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Smit KC, Derksen JWG, Stellato RK, VAN Lanen AS, Wesselink E, Belt EJT, Balen MCVAN, Coene PPLO, Dekker JWT, DE Groot JW, Haringhuizen AW, VAN Halteren HK, VAN Heek TT, Helgason HH, Hendriks MP, DE Hingh IHJT, Hoekstra R, Houtsma D, Janssen JJB, Kok N, Konsten JLM, Los M, Meijerink MR, Mekenkamp LJM, Peeters KCMJ, Polée MB, Rietbroek RC, Schiphorst AHW, Schrauwen RWM, Schreinemakers J, Sie MPS, Simkens L, Sonneveld EJA, Terheggen F, Iersel LVVAN, Vles WJ, Wasowicz-Kemps DK, DE Wilt JHW, Kok DE, Winkels RM, Kampman E, VAN Duijnhoven FJB, Koopman M, May AM. Determinants of Physical Activity among Patients with Colorectal Cancer: From Diagnosis to 5 Years after Diagnosis. Med Sci Sports Exerc 2024; 56:623-634. [PMID: 38079324 DOI: 10.1249/mss.0000000000003351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2024]
Abstract
INTRODUCTION Physical activity (PA) is associated with higher quality of life and probably better prognosis among colorectal cancer (CRC) patients. This study focuses on determinants of PA among CRC patients from diagnosis until 5 yr postdiagnosis. METHODS Sociodemographic and disease-related factors of participants of two large CRC cohort studies were combined. Moderate-to-vigorous PA during sport and leisure time (MVPA-SL) was measured at diagnosis (T0) and 6, 12, 24, and 60 months (T6 to T60) postdiagnosis, using the SQUASH questionnaire. Mixed-effects models were performed to identify sociodemographic and disease-related determinants of MVPA-SL, separately for stage I-III colon (CC), stage I-III rectal cancer (RC), and stage IV CRC (T0 and T6 only). Associations were defined as consistently present when significant at ≥4 timepoints for the stage I-III subsets. MVPA-SL levels were compared with an age- and sex-matched sample of the general Dutch population. RESULTS In total, 2905 CC, 1459 RC and 436 stage IV CRC patients were included. Patients with higher fatigue scores, and women compared with men had consistently lower MVPA-SL levels over time, regardless of tumor type and stage. At T6, having a stoma was significantly associated with lower MVPA-SL among stage I-III RC patients. Systemic therapy and radiotherapy were not significantly associated with MVPA-SL changes at T6. Compared with the general population, MVPA-SL levels of CRC patients were lower at all timepoints, most notably at T6. CONCLUSIONS Female sex and higher fatigue scores were consistent determinants of lower MVPA-SL levels among all CRC patients, and MVPA-SL levels were lowest at 6 months postdiagnosis. Our results can inform the design of intervention studies aimed at improving PA, and guide healthcare professionals in optimizing individualized support.
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Affiliation(s)
- Karel C Smit
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, THE NETHERLANDS
| | - Jeroen W G Derksen
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, THE NETHERLANDS
| | - Rebecca K Stellato
- Department of Data Science and Biostatistics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, THE NETHERLANDS
| | - Anne-Sophie VAN Lanen
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, THE NETHERLANDS
| | - Evertine Wesselink
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, THE NETHERLANDS
| | - Eric J Th Belt
- Department of Surgery, Albert Schweitzer Hospital, Dordrecht, THE NETHERLANDS
| | | | | | | | | | | | - Henk K VAN Halteren
- Department of Medical Oncology, Admiraal de Ruyter Hospital, Goes, THE NETHERLANDS
| | - Tjarda T VAN Heek
- Department of Surgery, Ziekenhuis Gelderse Vallei, Ede, THE NETHERLANDS
| | - Helgi H Helgason
- Department of Medical Oncology, Haaglanden Medical Center, Den Haag, THE NETHERLANDS
| | - Mathijs P Hendriks
- Department of Medical Oncology, Northwest Clinics, Alkmaar, THE NETHERLANDS
| | | | - Ronald Hoekstra
- Department of Medical Oncology, Ziekenhuisgroep Twente, Hengelo, THE NETHERLANDS
| | - Danny Houtsma
- Department of Medical Oncology, Haga Hospital, Den Haag, THE NETHERLANDS
| | - Johan J B Janssen
- Department of Medical Oncology, Canisius Wilhelmina Hospital, Nijmegen, THE NETHERLANDS
| | - Niels Kok
- Department of Gastrointestinal Oncology, Antoni Van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, THE NETHERLANDS
| | | | - Maartje Los
- Department of Medical Oncology, St. Antonius Hospital, Nieuwegein, THE NETHERLANDS
| | - Martijn R Meijerink
- Department of Radiology and Nuclear Medicine, VU Medical Center, Amsterdam, THE NETHERLANDS
| | - Leonie J M Mekenkamp
- Department of Medical Oncology, Medisch Spectrum Twente, Enschede, THE NETHERLANDS
| | - Koen C M J Peeters
- Department of Surgery, Leiden University Medical Center, University of Leiden, Leiden, THE NETHERLANDS
| | - Marco B Polée
- Department of Medical Oncology, Medical Center Leeuwarden, Leeuwarden, THE NETHERLANDS
| | - Ron C Rietbroek
- Department of Medical Oncology, Rode Kruis Hospital, Beverwijk, THE NETHERLANDS
| | | | - Ruud W M Schrauwen
- Department of Gastroenterology and Hepatology, Bernhoven Hospital, Uden, THE NETHERLANDS
| | | | - Mark P S Sie
- Department of Medical Oncology, ZorgSaam Hospital, Terneuzen, THE NETHERLANDS
| | - Lieke Simkens
- Department of Medical Oncology, Maxima Medical Center, Eindhoven, THE NETHERLANDS
| | | | - Frederiek Terheggen
- Department of Medical Oncology, Bravis Hospital, Roosendaal, THE NETHERLANDS
| | - Liselot Valkenburg-VAN Iersel
- Maastricht University Medical Center, Department of Internal Medicine, Division of Medical Oncology, GROW, Maastricht University, Maastricht, THE NETHERLANDS
| | - Wouter J Vles
- Department of Surgery, Ikazia Hospital, Rotterdam, THE NETHERLANDS
| | | | - Johannes H W DE Wilt
- Department of Surgery, Radboud University Medical Center, University of Nijmegen, Nijmegen, THE NETHERLANDS
| | - Dieuwertje E Kok
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, THE NETHERLANDS
| | - Renate M Winkels
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, THE NETHERLANDS
| | - Ellen Kampman
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, THE NETHERLANDS
| | | | - Miriam Koopman
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, THE NETHERLANDS
| | - Anne M May
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, THE NETHERLANDS
