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Marín-Chollom AM, Rillamas-Sun E, Koch PA, Contento IR, Gaffney AO, Ulanday KT, Hershman DL, Greenlee H. Social Support, Diet, and Physical Activity among Latina/Hispanic Women Breast Cancer Survivors. J Immigr Minor Health 2024:10.1007/s10903-024-01614-5. [PMID: 38954235 DOI: 10.1007/s10903-024-01614-5] [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] [Accepted: 06/20/2024] [Indexed: 07/04/2024]
Abstract
Diet and physical activity guidelines for cancer survivorship are less likely to be followed by populations of minority cancer survivors, such as Latina/Hispanic women, compared to non-Hispanic White women. It is important to understand psychosocial mechanisms that may increase adherence to healthy lifestyle habits, especially in populations at risk for poorer cancer outcomes. This cross-sectional study examined the relationships between overall social support (SS) and SS from three sources (family, friends, and significant other) with diet (fruit and vegetables, fat, energy density, and diet quality), and moderate-to-vigorous physical activity (MVPA) behaviors in Latina/Hispanic women with a history of breast cancer (n = 85; M age = 55.2; SD = 9.2). Linear regression models and odds ratios were used to examine associations and adjusted for age, income, and acculturation. Family, significant other, and total SS were positively related to total fruit and vegetable intake but SS from friends was not. Higher levels of SS from all sources were each related to a low energy density diet. A higher quality diet was only related to SS from family. SS was not related to fat intake or MVPA. Higher SS from family and a significant other were associated with higher odds of meeting the fruit/vegetable guidelines; (family, OR = 3.72, 95% CI [1.21, 11.39]; significant other, OR = 3.32, 95% CI [1.08, 10.30]). Having more SS from family or a significant other may contribute to Latina/Hispanic women breast cancer survivors meeting national guidelines for a diet high in fruits and vegetables and low in energy density.
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Affiliation(s)
- Amanda M Marín-Chollom
- Department of Psychological Science, Central Connecticut State University, Marcus White, Room 216, 1615 Stanley Street, P.O. Box 4010, New Britain, CT, 06053, USA.
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
| | - Eileen Rillamas-Sun
- Cancer Prevention Program, Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Pamela A Koch
- Teachers College, Columbia University, New York, NY, USA
| | | | | | - Kathleene T Ulanday
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Dawn L Hershman
- Division of Hematology/Oncology, Irving College of Physicians and Surgeons, Columbia University Medical Center, New York, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, USA
| | - Heather Greenlee
- Cancer Prevention Program, Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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Millar MM, Edwards SL, Codden RR, Ofori-Atta BS, Herget KA, Carter ME, Kirchhoff AC, Coletta AM, Sweeney C. Physical Activity Among Utah Cancer Survivors: Analysis From a Population-Based Statewide Survey. J Phys Act Health 2024:1-10. [PMID: 38866381 DOI: 10.1123/jpah.2023-0683] [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: 11/16/2023] [Revised: 04/17/2024] [Accepted: 04/18/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND Regular physical activity improves cancer survivors' health-related quality of life and physical function. We estimated the proportion of Utah cancer survivors meeting U.S. Department of Health and Human Services guidelines for weekly physical activity (aerobic plus strength exercise) and identify sociodemographic, cancer, and health-related factors associated with meeting guidelines. METHODS Survivors randomly sampled from Utah Cancer Registry records were surveyed from 2018 to 2022 to ascertain physical activity. We calculated the percent of survivors meeting guidelines and conducted logistic regression to assess predictors of meeting guidelines. Analyses were weighted to account for complex survey sample design and nonresponse and age adjusted. RESULTS Among Utah cancer survivors, 20.7% (95% CI, 18.5%-23.2%) met guidelines for both aerobic activity and strength exercise. 22.4% reported no aerobic exercise in a typical week, and 59.4% reported no strength exercise. Survivors 75 or older were less likely to meet physical activity guidelines than those under 55 (adjusted odds ratio: 0.40; 95% CI, 0.25-0.65). Survivors with a bachelor's degree or higher were more likely to meet physical activity guidelines than those without a college degree. Individuals with poorer overall health were less likely to report sufficient physical activity. Individuals treated with both chemotherapy and radiation had decreased odds of meeting guidelines compared to no treatment (adjusted odds ratio: 0.54; 95% CI, 0.29-0.99). CONCLUSIONS Most Utah cancer survivors, and particularly those who received multiple modes of adjuvant treatment, are not participating in sufficient physical activity to improve longevity and quality of life after cancer.
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Affiliation(s)
- Morgan M Millar
- Utah Cancer Registry, University of Utah School of Medicine, Salt Lake City, UT, USA
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
- Cancer Control and Population Sciences Program, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Sandra L Edwards
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Rachel R Codden
- Utah Cancer Registry, University of Utah School of Medicine, Salt Lake City, UT, USA
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Blessing S Ofori-Atta
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Kimberly A Herget
- Utah Cancer Registry, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Marjorie E Carter
- Utah Cancer Registry, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Anne C Kirchhoff
- Cancer Control and Population Sciences Program, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT, USA
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Adriana M Coletta
- Cancer Control and Population Sciences Program, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT, USA
- Department of Health and Kinesiology, University of Utah College of Health, Salt Lake City, UT, USA
| | - Carol Sweeney
- Utah Cancer Registry, University of Utah School of Medicine, Salt Lake City, UT, USA
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
- Cancer Control and Population Sciences Program, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT, USA
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O'Rourke RH, Vani MF, O'Loughlin EK, Thibodeau DE, Sabiston CM. Exploring the reasons for wanting a peer partner to be physically active among women living with and beyond a cancer diagnosis: a content analysis. Support Care Cancer 2024; 32:411. [PMID: 38839643 DOI: 10.1007/s00520-024-08602-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 05/24/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND Initiating and maintaining exercise is challenging for women during and post-cancer treatment. Adopting a peer partner model to provide social support to be active may contribute to lasting behaviour change of both partners. Despite this, finding a "like peer" can be challenging. PURPOSE To explore women's reasons for seeking an online exercise partner following a diagnosis with cancer (through www.activematch.ca ). We also examined women's potential sociodemographic and cancer-related differences by reported reasons for wanting an exercise partner. METHODS Individuals creating an ActiveMatch profile completed demographic and physical activity questions (N = 199, Mage(SD) = 51.9(10.8) years), including an open-ended question regarding their "reason for wanting an exercise partner". An inductive content analysis was completed focusing on the participants' peer exercise partner preferences. Additional chi-square tests were run to assess whether participants differed based on sociodemographic and cancer-related characteristics and their motivations to be active by category of "reason for wanting an exercise partner" endorsed in the open-ended question. RESULTS The participants' reasons for wanting an exercise partner were coded into seven categories, with most participants highlighting the reasons of motivation (52.3%), social support (48.7%), and accountability and adherence (26.6%). Women < 50 years of age were more likely to report accountability and adherence-related preferences for a partner. Those reporting endorsing weight loss as their primary reason for becoming active were more likely to be categorized as wanting a peer partner for motivation. CONCLUSIONS While finding a peer partner can be challenging, matching women living with and beyond a cancer diagnosis based on their reason for wanting an exercise partner, as well as their reasons for wanting to be active, may be important to build successful peer exercise partnerships.
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Affiliation(s)
- Roxy H O'Rourke
- Faculty of Kinesiology and Physical Education, University of Toronto, 320 Huron Street, Toronto, ON, M5S 3J7, Canada
| | - Madison F Vani
- Faculty of Kinesiology and Physical Education, University of Toronto, 320 Huron Street, Toronto, ON, M5S 3J7, Canada
| | - Erin K O'Loughlin
- Faculty of Kinesiology and Physical Education, University of Toronto, 320 Huron Street, Toronto, ON, M5S 3J7, Canada
- Centre de Recherche du Centre Hospitalier, Université de Montréal, Montréal, Québec, Canada
| | - Delaney E Thibodeau
- Faculty of Kinesiology and Physical Education, University of Toronto, 320 Huron Street, Toronto, ON, M5S 3J7, Canada
| | - Catherine M Sabiston
- Faculty of Kinesiology and Physical Education, University of Toronto, 320 Huron Street, Toronto, ON, M5S 3J7, Canada.
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Cloyes KG, Mansfield KJ, Wawrzynski SE, Vega M, Kent-Marvick J, Guo JW. Cancer Survivors' and Care Partners' Audio Diaries on Stress and Social Support Resources During the COVID-19 Pandemic. Semin Oncol Nurs 2024; 40:151623. [PMID: 38538507 PMCID: PMC11045306 DOI: 10.1016/j.soncn.2024.151623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 02/25/2024] [Accepted: 02/29/2024] [Indexed: 04/28/2024]
Abstract
OBJECTIVES To describe cancer survivors' and care partners' perceived stress and social support during the COVID-19 pandemic and assess the feasibility of audio diaries for assessing role-related needs and resources. METHODS Participants (N = 51; n = 28 survivors, n = 23 care partners) recorded three monthly audio diaries reporting stress and support experiences. Diaries were transcribed and content-analyzed using a hybrid approach. Stress-related content was inductively coded, and social support content was deductively coded by type (instrumental, information, emotional, companionship, appraisal; κ = 0.75) then inductively coded. Descriptive statistics summarized sociodemographic data and compared coding frequencies by role. We developed narrative summaries of stress and support categories and selected quotes for contextual detail. RESULTS Cancer-related stressors were most prevalent (28.8%), followed by work (26.8%), family (23.1%), social isolation (13.4%), and finances (8.0%). While no significant difference in reporting frequency was observed between roles, cancer-related stress was more prevalent for survivors while work-related stress was mentioned more by care partners. Emotional support was the most prevalent support type (32.1%), followed by companionship (25.3%), appraisal (17.9%), instrumental (16.67%), and informational support (8%). Survivors reported more appraisal support than care partners (χ2 = 6.48, df = 1, P = .011) and more support for self-care, while care partners expressed more other-oriented concerns and focused more on managing responsibilities and interactions outside the household. CONCLUSIONS The pandemic complicated and intensified role-based stressors already present in the survivorship context. Our findings highlight the importance of informal social support networks, particularly when access to formal services is limited, and suggest that audio diaries can be an effective tool for assessing support needs and resources. IMPLICATIONS FOR NURSING PRACTICE Nurses and healthcare providers should tailor social support assessments to address the distinct support needs and individual resources of cancer survivors and their care partners. This is especially critical in contexts that limit access to care and formal services.
