences, Northeastern University, Boston, MA, USA
| | - Anita Martin
- Department of Rehabilitation and Movement Science, University of Vermont, 306B Rowell 106 Carrigan Drive, Burlington, VT, 05405, USA
| | - Myeongjin Bae
- Department of Rehabilitation and Movement Science, University of Vermont, 306B Rowell 106 Carrigan Drive, Burlington, VT, 05405, USA
| | - Kushang V Patel
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, USA
- Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington, Seattle, USA
| |
Collapse
|
3
|
Moffitt RL. A psychosocial investigation of exercise preferences in real and virtual environments. PSYCHOLOGY OF SPORT AND EXERCISE 2024; 70:102530. [PMID: 37678040 DOI: 10.1016/j.psychsport.2023.102530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 07/03/2023] [Accepted: 08/31/2023] [Indexed: 09/09/2023]
Abstract
Three studies explored exercise preferences in real-world and virtual environments, and their relationship with social physique anxiety (SPA), social comparison, and self-presentational efficacy (SPE). In Study 1 (N = 230), real-world exercise preferences were explored. Study 2 (N = 228) measured preferences for real-world and virtual reality (VR) exercise, and Study 3 (N = 249) investigated preferences for avatar embodiment and virtual companions within VR. Results revealed that participants who preferred home-based exercise had lower exercise behaviour, more negative fitness-related social comparisons, or lower SPE expectancy and outcome value (Study 1). Individuals with lower exercise behaviour, more negative fitness-related social comparisons, lower SPE expectancy, or higher SPA were also more likely to choose VR than real-world exercise (Study 2). In a VR exercise setting, participants with higher SPA and more negative social comparisons also preferred to embody a non-human and fantasy avatar more than a realistic avatar. A heightened threat of negative social comparison when imagining exercise with a physically superior virtual companion resulted in the strongest preference to embody a fantasy avatar (Study 3). The results suggest that individuals who place high importance on self-presentation and have low belief in their capacity to project an image of competence to others, are more likely to prefer exercise contexts that minimise physique- and fitness-related evaluation. Moreover, VR may afford a less psychosocially threatening context for individuals who feel self-conscious or comparatively inferior to others during exercise.
Collapse
Affiliation(s)
- Robyn L Moffitt
- School of Psychology, Faculty of Health, Deakin University, Geelong, VIC, Australia; School of Applied Psychology, Griffith University, Gold Coast, QLD, Australia.
| |
Collapse
|
4
|
Sattar S, Papadopoulos E, Smith GVH, Haase KR, Kobekyaa F, Tejero I, Bradley C, Nadler MB, Campbell KL, Santa Mina D, Alibhai SMH. State of research, feasibility, safety, acceptability, and outcomes examined on remotely delivered exercises using technology for older adult with cancer: a scoping review. J Cancer Surviv 2023:10.1007/s11764-023-01427-9. [PMID: 37418170 DOI: 10.1007/s11764-023-01427-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 06/28/2023] [Indexed: 07/08/2023]
Abstract
INTRODUCTION Technology-based exercise is gaining attention as a promising strategy for increasing physical activity (PA) in older adults with cancer (OACA). However, a comprehensive understanding of the interventions, their feasibility, outcomes, and safety is limited. This scoping review (1) assessed the prevalence and type of technology-based remotely delivered exercise interventions for OACA and (2) explored the feasibility, safety, acceptability, and outcomes in these interventions. METHODS Studies with participant mean/median age ≥ 65 reporting at least one outcome measure were included. Databases searched included the following: PubMed, CINAHL, Embase, Cochrane Library Online, SPORTDiscus, and PsycINFO. Multiple independent reviewers completed screening and data abstractions of articles in English, French, and Spanish. RESULTS The search yielded 2339 citations after removing duplicates. Following title and abstract screening, 96 full texts were review, and 15 were included. Study designs were heterogeneous, and sample sizes were diverse (range 14-478). The most common technologies used were website/web portal (n = 6), videos (n = 5), exergaming (n = 2), accelerometer/pedometer with video and/or website (n = 4), and live-videoconferencing (n = 2). Over half (9/15) of the studies examined feasibility using various definitions; feasibility outcomes were reached in all. Common outcomes examined include lower body function and quality of life. Adverse events were uncommon and minor were reported. Qualitative studies identified cost- and time-savings, healthcare professional support, and technology features that encourage engagement as facilitators. CONCLUSION Remote exercise interventions using technology appear to be feasible and acceptable in OACA. IMPLICATIONS FOR CANCER SURVIVORS Some remote exercise interventions may be a viable way to increase PA for OACA.
Collapse
Affiliation(s)
- S Sattar
- College of Nursing, University of Saskatchewan, 108-4400 4th Ave, Regina, SK, S4T 0H6, Canada.
| | - E Papadopoulos
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 610 University Ave, Toronto, ON, M5G 2C4, Canada
- Department of Medicine, University of Toronto, Toronto, 6 Queen's Park Crescent West, 3/F, Toronto, ON, M5S 3H2, Canada
| | - G V H Smith
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, 212 - 2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - K R Haase
- Faculty of Applied Science, School of Nursing, University of British Columbia, T201-2211, Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada
| | - F Kobekyaa
- Faculty of Applied Science, School of Nursing, University of British Columbia, T201-2211, Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada
| | - I Tejero
- Department of Geriatric Medicine, Parc de Salut Mar, Pg. Marítim de la Barceloneta, 25, 29, 08003, Barcelona, Spain
| | - C Bradley
- Library, University of Regina, 3737 Wascana Parkway, Regina, SK, S4S 0A2, Canada
| | - M B Nadler
- Department of Medicine, University of Toronto, Toronto, 6 Queen's Park Crescent West, 3/F, Toronto, ON, M5S 3H2, Canada
- Division of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, 610 University Ave, Toronto, ON, M5G 2C4, Canada
| | - K L Campbell
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, 212 - 2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - D Santa Mina
- Faculty of Kinesiology and Physical Education, University of Toronto, 55 Harbord Street, Toronto, ON, M5S 2W6, Canada
| | - S M H Alibhai
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 610 University Ave, Toronto, ON, M5G 2C4, Canada
- Department of Medicine, University of Toronto, Toronto, 6 Queen's Park Crescent West, 3/F, Toronto, ON, M5S 3H2, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, 155 College Street, Ste. 425, Toronto, ON, M5T 3M6, Canada
| |
Collapse
|
5
|
Schleicher E, McAuley E, Courneya KS, Anton P, Ehlers DK, Phillips SM, Brown NI, Oster RA, Pekmezi D, Rogers LQ. Breast cancer survivors' exercise preferences change during an exercise intervention are associated with post-intervention physical activity. J Cancer Surviv 2023:10.1007/s11764-023-01389-y. [PMID: 37120460 DOI: 10.1007/s11764-023-01389-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 04/19/2023] [Indexed: 05/01/2023]
Abstract
PURPOSE Exercise program preferences are important for designing physical activity (PA) interventions; yet may change following an intervention. Further, the relationship between preferences and PA behavior change is unclear. This study evaluated exercise program preferences among breast cancer survivors (BCS) before and after a behavioral intervention and associations between program preferences and PA change. METHODS BCS were randomized to the BEAT Cancer intervention (n = 110) or written materials (n = 112). Questionnaires assessed exercise program preferences. Minutes per week of moderate-to-vigorous PA (MVPA) were accelerometer-measured and self-reported at baseline (M0), post-intervention (M3), and 3-month follow-up (M6). RESULTS At M0, the majority of intervention group participants preferred exercising with others (62%) yet shifted to preferring exercising alone (59%) at M3 (p < 0.001). Furthermore, preferring exercising with others at M0 was associated with greater increases in self-reported MVPA between M0 and M6 (124.2 ± 152 vs. 53.1 ± 113.8, p = 0.014). BCS preferring facility-based exercise decreased after the BEAT Cancer intervention (14% vs. 7%, p = 0.039) and preferring exercising at home/had no preference at M0 had greater improvements in accelerometer-measured MVPA from M0 to M3 (74.3 ± 118.8 vs. -2.3 ± 78.4, p = 0.033) and M0 to M6 (44.9 ± 112.8 vs. 9.3 ± 30.4, p = 0.021). Exercise program preferences regarding mode of counseling, training supervision, and type of exercise changed from M0 to M3 but were not associated with changes in MVPA. CONCLUSION Findings suggest BCS exercise program preferences may change after an intervention and be associated with changes in MVPA. Understanding the role of PA preferences will better inform the design and success of PA behavior change interventions. ClinicTrials.gov, ClinicalTrials.gov number: NCT00929617.
Collapse
Affiliation(s)
- Erica Schleicher
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA.
- O'Neal Comprehensive Cancer Center at UAB, Birmingham, AL, USA.
| | - Edward McAuley
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA
- The Cancer Center at Illinois, Urbana, IL, USA
| | - Kerry S Courneya
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB, Canada
| | - Philip Anton
- School of Human Sciences, Southern Illinois University Carbondale, Carbondale, IL, USA
| | - Diane K Ehlers
- Division of Epidemiology, Mayo Clinic, Scottsdale, AZ, USA
| | - Siobhan M Phillips
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Nashira I Brown
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Robert A Oster
- O'Neal Comprehensive Cancer Center at UAB, Birmingham, AL, USA
- Division of Preventive Medicine, Department of Medicine, Birmingham, AL, USA
| | - Dorothy Pekmezi
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
- O'Neal Comprehensive Cancer Center at UAB, Birmingham, AL, USA
| | - Laura Q Rogers
- O'Neal Comprehensive Cancer Center at UAB, Birmingham, AL, USA
- Division of Preventive Medicine, Department of Medicine, Birmingham, AL, USA
| |
Collapse
|
6
|
Way KM, Bourne JE, Armstrong MEG. "I'm Hooked on e-cycling, I Can Finally Be Active Again": Perceptions of e-cycling as a Physical Activity Intervention during Breast Cancer Treatment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5197. [PMID: 36982111 PMCID: PMC10049330 DOI: 10.3390/ijerph20065197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/06/2023] [Accepted: 03/10/2023] [Indexed: 06/18/2023]
Abstract
Electrically-assisted bicycles (e-bikes) are a means through which to increase individual physical activity (PA) and overcome some commonly reported barriers to engaging in conventional cycling. Fatigue is a common side effect to breast cancer treatment, and the rate of PA engagement drops significantly following a breast cancer diagnosis. The aim of this qualitative study was to examine perceptions of e-cycling as a means of increasing PA in this population. Twenty-four participants (mean age = 57.88 (standard deviation 10.8), 100% female) who have had a breast cancer diagnosis, completed two semi-structured interviews via Zoom. One interview was conducted prior to an e-bike taster session and a second, after the session. Taster sessions were conducted by certified cycling instructors in the community. Interviews were conducted between December 2021 and May 2022. Data were transcribed verbatim and analyzed thematically using NVivo 12 software. An inductive and deductive approach to analysis was adopted. Five themes were generated: (1) Perceived role of e-bikes during treatment, (2) The relationship between e-bikes and fatigue, (3) Cancer-specific considerations, (4) Is e-cycling 'enough'?, and (5) Optimizing the intervention. Negative perceptions of e-bikes noted before the taster session were altered following riding an e-bike. The multiple levels of assistance made cycling manageable and less impacted by fatigue, thereby enabling individuals to re-establish previous cycling habits. E-cycling may be a suitable option to increase PA behavior amongst individuals being treated for breast cancer, with the potential to overcome many of the barriers of conventional cycling. Enabling this population to trial an e-bike elicits positive physical and psychological responses that may help to promote future engagement.
Collapse
|
7
|
Relationships between Obesity, Exercise Preferences, and Related Social Cognitive Theory Variables among Breast Cancer Survivors. Nutrients 2023; 15:nu15051286. [PMID: 36904284 PMCID: PMC10005113 DOI: 10.3390/nu15051286] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 02/22/2023] [Accepted: 03/01/2023] [Indexed: 03/08/2023] Open
Abstract
Breast cancer survivors with obesity have an increased risk of cancer recurrence, second malignancy, and comorbidities. Though physical activity (PA) interventions are needed, investigation of the relationships between obesity and factors influencing PA program aspects among cancer survivors remain understudied. Thus, we conducted a cross-sectional study examining associations amongst baseline body mass index (BMI), PA program preferences, PA, cardiorespiratory fitness, and related social cognitive theory variables (self-efficacy, exercise barriers interference, social support, positive and negative outcome expectations) from a randomized controlled PA trial with 320 post-treatment breast cancer survivors. BMI was significantly correlated with exercise barriers interference (r = 0.131, p = 0.019). Higher BMI was significantly associated with preference to exercise at a facility (p = 0.038), lower cardiorespiratory fitness (p < 0.001), lower walking self-efficacy (p < 0.001), and higher negative outcome expectations (p = 0.024), independent of covariates (comorbidity score, Western Ontario and McMaster Universities osteoarthritis index score, income, race, education). Those with class I/II obesity reported a higher negative outcome expectations score compared with class III. Location, walking self-efficacy, barriers, negative outcome expectations, and fitness should be considered when designing future PA programs among breast cancer survivors with obesity.
Collapse
|
8
|
Nuzzo JL. Narrative Review of Sex Differences in Muscle Strength, Endurance, Activation, Size, Fiber Type, and Strength Training Participation Rates, Preferences, Motivations, Injuries, and Neuromuscular Adaptations. J Strength Cond Res 2023; 37:494-536. [PMID: 36696264 DOI: 10.1519/jsc.0000000000004329] [Citation(s) in RCA: 42] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
ABSTRACT Nuzzo, JL. Narrative review of sex differences in muscle strength, endurance, activation, size, fiber type, and strength training participation rates, preferences, motivations, injuries, and neuromuscular adaptations. J Strength Cond Res 37(2): 494-536, 2023-Biological sex and its relation with exercise participation and sports performance continue to be discussed. Here, the purpose was to inform such discussions by summarizing the literature on sex differences in numerous strength training-related variables and outcomes-muscle strength and endurance, muscle mass and size, muscle fiber type, muscle twitch forces, and voluntary activation; strength training participation rates, motivations, preferences, and practices; and injuries and changes in muscle size and strength with strength training. Male subjects become notably stronger than female subjects around age 15 years. In adults, sex differences in strength are more pronounced in upper-body than lower-body muscles and in concentric than eccentric contractions. Greater male than female strength is not because of higher voluntary activation but to greater muscle mass and type II fiber areas. Men participate in strength training more frequently than women. Men are motivated more by challenge, competition, social recognition, and a desire to increase muscle size and strength. Men also have greater preference for competitive, high-intensity, and upper-body exercise. Women are motivated more by improved attractiveness, muscle "toning," and body mass management. Women have greater preference for supervised and lower-body exercise. Intrasexual competition, mate selection, and the drive for muscularity are likely fundamental causes of exercise behaviors in men and women. Men and women increase muscle size and strength after weeks of strength training, but women experience greater relative strength improvements depending on age and muscle group. Men exhibit higher strength training injury rates. No sex difference exists in strength loss and muscle soreness after muscle-damaging exercise.