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Salisbury CE, Hyde MK, Cooper ET, Stennett RC, Gomersall SR, Skinner TL. Physical activity behaviour change in people living with and beyond cancer following an exercise intervention: a systematic review. J Cancer Surviv 2023; 17:569-594. [PMID: 37074621 PMCID: PMC10209249 DOI: 10.1007/s11764-023-01377-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/31/2023] [Indexed: 04/20/2023]
Abstract
PURPOSE Exercise interventions can increase physical activity and wellbeing of people living with/beyond cancer. However, little is known about maintenance of physical activity in this population ≥ 6 months post-exercise intervention, when theoretical evidence suggests behaviour maintenance occurs. Study aims are to (i) systematically review maintenance of physical activity ≥ 6-month post-exercise intervention, and (ii) investigate the influence of behaviour change techniques (BCTs) on physical activity maintenance in people living with/beyond cancer. METHODS CINAHL, CENTRAL, EMBASE and PubMed databases were searched for randomised controlled trials up to August 2021. Trials including adults diagnosed with cancer that assessed physical activity ≥ 6 months post-exercise intervention were included. RESULTS Of 142 articles assessed, 21 reporting on 18 trials involving 3538 participants were eligible. Five (21%) reported significantly higher physical activity ≥ 6 months post-exercise intervention versus a control/comparison group. Total number of BCTs (M = 8, range 2-13) did not influence intervention effectiveness. The BCTs Social support, Goal setting (behaviour), and Action planning, alongside supervised exercise, were important, but not sufficient, components for long-term physical activity maintenance. CONCLUSIONS Evidence for long-term physical activity maintenance post-exercise intervention for people living with/beyond cancer is limited and inconclusive. Further research is required to ensure the physical activity and health benefits of exercise interventions do not quickly become obsolete. IMPLICATIONS FOR CANCER SURVIVORS Implementation of the BCTs Social support, Goal setting (behaviour), and Action planning, alongside supervised exercise, may enhance physical activity maintenance and subsequent health outcomes in people living with/beyond cancer.
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Affiliation(s)
- Chloe E Salisbury
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, Australia.
| | - Melissa K Hyde
- School of Psychology, The University of Queensland, Brisbane, QLD, Australia
| | - Ella T Cooper
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Rebecca C Stennett
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Sjaan R Gomersall
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Tina L Skinner
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, Australia
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3
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Mbous YPV, Mohamed R, Bhandari R. A Decomposition Analysis of Racial Disparities in Physical Activity Among Cancer Survivors: National Health Interview Survey 2009-2018. J Phys Act Health 2023:1-12. [PMID: 37210077 DOI: 10.1123/jpah.2022-0356] [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: 07/04/2022] [Revised: 03/31/2023] [Accepted: 04/06/2023] [Indexed: 05/22/2023]
Abstract
PURPOSE In light of the known benefits of physical activity (PA) for cancer survivors, this exploratory study sought to investigate the uptake of PA among this population in the United States. METHODS Using the National Health Interview Survey data from 2009 to 2018, lung, breast, colorectal, prostate, ovarian, and lymphoma cancer survivors were identified, and their PA adherence measured per the standards of the American College of Sports Medicine. Logistic regression and the Fairlie decomposition were used, respectively, to identify correlates of PA and to explain the difference in PA adherence between races. RESULTS Uptake of PA was significantly different between Whites and minorities. Blacks had lower odds than Whites (adjusted odds ratio: 0.77; 95% confidence interval, 0.66-0.93), whereas Mixed Race had twice the odds of Whites (adjusted odds ratio: 1.94; 95% confidence interval, 0.27-0.98) of adhering to PA recommendations. Decomposition identified education, family income-to-poverty ratio, body mass index, number of chronic conditions, alcohol use, and general health as key factors accounting for the PA disparity between cancer survivors of White and Black or Multiple/Mixed racial group. CONCLUSION These findings could help inform behavioral PA interventions to improve their design and targeting to different racial groups of cancer survivors.
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Affiliation(s)
- Yves Paul Vincent Mbous
- School of Pharmacy, Department of Pharmaceutical Systems and Policy, West Virginia University, Morgantown, WV,USA
| | - Rowida Mohamed
- School of Pharmacy, Department of Pharmaceutical Systems and Policy, West Virginia University, Morgantown, WV,USA
| | - Ruchi Bhandari
- School of Public Health, Department of Epidemiology and Biostatistics, West Virginia University, Morgantown, WV,USA
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4
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Wang X, Liu Y, Xu J. Influence of Exercise Intervention on the Quality of Life for Colon
Cancer: A Meta-Analysis of Randomized Controlled Studies. PHYSIKALISCHE MEDIZIN, REHABILITATIONSMEDIZIN, KURORTMEDIZIN 2022. [DOI: 10.1055/a-1623-4968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Abstract
Introduction The influence of exercise intervention for colon cancer
remains controversial. We conduct a systematic review and meta-analysis to
explore the effect of exercise intervention on the quality of life in patients
with colon cancer.
Methods We have searched PubMed, EMbase, Web of science, EBSCO, and
Cochrane library databases through September 2020 for randomized controlled
trials (RCTs) assessing the effect of exercise intervention for colon cancer.
This meta-analysis is performed using the random-effect model.
Results Five RCTs are included in the meta-analysis. In patients with
colon cancer, exercise intervention is associated with improved health-related
quality of life (SMD=2.79; 95% CI=1.66 to 3.92;
P<0.00001) and reduced fatigue score (SMD=−2.21;
95% CI=−3.22 to −1.20; P<0.0001), but
revealed no obvious impact on emotional functioning (SMD=0.51;
95% CI=−0.57 to 1.58; P=0.35), anxiety score
(SMD=−0.93; 95% CI=−2.50 to 0.64;
P=0.25) or weight (SMD=0.28; 95%
CI=−0.19 to 0.75; P=0.24).