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Affiliation(s)
- Kristin G Cloyes
- School of Nursing, Oregon Health & Science University, Portland, OR.
| | - Kelly J Mansfield
- College of Nursing, University of Utah College of Nursing, Salt Lake City, UT
| | - Sarah E Wawrzynski
- Center for Healthcare Delivery Science, Nemours Children's Health, Wilmington, DE
| | - Marilisa Vega
- College of Nursing, University of Utah College of Nursing, Salt Lake City, UT
| | | | - Jia-Wen Guo
- College of Nursing, University of Utah College of Nursing, Salt Lake City, UT
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Adamovich T, Watson R, Murdoch S, Giovino L, Kulkarni S, Luchak M, Smith-Turchyn J. Barriers and facilitators to physical activity participation for child, adolescent, and young adult cancer survivors: a systematic review. J Cancer Surviv 2024; 18:245-262. [PMID: 35665472 DOI: 10.1007/s11764-022-01217-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 05/18/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE The aim of this systematic review is to explore and describe the barriers and facilitators to physical activity (PA) participation for child, adolescent, and young adult cancer survivors. METHODS MEDLINE, Embase, AMED, CINAHL, Cochrane, and Web of Science were searched for manuscripts published between January 2000 and February 2021. To be included in this review, studies had to report qualitative or quantitative data on barriers and facilitators to PA participation in child (4 to < 10 years), adolescent (10 to 19 years), and young adult (> 19 to < 40 years) cancer survivors. Six independent reviewers assessed methodological quality using the Mixed Methods Appraisal Tool (MMAT-version 18) in duplicate. RESULTS Fifteen studies were included in this systematic review. Fatigue and psychological factors were the most prevalent barriers shared between children, adolescents, and young adults. Support from others was a shared facilitator between age groups. CONCLUSION Psychological barriers and social support are important to address in younger cancer survivors. Clinicians can use these findings to create exercise interventions to facilitate and overcome barriers to PA participation. IMPLICATIONS FOR CANCER SURVIVORS While PA is beneficial for cancer survivors of all ages, different barriers and facilitators to PA participation exist depending on a survivors age and life stage. Survivors should discuss PA with their healthcare team at all timepoints in the cancer treatment trajectory in order to gain the associated benefits during and after treatment.
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Affiliation(s)
- Tatsiana Adamovich
- School of Rehabilitation Sciences, McMaster University, Hamilton, ON, Canada
| | - Rebecca Watson
- School of Rehabilitation Sciences, McMaster University, Hamilton, ON, Canada
| | - Sydney Murdoch
- School of Rehabilitation Sciences, McMaster University, Hamilton, ON, Canada
| | - Liana Giovino
- School of Rehabilitation Sciences, McMaster University, Hamilton, ON, Canada
| | - Sunket Kulkarni
- School of Rehabilitation Sciences, McMaster University, Hamilton, ON, Canada
| | - Michael Luchak
- School of Rehabilitation Sciences, McMaster University, Hamilton, ON, Canada
| | - Jenna Smith-Turchyn
- School of Rehabilitation Sciences, McMaster University, Hamilton, ON, Canada.
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Haegele JA, Zhu X, Luginsland LA. The role of social support in the relationship between physical activity and health-related quality of life among adults with visual impairments. Disabil Health J 2024; 17:101518. [PMID: 37673785 DOI: 10.1016/j.dhjo.2023.101518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/07/2023] [Accepted: 08/07/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Studies support assertions that more social support may be related to higher physical activity behavior, which may, in turn, relate to higher health-related quality of life (HRQoL). However, these relationships remain unexplored, particularly among adults with visual impairments. OBJECTIVE The purpose of this study was to examine the relationships between physical activity-specific social support, physical activity participation, and HRQoL among adults with visual impairments. METHODS This cross-sectional study utilized an online survey methodology. Adults with visual impairments (n = 251) were recruited via three visual impairment LISTSERVs housed in the USA and completed four questionnaires. Data were analyzed using (a) a descriptive analysis, (b) one sample t-test, and (c) structural equation modeling to examine the relations among social support, physical activity, and HRQoL components. RESULTS The participants reported relatively low weekly physical activity participation, with mean physical activity about 1362.02 ± 1231.37 MET-min/week. Compared to the mean T-scores of the general adult US population, the participants had significantly lower physical (43.56 ± 6.76, t = -15.10, p < .01) and mental components of HRQoL (38.24 ± 11.37, t = -16.39, p < .01). Structural equational modeling results show that social support positively predicted weekly physical activity participation (β = 0.11), which, in turn, predicted physical component (β = 0.12) but not mental component HRQoL (β = 0.04, p > .05). CONCLUSIONS Our participant sample reported significantly lower HRQoL than the general US populations. The findings suggest that social support can both directly and indirectly, through physical activity, influence psychological HRQoL among adults with visual impairments.
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Affiliation(s)
| | - Xihe Zhu
- Old Dominion University, United States
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Santos A, Braaten K, MacPherson M, Vasconcellos D, Vis-Dunbar M, Lonsdale C, Lubans D, Jung ME. Rates of compliance and adherence to high-intensity interval training: a systematic review and Meta-analyses. Int J Behav Nutr Phys Act 2023; 20:134. [PMID: 37990239 PMCID: PMC10664287 DOI: 10.1186/s12966-023-01535-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 11/07/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND To determine rates of compliance (i.e., supervised intervention attendance) and adherence (i.e., unsupervised physical activity completion) to high-intensity interval training (HIIT) among insufficiently active adults and adults with a medical condition, and determine whether compliance and adherence rates were different between HIIT and moderate-intensity continuous training (MICT). METHODS Articles on adults in a HIIT intervention and who were either insufficiently active or had a medical condition were included. MEDLINE, EMBASE, PsychINFO, SPORTDiscus, CINAHL, and Web of Science were searched. Article screening and data extraction were completed by two independent reviewers. Risk of bias was assessed using RoB 2.0 or ROBINS-I. Meta-analyses were conducted to discern differences in compliance and adherence between HIIT vs. MICT. Sensitivity analyses, publication bias, sub-group analyses, and quality appraisal were conducted for each meta-analysis. RESULTS One hundred eighty-eight unique studies were included (n = 8928 participants). Compliance to HIIT interventions averaged 89.4% (SD:11.8%), while adherence to HIIT averaged 63% (SD: 21.1%). Compliance and adherence to MICT averaged 92.5% (SD:10.6%) and 68.2% (SD:16.2%), respectively. Based on 65 studies included in the meta-analysis, compliance rates were not different between supervised HIIT and MICT interventions [Hedge's g = 0.015 (95%CI: - 0.088-0.118), p = .78]. Results were robust and low risk of publication bias was detected. No differences were detected based on sub-group analyses comparing medical conditions or risk of bias of studies. Quality of the evidence was rated as moderate over concerns in the directness of the evidence. Based on 10 studies, adherence rates were not different between unsupervised HIIT and MICT interventions [Hedge's g = - 0.313 (95%CI: - 0.681-0.056), p = .096]. Sub-group analysis points to differences in adherence rates dependent on the method of outcome measurement. Adherence results should be interpreted with caution due to very low quality of evidence. CONCLUSIONS Compliance to HIIT and MICT was high among insufficiently active adults and adults with a medical condition. Adherence to HIIT and MICT was relatively moderate, although there was high heterogeneity and very low quality of evidence. Further research should take into consideration exercise protocols employed, methods of outcome measurement, and measurement timepoints. REGISTRATION This review was registered in the PROSPERO database and given the identifier CRD42019103313.
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Affiliation(s)
- Alexandre Santos
- Faculty of Health and Social Development, University of British Columbia - Okanagan Campus, Kelowna, British Columbia, Canada
| | - Kyra Braaten
- Faculty of Health and Social Development, University of British Columbia - Okanagan Campus, Kelowna, British Columbia, Canada
| | - Megan MacPherson
- Faculty of Health and Social Development, University of British Columbia - Okanagan Campus, Kelowna, British Columbia, Canada
| | - Diego Vasconcellos
- Institute for Positive Psychology & Education, Australian Catholic University, Melbourne, Victoria, Australia
| | - Mathew Vis-Dunbar
- Library, University of British Columbia - Okanagan Campus, Kelowna, British Columbia, Canada
| | - Chris Lonsdale
- Institute for Positive Psychology & Education, Australian Catholic University, Melbourne, Victoria, Australia
| | - David Lubans
- School of Education, University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Mary E Jung
- Faculty of Health and Social Development, University of British Columbia - Okanagan Campus, Kelowna, British Columbia, Canada.
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St-Cyr J, Saint-Onge K, Doré I, Gauvin L. Milestones and turning points in the experience of physical activity throughout cancer care: a qualitative study to inform physical activity promotion. Support Care Cancer 2023; 31:682. [PMID: 37943370 PMCID: PMC10635913 DOI: 10.1007/s00520-023-08093-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 09/29/2023] [Indexed: 11/10/2023]
Abstract
PURPOSE Physical activity (PA) is an important supportive care strategy to manage cancer and treatment-related side effects, yet PA participation is low among people diagnosed with cancer. This study examined patients', health professionals', and managers' perspectives on PA throughout cancer care to glean implications for PA promotion. METHODS Random selection and purposeful sampling methods allowed for the recruitment of 21 patients (76.2% women) and 20 health professionals and managers (80% women) who participated in individual semi-structured interviews. Interview questions explored facilitators and barriers to PA participation and promotion across the cancer care continuum. Interviews were audio-recorded and transcribed. Then, qualitative thematic analysis was performed. RESULTS The analysis produced five main themes describing milestones in PA participation throughout cancer care: (1) Getting Started, (2) Discovering PA Resources, (3) Taking Action, (4) Striving for Change, and (5) Returning to a "New Normal." The sub-themes underscored turning points, i.e., tasks and challenges to PA participation that had to be overcome at each milestone. Achieving milestones and successfully navigating turning points were dependent on clinical, social, and community factors. CONCLUSION Cancer patients appear to progress through a series of milestones in adopting and maintaining PA throughout cancer care. Intervention strategies aimed at promoting PA could test whether support in navigating turning points could lead to greater PA participation. These findings require replication and extension, specifically among patients who are men, younger adults, and culturally diverse.