Collapse
Affiliation(s)
- James L Nuzzo
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| |
Collapse
|
9
|
Schleicher E, McAuley E, Courneya KS, Anton P, Ehlers DK, Phillips SM, Brown NI, Oster RA, Pekmezi D, Rogers LQ. Breast Cancer Survivors' Exercise Preferences Change During an Exercise Intervention and are associated with Post-Intervention Physical Activity. RESEARCH SQUARE 2023:rs.3.rs-2488848. [PMID: 36711885 PMCID: PMC9882674 DOI: 10.21203/rs.3.rs-2488848/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Purpose Exercise program preferences are important for designing physical activity (PA) interventions; yet may change following an intervention. Further, the relationship between preferences and PA behavior change is unclear. This study evaluated exercise program preferences among breast cancer survivors (BCS) before and after a behavioral intervention and associations between program preferences and PA change. Methods BCS were randomized to the BEAT Cancer intervention (n = 110) or written materials (n = 112). Questionnaires assessed exercise program preferences. Minutes per week of moderate-to-vigorous PA (MVPA) were accelerometer-measured and self-reported at baseline (M0), post-intervention (M3), and 3-month follow-up (M6). Results At M0, the majority of intervention group participants preferred exercising with others (62%) yet shifted to preferring exercising alone (59%) at M3 ( p < 0.001). Furthermore, preferring exercising with others at M0 was associated with greater increases in self-reported MVPA between M0 and M6 (124.2 ± 152 vs. 53.1 ± 113.8, p = 0.014). BCS preferring facility-based exercise decreased after the BEAT Cancer intervention (14% vs. 7%, p = 0.039) and preferring exercising at home/had no preference at M0 had greater improvements in accelerometer-measured MVPA from M0 to M3 (74.3 ± 118.8 vs. -2.3 ± 78.4, p = 0.033) and M0 to M6 (44.9 ± 112.8 vs. 9.3 ± 30.4, p = 0.021). Exercise program preferences regarding mode of counseling, training supervision, and type of exercise changed from M0 to M3 but were not associated with changes in MVPA. Conclusion Findings suggest BCS exercise program preferences may change after an intervention and be associated with changes in MVPA. Understanding the role of PA preferences will better inform the design and success of PA behavior change interventions. ClinicTrials.gov, ClinicalTrials.gov number: NCT00929617.
Collapse
|
10
|
Orange ST, Hallsworth K, Brown MC, Reeves HL. The feasibility and acceptability of a home-based, virtual exercise intervention for older patients with hepatocellular carcinoma: protocol for a non-randomised feasibility study (TELEX-Liver Cancer). Pilot Feasibility Stud 2022; 8:113. [PMID: 35624520 PMCID: PMC9135985 DOI: 10.1186/s40814-022-01069-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 05/17/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND The number of incident cases and deaths from primary liver cancer, predominantly hepatocellular carcinoma (HCC), has increased markedly in the last two decades. HCC is generally diagnosed at an advanced stage, and most new cases are in people aged over 70 years with age-related comorbidities. Treatment options are often limited, with most patients receiving palliative treatment or supportive care only. As a consequence, maintaining quality of life (QoL) through symptom management is critically important and is a core objective of clinical care. Strong evidence supports the efficacy of supervised exercise training for addressing certain cancer-related symptoms, including QoL, physical function, and fatigue. However, there are many barriers to implementing supervised exercise programmes within cancer care pathways, including economic pressures on healthcare systems and personal barriers for patients. Recent advances in technology allow patients to exercise at home under the 'virtual' supervision of an exercise professional through videoconferencing software (termed 'telehealth exercise'). Despite its potential, there are uncertainties relating to the feasibility, acceptability, and safety of telehealth exercise in people living with HCC. METHODS This is a protocol for a prospective, single-centre, single-arm, pretest-posttest feasibility trial. We aim to recruit 20 patients aged 60 years or older who have received treatment for HCC and are undergoing routine clinical monitoring. Patients will be invited to take part in two online, home-based, group exercise sessions per week for 10 consecutive weeks. The 'virtual' exercise sessions will be delivered in real time by an exercise professional through videoconferencing software. Each session will comprise 30 min of aerobic and resistance exercise performed at a moderate intensity, as guided by the 10-point Borg rating of perceived exertion scale. Feasibility outcomes include recruitment, retention, adherence, intervention fidelity, and safety. Acceptability of the intervention will be assessed using a mixed-methods approach via monthly online surveys and an exit telephone interview. Physical function, accelerometry-measured physical activity, mid-upper arm circumference, and patient-reported outcome measures (PROMS) will be assessed before and after the intervention to determine the feasibility of assessing outcome measures. Physical function outcomes include the short physical performance battery and Liver Frailty Index. PROMS include the Functional Assessment of Cancer Therapy-Hepatobiliary questionnaire, Functional Assessment of Chronic Illness Therapy-Fatigue questionnaire, Activities-specific Balance Confidence scale, Hospital Anxiety and Depression Scale, and the Godin Leisure-Time Exercise Questionnaire. DISCUSSION This mixed-methods study will address uncertainties relating to the feasibility and acceptability of delivering live, online, home-based, group exercise sessions to patients with HCC. The findings will inform whether any modifications are required to refine and optimise the intervention, and the assessment of outcome measures will provide information on the likely size and variability of intervention effects. Collectively, the data generated will inform the design of a subsequent, adequately powered, randomised controlled trial to evaluate the efficacy of the telehealth exercise intervention. TRIAL REGISTRATION ISRCTN14411809.
Collapse
Affiliation(s)
- Samuel T Orange
- Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK
- School of Biomedical, Nutritional and Sport Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Kate Hallsworth
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- The Liver Unit, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Morven C Brown
- Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Helen L Reeves
- Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK.
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.
- The Liver Unit, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK.
| |
Collapse
|
11
|
Smith-Turchyn J, Allen L, Dart J, Lavigne D, Rooprai S, Dempster H, Trenholm R, Santa Mina D, Sabiston CM, MacMillan L, Adams SC. Characterizing the Exercise Behaviour, Preferences, Barriers, and Facilitators of Cancer Survivors in a Rural Canadian Community: A Cross-Sectional Survey. ACTA ACUST UNITED AC 2021; 28:3172-3187. [PMID: 34436042 PMCID: PMC8395505 DOI: 10.3390/curroncol28040276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 08/16/2021] [Accepted: 08/16/2021] [Indexed: 01/06/2023]
Abstract
Barriers, facilitators, and motivators to exercise for cancer survivors living in urban settings are well described in the literature. However, there is a lack of comparable information for cancer survivors living in rural communities. We describe the exercise behaviours, barriers, facilitators, and motivators to exercise participation of cancer survivors living in a rural Canadian community. Adult cancer survivors with a primary address in a rural region of Ontario, Canada, who had visited a community hospital in the previous five years were mailed a cross-sectional survey assessing current exercise volume (minutes of moderate-to-vigorous aerobic and resistance exercise), as well as exercise preferences, barriers, and facilitators. Seventy-two survivors (mean age 65 years) completed the survey (16% response rate). A majority of respondents were diagnosed with breast cancer (49%) in the last 5 years (61%). Aerobic- and resistance-training guidelines for cancer survivors were met by 38% and 10% of respondents, respectively. Physical side effects were the most common barrier to exercise during treatment (65%) and post-treatment (35%). Being unaware of available exercise programs, time for exercise, distance to exercise services, and cost were commonly reported barriers during and post-treatment (reported by 10–22%). Respondents reported needing information from a qualified exercise professional (46%), access to a gym (33%) and exercise equipment (26%), and social support (25%) to facilitate exercise participation. Consistent with urban-based cancer survivors, most rural survivors surveyed in this study were not meeting the physical-activity guidelines and reported numerous exercise barriers. These findings can serve as a resource for this and similar rural communities when developing community-based exercise-support services for cancer survivors.
Collapse
Affiliation(s)
- Jenna Smith-Turchyn
- School of Rehabilitation Science, McMaster University, 1400 Main Street West, Hamilton, ON L8S 1C7, Canada;
| | - Lisa Allen
- Huntsville Physicians, South Muskoka and Parry Sound Local Education Groups, 100 Frank Miller Drive, Huntsville, ON P1H 1H7, Canada; (L.A.); (J.D.); (D.L.)
| | - Jennifer Dart
- Huntsville Physicians, South Muskoka and Parry Sound Local Education Groups, 100 Frank Miller Drive, Huntsville, ON P1H 1H7, Canada; (L.A.); (J.D.); (D.L.)
| | - Deanna Lavigne
- Huntsville Physicians, South Muskoka and Parry Sound Local Education Groups, 100 Frank Miller Drive, Huntsville, ON P1H 1H7, Canada; (L.A.); (J.D.); (D.L.)
| | - Simran Rooprai
- School of Interdisciplinary Science, Faculty of Science, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8, Canada;
| | - Helen Dempster
- Northern Ontario School of Medicine, 935 Ramsey Lake Road, Sudbury, ON P3E 2C6, Canada; (H.D.); (R.T.); (L.M.)
| | - Richard Trenholm
- Northern Ontario School of Medicine, 935 Ramsey Lake Road, Sudbury, ON P3E 2C6, Canada; (H.D.); (R.T.); (L.M.)
| | - Daniel Santa Mina
- Faculty of Kinesiology and Physical Education, University of Toronto, 55 Harbord Street, Toronto, ON M5S 2W6, Canada; (D.S.M.); (C.M.S.)
| | - Catherine M. Sabiston
- Faculty of Kinesiology and Physical Education, University of Toronto, 55 Harbord Street, Toronto, ON M5S 2W6, Canada; (D.S.M.); (C.M.S.)
| | - Lindsay MacMillan
- Northern Ontario School of Medicine, 935 Ramsey Lake Road, Sudbury, ON P3E 2C6, Canada; (H.D.); (R.T.); (L.M.)
| | - Scott C. Adams
- Faculty of Kinesiology and Physical Education, University of Toronto, 55 Harbord Street, Toronto, ON M5S 2W6, Canada; (D.S.M.); (C.M.S.)
- Department of Cardiology, Toronto General Hospital Research Institute, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada
- Ted Rogers Cardiotoxicity Prevention Program, Peter Munk Cardiac Centre, 661 University Avenue, Toronto, ON M5G 1X8, Canada
- Correspondence:
| |
Collapse
|
12
|
Ibeggazene S, Turner R, Rosario D, Bourke L. Remote interventions to improve exercise behaviour in sedentary people living with and beyond cancer: a systematic review and meta-analysis. BMC Cancer 2021; 21:308. [PMID: 33761906 PMCID: PMC7987748 DOI: 10.1186/s12885-021-07989-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 03/01/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has forced many cancer services to consider a transition to a remote format of delivery that is largely untested. Accordingly, we sought to perform a systematic review of the effects of remotely delivered interventions to improve exercise behaviour in sedentary adults living with and beyond cancer. METHODS Eligible studies were randomised controlled trials comparing a remotely delivered exercise intervention to a usual care comparison in sedentary people over 18 years old with a primary cancer diagnosis. Nine electronic databases were searched from inception to November 2020. RESULTS The review included three trials, totalling 186 participants. Two of the included trials incorporated prescriptions that meet current aerobic exercise recommendations, one of which also meets the guidelines for resistance exercise. No trials reported an intervention adherence of 75% or more for a set prescription that meets current exercise guidelines. CONCLUSION There is little evidence suggesting that remote exercise interventions promote exercise behaviours or improve physical function in sedentary adults living with and beyond cancer. The development and evaluation of novel remote exercise interventions is needed to establish their usefulness for clinical practice. Given the social response to the COVID-19 pandemic, further research in this area is urgently needed.
Collapse
Affiliation(s)
- Saïd Ibeggazene
- College of Health, Wellbeing and Life Sciences, Sheffield Hallam University, Sheffield, UK.
| | - Rebecca Turner
- College of Health, Wellbeing and Life Sciences, Sheffield Hallam University, Sheffield, UK
| | - Derek Rosario
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Liam Bourke
- College of Health, Wellbeing and Life Sciences, Sheffield Hallam University, Sheffield, UK
| |
Collapse
|
13
|
Adams JL, Martin MY, Pisu M, Oster RA, Qu H, Shewchuk RM, Sheffield ME, Minter A, Baumann AA, Rogers LQ. Determining patient needs to enhance exercise program implementation and uptake in rural settings for women after a cancer diagnosis. Support Care Cancer 2021; 29:4641-4649. [PMID: 33495849 DOI: 10.1007/s00520-021-05990-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 01/06/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE To qualitatively explore exercise barriers and facilitators experienced by rural female cancer survivors from the program interventionist and recipient perspective for the purpose of enhancing exercise program implementation and uptake in rural settings. METHODS A descriptive qualitative study design was utilized. Focus groups were conducted prior to implementation of an evidence-based exercise program by a rural non-research cancer clinical site. Nineteen rural female cancer survivors (mean age = 61.7 ± 10.9 years) and 11 potential interventionists (mean age = 42.3 ± 15.3 years) completed focus groups (stratified by participant role). Focus groups were audio recorded, transcribed, coded, and analyzed using inductive thematic analysis with NVivo 11. RESULTS Cancer survivors identified 12 barrier themes (cancer specific adverse effects, lack of support, lack of knowledge, perceived negative aspects of exercise, cost, lack of resources, motivation, inconvenience, lack of program flexibility, time, weather, safety) and eight facilitator themes (knowledge, ease of access, resources, awareness, cost, options, organized, fun) related to exercise. Interventionists identified seven barrier themes (cost, transportation, lack of cancer survivor and interventionist knowledge, fear, motivation, lack of support, lack of resources) and four facilitator themes (resources, support, knowledge, motivation). Narratives revealed differing role-specific perspectives on shared themes between survivors and interventionists as well as potential implementation strategies for enhancing exercise participation and exercise program uptake among rural female cancer survivors. CONCLUSION Exploring multi-level stakeholder perspectives on cancer survivors' exercise needs and related strategies yields important information for organizations to consider when implementing exercise programs in rural contexts.