Conclusions Exercise intervention is effective to improve the quality of
life in patients with colon cancer.
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Affiliation(s)
- Xuefen Wang
- Kaizhou People Hospital, General Surgery, Chongqing,
China
| | - Yunfeng Liu
- Kaizhou People Hospital, General Surgery, Chongqing,
China
| | - Jifan Xu
- Kaizhou People Hospital, General Surgery, Chongqing,
China
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5
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Kim H, Park H, Kim EK. Risk factors for postoperative delirium in patients with colorectal cancer. J Clin Nurs 2022; 31:174-183. [PMID: 34096659 DOI: 10.1111/jocn.15894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 05/07/2021] [Accepted: 05/11/2021] [Indexed: 11/30/2022]
Abstract
AIM The purpose of this study was to identify the incidence of postoperative delirium in PCC (patients with colorectal cancer) and the related factors of postoperative delirium by analysing the differences in the general, disease-related and operation-related characteristics. BACKGROUND Previous studies had some limitations in generalising the risk factors for postoperative delirium in PCC due to the lack of relevant factors, such as disease- and operation-related characteristics. There is a need to investigate the factors of postoperative delirium by including cancer and surgical characteristics. DESIGN The current study is a cross-sectional study to investigate the correlated factors of postoperative delirium in PCC. METHODS A total of 196 patients who underwent colorectal cancer surgery at the Keimyung University Dongsan Hospital in Korea participated in the study. Data collection was performed from 15 August 2018 to 10 July 2019. Patients' general, disease-related and operation-related characteristics were collected from questionnaires and electronic medical records. Data analysis was performed using descriptive statistics, t test, Chi-square test and logistic regression using SPSS/WIN 22.0. The STROBE checklist has been used to report this study. RESULTS The results of this study showed that 26 (13.2%) PCC exhibited postoperative delirium and the risk factors for postoperative delirium were physical activity (OR = 2.94, p = .001), infection (OR = 2.17, p = .001) and nutritional status (OR = 1.10, p = .028). CONCLUSION To reduce and prevent the occurrence of postoperative delirium in PCC, encouraging participation in physical activity before and after surgery are required, and regular monitoring of the infection symptoms and nutritional status. RELEVANCE TO CLINICAL PRACTICE Based on the results of this study, postoperative delirium in PCC could be decreased by encouraging physical activity immediately following operation, monitoring the signs and symptoms of infection using diverse objective laboratory findings and maintaining the nutritional status within the normal range.
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Affiliation(s)
- Hyunhwa Kim
- Keimyung University College of Nursing, Research Institute of Nursing Science, Daegu, Korea.,Keimyung University Dongsan Hospital, Daegu, Korea
| | - Heeok Park
- Keimyung University College of Nursing, Research Institute of Nursing Science, Daegu, Korea
| | - Eun Kyung Kim
- Keimyung University College of Nursing, Research Institute of Nursing Science, Daegu, Korea
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James A, Lawrence B, O’Connor M. Healthy Eating as a New Way of Life: A Qualitative Study of Successful Long-Term Diet Change. INQUIRY: THE JOURNAL OF HEALTH CARE ORGANIZATION, PROVISION, AND FINANCING 2022; 59:469580221090397. [PMID: 35418258 PMCID: PMC9016560 DOI: 10.1177/00469580221090397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Improving diet quality has been shown to be an effective way to improve
health and well-being. Yet information on how to assist those wanting to
transition to and maintain a healthier diet is still limited. The aim of
this study was to explore what motivated people to initiate and maintain a
healthy diet. Methods Semi-structured interviews were conducted with 20 participants (all
Australian residents) who had made significant improvements to their diets
and had maintained these changes for a minimum of two years
(nfemale = 15, nmale = 5, Mage = 37.7, SD = 12.4). The transcripts were analysed
using thematic analysis which identified five overarching themes: A desire
to feel better, investigation and learning, helpful habits, benefits, and
values. Results Participants reported a strong wish to feel better and investigated the role
of diet as a possible way to improve well-being. Through daily habits and
continuous engagement with the topic, healthy eating became a way of life
for many participants. Experiencing the benefits of a healthier diet and
having developed strong values regarding diet and health supported long-term
maintenance. Conclusions Findings from the present study contribute to the literature in highlighting
the importance of internal motivation and autonomy for health behaviours.
Findings may inform the development of healthy eating interventions.
Encouraging autonomy, fostering values aligned with a healthier diet, and
helping individuals establish daily habits is likely to support change.
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Affiliation(s)
- Anna James
- WA Cancer Prevention Research Unit, Discipline of Psychology, School of Population Health, Curtin University, Perth, WA, Australia
| | - Blake Lawrence
- WA Cancer Prevention Research Unit, Discipline of Psychology, School of Population Health, Curtin University, Perth, WA, Australia
| | - Moira O’Connor
- WA Cancer Prevention Research Unit, Discipline of Psychology, School of Population Health, Curtin University, Perth, WA, Australia
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Physical activity levels after low anterior resection for rectal cancer: one-year follow-up. BMC Public Health 2021; 21:2270. [PMID: 34903207 PMCID: PMC8667409 DOI: 10.1186/s12889-021-12311-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 11/17/2021] [Indexed: 12/22/2022] Open
Abstract
Background Overall survival rates after rectal cancer have increased. Therefore, functional outcomes rightly deserve more interest. The aims of this study were to assess progression in total, sports, occupational and household physical activity levels of rectal cancer survivors, from preoperatively to 12 months after surgery/stoma closure and to explore predictive factors. Methods Multi-center prospective study with 125 patients who underwent low anterior resection for rectal cancer. The Flemish Physical Activity Computerized Questionnaire was completed concerning all physical activity levels at baseline (past preoperative year) and at 1, 4, 6 and 12 months after surgery/stoma closure. At these timepoints, questionnaires (LARS−/ COREFO-questionnaire) regarding bowel symptoms were also filled out. Results were analyzed using linear mixed models for repeated measures. Results Total physical activity levels up to 12 months remained significantly lower than preoperative. Occupational and sports physical activity levels remained significantly lower until 6 and 4 months postoperative, respectively. Predictive factors for decreased physical activity levels at a specific timepoint were: younger age and no stoma (total physical activity, 1 month), low/mid rectal tumor, no stoma, non-employed status (total, 4 months), higher COREFO-scores (occupational, 4 months) and non-employed status (total, 12 months). At all timepoints, lower COREFO-scores were associated with higher total physical activity levels; male gender and lower educational levels with higher occupational levels; younger age, normal BMI, employed status and adjuvant therapy with higher sports levels; and female gender, lower educational level and unemployed status with higher household levels. Conclusions One year after rectal cancer treatment, total physical activity levels were still not recovered. Rectal cancer patients, especially those at risk for decreased physical activity levels and with major bowel complaints, should be identified and guided to increase their activities. Trial registration This trial has been registered at Netherlands Trial Register (NTR6383, 23/01/2017).