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Affiliation(s)
- Jany St-Cyr
- Department of Psychology, Université du Québec à Montréal, Montreal, QC, Canada
| | - Kadia Saint-Onge
- Social and Preventive Medicine Department, School of Public Health, Université de Montréal, Montreal, QC, Canada.
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CR CHUM), Montreal, QC, Canada.
| | - Isabelle Doré
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CR CHUM), Montreal, QC, Canada
- School of Kinesiology and Physical Activity Sciences, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Lise Gauvin
- Social and Preventive Medicine Department, School of Public Health, Université de Montréal, Montreal, QC, Canada
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CR CHUM), Montreal, QC, Canada
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Piché A, Santa Mina D, Lambert S, Doré I. Assessing real-world implementability of a multimodal group-based tele-prehabilitation program in cancer care: a pragmatic feasibility study. Front Oncol 2023; 13:1271812. [PMID: 37965450 PMCID: PMC10641394 DOI: 10.3389/fonc.2023.1271812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/04/2023] [Indexed: 11/16/2023] Open
Abstract
Introduction Multimodal prehabilitation is intended to optimize a patient's mental and physical health prior to surgery. Most multimodal prehabilitation interventions are delivered on a one-on-one format, which may limit benefits associated with social interactions that can be achieved in a group context, and are delivered in-person, which may limit the accessibility. The purpose of this study was to develop a group-based, multimodal, tele-prehabilitation intervention for individuals diagnosed with cancer (iACTIF) and assess its implementability in a "real-world" clinical setting by measuring feasibility, acceptability, fidelity, and preliminary effects. Methods A prospective, single-group, pragmatic feasibility study was conducted with assessments at baseline, pre-surgery, and 12-weeks post-surgery. iACTIF consisted of three 90-min live videoconference sessions per week, including exercise and educational components. Descriptive statistics were used to document feasibility, acceptability, and fidelity indicators. Paired t-test, Wilcoxon test, and Cohen's D-test were conducted to assess changes in health-related outcomes. Results A total of 25 participants (mean age ± SD= 60.2 ± 14.0) were recruited. The feasibility assessment revealed a low referral rate (31.4%) and a high study retention (98%) and program attendance [session attended/possible session] (70.2%), with a prehabilitation window of 32.7 days (SD= 20.9, median= 28). Acceptability was high (84%-100%) according to satisfaction, utility and safety, delivery modality, and intention to continue physical activity and to recommend iACTIF to a relative. Pre-post-intervention assessments suggest positive changes on physical functional capacity based on the 2-min step test (mean difference= +18.9 steps, p=0.005), the 30-s sit-to-stand (mean difference= +1.1 repetition, p=0.011), and volume of moderate intensity physical activity per week (mean difference= +104.8 min, p<0.001). Fidelity was supported by conformity and coherence, with only minimal adjustments required to meet participants' needs. Discussion iACTIF implementability in a "real-world" clinical setting is promising, and preliminary outcomes suggest moderate benefits on physical health and small increase in mental health indicators.
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Affiliation(s)
- Alexia Piché
- Centre de recherche du Centre hospitalier de l’Université de Montréal, Montréal, QC, Canada
- School of Kinesiology and Physical Activity Sciences, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Daniel Santa Mina
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
- Department of Anesthesia and Pain Management, University Health Network, Toronto, ON, Canada
| | - Sylvie Lambert
- St. Mary’s Research Centre, Montréal, QC, Canada
- Ingram School of Nursing, McGill University, Montréal, QC, Canada
| | - Isabelle Doré
- Centre de recherche du Centre hospitalier de l’Université de Montréal, Montréal, QC, Canada
- School of Kinesiology and Physical Activity Sciences, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montréal, QC, Canada
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Ester M, Wagoner CW, Dreger J, Chen G, McDonough MH, McNeely ML, Culos-Reed SN. Effectiveness of a Self-Monitoring App in Supporting Physical Activity Maintenance Among Rural Canadians With Cancer After an Exercise Oncology Program: Cluster Randomized Controlled Trial. JMIR Cancer 2023; 9:e47187. [PMID: 37676714 PMCID: PMC10514772 DOI: 10.2196/47187] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 07/03/2023] [Accepted: 07/26/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Despite the benefits of physical activity (PA) for individuals with cancer, most remain insufficiently active. Exercise oncology interventions can improve PA levels. Individuals struggle to maintain PA levels after interventions because of persistent psychological and environmental PA barriers. Health technology (eHealth) may address some PA barriers and deliver effective, scalable PA interventions in oncology, yet its effectiveness for changing PA levels remains mixed. Using eHealth to support PA maintenance among rural populations with cancer, who may need greater PA support given lower PA levels and worse health outcomes, remains under-studied. OBJECTIVE This study examined the effectiveness of an app-based self-monitoring intervention in supporting PA maintenance among rural populations with cancer after a supervised web-based exercise oncology program. METHODS This 2-arm, cluster randomized controlled trial was embedded within the Exercise for Cancer to Enhance Living Well (EXCEL) effectiveness-implementation study. Upon consent, participants were randomized 1:1 by EXCEL class clusters to the intervention (24 weeks of app-based PA self-monitoring) or waitlist control (app access after 24 weeks). Both groups completed a 12-week supervised web-based exercise oncology program followed by a 12-week self-directed PA maintenance period. Baseline demographics, eHealth literacy, and patient-reported outcomes were compared using chi-square and 2-tailed t tests. App use was measured throughout the intervention. The primary outcome-self-reported moderate-to-vigorous PA (MVPA) minutes-and secondary outcomes-objective MVPA minutes and steps and app usability ratings-were collected at baseline, 12 weeks, and 24 weeks. Intervention effects on self-report MVPA maintenance were assessed via linear mixed modeling, with secondary outcomes explored descriptively. RESULTS Of the 359 eligible EXCEL participants, 205 (57.1%) consented, 199 (55.4%; intervention: 106/199, 53.3%; control: 93/199, 46.7%) started the study, and 183 (51%; intervention: 100/183, 54.6%; control: 83/183, 45.4%) and 141 (39.3%; intervention: 69/141, 48.9%; control: 72/141, 51.1%) completed 12- and 24-week measures, respectively. Mean age was 57.3 (SD 11.5) years. Most participants were female (174/199, 87.4%), White (163/199, 81.9%), and diagnosed with breast cancer (108/199, 54.3%). Median baseline self-report weekly MVPA minutes were 60.0 (IQR 0-180) and 40.0 (IQR 0-135) for the intervention and waitlist control groups, respectively (P=.74). Median app use duration was 10.3 (IQR 1.3-23.9) weeks, with 9.6 (IQR 4.4-17.8) self-monitoring entries/week. Both groups increased their weekly MVPA minutes significantly at 12 weeks (P<.001) and maintained the increases at 24 weeks (P<.001), relative to baseline, with no between-group differences (P=.87). The intervention group had significantly higher step counts for 7 of the 12 weeks during the PA maintenance period (P=.048 to <.001). CONCLUSIONS The app-based self-monitoring intervention did not improve MVPA maintenance but may have contributed to increased step counts during the PA maintenance period. More work is needed to realize the full potential of eHealth in exercise oncology. TRIAL REGISTRATION ClinicalTrials.gov NCT04790578; https://clinicaltrials.gov/study/NCT04790578. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1016/j.cct.2021.106474.
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Affiliation(s)
- Manuel Ester
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Chad W Wagoner
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Julianna Dreger
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Guanmin Chen
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Data and Analytics, Alberta Health Services, Calgary, AB, Canada
| | | | - Margaret L McNeely
- Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada
- Department of Oncology, University of Alberta, Edmonton, AB, Canada
- Rehabilitation Medicine, Cross Cancer Institute, Edmonton, AB, Canada
| | - S Nicole Culos-Reed
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- Department of Oncology, Cummings School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Psychosocial Resources, Tom Baker Cancer Centre, Alberta Health Services Cancer Care, Calgary, AB, Canada
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11
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Soltero EG, James DL, Han S, Larkey LK. The impact of a meditative movement practice intervention on short- and long-term changes in physical activity among breast cancer survivors. J Cancer Surviv 2023:10.1007/s11764-023-01430-0. [PMID: 37507530 DOI: 10.1007/s11764-023-01430-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023]
Abstract
PURPOSE Tai Chi Easy (TCE) is a low-impact, meditative movement practice that is feasible for breast cancer survivors, even in the face of post-treatment symptoms, and may even serve as a gateway into developing an active lifestyle and improving overall physical activity (PA). In the context of a randomized controlled trial testing effects of an 8-week TCE intervention on breast cancer survivors' symptoms, we examined the short- (8-week) and long-term (9-month) impact on total PA compared to an educational control group. METHODS Participants were recruited from two hospital systems, local community organizations, and different media platforms. Eligible participants were predominant non-Hispanic White (82%), college educated (92%), and middle- to high-income (65%), and most commonly reported stage 1 (40%) or 2 breast cancer (38%). After baseline assessments, participants were randomized to the 8-week TCE intervention (N=51) or education control (N=53). Weekly intervention TCE classes were led by a trained instructor. Weekly educational control classes focused on a series of readings and group discussions. Total PA and steps were objectively measured via accelerometry, and the international physical activity questionnaire was used to measure self-reported total PA. RESULTS Multilevel mixed-effects linear regression models revealed no significant short- or long-term changes in objectively measured total PA or steps in either group; however, participants in the intervention reported short- and long-term changes in self-reported total PA. CONCLUSIONS TCE is an appropriate PA strategy for survivors that may lead to modest improvements in PA; however, more research is needed to examine the long-term impact on PA as well as other physical and psychological outcomes (i.e., flexibility, mobility, stress). IMPLICATIONS FOR CANCER SURVIVORS Low-impact, low-intensity activities like meditative movement practices are needed to assist survivors in overcoming post-treatment physical and psychological limitations to initiate a more active lifestyle.