Collapse
Affiliation(s)
- Jessica L Adams
- University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, 35294, USA
| | | | - Maria Pisu
- University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, 35294, USA
| | - Robert A Oster
- University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, 35294, USA
| | - Haiyan Qu
- University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, 35294, USA
| | - Richard M Shewchuk
- University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, 35294, USA
| | | | - Alex Minter
- Russell Medical Center, Alexander City, AL, USA
| | - Ana A Baumann
- Washington University in Saint Louis, Saint Louis, MO, USA
| | - Laura Q Rogers
- University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, 35294, USA.
| |
Collapse
|
14
|
Bastos VS, Martins JC, Faria CDCDM. Preferência de exercícios de indivíduos acometidos pelo acidente vascular cerebral usuários da atenção básica de saúde. FISIOTERAPIA E PESQUISA 2021. [DOI: 10.1590/1809-2950/20008528032021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO Indivíduos acometidos pelo acidente vascular cerebral (AVC) tendem a manter um padrão sedentário de vida com nível de atividade física insuficiente, gerando limitações funcionais, restrição na participação e dificuldade de envolvimento em programas de exercícios. Compreender a preferência de exercícios desta população é importante para o entendimento dos fatores contextuais e a adequação de programas voltados à promoção de saúde e funcionalidade. Trata-se de um estudo transversal com amostra de conveniência, cujos objetivos foram identificar a preferência de exercícios de indivíduos na fase crônica do AVC usuários do Sistema Único de Saúde em Belo Horizonte, (MG), Brasil, e investigar a associação com o grau de comprometimento motor, velocidade de marcha, nível de atividade física e qualidade de vida. A preferência de exercícios foi avaliada pelo Questionário de Preferência de Exercícios(AVC)-Brasil. Foram entrevistados 24 indivíduos (59±15 anos) que reportaram preferência por exercícios realizados em ambientes controlados e ofertados em grupo. Os exercícios favoritos foram a caminhada e o treino de força muscular. Não houve correlação entre a preferência de exercícios e as variáveis investigadas. Identificar a preferência de exercícios desta população pode contribuir para uma melhor assistência à saúde fornecida pelos serviços públicos, além de aumentar a adesão desses indivíduos aos programas de promoção à saúde e funcionalidade.
Collapse
|
15
|
Mama SK, Bhuiyan N, Foo W, Segel JE, Bluethmann SM, Winkels RM, Wiskemann J, Calo WA, Lengerich EJ, Schmitz KH. Rural-urban differences in meeting physical activity recommendations and health status in cancer survivors in central Pennsylvania. Support Care Cancer 2020; 28:5013-5022. [PMID: 32036469 PMCID: PMC7415488 DOI: 10.1007/s00520-020-05342-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 02/02/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE This study explored rural-urban differences in meeting physical activity (PA) recommendations and health status in cancer survivors in central Pennsylvania and associations between PA and health status. METHODS Cancer survivors (N = 2463) were identified through a state cancer registry and mailed questionnaires assessing PA and health status. Rural-urban residence was based on county of residence at diagnosis. Participants self-reported frequency and duration of leisure-time PA and were classified as meeting: (1) aerobic recommendations (≥ 150 min/week), (2) muscle-strengthening recommendations (≥ 2 times/week), (3) both aerobic and muscle-strengthening recommendations, or (4) neither recommendation. Logistic regression models examined associations between rural-urban residence and meeting PA recommendations and associations between PA and health status, adjusting for age, cancer type, gender, and income. RESULTS Nearly 600 (N = 591, 24.0%) cancer survivors returned completed questionnaires (rural 9.5%, urban 90.5%). Half (50.0%) of rural cancer survivors reported no leisure-time PA compared to 35.2% of urban cancer survivors (p = 0.020), and urban cancer survivors were 2.6 times more likely to meet aerobic PA recommendations (95% CI 1.1-6.4). Odds of reporting good physical and mental health were 2.3 times higher among survivors who reported meeting aerobic recommendations compared to those who did not meet PA recommendations (95% CI 1.1-4.5), adjusting for rurality and covariates. CONCLUSIONS Results demonstrate persistent rural-urban differences in meeting PA recommendations in cancer survivors and its association with self-reported health. IMPLICATIONS FOR CANCER SURVIVORS Findings underscore the need for interventions to increase PA in rural cancer survivors in an effort to improve health status and reduce cancer health disparities.
Collapse
Affiliation(s)
- Scherezade K Mama
- Department of Kinesiology, The Pennsylvania State University, 268J Recreation Building, University Park, PA, 16802, USA.
- Penn State Cancer Institute, Hershey, PA, USA.
| | - Nishat Bhuiyan
- Department of Kinesiology, The Pennsylvania State University, 268J Recreation Building, University Park, PA, 16802, USA
| | - Wayne Foo
- Penn State Cancer Institute, Hershey, PA, USA
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Joel E Segel
- Penn State Cancer Institute, Hershey, PA, USA
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA
- Department of Health Policy and Administration, The Pennsylvania State University, University Park, PA, USA
| | - Shirley M Bluethmann
- Penn State Cancer Institute, Hershey, PA, USA
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Renate M Winkels
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA
- Human Nutrition & Health, Wageningen University & Research, Wageningen, The Netherlands
| | - Joachim Wiskemann
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA
- Department of Medical Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, Heidelberg, Germany
| | - William A Calo
- Penn State Cancer Institute, Hershey, PA, USA
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Eugene J Lengerich
- Penn State Cancer Institute, Hershey, PA, USA
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Kathryn H Schmitz
- Penn State Cancer Institute, Hershey, PA, USA
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| |
Collapse
|
16
|
Maxwell-Smith C, Hagger MS, Kane R, Cohen PA, Tan J, Platell C, Makin GB, Saunders C, Nightingale S, Lynch C, Sardelic F, McCormick J, Hardcastle SJ. Psychological correlates of physical activity and exercise preferences in metropolitan and nonmetropolitan cancer survivors. Psychooncology 2020; 30:221-230. [PMID: 32920935 DOI: 10.1002/pon.5553] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 09/01/2020] [Accepted: 09/08/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Interventions to increase physical activity (PA) in cancer survivors have often adopted a "one-size-fits-all" approach and may benefit from being tailored to psychological constructs associated with behavior. The study objective was to investigate the exercise preferences and psychological constructs related to PA among cancer survivors. METHODS Posttreatment colorectal, endometrial, and breast cancer survivors (n = 183) living in metropolitan and nonmetropolitan areas completed survey measures of PA, exercise preferences, attitudes, self-efficacy, perceived behavioral control (PBC), and intention toward PA. RESULTS A structural equation model with adequate fit and quality indices revealed that instrumental attitude and self-efficacy were related to PA intention. Intention was related to behavior and mediated the relationship between self-efficacy and behavior. Preferred exercise intensity was related to self-efficacy, PBC, attitudes, and intention, while preferred exercise company was related to self-efficacy and PBC. Participants preferred moderate-intensity PA (71%), specifically self-paced (52%) walking (65%) in an outdoor environment (58%). CONCLUSIONS Since instrumental attitude and self-efficacy were associated with PA, incorporating persuasive communications targeting attitudes in PA interventions may promote PA participation. As cancer survivors who prefer low-intensity exercise and exercising with others report lower self-efficacy and PBC, interventions targeting confidence and successful experience in this group may also be warranted.
Collapse
Affiliation(s)
- Chloe Maxwell-Smith
- School of Psychology, Curtin University, Perth, Western Australia, Australia.,Institute for Health Research, University of Notre Dame, Fremantle, Western Australia, Australia
| | - Martin S Hagger
- School of Psychological Sciences, University of California, Merced, USA.,Faculty of Sport and Health Sciences, University of Jyväskylä, Jyvaskyla, Finland
| | - Robert Kane
- School of Psychology, Curtin University, Perth, Western Australia, Australia
| | - Paul A Cohen
- St John of God Hospital, Subiaco, Western Australia, Australia
| | - Jason Tan
- St John of God Hospital, Subiaco, Western Australia, Australia
| | - Cameron Platell
- St John of God Hospital, Subiaco, Western Australia, Australia
| | | | | | | | - Craig Lynch
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Frank Sardelic
- Tamara Private Hospital, Tamworth, New South Wales, Australia
| | | | - Sarah J Hardcastle
- Institute for Health Research, University of Notre Dame, Fremantle, Western Australia, Australia.,School of Health and Human Performance, Dublin City University, Dublin, Ireland
| |
Collapse
|
17
|
Modesitt SC, Eichner N, Penberthy JK, Horton BJ, Stewart ME, Lacy R, Weltman AL. "Moving Away From Cancer" Prospective Exercise Trial for Female Rural Cancer Survivors: How Can We Step It Up? JCO Oncol Pract 2020; 17:e16-e25. [PMID: 32877271 DOI: 10.1200/op.20.00407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE This prospective trial's objective was to determine feasibility and outcomes of an exercise-based intervention for rural overweight/obese female cancer survivors. MATERIALS AND METHODS Survivors of endometrial, breast, or ovarian cancer enrolled in a 6-month program of increased aerobic activity (30 minutes daily walking) and strength-training exercises using exercise bands (THERABAND; Akron, OH) with personalized telephone motivational coaching. Baseline demographics, anthropomorphic measurements, quality of life (QOL), fitness, and readiness to adopt exercise changes were assessed; daily steps, band use, and follow-up measurements were assessed at 3 and 6 months. Study completion was modeled using logistic regression. RESULTS The mean age of the 99 women was 59.9 years, the mean body mass index (BMI) was 35.9 kg/m2, 88.9% were white, and 41.4% reported current exercise. Fifty-five women (55.6%) completed the 6-month program, and 36 (36.4%) completed exercise interventions. Using logistic regression to model study completion, only baseline QOL scores (physical component summary) and mental component summary) remained significant predictors. The mean weight change was a gain (0.88 kg). Higher MCS baseline scores and prior regular exercise predicted continued exercise and increased step counts, whereas higher BMI and baseline sleep predicted decreased QOL. Top walking barriers were feeling unwell and weather; barriers to strength exercises were band dislike and pain. CONCLUSION The most significant predictor of trial completion and improved exercise outcomes was a higher baseline mental QOL. Motivation, belief in the importance of exercise, and prescribed/monitored exercise regimens were not sufficient; supportive and cognitive behavioral therapy interventions for survivors are needed to sustain uptake.
Collapse
Affiliation(s)
- Susan C Modesitt
- Thornton Gynecologic Oncology Service, Department of Obstetrics and Gynecology, School of Medicine, University of Virginia, Charlottesville, VA
| | - Natalie Eichner
- Department of Kinesiology, Curry School of Education and Human Development, University of Virginia, Charlottesville, VA
| | - J Kim Penberthy
- Department of Psychiatry and Neurobehavioral Sciences, School of Medicine, University of Virginia, Charlottesville, VA
| | - Bethany J Horton
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, VA
| | - Martha E Stewart
- Thornton Gynecologic Oncology Service, Department of Obstetrics and Gynecology, School of Medicine, University of Virginia, Charlottesville, VA
| | - Rachel Lacy
- Thornton Gynecologic Oncology Service, Department of Obstetrics and Gynecology, School of Medicine, University of Virginia, Charlottesville, VA
| | - Arthur L Weltman
- Department of Kinesiology, Curry School of Education and Human Development, University of Virginia, Charlottesville, VA.,Department of Medicine, School of Medicine, University of Virginia, Charlottesville, VA
| |
Collapse
|
18
|
Avancini A, Trestini I, Tregnago D, Wiskemann J, Lanza M, Milella M, Pilotto S. Physical Activity for Oncological Patients in COVID-19 Era: No Time to Relax. JNCI Cancer Spectr 2020; 4:pkaa071. [PMID: 33385107 PMCID: PMC7499670 DOI: 10.1093/jncics/pkaa071] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/30/2020] [Accepted: 08/01/2020] [Indexed: 01/09/2023] Open
Abstract
Whereas the coronavirus disease 2019 (COVID-19) storm is relentlessly progressing worldwide, a great effort from scientific societies has been made to give recommendations for safely continuing oncological care, prioritizing the interventions according to patients' condition and type and stage of tumor. Nevertheless, to date no specific suggestions regarding physical activity and exercise in cancer patients during the COVID-19 era have been released, neglecting the potential deleterious effects of quarantine and sedentary behaviour (imposed as containment measures against COVID-19), particularly in these subjects. Moreover, literature is constantly consolidating the crucial impact of regular physical activity in cancer in reducing recurrence and mortality risk. In this commentary, we discuss possible adaptations of the recently published exercise guidelines to the current pandemic emergency, proposing various modalities to prevent or mitigate the physical inactivity risk in cancer patients.
Collapse
Affiliation(s)
- Alice Avancini
- Department of Medicine, Biomedical, Clinical and Experimental Sciences, University of Verona, Verona, Italy
| | - Ilaria Trestini
- Department of Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Daniela Tregnago
- Department of Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Joachim Wiskemann
- Division of Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg and University Clinic Heidelberg, Heidelberg, Germany
| | - Massimo Lanza
- Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Michele Milella
- Department of Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Sara Pilotto
- Department of Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| |
Collapse
|
19
|
McDonough AL, Lei Y, Kwak AH, Haggett DE, Jimenez RB, Johnston KT, Moy B, Spring LM, Peppercorn J. Implementation of a Brief Screening Tool to Identify Needs of Breast Cancer Survivors. Clin Breast Cancer 2020; 21:e88-e95. [PMID: 32807644 DOI: 10.1016/j.clbc.2020.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/26/2020] [Accepted: 07/09/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Innovation in health care delivery is needed to improve care for cancer survivors. We report our experience with adapting screening questions from the National Comprehensive Cancer Network (NCCN) guideline to evaluate the needs of breast cancer survivors. MATERIALS AND METHODS We adapted the NCCN-recommended screening questions into a plain language, self-administered 1-page intake questionnaire. The tool was administered to a convenience sample of female breast cancer survivors at follow-up oncology and primary care visits. Domains included symptoms, lifestyle concerns, and financial issues. Frequency of concerns was assessed as "never," "rarely," "sometimes," "very frequently," and "always." We evaluated feasibility and utility of administration and the prevalence and frequency of patient-reported concerns. RESULTS The questionnaire was highly acceptable to patients and enhanced visits for clinicians. Clinicians reported that it led to discussion of issues that may not otherwise be addressed in the visit and did not find it burdensome. The most commonly endorsed patient concerns were desire to improve fitness or nutrition, worry about cancer recurrence, and insomnia. A majority also reported feeling anxiety and aches or pains in joints or extremities. Several issues known to be underreported in clinic visits were frequently endorsed, included sexual dissatisfaction and memory impairments. Clinicians suggested incorporating the tool into the electronic health record to increase utility and awareness. CONCLUSION Screening for individual needs among breast cancer survivors is feasible, efficient, and may identify prevalent issues that otherwise can be missed in routine survivorship care.