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Nicklett EJ, Chen J, Xiang X, Abrams LR, Sonnega AJ, Johnson KE, Cheng J, Assari S. Associations Between Diagnosis with Type 2 Diabetes and Changes in Physical Activity among Middle-Aged and Older Adults in the United States. Innov Aging 2020; 4:igz048. [PMID: 32099903 PMCID: PMC7032072 DOI: 10.1093/geroni/igz048] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Physical activity (PA) is an effective strategy for diabetes self-management and is central to the diabetes regimen. Diagnostic events present an opportunity for health behavior change; however, many older adults with type 2 diabetes (T2D) do not engage in regular PA. The relationships between diagnosis events and subsequent changes in PA are not well understood. Drawing upon life-course theory, this is the first study to examine whether the diagnosis of T2D is followed by a change in PA, whether these changes are sustained, and the sociodemographic characteristics associated with these changes. RESEARCH DESIGN AND METHODS We examined associations between T2D diagnosis and PA changes among 2,394 adults ages 51+ from the Health and Retirement Study (2004-2014). PA changes were measured using metabolic equivalents of task (METs) estimated values accounting for the vigor and frequency of self-reported PA. Using piecewise mixed models, we examined initial and sustained changes in METs over time and tested whether these changes were modified by race/ethnicity, educational level, gender, and age at diagnosis. RESULTS Across participants, a significant postdiagnosis increase was observed in self-reported PA following the diagnostic event (β: 0.54, 95% CI: 0.10, 0.97). The steepness of decline in PA participation over time did not change significantly following T2D diagnosis. Age at diagnosis and race/ethnicity significantly moderated these relationships: participants diagnosed at older ages were less likely to improve PA following diagnosis and non-Hispanic whites experienced relatively steeper rates of decline following diagnosis with T2D. DISCUSSION AND IMPLICATIONS Modest diagnosis-related increases in PA were observed among participants overall. The usual rate of decline in PA appears unaffected by diagnosis overall. Age at diagnosis and race/ethnicity moderated these relationships. Key implications for future research and clinical practice are discussed.
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Affiliation(s)
- Emily J Nicklett
- School of Social Work, University of Michigan, Ann Arbor,Address correspondence to: Emily J. Nicklett, PhD, MA, MSSW, School of Social Work, University of Michigan, 1080 South University Avenue, Ann Arbor, MI 48109-2029. E-mail:
| | - Jieling Chen
- Department of Social Work and Social Administration, The University of Hong Kong
| | - Xiaoling Xiang
- School of Social Work, University of Michigan, Ann Arbor
| | - Leah R Abrams
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor
| | - Amanda J Sonnega
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor
| | - Kimson E Johnson
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor
| | - Jianjia Cheng
- School of Social Work, University of Michigan, Ann Arbor
| | - Shervin Assari
- Department of Family Medicine, Charles R. Drew University of Medicine and Science, University of California, Los Angeles
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9
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Webb J, Peel J, Fife-Schaw C, Ogden J. A mixed methods process evaluation of a print-based intervention supported by internet tools to improve physical activity in UK cancer survivors. Public Health 2019; 175:19-27. [PMID: 31374452 DOI: 10.1016/j.puhe.2019.06.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 06/13/2019] [Accepted: 06/19/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE A waiting list randomised control trial has shown the Move More Pack, a print-based intervention supported by Internet tools, to improve physical activity levels in cancer survivors; however, one-third of them do not improve from the intervention. The objective of this process evaluation is to understand intervention use, the mechanisms of impact, the perceived benefits and the contextual factors influencing these, identifying for whom it is a useful resource. METHODS The process evaluation used mixed methods, based on guidance from the UK Medical Research Council, including 181 questionnaire responses on intervention use and physical activity improvement over 12 weeks, 56 open-text responses and 17 semistructured interviews. RESULTS The Move More Pack was suggested to be most useful when delivered towards the start of the cancer journey to those with a positive attitude to fight cancer but with a low level of physical activity, capitalising on a teachable moment. It was suggested that healthcare professionals could support the effective distribution of the Move More Pack. The intervention's printed components were more popular and well used than the Internet tools. Use of the printed intervention components was positively correlated with physical activity improvement but use of the Internet tools was not. Women were more likely to use the intervention's printed components than men. Cancer survivors using the intervention reflected that they had increased confidence and motivation for physical activity and other lifestyle behaviours. CONCLUSION The Move More Pack should be offered by healthcare professionals, during cancer treatment, when health is salient, to those with a positive attitude to fight cancer but with low levels of physical activity. Use of the intervention's printed components is more likely to improve physical activity than the Internet tools, and the components are more likely to be used by women. The use of Internet tools to support physical activity improvement in cancer survivors requires further investigation.
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Affiliation(s)
- J Webb
- London Metropolitan University, 166-220, Holloway Road, London, N7 8DB, UK.
| | - J Peel
- British Lung Foundation, 73-75 Goswell Road, London, EC1V 7ER, UK.
| | - C Fife-Schaw
- University of Surrey, School of Psychology, Faculty of Health and Medical Sciences, Guildford, Surrey, GU2 7XH, UK.
| | - J Ogden
- University of Surrey, School of Psychology, Faculty of Health and Medical Sciences, Guildford, Surrey, GU2 7XH, UK.