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Affiliation(s)
- Erica G Soltero
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, 1100 Bates St, Houston, TX, 77030, USA.
| | - Dara L James
- College of Nursing, University of South Alabama, 5721 USA Drive North, Mobile, AL, 36688, USA
| | - SeungYong Han
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Linda K Larkey
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, 500N 3rd St, Phoenix, AZ, 85004, USA
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12
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Bultijnck R, Rammant E, Raes A, Vandecasteele N, Decaestecker K, Fonteyne V, Lumen N, Ost P, Deforche B. Experiences of Men With Prostate Cancer Participating in a Clinical Pathway With a Supervised Group-based Exercise Program to Combat Androgen Deprivation-Induced Side Effects: A Qualitative Focus Group Study. Semin Oncol Nurs 2023; 39:151404. [PMID: 36925317 DOI: 10.1016/j.soncn.2023.151404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 01/30/2023] [Accepted: 02/08/2023] [Indexed: 03/17/2023]
Abstract
OBJECTIVES A clinical pathway in daily practice improved implementation of evidence-based strategies for the management of androgen deprivation-induced side effects in men with prostate cancer. This study aimed to explore patients' expectations and reasons to start with the clinical pathway; explore patients' experiences and attitudes toward the pathway; and identify key pathway ingredients and examine patients' attitudes about a possible transition toward the home environment after a hospital-based pathway participation. DATA SOURCES Focus group interviews were conducted through purposeful sampling, consisting of former and current participants of the clinical pathway at Ghent University Hospital. Data was audiotaped and transcribed verbatim, coded in NVivo12, and thematically and inductively analyzed through constant comparisons. CONCLUSION Men with prostate cancer have positive experiences toward the use of a holistic multidisciplinary approach (ie, clinical pathway) to combat androgen deprivation therapy-induced side effects in practice. Patients identified several key ingredients of the pathway, such as peer support, physiotherapist involvement, and availability of a multidisciplinary team. Patients were, however, reluctant to continue the exercise component at home because of negative attitudes toward a public gym, practical issues, absence of known facilitators, and other priorities. IMPLICATIONS FOR NURSING PRACTICE Referral by a health care provider remains an important motivator for pathway participation. Peer support, physiotherapist involvement, and availability of a multidisciplinary team are crucial components of the clinical pathway and should be taken into account when developing and implementing similar pathways to increase program uptake in daily practice.
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Affiliation(s)
- Renée Bultijnck
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium; Research Foundation - Flanders (FWO), Brussels, Belgium.
| | - Elke Rammant
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | | | | | - Karel Decaestecker
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Valérie Fonteyne
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Nicolaas Lumen
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Piet Ost
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Benedicte Deforche
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium; Department of Movement and Sport Sciences, Vrije Universiteit Brussel, Brussels, Belgium
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13
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Stevens CJ, Liao Y, Chen M, Heredia NI, Arem H, Sukumar J, Joffe L, Schmitz KH, Mama SK. Linking social and built environmental factors to leisure-time physical activity in rural cancer survivors. J Natl Cancer Inst Monogr 2023; 2023:125-132. [PMID: 37139981 PMCID: PMC10157784 DOI: 10.1093/jncimonographs/lgad004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 01/06/2023] [Accepted: 01/25/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND This study explored associations between social and built environmental factors and leisure-time physical activity (LTPA) in rural cancer survivors (RCS) and whether these associations differed by exercise stage of change (SOC). METHOD RCS (n = 219) completed questionnaires assessing LTPA, SOC, and social (social status, connectedness, support) and environmental (home environment, neighborhood environment) factors. Linear regression models examined associations between social and built environmental factors and LTPA and tested for moderation by SOC. RESULTS Half (50.7%) of RCS were physically active, and 49.3% were not active. Social factors positively associated with LTPA included subjective social status in the community (B = 89.0, P = .014) and in the United States (B = 181.3, P < .001), social connectedness (B = 122.3, P = .024), and social support for physical activity from family (B = 41.9, P < .001) and friends (B = 44.3, P < .001). Environmental factors positively associated with LTPA included the home environment (B = 111.2, P < .001), perceived environmental support for PA (B = 355.4, P = .004), and neighborhood attributes, including bicycling infrastructure (B = 191.3, P = .003), proximity to recreation facilities (B = 140.1, P = .021), traffic safety (B = 184.5, P = .025), and aesthetics (B = 342.6, P < .001). SOC statistically significantly moderated the association between social status in the United States and LTPA (B = 160.3, P = .031). CONCLUSIONS Social and built environmental factors were consistently linked with LTPA and provide context for multilevel interventions promoting LTPA in RCS.
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Affiliation(s)
- Courtney J Stevens
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
- Cancer Population Sciences, Dartmouth Cancer Center, Lebanon, NH, USA
| | - Yue Liao
- Department of Kinesiology, University of Texas at Arlington, Arlington, TX, USA
| | - Minxing Chen
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Natalia I Heredia
- Department of Health Promotion and Behavioral Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Hannah Arem
- Healthcare Delivery Research Program, Medstar Health Research Institute, Washington, DC, USA
- Department of Oncology, Georgetown University, Washington, DC, USA
| | - Jasmine Sukumar
- Department of Breast Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lenat Joffe
- Department of Pediatric Hematology, Oncology, and Stem Cell Transplantation, Cohen Children’s Medical Center, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA
| | - Kathryn H Schmitz
- Hillman Cancer Center and Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Scherezade K Mama
- Department of Health Disparities Research, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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14
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Murray RM, Smith-Turchyn J, Vani MF, McDonough MH, Fong AJ, Mina DS, Arbour-Nicitopoulos KP, Trinh L, Jones JM, Bender JL, Culos-Reed SN, Tomasone JR, Sabiston CM. Matched and moving: exploring daily social support among women partnered for exercise after a breast cancer diagnosis. Support Care Cancer 2023; 31:258. [PMID: 37043074 PMCID: PMC10091327 DOI: 10.1007/s00520-023-07643-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 02/13/2023] [Indexed: 04/13/2023]
Abstract
PURPOSE Exercise and social support are non-pharmacological strategies that improve health and wellbeing in women treated for breast cancer (WTBC). However, strategies to facilitate support and exercise in WTBC are typically resource intensive. The purpose of this study was to examine whether various forms of social support received from a matched peer were associated with increased exercise among WTBC. METHODS A daily diary study was conducted to examine naturally occurring social support as it relates to daily exercise behavior. Forty-six WTBC were matched (23 pairs) and completed pre-screening survey assessing eligibility and baseline levels of exercise. Participants were given Fitbit devices to track physical activity behavior and completed daily surveys across 3 weeks assessing perceptions of exercise-related social support at fixed times at the end of each day. RESULTS Mixed models accounting for day of study, baseline support, and baseline exercise levels revealed that higher levels of daily exercise-related tangible social support were associated with more daily steps (b = 506, SE = 143) and more light physical activity (LPA) minutes (b = 7.01, SE = 3.15). Informational social support was associated with higher moderate to vigorous physical activity (MVPA) minutes (b = 3.18, SE = 1.60). CONCLUSIONS Overall, peer matching programs aimed at increasing exercise-related social support among WTBC might encourage exercise behaviors, especially among women who share exercise-specific information (e.g., benefits, type, activities).
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Affiliation(s)
- Ross M Murray
- University of Toronto, 55 Harbord Street, Toronto, Ontario, M5S 2W6, Canada
| | | | - Madison F Vani
- University of Toronto, 55 Harbord Street, Toronto, Ontario, M5S 2W6, Canada
| | | | | | - Daniel Santa Mina
- University of Toronto, 55 Harbord Street, Toronto, Ontario, M5S 2W6, Canada
| | | | - Linda Trinh
- University of Toronto, 55 Harbord Street, Toronto, Ontario, M5S 2W6, Canada
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15
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Craig BAP, McDonough MH, Culos-Reed SN, Bridel W. Social Support Behaviours and Barriers in Group Online Exercise Classes for Adults Living with and beyond Cancer: A Qualitative Study. Curr Oncol 2023; 30:3735-3754. [PMID: 37185397 PMCID: PMC10136529 DOI: 10.3390/curroncol30040284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/21/2023] [Accepted: 03/22/2023] [Indexed: 03/30/2023] Open
Abstract
Social support can be facilitated through exercise programs for people living with cancer, but there is limited research on how best to foster it in online exercise oncology classes. This study examined current training that fitness professionals receive on the provision and facilitation of social support, experiences people living with cancer have with social support, and supportive behaviours and barriers for providing and obtaining support in online group exercise oncology programs in Calgary, Alberta, Canada. Guided by interpretive description methodology, training materials were reviewed, observations of fitness professional training and online exercise classes (n = 10) were conducted, and adults living with and beyond cancer (n = 19) and fitness professionals (n = 15) were interviewed. These data were collected from January 2021 to June 2021. Analysis of the data collected resulted in the identification of three themes: Creating a welcoming environment, helping improve exercise ability and reach goals, and learning to provide and facilitate support online. A catalogue of supportive behaviours that can help to provide and facilitate and barriers that can hinder the provision and obtaining of social support in exercise oncology classes is presented. The findings provide guidance when structuring online classes and inform developing strategies for fitness professionals to use in online classes to foster social support by considering the wants and needs of participants, facilitating support between participants with similar experiences and interests, and integrating support into physical activity.