Collapse
Affiliation(s)
| | - Yvonne Lei
- Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Agnes H Kwak
- Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Dana E Haggett
- Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Rachel B Jimenez
- Department of Medicine, Massachusetts General Hospital, Boston, MA
| | | | - Beverly Moy
- Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Laura M Spring
- Department of Medicine, Massachusetts General Hospital, Boston, MA
| | | |
Collapse
|
20
|
Avancini A, Pala V, Trestini I, Tregnago D, Mariani L, Sieri S, Krogh V, Boresta M, Milella M, Pilotto S, Lanza M. Exercise Levels and Preferences in Cancer Patients: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E5351. [PMID: 32722265 PMCID: PMC7432474 DOI: 10.3390/ijerph17155351] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 07/20/2020] [Accepted: 07/22/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Despite the benefits related to physical exercise, large numbers of cancer patients are not sufficiently active. METHODS To investigate exercise levels and preferences in cancer patients, a cross-sectional study was conducted on a random sample of 392 cancer outpatients who anonymously completed a questionnaire investigating general and medical characteristics, and expressed willingness to participate in exercise programs. Current exercise levels were estimated with the Leisure Score Index (LSI). RESULTS Most patients (93%) were insufficiently active but 80% declared an interest in exercise programs. Patients preferred oncologist-instructed programs and specified particular exercise needs. Multivariate logistic regression showed that willingness to exercise was associated with education (OR: 1.87; 95% CI: 1.15-3.04 beyond age 14 years vs. up to 14 years) and current physical activity (OR: 1.92; 95% CI: 1.92-3.63 for sweat-inducing activity >2 times/week vs. <1 time/week). Patients given chemotherapy were less inclined to exercise (OR: 0.45; 95% CI: 0.23-0.86) than those who did not. LSI was lower if cancer stage was advanced (β: -0.36; 95% CI: -0.75 to -0.02) than if it was in remission. High LSI was also associated with longer education, lower BMI, and longer time after diagnosis. CONCLUSION Cancer patients are insufficiently active but are willing to participate in personalized exercise programs. Information from this survey may help in designing personalized interventions so these patients will achieve sufficient exercise.
Collapse
Affiliation(s)
- Alice Avancini
- Department of Medicine, Biomedical, Clinical and Experimental Sciences, University of Verona, 37134 Verona, Italy;
| | - Valeria Pala
- Department of Research, Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (S.S.); (V.K.)
| | - Ilaria Trestini
- Medical Oncology Unit, University of Verona, Azienda Ospedaliera Universitaria Integrata, 37134 Verona, Italy; (I.T.); (D.T.); (M.M.); (S.P.)
| | - Daniela Tregnago
- Medical Oncology Unit, University of Verona, Azienda Ospedaliera Universitaria Integrata, 37134 Verona, Italy; (I.T.); (D.T.); (M.M.); (S.P.)
| | - Luigi Mariani
- Department of Medical Statistics, Biometry and Bioinformatics, Unit of Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milan, Italy;
| | - Sabina Sieri
- Department of Research, Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (S.S.); (V.K.)
| | - Vittorio Krogh
- Department of Research, Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (S.S.); (V.K.)
| | - Marco Boresta
- Department of Computer, Control and Management Engineering Antonio Ruberti, Sapienza University of Rome, 00185 Rome, Italy;
| | - Michele Milella
- Medical Oncology Unit, University of Verona, Azienda Ospedaliera Universitaria Integrata, 37134 Verona, Italy; (I.T.); (D.T.); (M.M.); (S.P.)
| | - Sara Pilotto
- Medical Oncology Unit, University of Verona, Azienda Ospedaliera Universitaria Integrata, 37134 Verona, Italy; (I.T.); (D.T.); (M.M.); (S.P.)
| | - Massimo Lanza
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy;
| |
Collapse
|
21
|
Reducing Financial Impact: Community Services to Prevent Falls and Support Older Cancer Survivors. REHABILITATION ONCOLOGY 2020. [DOI: 10.1097/01.reo.0000000000000222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
22
|
Toth MJ, Voigt TB, Tourville TW, Prior SM, Guigni BA, Schlosberg AV, Smith IB, Forest TJ, Kaufman PA, Wood ME, Rehman H, Dittus K. Effect of neuromuscular electrical stimulation on skeletal muscle size and function in patients with breast cancer receiving chemotherapy. J Appl Physiol (1985) 2020; 128:1654-1665. [PMID: 32378975 DOI: 10.1152/japplphysiol.00203.2020] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Exercise has numerous benefits for patients with cancer, but implementation is challenging because of practical and logistical hurdles. This study examined whether neuromuscular electrical stimulation (NMES) can serve as a surrogate for classic exercise by eliciting an exercise training response in skeletal muscle of women diagnosed with breast cancer undergoing chemotherapy. Patients (n = 22) with histologically confirmed stage I, II, or III breast cancer scheduled to receive neoadjuvant or adjuvant chemotherapy were randomized to 8 wk of bilateral neuromuscular electrical stimulation (NMES; 5 days/wk) to their quadriceps muscles or control. Biopsy of the vastus lateralis was performed at baseline and after 8 wk of intervention to assess muscle fiber size, contractility, and mitochondrial content. Seventeen patients (8 control/9 NMES) completed the trial and were included in analyses. NMES promoted muscle fiber hypertrophy (P < 0.001), particularly in fast-twitch, myosin heavy chain (MHC) IIA fibers (P < 0.05) and tended to induce fiber type shifts in MHC II fibers. The effects of NMES on single-muscle fiber contractility were modest, and it was unable to prevent declines in the function in MHC IIA fibers. NMES did not alter intermyofibrillar mitochondrial content/structure but was associated with reductions in subsarcolemmal mitochondria. Our results demonstrate that NMES induces muscle fiber hypertrophy and fiber type shifts in MHC II fibers but had minimal effects on fiber contractility and promoted reductions in subsarcolemmal mitochondria. Further studies are warranted to evaluate the utility of NMES as an exercise surrogate in cancer patients and other conditions.NEW & NOTEWORTHY This is the first study to evaluate whether neuromuscular electrical stimulation (NMES) can be used as an exercise surrogate to improve skeletal muscle fiber size or function in cancer patients receiving treatment. We show that NMES promoted muscle fiber hypertrophy and fiber type shifts but had minimal effects on single-fiber contractility and reduced subsarcolemmal mitochondria.
Collapse
Affiliation(s)
- Michael J Toth
- Department of Medicine, University of Vermont, Burlington, Vermont.,Department of Molecular Physiology and Biophysics, University of Vermont, Burlington, Vermont.,Department of Orthopedics and Rehabilitation, University of Vermont, Burlington, Vermont.,Vermont Cancer Center, University of Vermont, Burlington, Vermont
| | - Thomas B Voigt
- Department of Medicine, University of Vermont, Burlington, Vermont
| | - Timothy W Tourville
- Department of Orthopedics and Rehabilitation, University of Vermont, Burlington, Vermont.,College of Nursing and Health Sciences, University of Vermont, Burlington, Vermont
| | - Shannon M Prior
- Vermont Cancer Center, University of Vermont, Burlington, Vermont
| | - Blas A Guigni
- Department of Medicine, University of Vermont, Burlington, Vermont.,Department of Molecular Physiology and Biophysics, University of Vermont, Burlington, Vermont
| | | | - Isaac B Smith
- Department of Medicine, University of Vermont, Burlington, Vermont
| | - Taylor J Forest
- Department of Medicine, University of Vermont, Burlington, Vermont
| | - Peter A Kaufman
- Department of Medicine, University of Vermont, Burlington, Vermont.,Vermont Cancer Center, University of Vermont, Burlington, Vermont
| | - Marie E Wood
- Department of Medicine, University of Vermont, Burlington, Vermont.,Vermont Cancer Center, University of Vermont, Burlington, Vermont
| | - Hibba Rehman
- Department of Medicine, University of Vermont, Burlington, Vermont.,Vermont Cancer Center, University of Vermont, Burlington, Vermont
| | - Kim Dittus
- Department of Medicine, University of Vermont, Burlington, Vermont.,Vermont Cancer Center, University of Vermont, Burlington, Vermont
| |
Collapse
|
23
|
Anbari AB, Wanchai A, Graves R. Breast cancer survivorship in rural settings: a systematic review. Support Care Cancer 2020; 28:3517-3531. [DOI: 10.1007/s00520-020-05308-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 01/14/2020] [Indexed: 01/20/2023]
|
24
|
Hardcastle SJ, Galliott M, Lynch BM, Nguyen NH, Cohen PA, Mohan GR, Johansen NJ, Saunders C. 'If I Had Someone Looking Over My Shoulder…': Exploration of Advice Received and Factors Influencing Physical Activity Among Non-metropolitan Cancer Survivors. Int J Behav Med 2019; 26:551-561. [PMID: 31364038 DOI: 10.1007/s12529-019-09808-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND There are significant geographic inequalities in cancer survival with poorer survival rates in non-metropolitan areas compared to major cities. Physical activity (PA) can reduce cancer recurrence and prevent cardiovascular disease. However, few survivors participate in sufficient PA and the prevalence of inactivity is significantly higher in non-metropolitan survivors. The study investigated non-metropolitan survivors' recollections regarding PA advice received following cessation of active treatment, their knowledge of PA guidelines, and the factors that impact on PA behaviour change. METHOD Sixteen individuals (14 women and 2 men) with breast (n = 8), endometrial (n = 4) or colorectal cancer (n = 4), with a mean age of 60 years (SD = 12) completed semi-structured interviews as part of a larger study to examine the acceptability and utility of wearable trackers to increase PA. Interviews explored survivors' recollections regarding the advice they received concerning PA following active treatment, knowledge of PA guidelines for cancer survivors and the influences on PA behaviour change. Interview transcripts were analysed using thematic analysis. RESULTS Four main themes emerged: (i) insufficient knowledge of guidelines, (ii) support from the treating oncology team, (iii) external accountability, and (iv) barriers to PA. CONCLUSIONS Survivors' knowledge of PA guidelines was limited and they did not often recall their oncologists making specific recommendations concerning PA. Survivors' referred to the desire for accountability and monitoring in order to successfully change PA. Lack of motivation was the main barrier to PA participation. Other barriers included age, health status, and lack of facilities or exercise programs.
Collapse
Affiliation(s)
- Sarah J Hardcastle
- School of Psychology, Curtin University, Perth, WA, Australia. .,School of Medicine, University of Western Australia, Crawley, WA, Australia.
| | | | - Brigid M Lynch
- Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, VIC, Australia
| | - Nga H Nguyen
- Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, VIC, Australia
| | - Paul A Cohen
- School of Medicine, University of Western Australia, Crawley, WA, Australia.,St John of God Hospital, Subiaco, Subiaco, WA, Australia
| | | | | | - Christobel Saunders
- School of Medicine, University of Western Australia, Crawley, WA, Australia.,St John of God Hospital, Subiaco, Subiaco, WA, Australia
| |
Collapse
|
25
|
Outcomes of a text message, Fitbit, and coaching intervention on physical activity maintenance among cancer survivors: a randomized control pilot trial. J Cancer Surviv 2019; 14:80-88. [PMID: 31776849 DOI: 10.1007/s11764-019-00831-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 10/26/2019] [Indexed: 12/20/2022]
Abstract
PURPOSE We aimed to determine the effect of a health coach, text message, and Fitbit intervention on moderate-to-vigorous physical activity (MVPA) maintenance in cancer survivors following a supervised exercise program compared to provision of a Fitbit alone. METHODS Participants were recruited during the last month of an exercise-based oncology rehabilitation program and randomly assigned to the full intervention (n = 34) or Fitbit-only control groups (n = 32). In total, 59 cancer survivors completed the program (81% female; mean age 61.4 ± 9.0). Group by time differences in accelerometer-measured MVPA was assessed using linear mixed models. Additionally, we examined mean weekly Fitbit-derived MVPA levels. RESULTS Intervention participants maintained weekly MVPA from pre- (295.7 ± 139.6) to post-intervention (322.0 ± 199.4; p = 0.37), whereas those in the Fitbit-only group had a significant decrease in MVPA (305.5 ± 181.1 pre vs 250.7 ± 166.5 post; p = 0.03, effect size 0.57). The intervention participants maintained recommended levels of MPVA for health benefits during the 8-week intervention, whereas the Fitbit-only control group did not. CONCLUSIONS The findings demonstrate that a remote intervention delivered through health coaching, text messages, and Fitbit can promote maintenance of MVPA after a structured program for cancer survivors. However, use of a Fitbit alone was not sufficient to prevent expected decline in MVPA. Additional research is warranted to examine long-term impacts and efficacy in a more diverse population of cancer survivors. IMPLICATIONS FOR CANCER SURVIVORS Use of a wearable tracker alone may not be sufficient for exercise maintenance among cancer survivors after transition to an independent program. Additional planning for relapse prevention is recommended.
Collapse
|
26
|
Delrieu L, Vallance JK, Morelle M, Fervers B, Pialoux V, Friedenreich C, Dufresne A, Bachelot T, Heudel PE, Trédan O, Pérol O, Touillaud M. Physical activity preferences before and after participation in a 6-month physical activity intervention among women with metastatic breast cancer. Eur J Cancer Care (Engl) 2019; 29:e13169. [PMID: 31571315 DOI: 10.1111/ecc.13169] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 08/02/2019] [Accepted: 09/04/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVE This secondary analysis of the ABLE Trial (ClinicalTrials.gov NCT03148886) aimed to assess physical activity preferences before and after a 6-month physical activity intervention for women recently diagnosed with metastatic breast cancer and to investigate demographic and clinical correlates of these preferences. METHODS Forty-nine patients participated in the ABLE Trial, a single-arm, unsupervised 6-month physical activity intervention with activity trackers. At baseline and 6 months, physical activity preferences, physical activity level, clinical variables, demographics and social vulnerability were assessed. RESULTS At baseline, 49 participants were included, among whom 85% were interested in receiving physical activity counselling and 89% were interested in following a physical activity programme designed for metastatic breast cancer. At the end of the study, more participants preferred practising in a community fitness centre (66%) rather than at home (19% vs. 44% at baseline, p = .03). A higher social vulnerability score and not being treated by chemotherapy at baseline were significantly associated with lower desire to receive physical activity counselling (p = .01 and p = .04 respectively). CONCLUSIONS This study will help design future studies within patients with metastatic breast cancer in accordance with their preferences. Designing tailored physical activity interventions according to the participant's preferences may be one key to success for adherence.