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Webb J, Fife-Schaw C, Ogden J. A randomised control trial and cost-consequence analysis to examine the effects of a print-based intervention supported by internet tools on the physical activity of UK cancer survivors. Public Health 2019; 171:106-115. [PMID: 31121557 DOI: 10.1016/j.puhe.2019.04.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 04/02/2019] [Accepted: 04/08/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the effectiveness of a print-based intervention supported by Internet tools at improving physical activity in cancer survivors compared with a standard letter recommendation. Prediagnosis physical activity and self-efficacy were hypothesised to predict physical activity improvement. STUDY DESIGN Waiting list randomised control trial and cost-consequence analysis. METHODS Adult cancer survivors who could become physically active without prior medical approval were randomised to receive either a print-based intervention supported by Internet tools (intervention, n = 104) or a standard letter recommendation (control, n = 103). Physical activity was assessed at 12 weeks with maintenance assessed at 24 weeks in the intervention arm. The number needed to treat was calculated, and a cost-consequence analysis completed. RESULTS Participants in receipt of a print-based intervention supported by Internet tools improved their physical activity by 36.9% over 12 weeks compared with 9.1% in the control arm. Physical activity was maintained at 24 weeks in the intervention arm. A total of 6.29 cancer survivors needed to receive the intervention for one cancer survivor to improve their physical activity over a standard letter recommendation. Intervention delivery cost £8.19 per person. Prediagnosis physical activity and self-efficacy did not predict physical activity improvement. CONCLUSION A print-based intervention supported by Internet tools offers a promising low-cost means to intervene to improve physical activity in cancer survivors. The study was registered with the International Standard Randomised Controlled Trials Number registry (registration number: 66418871), and ethical approval was received from the University of Surrey (reference: UEC/2017/023/FHMS).
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Affiliation(s)
- J Webb
- London Metropolitan University, 166-220 Holloway Road, London, N7 8DB, UK.
| | - C Fife-Schaw
- University of Surrey, School of Psychology, Faculty of Health and Medical Sciences, Guildford Surrey, GU2 7XH, UK.
| | - J Ogden
- University of Surrey, School of Psychology, Faculty of Health and Medical Sciences, Guildford Surrey, GU2 7XH, UK.
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11
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Mikkelsen MK, Nielsen DL, Vinther A, Lund CM, Jarden M. Attitudes towards physical activity and exercise in older patients with advanced cancer during oncological treatment - A qualitative interview study. Eur J Oncol Nurs 2019; 41:16-23. [PMID: 31358249 DOI: 10.1016/j.ejon.2019.04.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 04/30/2019] [Accepted: 04/30/2019] [Indexed: 01/29/2023]
Abstract
PURPOSE Older patients with cancer are underrepresented in exercise-based trials. To engage older patients in physical activity (PA), it is necessary to consider age-related decline in health, comorbidities and practicalities. The study aim was to explore attitudes towards PA and exercise among older patients with cancer to inform future exercise-based interventions. METHOD Individual interviews (N = 23) were conducted in patients ≥ 65 years with advanced lung, biliary tract and pancreatic cancer receiving palliative oncological treatment. Patients were recruited with a purposive sampling strategy. A semi-structured interview guide focusing on attitudes towards PA and exercise, including barriers, facilitators and motivators, was used. Data on the informants' medical history, demographics and PA level was collected. RESULTS Identified themes were: 1) a general positive perception of physical activity is expressed 2) comorbidities and external circumstances prevent physical activity, 3) fatigue overshadows life, 4) social support is key to short and long-term motivation, 5) fixed conditions keep one focused, 6) familiarity raises confidence and motivation. CONCLUSIONS Even though perceptions of PA were positive among older patients with cancer, most struggled to stay physically active during oncological treatment. Several factors related to cancer and aging were identified as barriers; most profoundly was the overwhelming feeling of fatigue. Improving physical and mental well-being, fixed conditions (e.g. group-based exercise and supervision) and social support were identified as motivators and facilitators. Preferences for PA varied, but activities that were familiar increased motivation. Exercise programs for older patients with cancer must be adjustable to each patient's limitations, needs and personal resources.
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Affiliation(s)
- Marta Kramer Mikkelsen
- Department of Oncology and Hematology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark; Department of Oncology, Copenhagen University Hospital, Herlev and Gentofte Hospital, Herlev Ringvej 75, 2730, Herlev, Denmark.
| | - Dorte Lisbet Nielsen
- Department of Oncology, Copenhagen University Hospital, Herlev and Gentofte Hospital, Herlev Ringvej 75, 2730, Herlev, Denmark.
| | - Anders Vinther
- Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev and Gentofte Hospital, Herlev Ringvej 75, 2730, Herlev, Denmark; QD-Research Unit, Copenhagen University Hospital, Herlev and Gentofte Hospital, Herlev Ringvej 75, 2730, Herlev, Denmark.
| | - Cecilia Margareta Lund
- Department of Medicine, Copenhagen University Hospital, Herlev and Gentofte Hospital, Herlev Ringvej 75, 2730, Herlev, Denmark.
| | - Mary Jarden
- Department of Oncology and Hematology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark.
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12
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Tabaczynski A, Strom DA, Wong JN, McAuley E, Larsen K, Faulkner GE, Courneya KS, Trinh L. Demographic, medical, social-cognitive, and environmental correlates of meeting independent and combined physical activity guidelines in kidney cancer survivors. Support Care Cancer 2019; 28:43-54. [PMID: 30980259 DOI: 10.1007/s00520-019-04752-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 03/15/2019] [Indexed: 01/07/2023]
Abstract
PURPOSE Guidelines for cancer survivors recommend both aerobic physical activity (PA) and strength training (ST). Few kidney cancer survivors (KCS) are meeting single-activity or combined guidelines; therefore, examining factors influencing PA participation is warranted. The purpose of this study is to examine demographic, medical, social-cognitive, and environmental correlates of meeting independent (i.e., aerobic-only, strength training (ST)-only) and combined guidelines (i.e., aerobic and ST) in KCS. METHODS KCS (N = 651) completed self-reported measures of PA and demographic, medical, social-cognitive, and perceived environmental factors. Built environment was assessed using the geographic information systems (GIS). Multinomial logistic regressions were conducted to determine the correlates of meeting the combined versus independent guidelines. RESULTS Compared with meeting neither guideline, meeting aerobic-only guidelines was associated with higher intentions (p < .01) and planning (p < .01); meeting ST-only guidelines was associated with higher intentions (p = .02) and planning (p < .01), lower perceived behavioral control (PBC) (p = .03), healthy weight (p = .01), and older age (p < .01); and meeting the combined guidelines were associated with higher intentions (p < .01), planning (p = .02), higher instrumental attitudes (p < .01), higher education (p = .04), better health (p < .01), and localized cancer (p = .05). Additionally, compared with neither guideline, meeting aerobic-only (p < .01) and combined (p < .01) guidelines was significantly associated with access to workout attire. Compared with neither guideline, meeting aerobic-only guidelines was associated with proximity to retail (p = .02). CONCLUSION PA participation correlates may vary based on the modality of interest. Interventions may differ depending on the modality promoted and whether KCS are already meeting single-modality guidelines.