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16
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Larsen EH, Mellblom AV, Larsen MH, Ruud E, Thorsen L, Petersen NN, Larsen HB, Fridh MK, Lie HC. Perceived barriers and facilitators to physical activity in childhood cancer survivors and their parents: A large-scale interview study from the International PACCS Study. Pediatr Blood Cancer 2023; 70:e30056. [PMID: 36251019 DOI: 10.1002/pbc.30056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 09/20/2022] [Accepted: 09/21/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Physical activity (PA) may reduce risks of late effects in childhood cancer survivors, yet many have low activity levels. Using the WHO's International Classification of Functioning, Disability, and Health for Children and Youths (ICF-CY) as a conceptual framework, we aimed to identify perceived barriers and facilitators to PA in young survivors and their parents. DESIGN/METHODS We conducted individual, semi-structured interviews with 63 survivors, aged 9-18 years, ≥1-year off treatment, and 68 parents, recruited from three pediatric oncology departments in Norway and Denmark. Interviews were analyzed inductively using thematic analysis to identify barriers and facilitators to PA, which were mapped onto the ICF-CY model components; body function/structures, activities, participation, and environmental and personal factors. RESULTS Two-thirds of the survivors described how treatment-related impairments of bodily functions (e.g., fatigue, physical weakness, reduced lung capacity) caused physical limitations, reducing opportunities to participate in PA, especially team sports and school physical education. This resulted in a perceived ability gap between survivors and peers, reducing motivation for PA. These PA barriers were moderated by environmental factors that facilitated or further hindered PA participation (family, peer, and school support). Similarily, personal factors also facilitated (acceptance, motivation, goal setting) or hindered (anxiety, low motivation, and lack of trust) PA participation. CONCLUSION Treatment-related long-term or late effects represented significant barriers to PA as their functional consequences reduced survivors' capacities and capabilities to be active. Environmental and personal factors acting as facilitators or further barriers to PA were identified. Applying the ICF-CY framework in clinical practice could help to enable PA participation.
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Affiliation(s)
- Elna Hamilton Larsen
- Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Paediatric Medicine, Oslo University Hospital, Rikshospitalet, Norway
| | - Anneli Viktoria Mellblom
- Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway.,Regional Centre for Child and Adolescent Mental Health Eastern and Southern Norway (RBUP), Oslo, Norway
| | - Marie Hamilton Larsen
- Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ellen Ruud
- Department of Paediatric Medicine, Oslo University Hospital, Rikshospitalet, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Lene Thorsen
- Department of Oncology, National Advisory Unit on Late Effects after Cancer Treatment, Oslo University Hospital, Oslo, Norway.,Department for Clinical Service, Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway
| | - Natasha Nybro Petersen
- Department of Pediatrics and Adolescents Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Hanne Baekgaard Larsen
- Department of Pediatrics and Adolescents Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark.,Faculty of Health Sciences, University of Copenhagen and The Pediatric Clinic, Juliane Marie Centre, Rigshospitalet, Copenhagen, Denmark
| | - Martin Kaj Fridh
- Department of Pediatrics and Adolescents Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Hanne Cathrine Lie
- Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
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17
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Schleicher E, McAuley E, Courneya KS, Anton P, Ehlers DK, Phillips SM, Oster RA, Pekmezi D, Rogers LQ. Moderators of physical activity and quality of life response to a physical activity intervention for breast cancer survivors. Support Care Cancer 2023; 31:53. [PMID: 36526826 DOI: 10.1007/s00520-022-07477-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 11/09/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Moderate-to-vigorous physical activity (MVPA) can improve the quality of life (QoL) for breast cancer survivors (BCS), yet, most do not achieve 150 + weekly minutes of MVPA. This study investigated moderators of response to a physical activity (PA) behavior change intervention for BCS. METHODS BCS (N = 222) were randomized to the 3-month intervention (BEAT Cancer) or usual care. Measurements occurred at baseline, post-intervention, and 3 months post-intervention. Measures included accelerometry, self-reported MVPA, and Functional Assessment of Cancer Therapy (FACT-General, FACT-Breast, physical well-being (PWB), social well-being (SWB), emotional well-being (EWB), functional well-being (FWB), additional concerns (AC), and Trial Outcome Index (TOI)). RESULTS Adjusted linear mixed-model analyses indicated individuals ≤ 24 months post-diagnosis and who were single reported smaller increases in weekly self-reported MVPA than those > 24 months (44.07 vs 111.93) and partnered (- 16.24 vs. 49.16 min), all p < 0.05. As for QoL, participants < 12 months post-diagnosis who received chemotherapy experienced smaller improvements than those ≥ 12 months in FACT-General, FACT-Breast, PWB, and SWB scores. Survivors with a history of chemotherapy had smaller improvements in FACT-General, FACT-Breast, PWB, SWB, TOI, and AC scores, all p < 0.05. CONCLUSION These findings indicate that being < 2 years post-diagnosis, single, and prior chemotherapy may limit MVPA and QOL responses to a PA intervention. Further studies are needed to determine if and/or what additional PA supports and resources these subgroups of BCS might find beneficial and effective. TRIAL REGISTRATION ClinicalTrials.gov number: NCT00929617.
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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 the University of Alabama Birmingham (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
| | - Phillip Anton
- School of Human Sciences, Southern Illinois University Carbondale, Carbondale, IL, USA
| | - Diane K Ehlers
- Department of Quantitative Health Sciences, Mayo Clinic, Phoenix, AZ, USA
| | - Siobhan M Phillips
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Robert A Oster
- O'Neal Comprehensive Cancer Center at the University of Alabama Birmingham (UAB), Birmingham, AL, USA
- Department of Medicine, Division of Preventive 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 the University of Alabama Birmingham (UAB), Birmingham, AL, USA
| | - Laura Q Rogers
- O'Neal Comprehensive Cancer Center at the University of Alabama Birmingham (UAB), Birmingham, AL, USA
- Department of Medicine, Division of Preventive Medicine, Birmingham, AL, USA
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18
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Ellis KR, Raji D, Olaniran M, Alick C, Nichols D, Allicock M. A systematic scoping review of post-treatment lifestyle interventions for adult cancer survivors and family members. J Cancer Surviv 2022; 16:233-256. [PMID: 33713302 PMCID: PMC8564800 DOI: 10.1007/s11764-021-01013-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 02/19/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Supporting the health of cancer survivors and their families from diagnosis through survivorship is a recognized priority. However, the extent to which health promotion efforts after the completion of acute treatment attend to the needs of adult survivors and families is unclear. This systematic scoping review summarizes the key characteristics of post-treatment lifestyle interventions aiming to improve diet, physical activity, and/or weight-related outcomes for adult cancer survivors and family members. METHODS We retrieved relevant studies from six databases using keywords. Studies were appraised for quality and limited to English-language, peer-reviewed journal articles published in or after 2005. RESULTS A total of 2,376 articles were obtained from the databases; 14 main articles (and 2 supplemental articles) representing 14 unique interventions were retained for our analysis. Most interventions were designed to modify aspects of participant diet and physical activity (in combination) or physical activity alone; cited social cognitive theory as a guiding or interpretative framework; included survivors of multiple cancer types; and were limited to one type of familial relationship (e.g., spouse/partner, sister). Where reported, intervention samples were predominantly White. CONCLUSIONS Few post-treatment interventions concurrently target cancer survivor and family members' positive lifestyle behaviors. Positive findings highlight the potential for expanding this area of intervention research and increasing understanding of individual and familial factors that contribute to successful post-treatment family interventions. IMPLICATIONS FOR CANCER SURVIVORS Promoting cancer survivors' healthy behaviors within the family context could capitalize on existing support networks and improve the health of family members in supportive roles.
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Affiliation(s)
- Katrina R. Ellis
- University of Michigan, School of Social Work, Ann Arbor, MI, USA
| | - Dolapo Raji
- University of Michigan, School of Information, Ann Arbor, MI, USA
| | - Marianne Olaniran
- The University of Texas, Health Science Center at Houston School of Public Health, Department of Health Promotion and Behavioral Sciences, Dallas, TX, USA
| | - Candice Alick
- North Carolina Central University, Department of Human Sciences, Durham, NC, USA
| | - Darlene Nichols
- University of Michigan Library, Hatcher Graduate Library, Ann Arbor, MI, USA
| | - Marlyn Allicock
- The University of Texas, Health Science Center at Houston School of Public Health, Department of Health Promotion and Behavioral Sciences, Dallas, TX, USA
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19
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Du X, Zhan W, Li X, Yin S, Chen Q, Huang J, Chen Y, Liu J. Marital status and survival in laryngeal squamous cell carcinoma patients: a multinomial propensity scores matched study. Eur Arch Otorhinolaryngol 2022; 279:3005-3011. [PMID: 35034189 DOI: 10.1007/s00405-022-07252-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 01/01/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To explore the correlation between the marital status and prognosis of patients with laryngeal squamous cell carcinoma (LSCC). STUDY DESIGN MPSM was adopted to minimize the maximum standardized average difference of the covariates among the four groups with different marital status. SETTING Multinomial propensity scores matching (MPSM) based on data from the surveillance, epidemiology, and end results (SEER) database. METHODS The Kaplan-Meier method and log-rank test were used to compare the survival outcomes of these groups with different marital status. RESULTS Totally, 16,981 LSCC patients (median [IQR] age 62 [55-69] years; 829 [76.41%] males) from 2004 to 2016 were included in this study. Among them, 9112 (53.66%) were married, 2708 (15.95%) divorced or separated, 1709 (10.06%) widowed, and 3452 (20.33%) single. After MPSM, the weights make the characteristics of four groups with different marital status sufficient balance. The Kaplan-Meier method and log-rank test showed widowed patients may lead to the highest mortality rate while married patients have a higher survival rate than the other three groups. Single and divorced or separated patients had no significant difference in the survival rate. In addition, multivariate analysis by controlling for confounding factors showed that in male, well-differentiated, and early stage patients, compared with married, unmarried was an independent risk factor for CSS (P < 0.05). CONCLUSION Marital status showed a significant association with the survival status of LSCC patients. Importantly, the outcome of married patients was better, while widowed patients tended to have worse prognosis.