Collapse
Affiliation(s)
- Lidia Delrieu
- Inter-University Laboratory of Human Movement Biology EA7424, University of Lyon, Villeurbanne, France.,Department of Cancer and Environment, Leon Berard Cancer Center, Lyon, France
| | - Jeff K Vallance
- Faculty of Health Disciplines, Athabasca University, Athabasca, Alberta, Canada
| | - Magali Morelle
- Department of Clinical Research and Innovation, Leon Berard Cancer Center, Lyon, France
| | - Béatrice Fervers
- Department of Cancer and Environment, Leon Berard Cancer Center, Lyon, France.,Cancer Research Center of Lyon, Leon Berard Cancer Center, INSERM UA8, Lyon, France
| | - Vincent Pialoux
- Inter-University Laboratory of Human Movement Biology EA7424, University of Lyon, Villeurbanne, France.,Institut Universitaire de France (IUF), Paris, France.,LabEx GR-Ex, Paris, France
| | - Christine Friedenreich
- Department of Cancer Epidemiology and Prevention Research, Cancer Control Alberta, Alberta Health Services, Calgary, Alberta, Canada.,Departments of Oncology and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Armelle Dufresne
- Department of Medical Oncology, Leon Berard Cancer Center, Lyon, France
| | - Thomas Bachelot
- Department of Medical Oncology, Leon Berard Cancer Center, Lyon, France
| | | | - Olivier Trédan
- Department of Medical Oncology, Leon Berard Cancer Center, Lyon, France
| | - Olivia Pérol
- Department of Cancer and Environment, Leon Berard Cancer Center, Lyon, France
| | - Marina Touillaud
- Department of Cancer and Environment, Leon Berard Cancer Center, Lyon, France.,Cancer Research Center of Lyon, Leon Berard Cancer Center, INSERM UA8, Lyon, France
| |
Collapse
|
27
|
McNeely ML, Sellar C, Williamson T, Shea-Budgell M, Joy AA, Lau HY, Easaw JC, Murtha AD, Vallance J, Courneya K, Mackey JR, Parliament M, Culos-Reed N. Community-based exercise for health promotion and secondary cancer prevention in Canada: protocol for a hybrid effectiveness-implementation study. BMJ Open 2019; 9:e029975. [PMID: 31519676 PMCID: PMC6747880 DOI: 10.1136/bmjopen-2019-029975] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 08/15/2019] [Accepted: 08/30/2019] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Cancer care has expanded from a disease-focused, survival-oriented model to an approach that now considers how survivors can live well in the aftermath of intensive therapy, where they may deal with significant changes to their bodies, mental health or emotional well-being. Research evidence supports the benefit of exercise during and following cancer treatments for cancer-related symptoms, physical functioning and fitness, and health-related quality of life. To move this efficacy evidence into practice, we designed and launched a 5-year study to evaluate the relative benefit from implementing a clinic-to-community-based cancer and exercise model of care. METHODS AND ANALYSIS A hybrid effectiveness and implementation trial design is being used to evaluate the effectiveness of delivery of community-based exercise and to collect data on implementation of the programme. The study opened in January 2017, with estimated completion by January 2022. The programme will be delivered in seven cities across the province of Alberta, Canada, with sites including three academic institutions, six YMCA locations, Wellspring Edmonton and Calgary, and six municipal fitness centres. Participants are adult cancer survivors (n=2500) from all tumour groups and stages and at any time point along their cancer treatment trajectory, up to 3 years post treatment completion. Survivors take part in a minimum of 60 min of mild-to-moderate intensity full body exercise twice weekly for a 12-week period. The primary effectiveness outcome is the proportion of participants meeting or exceeding 150 min of moderate intensity exercise per week at 1-year follow-up. The Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework will be utilised to capture individual-level and organizational-level impact of the exercise programme at 12 and 24 weeks and 1-year follow-up. The cohort of survivors participating in the study will allow for long-term (>5-year) evaluation of rates of cancer recurrence and secondary cancers beyond the funding period. ETHICS AND DISSEMINATION The study was approved by the Health Research Ethics Board of Alberta. The study is funded by Alberta Innovates and the Alberta Cancer Foundation. The study will help to answer critical questions on the effectiveness of cancer-specific community-based exercise programming in both the short-term and the long-term. Collectively, the findings will help to inform the acceptability, adoption, feasibility, reach and sustainability of community-based exercise. TRIAL REGISTRATION NUMBER NCT02984163; Pre-results.
Collapse
Affiliation(s)
- Margaret L McNeely
- Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
- Rehabilitation Medicine, Cross Cancer Institute, Edmonton, Alberta, Canada
| | | | | | - Melissa Shea-Budgell
- Arnie Charbonneau Cancer Institute, University of Calgary, Calgary, Alberta, Canada
| | - Anil Abraham Joy
- Division of Medical Oncology, Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Harold Y Lau
- Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Jacob C Easaw
- Medical Oncology, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Albert D Murtha
- Radiation Oncology, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Jeffrey Vallance
- Faculty of Health Disciplines, Athabasca University, Medicine Hat, Alberta, Canada
| | - Kerry Courneya
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - John R Mackey
- Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Matthew Parliament
- Radiation Oncology, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | | |
Collapse
|
28
|
Crowder SL, Douglas KG, Frugé AD, Carroll WR, Spencer SA, Locher JL, Demark-Wahnefried W, Rogers LQ, Arthur AE. Head and neck cancer survivors' preferences for and evaluations of a post-treatment dietary intervention. Nutr J 2019; 18:57. [PMID: 31506077 PMCID: PMC6737706 DOI: 10.1186/s12937-019-0479-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 08/27/2019] [Indexed: 02/14/2023] Open
Abstract
BACKGROUND Dietary preferences vary depending on cancer type. The purpose of this study was to report dietary intervention preferences and a study program evaluation from post-treatment head and neck cancer survivors participating in a dietary intervention. METHODS Between January 2015 and August 2016, 24 head and neck cancer survivors participated in a 12-week randomized clinical dietary intervention trial that promoted weekly consumption of 2.5 cups of cruciferous vegetables and 3.5 cups of green leafy vegetables. At study completion, survivors completed a preferences survey and a study program evaluation to probe interests and improvement aspects for planning future dietary intervention trials. Descriptive statistics (means and frequencies) were generated for multiple choice question responses. Responses to open-ended questions were recorded and grouped based on themes, and verified by quality assurance checks by a second study team member. RESULTS Twenty-three survivors completed the preferences and evaluation surveys (response rate 96%). Overall, most participants reported a preference for one-on-one telephone counseling from a registered dietitian nutritionist before beginning treatment. Ninety-six percent of participants ranked the overall study program as "very good" to "excellent," and all agreed the objectives of the study were clear, the study staff was helpful and easy to contact, and the registered dietitian nutritionist was knowledgeable. CONCLUSIONS Future research and dietary intervention planning for head and neck cancer survivors should focus on strategies to promote one-on-one telephone or other distance-based counseling combined with face-to-face visits, according to survivor preference.
Collapse
Affiliation(s)
- Sylvia L Crowder
- Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, 905 S Goodwin Ave, 386A Bevier Hall, Urbana, IL, 61801, USA
| | - Katherine G Douglas
- Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, 905 S Goodwin Ave, 386A Bevier Hall, Urbana, IL, 61801, USA
| | - Andrew D Frugé
- Department of Nutrition, Dietetics, & Hospitality Management, Auburn University, Auburn, AL, USA
| | - William R Carroll
- Department of Otolaryngology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sharon A Spencer
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Julie L Locher
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Laura Q Rogers
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Anna E Arthur
- Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, 905 S Goodwin Ave, 386A Bevier Hall, Urbana, IL, 61801, USA. .,Carle Cancer Center, Carle Foundation Hospital, Urbana, IL, USA.
| |
Collapse
|
29
|
Development and Evaluation of the Breast Cancer Online Rehabilitation (BRECOR) Program for Self-managed Upper-Body Rehabilitation for Women With Breast Cancer. REHABILITATION ONCOLOGY 2019. [DOI: 10.1097/01.reo.0000000000000151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
30
|
Ungar N, Tsiouris A, Haussmann A, Herbolsheimer F, Wiskemann J, Steindorf K, Sieverding M. To rest or not to rest-Health care professionals' attitude toward recommending physical activity to their cancer patients. Psychooncology 2019; 28:784-791. [PMID: 30716190 DOI: 10.1002/pon.5020] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 01/25/2019] [Accepted: 01/28/2019] [Indexed: 01/10/2023]
Abstract
OBJECTIVE While in the past cancer patients were advised to rest, recent research revealed various beneficial effects of physical activity, including increased treatment tolerability during cancer treatment and prolonged survival, which has led to a paradigm shift in relevant guidelines. This study examined if this paradigm shift from rest to activity has been consolidated in health care professionals' (HCP') attitude. It was investigated if the two dimensions of attitude (rest and activity) are endorsed empirically within the theory of planned behavior (TPB). Differences between physicians and nurses were examined. METHODS Five hundred forty seven physicians and 398 nurses treating breast, prostate, or colorectal cancer patients completed a cross-sectional questionnaire. To assess attitude toward physical activity during cancer treatment, we developed a 15-item scale, which included original statements of HCP. TPB variables were assessed. RESULTS A factor analysis revealed the proposed distinction of attitude into two dimensions. The activity-paradigm was stronger represented in HCP' attitude compared with rest-paradigm (Mactivity-paradigm = 4.1 versus Mrest-paradigm = 2.7, p < 0.001). Additionally, the activity-paradigm had higher exploratory power in explaining intention to recommend physical activity in cancer patients. However, the rest-paradigm was able to explain intention to recommend physical activity over and above activity-paradigm (ΔR2 = 0.05). Nurses had higher scores on the rest-paradigm than physicians. CONCLUSIONS The activity-paradigm has already been consolidated in HCP' minds. However, the rest-paradigm is still present in the daily routine of oncology physicians and nurses. Addressing concerns and insecurities related to supporting cancer patients in maintaining or building up a physically active lifestyle is a very important educational task.
Collapse
Affiliation(s)
- Nadine Ungar
- Institute of Psychology, Heidelberg University, Heidelberg
| | - Angeliki Tsiouris
- Division of Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg and University Hospital Heidelberg, Heidelberg
| | - Alexander Haussmann
- Division of Physical Activity, Prevention and Cancer, National Center for Tumor Diseases (NCT) Heidelberg and German Cancer Research Center (DKFZ), Heidelberg
| | - Florian Herbolsheimer
- Division of Physical Activity, Prevention and Cancer, National Center for Tumor Diseases (NCT) Heidelberg and German Cancer Research Center (DKFZ), Heidelberg.,Institute of the History, Philosophy and Ethics of Medicine, Ulm University, Ulm
| | - Joachim Wiskemann
- Division of Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg and University Hospital Heidelberg, Heidelberg
| | - Karen Steindorf
- Division of Physical Activity, Prevention and Cancer, National Center for Tumor Diseases (NCT) Heidelberg and German Cancer Research Center (DKFZ), Heidelberg
| | | |
Collapse
|
31
|
Gokal K, Munir F, Ahmed S, Kancherla K, Wallis D. Does walking protect against decline in cognitive functioning among breast cancer patients undergoing chemotherapy? Results from a small randomised controlled trial. PLoS One 2018; 13:e0206874. [PMID: 30485297 PMCID: PMC6261560 DOI: 10.1371/journal.pone.0206874] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 10/21/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Cancer related cognitive impairments have been subjectively reported and objectively detected in breast cancer patients treated with chemotherapy and are known to have a profound negative impact on productivity, psychosocial well-being and overall quality of life. Moderate levels of walking are known to be of benefit to the psychosocial well-being of those affected by breast cancer and for managing cognitive impairment in healthy adults, children, and the elderly. The purpose of this study is to investigate the effects of a home-based, self-managed, moderate intensity walking intervention on subjective and objective cognitive functioning in breast cancer patients undergoing chemotherapy. METHODS A home-based, self-managed intervention that consisted of moderate levels of walking was compared to usual care among breast cancer patients treated with chemotherapy in a randomised controlled trial. Outcome measures included changes in subjective (CFQ) and objectively detected cognitive functioning (Stroop, SART and two subscales from the WAIS- Digit Span and Block Design). Fifty participants were randomised to either the intervention group (n = 25), who completed 12 weeks of moderate intensity walking, or to the control group (n = 25) mid-way through chemotherapy. RESULTS Compared with the control group, the self-managed walking intervention had positive effects on perceived cognitive function but not on sustained attention, executive function, memory or visual spatial skills when assessed objectively using neuropsychological measures. CONCLUSION This home-based, self-managed intervention is beneficial for protecting against perceived cognitive decline in breast cancer patients treated with chemotherapy. There is a need for further research to objectively assess cognitive decline within this population with larger sample sizes of patients. TRIAL REGISTRATION Current Controlled Trials ISRCTN50709297.