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Affiliation(s)
- Allyson Tabaczynski
- Faculty of Kinesiology and Physical Education, University of Toronto, 55 Harbord Street, Toronto, ON, M5S 2W6, Canada
| | - Dominick A Strom
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, 906 South Goodwin Avenue, Urbana, IL, 61801, USA
| | - Jaime N Wong
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, 906 South Goodwin Avenue, Urbana, IL, 61801, USA
| | - Edward McAuley
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, 906 South Goodwin Avenue, Urbana, IL, 61801, USA
| | - Kristian Larsen
- CAREX Canada, Faculty of Health Sciences, Simon Fraser University, 105-515 West Hastings Street, Vancouver, BC, V6B 5K3, Canada.,Department of Geography and Planning, University of Toronto, 100 St. George Street, Toronto, ON, M5S 2W6, Canada
| | - Guy E Faulkner
- School of Kinesiology, University of British Columbia, 2259 Lower Mall, Vancouver, British Columbia, V6T 1Z4, Canada
| | - Kerry S Courneya
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, 113 University Hall, Edmonton, Alberta, T6G 2H9, Canada
| | - Linda Trinh
- Faculty of Kinesiology and Physical Education, University of Toronto, 55 Harbord Street, Toronto, ON, M5S 2W6, Canada.
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13
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Wang Y, Chen S, Zhang J, Zhang Y, Ernstsen L, Lavie CJ, Hooker SP, Chen Y, Sui X. Nonexercise Estimated Cardiorespiratory Fitness and All-Cancer Mortality: the NHANES III Study. Mayo Clin Proc 2018; 93:848-856. [PMID: 29602418 DOI: 10.1016/j.mayocp.2018.01.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 11/15/2017] [Accepted: 01/03/2018] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To examine the relationship between estimated cardiorespiratory fitness (eCRF) using nonexercise equations and all-cancer mortality in a representative sample of the US population. PARTICIPANTS AND METHODS A total of 8506 study participants were derived from the Third National Health and Nutrition Examination Survey, conducted from October 18, 1988, to October 15, 1994. They were followed for all-cancer mortality. Participants' CRF was estimated from nonexercise models that were determined by age, body mass index, waist circumference, resting heart rate, physical activity status, and smoking status, and further grouped into quintiles. Hazard ratios (HRs) and 95% CIs were calculated from Cox proportional hazards models for the relationship between eCRF and all-cancer mortality. RESULTS During a mean of 19.5 years of follow-up, 455 cancer deaths (263 men and 192 women) were registered. After adjustment for race/ethnicity, age, educational level, current smoking, hypertension, diabetes mellitus, and hypercholesterolemia, each 1-metabolic equivalent increase in eCRF was associated with 30% (95% CI, 24%-35%) and 27% (95% CI, 18%-36%) risk reduction for all-cancer mortality in men and women, respectively. When eCRF was categorized into quintiles, HRs (95% CIs) were 0.47 (0.24-0.95), 0.81 (0.46-1.44), 0.49 (0.26-0.93), and 0.57 (0.31-1.06) across incremental quintiles in women (quintile 1 was the reference group). However, none of the HRs reached statistical significance in men. CONCLUSION The eCRF was inversely associated with all-cancer mortality in quintiles 2 and 4 in women. More research is needed to further understand the association between eCRF and all-cancer mortality in men.
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Affiliation(s)
- Ying Wang
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, Norway
| | - Shujie Chen
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, Norway
| | - Jiajia Zhang
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, Norway
| | - Yanan Zhang
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, Norway
| | - Linda Ernstsen
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, LA
| | - Steven P Hooker
- Exercise Science and Health Promotion Program, College of Health Solutions, Arizona State University, Phoenix
| | - Yuhui Chen
- Department of Mathematics, University of Alabama, Tuscaloosa
| | - Xuemei Sui
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, Norway.
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14
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Eng L, Pringle D, Su J, Shen X, Mahler M, Niu C, Charow R, Tiessen K, Lam C, Halytskyy O, Naik H, Hon H, Irwin M, Pat V, Gonos C, Chan C, Villeneuve J, Harland L, Shani RM, Brown MC, Selby P, Howell D, Xu W, Liu G, Alibhai SMH, Jones JM. Patterns, perceptions, and perceived barriers to physical activity in adult cancer survivors. Support Care Cancer 2018; 26:3755-3763. [DOI: 10.1007/s00520-018-4239-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 04/26/2018] [Indexed: 11/28/2022]
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15
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Brown JC, Damjanov N, Courneya KS, Troxel AB, Zemel BS, Rickels MR, Ky B, Rhim AD, Rustgi AK, Schmitz KH. A randomized dose-response trial of aerobic exercise and health-related quality of life in colon cancer survivors. Psychooncology 2018; 27:1221-1228. [PMID: 29388275 PMCID: PMC5895514 DOI: 10.1002/pon.4655] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 01/17/2018] [Accepted: 01/18/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To examine the dose-response effects of aerobic exercise on health-related quality of life (HRQoL) among colon cancer survivors. METHODS Thirty-nine stage I to III colon cancer survivors were randomized to 1 of 3 groups: usual-care control, 150 min·wk-1 of aerobic exercise (low-dose) and 300 min·wk-1 of aerobic exercise (high-dose) for 6 months. HRQoL outcomes included the Short Form (SF)-36 physical and mental component summary, Functional Assessment of Cancer Therapy-Colorectal, Pittsburgh Sleep Quality Index, Fear of Cancer Recurrence Inventory, Fatigue Symptom Inventory, and North Central Cancer Treatment Group bowel function questionnaire, assessed at baseline and post intervention. The primary hypothesis was that exercise would improve HRQoL outcomes in a dose-response fashion, such that high-dose aerobic exercise would yield the largest improvements in HRQoL outcomes. RESULTS Over 6 months, the low-dose group completed 141 ± 10 min·wk-1 of aerobic exercise, and the high-dose group completed 247 ± 11 min·wk-1 of aerobic exercise. Over 6 months, exercise improved the physical component summary score of the SF-36 (Ptrend = 0.002), the Functional Assessment of Cancer Therapy-Colorectal (Ptrend = 0.025), the Pittsburgh Sleep Quality Index (Ptrend = 0.049), and the Fatigue Symptom Inventory (Ptrend = 0.045) in a dose-response fashion. Between-group standardized mean difference effects sizes for the above-described findings were small to moderate in magnitude (0.35-0.75). No dose-response effects were observed for the mental component summary score of the SF-36, the Fear of Cancer Recurrence Inventory, or bowel function. CONCLUSION Higher doses of aerobic exercise, up to 300 min·wk-1 , improve multiple HRQoL outcomes among stage I to III colon cancer survivors. These findings provide evidence that aerobic exercise may provide multiple health benefits for colon cancer survivors.