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Affiliation(s)
- Xiushuai Du
- Department of Preventive Medicine, Fujian Provincial Key Laboratory of Environment Factors and Cancer, Key Laboratory of Environment and Health, School of Public Health, Fujian Medical University, Xueyuan Road No. 1, Minhou County, Fuzhou, 350108, Fujian, People's Republic of China
| | - Wenqiang Zhan
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Xiaoqin Li
- Department of Preventive Medicine, Fujian Provincial Key Laboratory of Environment Factors and Cancer, Key Laboratory of Environment and Health, School of Public Health, Fujian Medical University, Xueyuan Road No. 1, Minhou County, Fuzhou, 350108, Fujian, People's Republic of China
| | - Shuo Yin
- Department of Preventive Medicine, Fujian Provincial Key Laboratory of Environment Factors and Cancer, Key Laboratory of Environment and Health, School of Public Health, Fujian Medical University, Xueyuan Road No. 1, Minhou County, Fuzhou, 350108, Fujian, People's Republic of China
| | - Qingquan Chen
- Department of Preventive Medicine, Fujian Provincial Key Laboratory of Environment Factors and Cancer, Key Laboratory of Environment and Health, School of Public Health, Fujian Medical University, Xueyuan Road No. 1, Minhou County, Fuzhou, 350108, Fujian, People's Republic of China
| | - Jialing Huang
- Department of Preventive Medicine, Fujian Provincial Key Laboratory of Environment Factors and Cancer, Key Laboratory of Environment and Health, School of Public Health, Fujian Medical University, Xueyuan Road No. 1, Minhou County, Fuzhou, 350108, Fujian, People's Republic of China
| | - Yao Chen
- Department of Preventive Medicine, Fujian Provincial Key Laboratory of Environment Factors and Cancer, Key Laboratory of Environment and Health, School of Public Health, Fujian Medical University, Xueyuan Road No. 1, Minhou County, Fuzhou, 350108, Fujian, People's Republic of China
| | - Jin Liu
- Department of Preventive Medicine, Fujian Provincial Key Laboratory of Environment Factors and Cancer, Key Laboratory of Environment and Health, School of Public Health, Fujian Medical University, Xueyuan Road No. 1, Minhou County, Fuzhou, 350108, Fujian, People's Republic of China.
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20
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Exercise. Cancer 2022. [DOI: 10.1016/b978-0-323-91904-3.00014-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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21
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Smith-Turchyn J, McCowan ME, O'Loughlin E, Fong AJ, McDonough MH, Santa Mina D, Arbour-Nicitopoulos KP, Trinh L, Jones JM, Bender JL, Culos-Reed SN, Tomasone JR, Vani MF, Sabiston CM. Connecting breast cancer survivors for exercise: protocol for a two-arm randomized controlled trial. BMC Sports Sci Med Rehabil 2021; 13:128. [PMID: 34649590 PMCID: PMC8515152 DOI: 10.1186/s13102-021-00341-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 09/08/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Peer-based exercise interventions that cultivate new opportunities for support with a fellow cancer survivor may result in increased exercise volume. It is not clear whether adding qualified exercise professional (QEP) support to peer-based interventions improves health outcomes. Therefore, the purpose of this study is to determine whether breast cancer survivor (BCS) dyads who receive 10 weekly sessions of virtually delivered QEP support have improved outcomes compared to BCS dyads who do not receive QEP support. METHODS Participants Adult BCS with medical clearance for exercise, who have an internet-connected device, and currently engage in < 150 min of moderate-intensity exercise per week. Intervention BCS will be matched using evidence-based criteria. The intervention group will receive dyadic exercise information sessions and a program tailored by a QEP for 10 weeks (intervention period) and have access to the QEP for an additional 4 weeks (tapering period). The control will not receive any QEP support. Outcomes The primary outcome is post-intervention self-reported exercise volume. Secondary outcomes include device-assessed exercise volume (i.e., Fitbit), social support, and health-related quality of life. Randomization 108 participants, matched in dyads, will be randomized 1:1 to the MatchQEP or Match groups using a web-based scheme. Statistical analysis Outcomes will be measured at baseline, post-intervention, post-tapering, and at 12 weeks post-intervention follow-up. DISCUSSION The findings from this RCT will determine if matched BCS dyads who receive 10 weeks of virtually delivered QEP support have higher levels of self-report and device-measured exercise, social support, and health related quality of life compared to matched dyads without QEP-delivered exercise guidance. To our knowledge this will be the first study to assess the combined effect of peer- and QEP support on exercise volume. Project findings will inform and optimize intervention methods aimed to increase exercise among BCS through accessible exercise supports. TRIAL REGISTRATION The study is registered on ClinicalTrials.gov (study identifier: NCT04771975, protocol Version Number: 2, date: July 22, 2021).
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Affiliation(s)
- Jenna Smith-Turchyn
- School of Rehabilitation Science, McMaster University, 1400 Main Street West, Hamilton, ON, L8S 1C7, Canada.
| | - Michelle E McCowan
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada
| | - Erin O'Loughlin
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada
| | - Angela J Fong
- Department of Kinesiology and Health, Rutgers University, New Brunswick, USA
| | | | - Daniel Santa Mina
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada
| | | | - Linda Trinh
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada
| | - Jennifer M Jones
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Jackie L Bender
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | | | - Jennifer R Tomasone
- School of Kinesiology and Health Studies, Queen's University, Kingston, Canada
| | - Madison F Vani
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada
| | - Catherine M Sabiston
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada.
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22
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Fong AJ, Sabiston CM, Nadler MB, Sussman J, Langley H, Holden R, Stokes-Noonan M, Tomasone JR. Development of an evidence-informed recommendation guide to facilitate physical activity counseling between oncology care providers and patients in Canada. Transl Behav Med 2021; 11:930-940. [PMID: 33590874 DOI: 10.1093/tbm/ibaa127] [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] [Indexed: 12/26/2022] Open
Abstract
Decision support aids help reduce decision conflict and are reported as acceptable by patients. Currently, an aid from the American College of Sports Medicine exists to help oncology care providers advise, assess, and refer patients to physical activity (PA). However, some limitations include the lack of specific resources and programs for referral, detailed PA, and physical function assessments and not being designed following an international gold standard (Appraisal of Guidelines for Research and Evaluation [AGREE] II). This study aimed to develop a recommendation guide to facilitate PA counseling by assessing the risk for PA-related adverse events and offering a referral to an appropriate recommendation. Recommendation guide development followed AGREE II, and an AGREE methodologist was consulted. Specifically, a stakeholder group of oncology care providers and cancer survivors were engaged to develop the assessment criteria for comorbidities, PA levels, and physical function. Assessment criteria were developed from published PA interventions, consultations with content experts, and targeted web-based searches for cancer-specific PA programs. Feedback on the recommendation guide was solicited from stakeholders and external reviewers with relevant knowledge and clinical experience. Independent AGREE methodologists appraised the development process. The recommendation guide is a five-page document, including a preamble, assessment criteria for absolute contraindications to PA, comorbidities, and PA/functional capacity with a list of appropriate resources. Independent AGREE methodologists rated the development process as strong and recommended the guide for use. The recommendation guide has the potential to facilitate PA counseling between oncology care providers and cancer survivors, thus, potentially impacting PA behavior.
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Affiliation(s)
- Angela J Fong
- School of Kinesiology and Health Studies, Queen's University, Kingston, ON, Canada.,Section of Behavioral Sciences, Rutgers Cancer Institute New Jersey, Rutgers University, New Brunswick, NJ, USA
| | - Catherine M Sabiston
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - Michelle B Nadler
- Division of Medical Oncology & Hematology, Department of Medicine, Princess Margaret Cancer Centre and University of Toronto, Toronto, ON, Canada
| | | | - Hugh Langley
- Department of Oncology, Queen's University, Kingston, ON, Canada
| | - Rachel Holden
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | | | - Jennifer R Tomasone
- School of Kinesiology and Health Studies, Queen's University, Kingston, ON, Canada
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23
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Krogsgaard M, Andersen RM, Danielsen AK, Thomsen T, Klausen TW, Christensen BM, Gögenur I, Vinther A. Physical activity after colorectal cancer surgery-a cross sectional study of patients with a long-term stoma. Support Care Cancer 2021; 30:555-565. [PMID: 34342750 DOI: 10.1007/s00520-021-06374-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/19/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE Physical activity is recommended to cancer survivors by the World Health Organisation (WHO) and is associated with improved survival after colorectal cancer. It remains unclear whether having a stoma is a barrier for an active lifestyle. We examined the level of physical activity and explored factors impacting physical activity in survivors with a stoma. METHODS A total of 1265 (65%) patients in the Danish Stoma Database completed a multidimensional survey. Physical activity of moderate- and vigorous-intensity was assessed using two validated questions. Based on WHO guidelines, physical activity was categorised into 'Meeting' or 'Not Meeting' recommendations. Multivariate regression analysis, adjusting for potential confounders, provided odds ratio (OR) and 95% confidence intervals (CI) for factors' association with'Not Meeting' guideline recommendations. RESULTS In total, 571 patients with colorectal cancer reported on physical activity at a median of 4.3 years (interquartile range 3.1-5.8) after stoma surgery. Two hundred ninety-three patients (51%) were 'Meeting recommendations' and 63% of them were 'Highly active'. Two hundred seventy-eight were 'Not meeting' recommendations (49%). Of the factors analysed, patients without support garment were more likely (OR 1.72 [95% CI 1.16; 2.54] not to meet guideline recommendations. We found no association between stoma type, surgical procedure, parastomal bulging and 'problematic stoma' and level of physical activity, respectively. CONCLUSION In this large sample of survivors with a stoma half of patients met or exceeded guideline recommendations. Of patients not meeting recommendations some could potentially meet the recommendations by modest increases in either moderate or vigorous activity.