Collapse
Affiliation(s)
- Kajal Gokal
- School of Sport, Exercise & Health Sciences, Loughborough University, Loughborough, Leicestershire, United Kingdom
- National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, Leicestershire, United Kingdom
| | - Fehmidah Munir
- School of Sport, Exercise & Health Sciences, Loughborough University, Loughborough, Leicestershire, United Kingdom
- National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, Leicestershire, United Kingdom
| | - Samreen Ahmed
- Leicester Royal Infirmary, University Hospitals of Leicester, Leicestershire, United Kingdom
| | - Kiran Kancherla
- Leicester Royal Infirmary, University Hospitals of Leicester, Leicestershire, United Kingdom
| | - Deborah Wallis
- School of Sport, Exercise & Health Sciences, Loughborough University, Loughborough, Leicestershire, United Kingdom
- National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, Leicestershire, United Kingdom
| |
Collapse
|
32
|
Differences in Physical Activity and Diet Patterns between Non-Rural and Rural Adults. Nutrients 2018; 10:nu10111601. [PMID: 30388741 PMCID: PMC6267585 DOI: 10.3390/nu10111601] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 10/10/2018] [Accepted: 10/24/2018] [Indexed: 12/04/2022] Open
Abstract
Background: It is unclear how rural occupations and lifestyles may play a role in shaping physical activity and diet behaviors that contribute to the rural–urban obesity disparity. Methods: Data come from the prospective and observational South Dakota Rural Bone Health Study, which included adults aged 20–66 years in three groups: (1) non-rural non-Hutterite, (2) rural non-Hutterite, and (3) rural Hutterite. Physical activity data were collected using 7-day physical activity questionnaires, and hours per day in physical activity categories are reported. Diet data were collected using food frequency questionnaires, and food group servings per day (svg/day) are reported. Mixed models were generated to determine group differences in physical activity and diet outcomes, and marginal group means are presented. Results: Among females, both rural groups spent more time in moderate activity (4.8 ± 0.13 h/day and 4.7 ± 0.09 h/day vs. 3.5 ± 0.11 h/day, both p < 0.001) and vigorous activity (0.58 ± 0.03 h/day and 0.53 ± 0.02 h/day vs. 0.43 ± 0.03 h/day, both p < 0.01) and less time sitting (4.4 ± 0.13 h/day and 4.3 ± 0.09 h/day vs. 5.0 ± 0.11 h/day, both p < 0.001) on weekdays than non-rural groups. Hutterite females spent fewer hours in moderate activity (2.6 ± 0.08 h/day vs. 4.5 ± 0.11 h/day, p < 0.001) and vigorous activity (0.18 ± 0.02 h/day vs. 0.46 ± 0.02 h/day, p < 0.001) on weekend days compared to rural females. Hutterite females consumed more fruits (2.2 ± 0.06 svg/day vs. 1.7 ± 0.10 svg/day, p < 0.001) and vegetables (3.6 ± 0.08 svg/day vs. 2.7 ± 0.12 svg/day, p < 0.001) than rural females. Among males, both rural groups spent more time in moderate activity (4.9 ± 0.13 h/day and 6.1 ± 0.12 h/day vs. 3.0 ± 0.16 h/day, both p < 0.001) and less time sitting (4.1 ± 0.13 h/day and 3.4 ± 0.12 h/day vs. 6.0 ± 0.15 h/day, both p < 0.001) on weekdays compared to non-rural groups. Hutterite males spent less time in moderate activity (2.1 ± 0.10 h/day vs. 4.1 ± 0.11 h/day, p < 0.001) and vigorous activity (0.15 ± 0.04 h/day vs. 0.74 ± 0.04 h/day, p < 0.001) on weekend days compared to rural males. Hutterite males consumed more vegetables (3.0 ± 0.10 svg/day vs. 2.0 ± 0.11 svg/day, p < 0.001) than rural males. Conclusions: A rural occupation and lifestyle appear to contribute to differences in physical activity, while traditional rural lifestyle practices contribute to differences in diet.
Collapse
|
33
|
Ungar N, Schmidt L, Gabrian M, Haussmann A, Tsiouris A, Sieverding M, Steindorf K, Wiskemann J. Which self-management strategies do health care professionals recommend to their cancer patients? An experimental investigation of patient age and treatment phase. J Behav Med 2018; 42:342-352. [PMID: 30353398 DOI: 10.1007/s10865-018-9980-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Accepted: 10/13/2018] [Indexed: 10/28/2022]
Abstract
This vignette based study aimed to examine recommendations of health care professionals (HCPs) in promoting self-management strategies to cancer patients. Nine-hundred-forty-two physicians and nurses were asked to (1) indicate if they would recommend self-management strategies to a vignette cancer patient, and (2) to specify those in an open format. Vignettes included a manipulation of patient age (60 vs. 75 years) and treatment phase (currently treated versus treatment completed). Six categories emerged through coding a total of 2303 recommendations: physical activity (71.8%), nutrition (64.3%), psychological support (36.7%), medical support (29.2%), conscious living (17.2%) and naturopathy (12.3%). While psychological support was particularly recommended during treatment, physical activity was more frequently recommended after completion of treatment. Results suggest that HCPs recommend a variety of self-management strategies besides standard medical treatment. Patient's treatment phase and age seem to partly influence recommendation behavior, potentially indicating insecurities regarding acute treatment situations and age-related stereotypes.
Collapse
Affiliation(s)
- Nadine Ungar
- Institute of Psychology, Heidelberg University, Hauptstr. 47-51, 69117, Heidelberg, Germany.
| | - Laura Schmidt
- Institute of Psychology, Heidelberg University, Hauptstr. 47-51, 69117, Heidelberg, Germany
| | - Martina Gabrian
- Institute of Psychology, Heidelberg University, Hauptstr. 47-51, 69117, Heidelberg, Germany
| | - Alexander Haussmann
- Division of Physical Activity, Prevention and Cancer, National Center for Tumor Diseases (NCT) Heidelberg and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Angeliki Tsiouris
- Division of Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg and University Hospital Heidelberg, Heidelberg, Germany
| | - Monika Sieverding
- Institute of Psychology, Heidelberg University, Hauptstr. 47-51, 69117, Heidelberg, Germany
| | - Karen Steindorf
- Division of Physical Activity, Prevention and Cancer, National Center for Tumor Diseases (NCT) Heidelberg and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Joachim Wiskemann
- Division of Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg and University Hospital Heidelberg, Heidelberg, Germany
| |
Collapse
|
34
|
Romero SAD, Brown JC, Bauml JM, Hay JL, Li QS, Cohen RB, Mao JJ. Barriers to physical activity: a study of academic and community cancer survivors with pain. J Cancer Surviv 2018; 12:744-752. [PMID: 30182150 DOI: 10.1007/s11764-018-0711-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 08/20/2018] [Indexed: 11/24/2022]
Abstract
PURPOSE Despite the numerous benefits of physical activity (PA) for patients with cancer, many cancer survivors report challenges to participating in PA. The objectives of this study were (1) to assess barriers to PA and (2) to examine participant characteristics associated with modifiable barriers to PA among cancer survivors with pain. METHODS We conducted a cross-sectional survey study at one academic medical center and 11 community hospitals. Participants completed the 12-item Physical Activity Barriers After Cancer (PABAC) instrument (Cronbach's alpha = 0.75). Multivariable regression models examined participant characteristics associated with PABAC scores with a higher score indicating more barriers to PA. RESULTS Among 662 survivors, 67% had moderate or severe pain (rating 4 or greater on a scale of 0 to 10). Seventy-five percent of survivors did not meet the American Cancer Society PA recommendations on average, and these individuals had higher mean PABAC scores (beta coefficient (β) = 2.02, 95% confidence interval (CI) 0.96-3.09, p < 0.001). In adjusted analyses, cancer survivors who were non-white (β = 1.55, 0.28-2.82, p = 0.02), treated at a community hospital (β = 1.07, 0.09-2.05, p = 0.03), had surgery (β = 1.69, 0.69-2.69, p = 0.001), or within 12 months of diagnosis (β = 1.15, 0.20-2.10, p = 0.02) reported greater barriers to PA. CONCLUSIONS The majority of cancer survivors with pain are not adequately participating in PA. Key demographic and clinical characteristics are associated with survivors' barriers. IMPLICATIONS FOR CANCER SURVIVORS Efforts to overcome specific barriers are needed to promote PA after a cancer diagnosis.
Collapse
Affiliation(s)
- Sally A D Romero
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA. .,Memorial Sloan Kettering Cancer Center, Bendheim Integrative Medicine Center, 1429 First Avenue, New York, NY, 10021, USA.
| | | | - Joshua M Bauml
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, PA, Philadelphia, USA
| | - Jennifer L Hay
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Q Susan Li
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Roger B Cohen
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, PA, Philadelphia, USA
| | - Jun J Mao
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA. .,Memorial Sloan Kettering Cancer Center, Bendheim Integrative Medicine Center, 1429 First Avenue, New York, NY, 10021, USA.
| |
Collapse
|
35
|
Are healthcare professionals being left in the lurch? The role of structural barriers and information resources to promote physical activity to cancer patients. Support Care Cancer 2018; 26:4087-4096. [PMID: 29934683 DOI: 10.1007/s00520-018-4279-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 05/17/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Although many cancer patients benefit from physical activity (PA), healthcare professionals (HCP) still do not promote it routinely. Including different groups of HCP, this study aimed to examine how structural barriers are perceived as impeding by HCP for promoting PA to cancer patients, how the perceptions of structural barriers are associated with promoting PA, and how HCP react to information resources. METHODS A total of 287 physicians in outpatient care, 242 physicians in inpatient care, and 388 oncology nurses completed our questionnaire (paper-pencil or online). Participants assessed nine different structural barriers (on a 4-point Likert Scale) and reported their PA promotion frequency. Further, they could request three different kinds of information resources about PA in oncological settings. RESULTS Across professional groups, more than 70% of HCP indicated that they promoted PA to their cancer patients often or routinely. Oncology nurses indicated that they were more impeded in promoting PA by six structural barriers than physicians (all p < .01). "Not enough time per patient" and "lack of an expert contact person" were associated with a reduced PA promotion in two professional groups (all p < .05). Information resources were requested by 69.5% of the participants: mostly physicians working in outpatient care and especially by those perceiving structural barriers. CONCLUSIONS Although a big proportion of HCP reported that they frequently promoted PA, our findings suggest that HCP still perceive structural barriers. The perception and influence of structural barriers differed between professional groups, pointing to the importance of profession specific guidance.
Collapse
|
36
|
Wong JN, McAuley E, Trinh L. Physical activity programming and counseling preferences among cancer survivors: a systematic review. Int J Behav Nutr Phys Act 2018; 15:48. [PMID: 29879993 PMCID: PMC5992647 DOI: 10.1186/s12966-018-0680-6] [Citation(s) in RCA: 128] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 05/20/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Physical activity (PA) participation and adherence among cancer survivors is low, despite research indicating numerous physical, psychological and emotional health benefits of exercise. Tailoring exercise programs specific to the PA preferences in cancer survivors has merit for increasing PA participation and adherence to accrue these benefits. This systematic review identifies and differentiates PA programming and counseling preferences of adult cancer survivors across various cancer survivor groups. METHODS PubMed, SPORTDiscus, Scopus, PsycINFO, EMBASE, Web of Science and CINAHL were electronically searched (inception to Oct 2017) and articles were identified using PRISMA guidelines. Two reviewers independently assessed identified articles to determine eligibility and then individually performed a quality assessment on all final studies. Extracted and analyzed data included participant characteristics, interest in exercise counseling and programming, as well as specific exercise and counseling preferences (e.g. location, timing, intensity). RESULTS Forty-one articles were included in this systematic review. Most studies assessed mixed cancer survivor groups or breast cancer survivors. Most cancer survivors felt able and interested in participating in a PA program, though starting a PA program after or before treatment was preferred. Walking was the strongest PA modality preference, and most cancer survivors preferred moderate intensity PA. Cancer survivors also indicated preferences for home-based PA that could take place in the morning. Slight preferences were found towards physical activity counseling delivered by a fitness expert from a cancer center. Both quantitative and qualitative studies were found to be of moderate to high quality based on the Appraisal Tool for Cross-Sectional Studies (AXIS) and the Consolidated Criteria for Reporting Qualitative Research (COREQ), respectively. CONCLUSION Cancer survivors have an interest in participating in PA programs with walking as the primary modality. Additionally, morning-based PA programs that can be tapered to home-based programs are desirable. However, there was wide variation in other PA preference variables, suggesting multiple program options would be beneficial. Many cancer survivors felt interested and able to participate in PA, and therefore designing PA programs that are tailored to cancer survivors is integral for optimizing recruitment and adherence, as well as enhancing health outcomes in cancer survivors.
Collapse
Affiliation(s)
- Jaime N. Wong
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL USA
| | - Edward McAuley
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL USA
| | - Linda Trinh
- Faculty of Kinesiology and Physical Education, University of Toronto, 55 Harbord Street, Toronto, ON M5S 2W6 Canada
| |
Collapse
|
37
|
Hubbard G, Campbell A, Fisher A, Harvie M, Maltinsky W, Mullen R, Banks E, Gracey J, Gorely T, Munro J, Ozakinci G. Physical activity referral to cardiac rehabilitation, leisure centre or telephone-delivered consultations in post-surgical people with breast cancer: a mixed methods process evaluation. Pilot Feasibility Stud 2018; 4:108. [PMID: 29881639 PMCID: PMC5984397 DOI: 10.1186/s40814-018-0297-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 05/15/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Physical activity (PA) programmes effective under 'research' conditions may not be effective under 'real-world' conditions. A potential solution is to refer patients to existing PA community-based PA services. METHODS A process evaluation of referral of post-surgical patients with early-stage breast cancer to cardiac rehabilitation exercise classes, leisure centre with 3-month free leisure centre membership or telephone-delivered PA consultations for 12 weeks. Quantitative data were collected about PA programme uptake and reach, patient engagement with the PA programme, delivery and fidelity and PA dose. Qualitative data were collected about patient experiences of taking part in the PA programmes. Audio-recorded qualitative interviews of participants about the programmes were analysed thematically. Quantitative data were reported descriptively using means and SD. RESULTS In Phase I, 30% (n = 20) of eligible patients (n = 20) consented, 85% (n = 17) chose referral to leisure centre, and 15% (n = 3) chose cardiac rehabilitation. In Phase II, 32% (n = 12) consented, 25% (n = 3) chose leisure centre and 75% (n = 9) chose telephone-delivered PA consultations. Walking at light intensity for about an hour was the most common PA. All Phase I participants received an induction by a cardiac rehabilitation physiotherapist or PA specialist from the leisure centre but only 50% of Phase II participants received an induction by a PA specialist from the leisure centre. Four themes were identified from qualitative interviews about programme choice: concerns about physical appearance, travel distance, willingness to socialise and flexibility in relation to doing PA. Four themes were identified about facilitators and barriers for engaging in PA: feeling better, feeling ill, weight management, family and friends. CONCLUSIONS The current community-based PA intervention is not yet suitable for a definitive effectiveness randomised controlled trial. Further work is needed to optimise PR programme reach, PA dose and intervention fidelity. TRIAL REGISTRATION ISRCTN11183372.