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Affiliation(s)
| | | | | | | | - Babette S. Zemel
- University of Pennsylvania, Philadelphia, PA, USA, 19104
- Childrens Hospital of Philadelphia, Philadelphia, PA, USA, 19104
| | | | - Bonnie Ky
- University of Pennsylvania, Philadelphia, PA, USA, 19104
| | | | - Anil K. Rustgi
- University of Pennsylvania, Philadelphia, PA, USA, 19104
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16
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van Nieuwenhuizen AJ, Buffart LM, van Uden-Kraan CF, van der Velden LA, Lacko M, Brug J, Leemans CR, Verdonck-de Leeuw IM. Patient-reported physical activity and the association with health-related quality of life in head and neck cancer survivors. Support Care Cancer 2017; 26:1087-1095. [PMID: 29164375 PMCID: PMC5847044 DOI: 10.1007/s00520-017-3926-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 10/09/2017] [Indexed: 12/17/2022]
Abstract
Purpose This study aimed to assess patient-reported levels of physical activity (PA) and its associations with health-related quality of life (HRQoL) adjusted for important demographic, lifestyle-related, and clinical factors, among head and neck (HNC) survivors. Methods This cross-sectional study included 116 HNC survivors. PA was assessed with the Physical Activity Scale for the Elderly (PASE) and HRQoL with the EORTC-QLQ-C30 and EORTC-HN35. Associations were studied using univariable and multivariable regression analyses. Results Median PASE score was 100.3 (interquartile range 65.1;170.8) of which 54% were household, 34% leisure-time, and 12% occupational activities. Younger HNC survivors had higher levels of PA. Higher PA was significantly associated with higher global QoL (p < 0.05). Findings for physical function, role function, social function, fatigue, and pain were in line, but not statistically significant (0.05 ≤ p < 0.10). Conclusions Among HNC survivors, a large proportion of PA consists of household activities. Younger HNC survivors had higher PA levels, and higher PA levels were associated with higher HRQoL.
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Affiliation(s)
- Annette J van Nieuwenhuizen
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, PO BOX 7057, 1007 MB, Amsterdam, The Netherlands
| | - Laurien M Buffart
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.,Department of Medical Oncology, Cancer Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Cornelia F van Uden-Kraan
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, PO BOX 7057, 1007 MB, Amsterdam, The Netherlands.,Department of Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Lilly-Ann van der Velden
- Department of Otolaryngology-Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands.,Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Martin Lacko
- Department of Otolaryngology-Head and Neck Surgery, University Medical Centre of Maastricht, Maastricht, The Netherlands
| | - Johannes Brug
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - C René Leemans
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, PO BOX 7057, 1007 MB, Amsterdam, The Netherlands
| | - Irma M Verdonck-de Leeuw
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, PO BOX 7057, 1007 MB, Amsterdam, The Netherlands. .,Department of Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
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17
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Conroy DE, Wolin KY, Blair CK, Demark-Wahnefried W. Gender-varying associations between physical activity intensity and mental quality of life in older cancer survivors. Support Care Cancer 2017; 25:3465-3473. [PMID: 28620700 PMCID: PMC5693626 DOI: 10.1007/s00520-017-3769-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 05/30/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Physical activity can enhance quality of life in cancer survivors, but this conclusion is based largely on research linking moderate-to-vigorous physical activity with quality of life. Light-intensity physical activity may be more feasible than more strenuous exercise for many older cancer survivors. This study reports a secondary analysis of baseline data from a lifestyle behavior intervention trial and examines the hypothesis that older cancer survivors who engage in more light-intensity physical activity, independent of moderate-to-vigorous activity, will report better mental quality of life. METHODS Older (≥65 years), overweight or obese breast, prostate, or colorectal cancer survivors (n = 641, 54% female) self-reported their physical activity and mental quality of life (i.e., mental health, emotional role functioning, vitality, and social role functioning from the Short-Form 36 Health Status Survey) as a part of the RENEW trial baseline assessment. Analysis of covariance was used to test hypotheses. RESULTS For older women (but not men), light physical activity was positively associated with mental quality of life after adjusting for moderate-to-vigorous physical activity. Light physical activity that involved social participation appeared to be responsible for this association. For older men (but not women), moderate-to-vigorous physical activity was positively associated with mental quality of life. CONCLUSIONS Some activity appears to be better than none for important dimensions of mental quality of life. Experimental research is needed to test the hypothesis that older cancer survivors should strive to avoid inactivity regardless of whether they are able to engage in moderate-to-vigorous physical activity.
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Affiliation(s)
- David E Conroy
- Department of Kinesiology, The Pennsylvania State University, 266 Rec Hall, University Park, PA, 16802, USA.