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Affiliation(s)
- Marianne Krogsgaard
- Department of Surgery and Transplantation, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark. .,Department of Gastroenterology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark. .,Centre for Surgical Sciences, Department of Surgery, Zealand University Hospital, Lykkebækvej 1, 4600, Koege, Denmark.
| | - Rune Martens Andersen
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, 4200, Slagelse, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Anne K Danielsen
- Department of Gastroenterology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Thordis Thomsen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Herlev Acute, Critical and Emergency Care Science Group, Department of Anaesthesiology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | | | - Bo Marcel Christensen
- Department of Surgery and Transplantation, Clinic C, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Ismail Gögenur
- Centre for Surgical Sciences, Department of Surgery, Zealand University Hospital, Lykkebækvej 1, 4600, Koege, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Anders Vinther
- Department of Physiotherapy and Occupational Therapy and Hospital Secretariat and Communications, Research, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
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24
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Individual, Interpersonal, and Home Environmental Factors Influencing Health Behaviors Among Chinese Childhood Cancer Survivors: A Structural Equation Analysis. Cancer Nurs 2021; 45:E604-E613. [PMID: 34310386 DOI: 10.1097/ncc.0000000000000991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Childhood cancer survivors (CCSs) are at increased risk of chronic health conditions, which could be controlled with health behaviors. However, the health behaviors and related factors of Chinese CCSs remain unclear. OBJECTIVE The aims of this study were to examine multiple health behaviors among Chinese CCSs and explore the individual, interpersonal, and home environmental factors affecting health behaviors. METHODS This cross-sectional study recruited 204 participants from 3 grade-A tertiary hospitals in Guangzhou, China. Participants provided data on health behaviors (smoking, drinking, drug use, screen time, internet addiction, dietary behaviors, physical activity, and sleep behaviors) and their determining factors. Structural equation modeling was used to analyze the data. RESULTS Chinese CCSs reported low rates of smoking, drinking, and drug use (0%-6.4%), but only 51% of survivors met screen time recommendations, and 24.5% of them had Internet addiction. Few survivors reported frequent soft-drink, sugar, and fast-food intake (2.0 to 7.4%), but many were finicky eaters (55.4%) or seldom drank milk (41.7%). In addition, 67.6% and 47.5% of survivors did not meet physical activity and sleep time recommendations. Childhood cancer survivors' health behaviors were influenced by the individual (age, education level, and time since diagnosis), interpersonal (peer and family support), and home environmental (residential location, parents' educations level, and household income) factors. CONCLUSIONS There were suboptimal health behaviors among Chinese CCSs. Targeted interventions should consider their individual, interpersonal, and home environmental factors. IMPLICATIONS FOR PRACTICE Knowledge of health behaviors and related factors of Chinese CCSs would help healthcare professionals develop further interventions to improve their care of this population.
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25
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Heckman CJ, Manne SL, Kashy DA, Bhurosy T, Ritterband L, Coups EJ. Correlates of sun protection behaviors among melanoma survivors. BMC Public Health 2021; 21:882. [PMID: 33962615 PMCID: PMC8105954 DOI: 10.1186/s12889-021-10951-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 04/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The study objective was to assess potential correlates of sun protection behaviors among melanoma survivors. METHODS Participants were 441 melanoma survivors recruited from three health centers and a state cancer registry in the United States. Sun protection behaviors (sunscreen, shade, protective shirts, and hats) were assessed through an online survey, as were potential correlates (demographic, melanoma risk, knowledge and beliefs, psychological and social influence factors). Hierarchical multiple regression analyses were conducted. RESULTS Correlates of sun protection behaviors included education, skin cancer risk factors, melanoma knowledge and beliefs, melanoma worry and distress, physician recommendation for sun protection, injunctive norms, and pro-protection beliefs (e.g., perceived barriers, self-efficacy). CONCLUSIONS Future efforts to improve sun safety among melanoma survivors may benefit from targeting individuals with lower education levels, and addressing sun protection social influence, barriers, and self-efficacy.
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Affiliation(s)
- Carolyn J Heckman
- Rutgers, The State University of New Jersey, 195 Little Albany St., New Brunswick, NJ, 08901, USA.
| | - Sharon L Manne
- Rutgers, The State University of New Jersey, 195 Little Albany St., New Brunswick, NJ, 08901, USA
| | | | - Trishnee Bhurosy
- Rutgers, The State University of New Jersey, 195 Little Albany St., New Brunswick, NJ, 08901, USA
| | | | - Elliot J Coups
- Rutgers, The State University of New Jersey, 195 Little Albany St., New Brunswick, NJ, 08901, USA
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26
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Effect of Two Interventions on Sleep Quality for Adolescent and Young Adult Cancer Survivors: A Pilot Randomized Controlled Trial. Cancer Nurs 2021; 45:E560-E572. [PMID: 33883477 DOI: 10.1097/ncc.0000000000000932] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Sleep disturbance is common among adolescent and young adult (AYA) cancer survivors. Physical activity (PA) and behavioral activation (BA) therapy have been reported as enhancing sleep quality, but few studies exist on the effects of such interventions combined with technology to promote sleep quality in AYA cancer patients. OBJECTIVE The aim of this study was to investigate the feasibility and effects of intelligent wearable device-based PA therapy and internet-based modified BA therapy to improve sleep quality among AYA cancer patients. METHODS A randomized controlled trial with 143 AYA cancer patients was conducted. Participants were randomly assigned to a control group (n = 48), which performed routine care, a PA group (n = 47), which received 8-week PA therapy based on intelligent wearable devices, and a BA group (n = 48), which participated in internet-based modified BA therapy for 8 weeks. RESULTS At 1 week and 3 months after the intervention for sleep quality, there were statistically significant differences between the PA group and the control group (P = .020), but no statistically significant difference between the BA group and the control group. CONCLUSIONS The intelligent wearable device-based PA therapy has more advantages than internet-based modified BA therapy in improving the overall state of AYA cancer patients, and the intervention effect was sustained for at least 3 months. IMPLICATIONS FOR PRACTICE Developing and implementing PA plans for AYA cancer survivors can improve their sleep quality. Social media, intelligent wearable devices, and mobile health applications have unique advantages in promoting sleep quality for AYA cancer survivors.
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27
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Faro JM, Mattocks KM, Nagawa CS, Lemon SC, Wang B, Cutrona SL, Sadasivam RS. Physical Activity, Mental Health, and Technology Preferences to Support Cancer Survivors During the COVID-19 Pandemic: Cross-sectional Study. JMIR Cancer 2021; 7:e25317. [PMID: 33471776 PMCID: PMC7860926 DOI: 10.2196/25317] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 12/31/2020] [Accepted: 01/16/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND COVID-19 has had significant health-related and behavioral impacts worldwide. Cancer survivors (hereafter referred to as "survivors") are particularly prone to behavioral changes and are encouraged to be more vigilant and observe stricter social distancing measures. OBJECTIVE We explored (1) changes in physical activity and sedentary behaviors since the onset of COVID-19, along with changes in mental health status, and (2) alternative strategies to support survivors' physical activity and social health during and after COVID-19, along with the role of digital health in such strategies. METHODS A questionnaire was distributed among survivors participating (currently or previously) in the community-based physical activity program LIVESTRONG at the Young Men's Christian Association (YMCA), from 3 sites outside an urban area in Massachusetts. Questions addressed pre-COVID-19 vs current changes in physical activity and sedentary behavior. Anxiety and depression were assessed using the 2-item Generalized Anxiety Disorder scale (GAD-2) and 2-item Patient Health Questionnaire (PHQ-2), and scores ≥3 indicated a clinical diagnosis of anxiety or depression, respectively. Digital health preferences were assessed through closed-ended questions. Open-ended responses addressing other preferences for physical activity programs and social support were analyzed, coded, and categorized into themes. RESULTS Among 61 participants (mean age 62 [SD 10.4] years; females: 51/61 [83.6%]), 67.2% (n=41) reported decreased physical activity and 67.2% (n=41) reported prolonged sitting times since the onset of COVID-19. Further, 24.6% (n=15) and 26.2% (n=16) met the GAD-2 and PHQ-2 criteria for clinical anxiety and depression, respectively. All participants owned a cellphone; 90% (n=54) owned a smartphone. Preferences for physical activity programs (n=28) included three themes: (1) use of digital or remote platforms (Zoom, other online platforms, and video platforms), (2) specific activities and locations (eg, outdoor activities, walking, gardening, biking, and physical activities at the YMCA and at senior centers), and (3) importance of social support regardless of activity type (eg, time spent with family, friends, peers, or coaches). The survey revealed a mean score of 71.8 (SD 21.4; scale 0-100) for the importance of social support during physical activity programs. Social support preferences (n=15) revealed three themes: (1) support through remote platforms (eg, texting, Zoom, phone calls, emails, and Facebook), (2) tangible in-person support (YMCA and senior centers), and (3) social support with no specific platform (eg, small gatherings and family or friend visits). CONCLUSIONS Physical activity and mental health are critical factors for the quality of life of survivors, and interventions tailored to their activity preferences are necessary. Digital or remote physical activity programs with added social support may help address the ongoing needs of survivors during and after the pandemic.