Collapse
Affiliation(s)
- Gill Hubbard
- Department of Nursing, University of the Highlands and Islands, Centre for Health Sciences, Old Perth Road, Inverness, IV2 3JH Scotland UK
| | - Anna Campbell
- School of Life Science, Sport and Social Science, Edinburgh Napier University, Edinburgh, EH11 4B Scotland UK
| | - Abi Fisher
- Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E 6BT England UK
| | - Michelle Harvie
- Prevent Breast Cancer Research Unit, The Nightingale Centre, Wythenshawe Hospital, Manchester, England UK
| | - Wendy Maltinsky
- Division of Health Research, Rural Health & Wellbeing, University of the Highlands and Islands, An Lòchran, Inverness Campus, Inverness, IV2 5NA Scotland UK
| | - Russell Mullen
- Highland Breast Centre, NHS Highland, Raigmore Hospital, Old Perth Road, Inverness, IV2 3UJ Scotland UK
| | - Elspeth Banks
- National Cancer Research Institute, Clinical Studies Group, Angel Building, 407 St John Street, London, EC1V 4AD England UK
| | - Jackie Gracey
- School of Health Sciences, Ulster University, Jordanstown campus, Shore Road, 7, Newtown Abbey, County Antrim, BT37 OQB Northern Ireland UK
| | - Trish Gorely
- Department of Nursing, University of the Highlands and Islands, Centre for Health Sciences, Old Perth Road, Inverness, IV2 3JH Scotland UK
| | - Julie Munro
- Department of Nursing, University of the Highlands and Islands, Centre for Health Sciences, Old Perth Road, Inverness, IV2 3JH Scotland UK
| | - Gozde Ozakinci
- School of Medicine, Medical & Biological Sciences, University of St Andrews, North Haugh, St Andrews, KY16 9TF Scotland UK
| |
Collapse
|
38
|
Haussmann A, Gabrian M, Ungar N, Jooß S, Wiskemann J, Sieverding M, Steindorf K. What hinders healthcare professionals in promoting physical activity towards cancer patients? The influencing role of healthcare professionals’ concerns, perceived patient characteristics and perceived structural factors. Eur J Cancer Care (Engl) 2018; 27:e12853. [DOI: 10.1111/ecc.12853] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Alexander Haussmann
- Division of Physical Activity, Prevention and Cancer; National Center for Tumor Diseases (NCT) Heidelberg and German Cancer Research Center (DKFZ); Heidelberg Germany
- Medical Faculty; Heidelberg University; Heidelberg Germany
| | - Martina Gabrian
- Institute of Psychology; Heidelberg University; Heidelberg Germany
| | - Nadine Ungar
- Institute of Psychology; Heidelberg University; Heidelberg Germany
| | - Stefan Jooß
- Division of Medical Oncology; National Center for Tumor Diseases (NCT) Heidelberg and University Clinic; Heidelberg Germany
| | - Joachim Wiskemann
- Division of Medical Oncology; National Center for Tumor Diseases (NCT) Heidelberg and University Clinic; Heidelberg Germany
| | | | - Karen Steindorf
- Division of Physical Activity, Prevention and Cancer; National Center for Tumor Diseases (NCT) Heidelberg and German Cancer Research Center (DKFZ); Heidelberg Germany
| |
Collapse
|
39
|
Mina DS, Sabiston CM, Au D, Fong AJ, Capozzi LC, Langelier D, Chasen M, Chiarotto J, Tomasone JR, Jones JM, Chang E, Culos-Reed SN. Connecting people with cancer to physical activity and exercise programs: a pathway to create accessibility and engagement. ACTA ACUST UNITED AC 2018; 25:149-162. [PMID: 29719431 DOI: 10.3747/co.25.3977] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Recent guidelines concerning exercise for people with cancer provide evidence-based direction for exercise assessment and prescription for clinicians and their patients. Although the guidelines promote exercise integration into clinical care for people with cancer, they do not support strategies for bridging the guidelines with related resources or programs. Exercise program accessibility remains a challenge in implementing the guidelines, but that challenge might be mitigated with conceptual frameworks ("pathways") that connect patients with exercise-related resources. In the present paper, we describe a pathway model and related resources that were developed by an expert panel of practitioners and researchers in the field of exercise and rehabilitation in oncology and that support the transition from health care practitioner to exercise programs or services for people with cancer. The model acknowledges the nuanced distinctions between research and exercise programming, as well as physical activity promotion, that, depending on the available programming in the local community or region, might influence practitioner use. Furthermore, the pathway identifies and provides examples of processes for referral, screening, medical clearance, and programming for people after a cancer diagnosis. The pathway supports the implementation of exercise guidelines and should serve as a model of enhanced care delivery to increase the health and well-being of people with cancer.
Collapse
Affiliation(s)
- D Santa Mina
- Faculty of Kinesiology and Physical Education and.,Faculty of Medicine, University of Toronto, Toronto, ON.,Cancer Rehabilitation and Survivorship, Princess Margaret Cancer Centre, Toronto, ON
| | - C M Sabiston
- Faculty of Kinesiology and Physical Education and
| | - D Au
- Faculty of Kinesiology and Physical Education and.,Cancer Rehabilitation and Survivorship, Princess Margaret Cancer Centre, Toronto, ON
| | - A J Fong
- Faculty of Kinesiology and Physical Education and
| | - L C Capozzi
- Cumming School of Medicine, University of Calgary, Calgary, AB
| | - D Langelier
- Cumming School of Medicine, University of Calgary, Calgary, AB
| | - M Chasen
- Faculty of Kinesiology and Physical Education and
| | - J Chiarotto
- Department of Medicine, Scarborough and Rouge Hospital, Toronto, ON
| | - J R Tomasone
- School of Kinesiology and Health Studies, Queen's University, Kingston, ON
| | - J M Jones
- Faculty of Medicine, University of Toronto, Toronto, ON.,Cancer Rehabilitation and Survivorship, Princess Margaret Cancer Centre, Toronto, ON
| | - E Chang
- Faculty of Medicine, University of Toronto, Toronto, ON.,Cancer Rehabilitation and Survivorship, Princess Margaret Cancer Centre, Toronto, ON.,Toronto Rehabilitation Institute, Toronto, ON
| | - S N Culos-Reed
- Cumming School of Medicine, University of Calgary, Calgary, AB.,Faculty of Kinesiology, University of Calgary, Calgary, AB.,Department of Psychosocial Resources, Tom Baker Cancer Centre, Alberta Health Services, Calgary, AB
| |
Collapse
|
40
|
Jackson C, Dowd AJ, Capozzi LC, Bridel W, Lau HY, Culos-Reed SN. A turning point: Head and neck cancer patients' exercise preferences and barriers before and after participation in an exercise intervention. Eur J Cancer Care (Engl) 2018; 27:e12826. [PMID: 29377317 DOI: 10.1111/ecc.12826] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2017] [Indexed: 12/22/2022]
Abstract
This study examined the exercise barriers and preferences of head and neck cancer (HNC) survivors in relation to exercise experience. Participants (n = 22; 46.8% response rate) completed retrospective self-report questionnaires on demographic and medical information, exercise barriers and preferences. A subset of participants then completed semi-structured interviews (n = 18). Participants had previously engaged in the ENHANCE trial during, or immediately following, radiation treatment, an average of 22.1 ± 5.8 months before. Retrospective questionnaires revealed that before ENHANCE participation, lack of interest and time were the primary exercise barriers. After participation, there was a significant decrease in typical barriers including lack of interest (p = .008), exercise not a priority (p = .039) and exercise not in routine (p = .004). Number of barriers experienced after ENHANCE participation was negatively correlated with age, quality of life and minutes of resistance exercise training per week. After ENHANCE participation, significant increases were found in preference for exercising at a cancer centre (p = .031) and with other cancer survivors (p = .016). Four higher order themes emerged inductively from interview data analysis pertaining to preferences (i.e., class format) and three higher order themes regarding barriers (physical, psychological and external). By investigating participants' perspectives after ENHANCE participation, key factors for effective HNC exercise programme design were identified.
Collapse
Affiliation(s)
- C Jackson
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - A J Dowd
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - L C Capozzi
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - W Bridel
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - H Y Lau
- Department of Oncology, Cumming School of Medicine, University of Calgary and Tom Baker Cancer Centre, Calgary, AB, Canada
| | - S N Culos-Reed
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada.,Department of Oncology, Cumming School of Medicine, University of Calgary and Tom Baker Cancer Centre, Calgary, AB, Canada.,Department of Psychosocial Resources, Tom Baker Cancer Center, Alberta Health Services, Calgary, AB, Canada
| |
Collapse
|
41
|
Demark-Wahnefried W, Schmitz KH, Alfano CM, Bail JR, Goodwin PJ, Thomson CA, Bradley DW, Courneya KS, Befort CA, Denlinger CS, Ligibel JA, Dietz WH, Stolley MR, Irwin ML, Bamman MM, Apovian CM, Pinto BM, Wolin KY, Ballard RM, Dannenberg AJ, Eakin EG, Longjohn MM, Raffa SD, Adams-Campbell LL, Buzaglo JS, Nass SJ, Massetti GM, Balogh EP, Kraft ES, Parekh AK, Sanghavi DM, Morris GS, Basen-Engquist K. Weight management and physical activity throughout the cancer care continuum. CA Cancer J Clin 2018; 68:64-89. [PMID: 29165798 PMCID: PMC5766382 DOI: 10.3322/caac.21441] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 10/10/2017] [Accepted: 10/11/2017] [Indexed: 12/20/2022] Open
Abstract
Mounting evidence suggests that weight management and physical activity (PA) improve overall health and well being, and reduce the risk of morbidity and mortality among cancer survivors. Although many opportunities exist to include weight management and PA in routine cancer care, several barriers remain. This review summarizes key topics addressed in a recent National Academies of Science, Engineering, and Medicine workshop entitled, "Incorporating Weight Management and Physical Activity Throughout the Cancer Care Continuum." Discussions related to body weight and PA among cancer survivors included: 1) current knowledge and gaps related to health outcomes; 2) effective intervention approaches; 3) addressing the needs of diverse populations of cancer survivors; 4) opportunities and challenges of workforce, care coordination, and technologies for program implementation; 5) models of care; and 6) program coverage. While more discoveries are still needed for the provision of optimal weight-management and PA programs for cancer survivors, obesity and inactivity currently jeopardize their overall health and quality of life. Actionable future directions are presented for research; practice and policy changes required to assure the availability of effective, affordable, and feasible weight management; and PA services for all cancer survivors as a part of their routine cancer care. CA Cancer J Clin 2018;68:64-89. © 2017 American Cancer Society.
Collapse
Affiliation(s)
| | - Kathryn H Schmitz
- Professor of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Catherine M Alfano
- Vice President, Survivorship, American Cancer Society, Inc., Washington, DC
| | - Jennifer R Bail
- Post-Doctoral Fellow, Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL
| | - Pamela J Goodwin
- Professor of Medicine, Mount Sinai Hospital, Lunenfeld-Tanenbaum Research Institute at the University of Toronto, Toronto, Ontario, Canada
| | - Cynthia A Thomson
- Professor of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ
| | - Don W Bradley
- Associate Consulting Professor, Community and Family Medicine, Duke School of Medicine, Durham, NC
| | - Kerry S Courneya
- Professor of Physical Education and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Christie A Befort
- Associate Professor of Preventive Medicine, University of Kansas Medical Center, Kansas City, KS
| | - Crystal S Denlinger
- Associate Professor of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | | | - William H Dietz
- Chair, Redstone Global Center for Prevention and Wellness, George Washington University, Washington, DC
| | | | - Melinda L Irwin
- Professor of Epidemiology, Yale School of Public Health, New Haven, CT
| | - Marcas M Bamman
- Professor of Cell Developmental and Integrative Biology, University of Alabama at Birmingham, Birmingham, AL
| | | | | | | | - Rachel M Ballard
- Director, Prevention Research Coordination, Office of Disease Prevention, Office of the Director, National Institutes of Health, Bethesda, MD
| | | | - Elizabeth G Eakin
- Professor and Director, Cancer Prevention Research Centre, School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Matt M Longjohn
- Vice President and National Health Officer, YMCA of the USA, Chicago, IL
| | - Susan D Raffa
- National Program Director for Weight Management, Veterans Health Administration, Durham, NC
| | | | - Joanne S Buzaglo
- Senior Vice President, Research and Training Institute, Cancer Support Community, Philadelphia, PA
| | - Sharyl J Nass
- Director, National Cancer Policy Forum and Board on Health Care Services, Health and Medicine Division, National Academies of Science, Engineering, and Medicine, Washington, DC
| | - Greta M Massetti
- Associate Director for Science, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
| | - Erin P Balogh
- Senior Program Officer, National Cancer Policy Forum, Health and Medicine Division, National Academies of Science, Engineering, and Medicine, Washington, DC
| | | | - Anand K Parekh
- Chief Medical Advisor, Bipartisan Policy Center, Washington, DC
| | - Darshak M Sanghavi
- Chief Medical Officer, Senior Vice President, Translation, Optum Labs, Cambridge, MA
| | | | - Karen Basen-Engquist
- Professor of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX
| |
Collapse
|
42
|
Factors influencing non-participation in an exercise program and attitudes towards physical activity amongst cancer survivors. Support Care Cancer 2017; 26:1289-1295. [DOI: 10.1007/s00520-017-3952-9] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 10/25/2017] [Indexed: 10/18/2022]
|
43
|
Hardcastle SJ, Cohen PA. Effective Physical Activity Promotion to Survivors of Cancer Is Likely to Be Home Based and to Require Oncologist Participation. J Clin Oncol 2017; 35:3635-3637. [PMID: 28915086 DOI: 10.1200/jco.2017.74.6032] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Sarah J Hardcastle
- Sarah J. Hardcastle, Curtin University, Perth; and University of Western Australia, Crawley, Western Australia, Australia; and Paul A. Cohen, St John of God Subiaco Hospital, Subiaco; University of Western Australia, Crawley; University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Paul A Cohen
- Sarah J. Hardcastle, Curtin University, Perth; and University of Western Australia, Crawley, Western Australia, Australia; and Paul A. Cohen, St John of God Subiaco Hospital, Subiaco; University of Western Australia, Crawley; University of Notre Dame Australia, Fremantle, Western Australia, Australia
| |
Collapse
|
44
|
Caetano LCG, Teixeira-Salmela LF, Samora GAR, Scianni AA. Cross-cultural adaptation and measurement properties of the Brazilian version of the Exercise Preference Questionnaire (stroke). Braz J Phys Ther 2017; 21:336-343. [PMID: 28716366 PMCID: PMC5628371 DOI: 10.1016/j.bjpt.2016.08.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 08/01/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The Exercise Preference Questionnaire (EPQ(stroke)) captures exercise preferences and measures personal factors, that influence motivation and adherence to exercise in stroke subjects. OBJECTIVES To perform the cross-cultural adaptation of the EPQ(stroke) into the Brazilian-Portuguese language and to evaluate its measurement properties. METHODS The EPQ(stroke) was cross-culturally adapted and primarily tested in 30 chronic stroke subjects. After the final version of the EPQ(stroke)-Brazil was created, its test-retest reliability was verified, using Kappa indices and intra-class correlation coefficients (ICCs) (n=50), and internal consistency was verified using Cronbach's alpha coefficients (n=101). Construct validity was assessed using exploratory factor analysis (n=101), content validity using the content validity index (CVI) (n=8), and face validity using the rate of agreement regarding the clarity, wording, ability to answer the questions, and lay-out and style of the questionnaire with two groups, including individuals with stroke (n=81) and multidisciplinary health professionals (n=32). RESULTS The pre-final version required revisions (items 9, 29, and 30) and, after another pre-test, it was shown to be appropriate. The Kappa indices ranged from 0.58 to 0.95; the ICCs from 0.35 to 0.93, and the Cronbach's alpha coefficient was 0.82 (0.768-0.869 CI), showing adequate internal consistency. The exploratory factor analysis and CVI confirmed the validity of the EPQ(stroke)-Brazil. The rate of agreement was greater than 80% for both groups. CONCLUSION The EPQ(stroke)-Brazil was found to be a valid and reliable measure for verifying exercise preferences of Brazilian individuals with stroke.