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Affiliation(s)
- Jamie M Faro
- Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Kristin M Mattocks
- Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
- VA Central Western Massachusetts Healthcare System, Northampton, MA, United States
| | - Catherine S Nagawa
- Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Stephenie C Lemon
- Division of Preventive Behavioral Medicine, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Bo Wang
- Biostatistics and Health Services Research, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Sarah L Cutrona
- Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, United States
| | - Rajani S Sadasivam
- Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
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28
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Valle CG, Pinto BM, LaRose JG, Diamond M, Horrell LN, Nezami BT, Hatley KE, Coffman EM, Polzien K, Hales DP, Deal AM, Rini CM, Rosenstein DL, Tate DF. Promoting physical activity in young adult cancer survivors using mHealth and adaptive tailored feedback strategies: Design of the Improving Physical Activity after Cancer Treatment (IMPACT) randomized controlled trial. Contemp Clin Trials 2021; 103:106293. [PMID: 33515784 DOI: 10.1016/j.cct.2021.106293] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/02/2020] [Accepted: 01/21/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Despite the health benefits of physical activity for cancer survivors, nearly 60% of young adult cancer survivors (YACS) are physically inactive. Few physical activity interventions have been designed specifically for YACS. PURPOSE To describe the rationale and design of the IMPACT (IMproving Physical Activity after Cancer Treatment) trial, which tests the efficacy of a theory-based, mobile physical activity intervention for YACS. METHODS A total of 280 physically inactive YACS (diagnosed at ages 18-39) will be randomized to a self-help control or intervention condition. All participants will receive an activity tracker and companion mobile app, cellular-enabled scale, individual videochat session, and access to a Facebook group. Intervention participants will also receive a 6-month mobile intervention based on social cognitive theory, which targets improvements in behavioral capability, self-regulation, self-efficacy, and social support, and incorporates self-regulation strategies and behavior change techniques. The program includes: behavioral lessons; adaptive goal-setting in response to individuals' changing activity patterns; tailored feedback based on objective data and self-report measures; tailored text messages; and Facebook prompts encouraging peer support. Assessments occur at baseline, 3, 6, and 12 months. The primary outcome is total physical activity min/week at 6 months (assessed via accelerometry); secondary outcomes include total physical activity at 12 months, sedentary behavior, weight, and psychosocial measures. CONCLUSIONS IMPACT uniquely focuses on physical activity in YACS using an automated tailored mHealth program. Study findings could result in a high-reach, physical activity intervention for YACS that has potential to be adopted on a larger scale and reduce cancer-related morbidity. ClinicalTrials.gov Identifier: NCT03569605.
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Affiliation(s)
- Carmina G Valle
- Department of Nutrition, Gillings School of Global Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | | | - Jessica Gokee LaRose
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Molly Diamond
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lindsey N Horrell
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Brooke T Nezami
- Department of Nutrition, Gillings School of Global Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Karen E Hatley
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Erin M Coffman
- Department of Nutrition, Gillings School of Global Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kristen Polzien
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Derek P Hales
- Department of Nutrition, Gillings School of Global Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Allison M Deal
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Christine M Rini
- Department of Medical Social Sciences, Feinberg School of Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| | - Donald L Rosenstein
- Departments of Psychiatry and Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Deborah F Tate
- Department of Nutrition, Gillings School of Global Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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29
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McDonough MH, Beselt LJ, Kronlund LJ, Albinati NK, Daun JT, Trudeau MS, Wong JB, Culos-Reed SN, Bridel W. Social support and physical activity for cancer survivors: a qualitative review and meta-study. J Cancer Surviv 2020; 15:713-728. [PMID: 33128705 DOI: 10.1007/s11764-020-00963-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 10/18/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Physical activity (PA) is important for well-being and coping among cancer survivors. Social support (SS) encourages adoption and maintenance of PA behavior, and PA contexts can provide opportunities for obtaining support for coping with cancer. The qualitative literature examining cancer survivors' experience with SS in and for PA could inform understanding of behaviors experienced as supportive. The purpose of this meta-study was to synthesize the research on adult cancer survivors' experiences with SS related to PA. METHODS Following meta-study guidelines, we searched nine databases and retrieved 39 articles describing intervention and observation studies, and extracted, analyzed, and synthesized information addressing SS and PA in cancer survivors. RESULTS Results emphasized ways that PA contexts facilitate relationships, which are a foundation for obtaining supportive behaviors that enable PA (e.g., providing encouragement and accountability) and assist with coping with cancer (e.g., understanding and talking about cancer). Some themes identified were unique to studies with female breast cancer, advanced cancer, interventions or programs, and that used interviews versus focus groups. CONCLUSIONS Understanding supportive behaviors could improve PA and coping with cancer in interventions. Future research should focus on identifying supportive behaviors, incorporating theory and methods to address the development of supportive relationships, and recruiting more diverse samples of participants in terms of gender, race/ethnicity, and cancer type. IMPLICATIONS FOR CANCER SURVIVORS PA can provide opportunities for positive social connections ranging from loose to close social ties, and this research identifies several behaviors in the PA context that may be supportive of PA behavior (e.g., providing actionable information), and coping with cancer (e.g., opportunities but low obligation to talk about cancer).
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Affiliation(s)
- Meghan H McDonough
- Faculty of Kinesiology, University of Calgary, 2500 University Dr. NW, Calgary, AB, T2N 1N4, Canada.
| | - L Jayne Beselt
- Faculty of Kinesiology, University of Calgary, 2500 University Dr. NW, Calgary, AB, T2N 1N4, Canada
| | - Liam J Kronlund
- Faculty of Kinesiology, University of Calgary, 2500 University Dr. NW, Calgary, AB, T2N 1N4, Canada
| | - Natalia K Albinati
- Faculty of Kinesiology, University of Calgary, 2500 University Dr. NW, Calgary, AB, T2N 1N4, Canada
| | - Julia T Daun
- Faculty of Kinesiology, University of Calgary, 2500 University Dr. NW, Calgary, AB, T2N 1N4, Canada
| | - Melanie S Trudeau
- Faculty of Kinesiology, University of Calgary, 2500 University Dr. NW, Calgary, AB, T2N 1N4, Canada
| | - Janet B Wong
- Faculty of Kinesiology, University of Calgary, 2500 University Dr. NW, Calgary, AB, T2N 1N4, Canada
| | - S Nicole Culos-Reed
- Faculty of Kinesiology, University of Calgary, 2500 University Dr. NW, Calgary, AB, T2N 1N4, Canada
| | - William Bridel
- Faculty of Kinesiology, University of Calgary, 2500 University Dr. NW, Calgary, AB, T2N 1N4, Canada
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30
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Grimmett C, Foster C, Bradbury K, Lally P, May CR, Myall M, Pinto B, Corbett T. Exploring maintenance of physical activity behaviour change among people living with and beyond gastrointestinal cancer: a cross-sectional qualitative study and typology. BMJ Open 2020; 10:e037136. [PMID: 33122311 PMCID: PMC7597473 DOI: 10.1136/bmjopen-2020-037136] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 09/23/2020] [Accepted: 09/29/2020] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES In the last decade, there has been a rapid expansion of physical activity (PA) promotion programmes and interventions targeting people living with and beyond cancer (LWBC). The impact that these initiatives have on long-term maintenance of PA remains under-researched. This study sought to explore the experiences of participants in order to characterise those who have and have not successfully sustained increases in PA following participation in a PA intervention after a diagnosis of gastrointestinal (GI) cancer, and identify barriers and facilitators of this behaviour. DESIGN Cross-sectional qualitative study. Semi-structured interviews with participants who had previously taken part in a PA programme in the UK, explored current and past PA behaviour and factors that promoted or inhibited regular PA participation. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis. Themes and subthemes were identified. Differences between individuals were recognised and a typology of PA engagement was developed. PARTICIPANTS Twenty-seven individuals (n=15 male, mean age=66.3 years) with a diagnosis of GI cancer who had participated in one of four interventions designed to encourage PA participation. SETTING UK. RESULTS Seven themes were identified: disease processes, the role of ageing, emotion and psychological well-being, incorporating PA into everyday life, social interaction, support and self-monitoring and competing demands. A typology with three types describing long-term PA engagement was generated: (1) maintained PA, (2) intermittent PA, (3) low activity. Findings indicate that identifying an enjoyable activity that is appropriate to an individual's level of physical functioning and is highly valued is key to supporting long-term PA engagement. CONCLUSION The typology described here can be used to guide stratified and personalised intervention development and support sustained PA engagement by people LWBC.
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Affiliation(s)
- Chloe Grimmett
- Macmillan Survivorship Research Group, School of Health Sciences, University of Southampton, Southampton, UK
| | - Claire Foster
- Macmillan Survivorship Research Group, School of Health Sciences, University of Southampton, Southampton, UK
| | - Katherine Bradbury
- Centre for Clinical and Community Health Psychology, University of Southampton, Southampton, UK
| | - Phillippa Lally
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Carl R May
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Michelle Myall
- NIHR ARC Wessex, School of Health Sciences, University of Southampton, Southampton, Hampshire, UK
| | - Bernardine Pinto
- College of Nursing, University of South Carolina, Columbia, South Carolina, USA
| | - Teresa Corbett
- NIHR ARC Wessex, School of Health Sciences, University of Southampton, Southampton, Hampshire, UK
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31
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The Relationship between Physical Activity Levels and Mental Health in Individuals with Spinal Cord Injury in South Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124423. [PMID: 32575553 PMCID: PMC7344782 DOI: 10.3390/ijerph17124423] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/15/2020] [Accepted: 06/17/2020] [Indexed: 12/16/2022]
Abstract
Background: The aim of this study was to assess the relationship between physical activity (PA) levels and mental health in individuals with spinal cord injury (SCI). Methods: Three hospitals in the Seoul metropolitan area were invited to recruit patients with SCI (n = 103). PA levels were measured by the Leisure Score Index of the Godin Leisure-Time Exercise Questionnaire (GLTEQ). The Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder-7 (GAD-7) questionnaire, and Multidimensional Scale of Perceived Social Support (MSPSS) were used to assess mental health. Results: Compared to the least physically active participants (1st tertile, 44.09 ± 52.74 min/week), the most physically active participants (3rd tertile, 670.86 ± 354.97 min/week) scored significantly lower on PHQ-9 (17.03 ± 5.70 vs. 12.49 ± 4.01, p < 0.001), GAD-7 (13.24 ± 4.78 vs. 9.86 ± 3.15, p < 0.001), while significantly higher MSPSS (51.24 ± 10.17 vs. 61.37 ± 11.90, p < 0.001) after the results were adjusted for age, gender, American Spinal Cord Injury Association impairment scale, and impaired spinal cord levels. Multivariate linear regression analysis showed that the PA was a significant predictor of depression (β = −1.50, p = 0.01), anxiety (β = −1.12, p = 0.02), and social support (β = 4.04, p = 0.01). Conclusion: Higher PA participation was associated with lower depression, anxiety, and higher social support scores.
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