Collapse
Affiliation(s)
- Lívia C G Caetano
- Programa de pós-graduação em Ciências da Reabilitação, Departamento de Fisioterapia, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Luci F Teixeira-Salmela
- Programa de pós-graduação em Ciências da Reabilitação, Departamento de Fisioterapia, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Giane A R Samora
- Programa de pós-graduação em Ciências da Reabilitação, Departamento de Fisioterapia, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Aline A Scianni
- Programa de pós-graduação em Ciências da Reabilitação, Departamento de Fisioterapia, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.
| |
Collapse
|
45
|
Phillips SM, Conroy DE, Keadle SK, Pellegrini CA, Lloyd GR, Penedo FJ, Spring B. Breast cancer survivors' preferences for technology-supported exercise interventions. Support Care Cancer 2017; 25:3243-3252. [PMID: 28470368 DOI: 10.1007/s00520-017-3735-3] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 04/24/2017] [Indexed: 01/01/2023]
Abstract
PURPOSE The purpose of this study was to explore breast cancer survivors' interest in and preferences for technology-supported exercise interventions. METHODS Post-treatment survivors [n = 279; M age = 60.7 (SD = 9.7)] completed a battery of online questionnaires in August 2015. Descriptive statistics were calculated for all data. Logistic regression analyses were conducted to examine relationships between survivors' interest in a technology-supported exercise interventions and demographic, disease, and behavioral factors. These same factors were examined in relation to perceived effectiveness of such interventions using multiple regression analyses. RESULTS About half (53.4%) of survivors self-reported meeting public health recommendations for physical activity. Fewer than half reported using an exercise or diet mobile app (41.2%) or owning an activity tracker (40.5%). The majority were interested in receiving remotely delivered exercise counseling (84.6%), participating in a remotely delivered exercise intervention (79.5%), and using an exercise app or website (68%). Survivors reported that the most helpful technology-supported intervention components would be an activity tracker (89.5%), personalized feedback (81.2%), and feedback on how exercise is influencing mood, fatigue, etc. (73.6%). Components rated as least helpful were social networking integration (31.2%), group competitions (33.9%), and ability to see others' progress (35.1%). CONCLUSIONS Preferences for technology-supported exercise interventions varied among breast cancer survivors. Nonetheless, data indicate that technology-supported interventions may be feasible and acceptable. Engaging stakeholders may be important in developing and testing potential intervention components.
Collapse
Affiliation(s)
- Siobhan M Phillips
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA.
| | - David E Conroy
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA.,Department of Kinesiology, The Pennsylvania State University, University Park, PA, USA
| | - Sarah Kozey Keadle
- Kinesiology Department, California Polytechnic State University, San Luis Obispo, CA, USA
| | - Christine A Pellegrini
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA
| | - Gillian R Lloyd
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA
| | - Frank J Penedo
- Departments of Medical Social Sciences and Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Bonnie Spring
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA
| |
Collapse
|
46
|
Bonner NS, O’Halloran PD, Bernhardt J, Cumming TB. Developing the Stroke Exercise Preference Inventory (SEPI). PLoS One 2016; 11:e0164120. [PMID: 27711242 PMCID: PMC5053595 DOI: 10.1371/journal.pone.0164120] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 09/20/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Physical inactivity is highly prevalent after stroke, increasing the risk of poor health outcomes including recurrent stroke. Tailoring of exercise programs to individual preferences can improve adherence, but no tools exist for this purpose in stroke. METHODS We identified potential questionnaire items for establishing exercise preferences via: (i) our preliminary Exercise Preference Questionnaire in stroke, (ii) similar tools used in other conditions, and (iii) expert panel consultations. The resulting 35-item questionnaire (SEPI-35) was administered to stroke survivors, along with measures of disability, depression, anxiety, fatigue and self-reported physical activity. Exploratory factor analysis was used to identify a factor structure in exercise preferences, providing a framework for item reduction. Associations between exercise preferences and personal characteristics were analysed using multivariable regression. RESULTS A group of 134 community-dwelling stroke survivors (mean age 64.0, SD 13.3) participated. Analysis of the SEPI-35 identified 7 exercise preference factors (Supervision-support, Confidence-challenge, Health-wellbeing, Exercise context, Home-alone, Similar others, Music-TV). Item reduction processes yielded a 13-item version (SEPI-13); in analysis of this version, the original factor structure was maintained. Lower scores on Confidence-challenge were significantly associated with disability (p = 0.002), depression (p = 0.001) and fatigue (p = 0.001). Self-reported barriers to exercise were particularly prevalent in those experiencing fatigue and anxiety. CONCLUSIONS The SEPI-13 is a brief instrument that allows assessment of exercise preferences and barriers in the stroke population. This new tool can be employed by health professionals to inform the development of individually tailored exercise interventions.
Collapse
Affiliation(s)
- Nicholas S. Bonner
- School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Paul D. O’Halloran
- School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Julie Bernhardt
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Toby B. Cumming
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
47
|
Kirkham AA, Neil-Sztramko SE, Morgan J, Hodson S, Weller S, McRae T, Campbell KL. Fee-for-service cancer rehabilitation programs improve health-related quality of life. ACTA ACUST UNITED AC 2016; 23:233-40. [PMID: 27536173 DOI: 10.3747/co.23.3038] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Rigorously applied exercise interventions undertaken in a research setting result in improved health-related quality of life (hrqol) in cancer survivors, but research to demonstrate effective translation of that research to practice is needed. The objective of the present study was to determine the effect of fee-for-service cancer rehabilitation programs in the community on hrqol and on self-reported physical activity and its correlates. METHODS After enrolment and 17 ± 4 weeks later, new clients (n = 48) to two fee-for-service cancer rehabilitation programs completed the 36-Item Short Form Health Survey (rand-36: rand Corporation, Santa Monica, CA, U.S.A.), the Godin Leisure-Time Exercise Questionnaire, and questions about physical activity correlates. Normal fee-for-service operations were maintained, including a fitness assessment and individualized exercise programs supervised in a group or one-on-one setting, with no minimum attendance required. Fees were associated with the assessment and with each exercise session. RESULTS Of the 48 participants, 36 (75%) completed both questionnaires. Improvements in the physical functioning, role physical, pain, and energy/fatigue scales on the rand-36 exceeded minimally important differences and were of a magnitude similar to improvements reported in structured, rigorously applied, and free research interventions. Self-reported levels of vigorous-intensity (p = 0.021), but not moderate-intensity (p = 0.831) physical activity increased. The number of perceived barriers to exercise (p = 0.035) and the prevalence of fatigue as a barrier (p = 0.003) decreased. Exercise self-efficacy improved only in participants who attended 11 or more sessions (p = 0.002). Exercise enjoyment did not change (p = 0.629). CONCLUSIONS Enrolment in fee-for-service cancer rehabilitation programs results in meaningful improvements in hrqol comparable to those reported by research interventions, among other benefits. The fee-for-service model could be an effective model for delivery of exercise to more cancer survivors.
Collapse
Affiliation(s)
- A A Kirkham
- Rehabilitation Sciences, University of British Columbia
| | - S E Neil-Sztramko
- School of Population and Public Health, University of British Columbia, Vancouver, BC
| | - J Morgan
- Back on Track Fitness, Vancouver, BC
| | - S Hodson
- Live Well Exercise Clinic, White Rock, BC
| | - S Weller
- Back on Track Fitness, Vancouver, BC
| | - T McRae
- Live Well Exercise Clinic, White Rock, BC
| | - K L Campbell
- Rehabilitation Sciences, University of British Columbia; Physical Therapy, University of British Columbia, Vancouver, BC
| |
Collapse
|
48
|
Rufa'i AA, Muda WAMW, Yen SH, Abd Shatar AK, Murali BVK, Tan SW. Design of a randomised intervention study: the effect of dumbbell exercise therapy on physical activity and quality of life among breast cancer survivors in Malaysia. BMJ Glob Health 2016; 1:e000015. [PMID: 28588911 PMCID: PMC5321396 DOI: 10.1136/bmjgh-2015-000015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 06/24/2016] [Accepted: 07/01/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Participation in physical activity has a positive impact on the overall health and quality of life, whereas physical inactivity is associated with a poor prognosis among breast cancer survivors. Despite the health-enhancing benefits of physical activity, the majority of Malaysian breast cancer survivors are not physically active. This paper presents the design of a randomised study to evaluate the feasibility and effect of exercise therapy intervention using light resistance dumbbell exercise to promote active lifestyle and improve the quality of life of breast cancer survivors in Malaysia. METHODS/DESIGN This is an intervention study of a 12-week exercise therapy that will explore and compare the effects of light resistance and aerobic exercise on physical activity level and quality of life components in 102 female breast cancer survivors. Major eligibility criteria include histologically confirmed diagnosis of breast cancer stages I-III, 3-12 months post-diagnosis, and absence of any disorder contraindicating exercise. Participants will be stratified based on menopausal status (pre-menopause vs post-menopause) and then assigned randomly to one of three groups. Participants in group A will participate in a three-times weekly supervised resistance exercise using light resistance dumbbells; participants in group B will participate in a three-times weekly supervised aerobic exercise; while participants in group C (control group) will be given aerobic exercise after completion of the intervention. The primary end points include physical activity level and quality of life components. The secondary end points are body mass index, body composition, total caloric intake, and waist-to-hip ratio. DISCUSSION Although there have been many studies of resistance exercise in breast cancer survivors, this is the first study using this specific mode of resistance. Findings will contribute data on the feasibility and effects of light resistance dumbbell exercises, and provide knowledge on the physical activity intervention programme that will maximally promote better overall health and well-being of survivors.
Collapse
Affiliation(s)
- Adamu Ahmad Rufa'i
- School of Health Sciences, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
- Department of Physiotherapy, College of Medical Sciences, University of Maiduguri, Borno, Nigeria
| | | | - Siew Hwa Yen
- School of Distance Education, Universiti Sains Malaysia, Pinang, Malaysia
| | - Aishah Knight Abd Shatar
- Advanced Medical and Dental Institute, Universiti Sains Malaysia, Kepala Batas, Penang, Malaysia
| | | | - Shu Wen Tan
- School of Health Sciences, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
| |
Collapse
|
49
|
Abstract
BACKGROUND Performing regular exercise of at least 150 minutes weekly has benefits for colorectal cancer survivors. However, barriers inhibit these survivors from performing regular exercise. OBJECTIVES The aim of this study was to explore exercise behaviors and significant factors influencing weekly exercise time of more than 150 minutes in colorectal cancer survivors. METHODS A cross-sectional study design was used to recruit participants in Taiwan. Guided by the ecological model of health behavior, exercise barriers were assessed including intrapersonal, interpersonal, and environment-related barriers. A multiple logistic regression was used to explore the factors associated with the amount of weekly exercise. RESULTS Among 321 survivors, 57.0% of them had weekly exercise times of more than 150 minutes. The results identified multiple levels of significant factors related to weekly exercise times including intrapersonal factors (occupational status, functional status, pain, interest in exercise, and beliefs about the importance of exercise) and exercise barriers related to environmental factors (lack of time and bad weather). No interpersonal factors were found to be significant. CONCLUSIONS Colorectal cancer survivors experienced low levels of physical and psychological distress. Multiple levels of significant factors related to exercise time including intrapersonal factors as well as exercise barriers related to environmental factors should be considered. IMPLICATIONS FOR PRACTICE Healthcare providers should discuss with their patients how to perform exercise programs; the discussion should address multiple levels of the ecological model such as any pain problems, functional status, employment status, and time limitations, as well as community environment.
Collapse
|
50
|
Arthur AE, Delk A, Demark-Wahnefried W, Christein JD, Contreras C, Posey JA, Vickers S, Oster R, Rogers LQ. Pancreatic cancer survivors' preferences, barriers, and facilitators related to physical activity and diet interventions. J Cancer Surviv 2016; 10:981-989. [PMID: 27138993 DOI: 10.1007/s11764-016-0544-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 04/18/2016] [Indexed: 01/26/2023]
Abstract
PURPOSE To conduct a telephone survey establishing pancreatic cancer survivors' level of interest in, preferences for, and perceived barriers and facilitators to participating in exercise and diet intervention programming. These data will inform the development of such interventions for newly-diagnosed patients. METHODS Seventy-one survivors treated for resectable pancreatic adenocarcinoma from October 2011 to August 2014 were identified through an institutional cancer registry and contacted via telephone. A telephone survey was conducted to query survivors' level of interest in, preferences for, and perceived barriers and facilitators to participating in an exercise and dietary intervention program shortly after disease diagnosis. Acceptability of a technology-based visual communication (e.g., Skype™, FaceTime®) intervention was also assessed. RESULTS Fifty participants completed the survey (response rate 71.8 %). Over two-thirds of participants reported interest in exercise and diet intervention programming. Over half reported comfort with a technology-delivered visual communication intervention. Barriers to participation included older age and physical, personal, and emotional problems. The most common facilitator was program awareness. Outcomes for future research important to participants were supportive care and quality of life. CONCLUSIONS Most pancreatic cancer patients are interested in exercise and diet interventions shortly after diagnosis; however, some barriers to program participation exist. IMPLICATIONS FOR CANCER SURVIVORS Future research and intervention planning for pancreatic cancer survivors should focus on developing messaging and strategies that provide support for survivorship outcomes, increase survivor awareness, address lack of familiarity with technology, reduce fears about potential barriers, and help survivors overcome these barriers. In so doing, survivorship needs can be better met and quality of life improved in this understudied population.
Collapse
Affiliation(s)
- Anna E Arthur
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ashley Delk
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - John D Christein
- Division of Gastrointestinal Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Carlo Contreras
- Division of Surgical Oncology, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - James A Posey
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Selwyn Vickers
- Division of Gastrointestinal Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Robert Oster
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Laura Q Rogers
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, USA.
| |
Collapse
|