- Department of Preventive Medicine, Northwestern University, Chicago, IL, USA.
| | - Kathleen Y Wolin
- Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
- Coeus Health, Chicago, IL, USA
| | - Cindy K Blair
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Wendy Demark-Wahnefried
- Department of Nutrition Science, University of Alabama-Birmingham, Birmingham, AL, USA
- University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL, USA
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18
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Hacker ED, Kim I, Park C, Peters T. Real-time Fatigue and Free-Living Physical Activity in Hematopoietic Stem Cell Transplantation Cancer Survivors and Healthy Controls: A Preliminary Examination of the Temporal, Dynamic Relationship. Cancer Nurs 2017; 40:259-268. [PMID: 27922918 PMCID: PMC5459685 DOI: 10.1097/ncc.0000000000000459] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Fatigue and physical inactivity, critical problems facing cancer survivors, impact overall health and functioning. Our group designed a novel methodology to evaluate the temporal, dynamic patterns in real-world settings. OBJECTIVE Using real-time technology, the temporal, dynamic relationship between real-time fatigue and free-living is described and compared in cancer survivors who were treated with hematopoietic stem cell transplantation (n = 25) and age- and gender-matched healthy controls (n = 25). METHODS Subjects wore wrist actigraphs on their nondominant hand to assess free-living physical activity, measured in 1-minute epochs, over 7 days. Subjects entered real-time fatigue assessments directly into the subjective event marker of the actigraph 5 times per day. Running averages of mean 1-minute activity counts 30, 60, and 120 minutes before and after each real-time fatigue score were correlated with real-time fatigue using generalized estimating equations, RESULTS:: A strong inverse relationship exists between real-time fatigue and subsequent free-living physical activity. This inverse relationship suggests that increasing real-time fatigue limits subsequent physical activity (B range= -0.002 to -0.004; P < .001). No significant differences in the dynamic patterns of real-time fatigue and free-living physical activity were found between groups. CONCLUSIONS To our knowledge, this is the first study to document the temporal and potentially causal relationship between real-time fatigue and free-living physical activity in real-world setting. These findings suggest that fatigue drives the subsequent physical activity and the relationship may not be bidirectional. IMPLICATIONS FOR PRACTICE Understanding the temporal, dynamic relationship may have important health implications for developing interventions to address fatigue in cancer survivors.
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Affiliation(s)
- Eileen Danaher Hacker
- Author Affiliations: Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago (Dr Hacker, Ms Kim, and Ms Peters); Department of Health Science Systems, College of Nursing, University of Illinois at Chicago (Dr Park)
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Abstract
BACKGROUND Fatigue is highly prevalent after hematopoietic stem cell transplantation (HCT). It has been described as intense and may last for years following treatment. OBJECTIVE The aim of this study is to compare fatigue, physical activity, sleep, emotional distress, cognitive function, and biological measures in HCT survivors with persistent fatigue (n = 25) with age- and gender-matched healthy controls with occasional tiredness (n = 25). METHODS Data were collected using (a) objective, real-time assessments of physical activity and sleep over 7 days; (b) patient-reported fatigue assessments; (c) computerized objective testing of cognitive functioning; and (d) biological measures. Differences between groups were examined using multivariate analysis of variance. RESULTS Survivors of HCT reported increased physical (P < .001), mental (P < .001), and overall (P < .001) fatigue as well as increased anxiety (P < .05) and depression (P < .01) compared with healthy controls. Red blood cell (RBC) levels were significantly lower in HCT survivors (P < .001). Levels of RBC for both groups, however, were in the normal range. Tumor necrosis factor-α (P < .001) and interleukin-6 (P < .05) levels were significantly higher in HCT survivors. CONCLUSIONS Persistent fatigue in HCT survivors compared with healthy controls with occasional tiredness is accompanied by increased anxiety and depression along with decreased RBC counts. Elevated tumor necrosis factor-α and interleukin-6 levels may be important biomarkers. IMPLICATIONS FOR PRACTICE This study provides preliminary support for the conceptualization of fatigue as existing on a continuum, with tiredness anchoring one end and exhaustion the other. Persistent fatigue experienced by HCT survivors is more severe than the occasional tiredness of everyday life.
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Drury A, Payne S, Brady AM. Cancer survivorship: Advancing the concept in the context of colorectal cancer. Eur J Oncol Nurs 2017; 29:135-147. [PMID: 28720260 DOI: 10.1016/j.ejon.2017.06.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 06/10/2017] [Accepted: 06/21/2017] [Indexed: 12/31/2022]
Abstract
PURPOSE Previous conceptualizations of cancer survivorship have focused on heterogeneous cancer survivors, with little consideration of the validity of conclusions for homogeneous tumour groups. This paper aims to examine the concept of cancer survivorship in the context of colorectal cancer (CRC). METHOD Rodgers' (1989) Evolutionary Method of Concept Analysis guided this study. A systematic search of PUBMED, CINAHL, PsycINFO and The Cochrane Library was conducted in November 2016 to identify studies of CRC survivorship. The Braun and Clarke (2006) framework guided the analysis and interpretation of data extracted from eighty-five publications. RESULTS Similar to general populations of cancer survivors, CRC survivors experience survivorship as an individual, life-changing process, punctuated by uncertainty and a duality of positive and negative outcomes affecting quality of life. However, CRC survivors experience specific concerns arising from the management of their disease. The concept of cancer survivorship has evolved over the past decade as the importance of navigating the healthcare system and its resources, and the constellation of met and unmet needs of cancer survivors are realised. CONCLUSIONS The results highlight core similarities between survivorship in the context of CRC and other tumour groups, but underlines issues specific to CRC survivorship. Communication and support are key issues in survivorship care which may detrimentally affect CRC survivors' well-being if they are inadequately addressed. Healthcare professionals (HCP's) therefore have a duty to ensure cancer survivors' health, information and supportive care needs are met in the aftermath of treatment.
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Affiliation(s)
- Amanda Drury
- School of Nursing & Midwifery, Faculty of Health Sciences, Trinity College Dublin, Dublin 2, Ireland.
| | - Sheila Payne
- International Observatory on End of Life Care, Division of Health Research, Lancaster University, Lancaster, UK
| | - Anne-Marie Brady
- School of Nursing & Midwifery, Faculty of Health Sciences, Trinity College Dublin, Dublin 2, Ireland; Centre for Practice and Healthcare Innovation, School of Nursing & Midwifery, Faculty of Health Sciences, Trinity College Dublin, Dublin 2, Ireland
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Physical activity, bowel function, and quality of life among rectal cancer survivors. Qual Life Res 2017; 26:3131-3142. [PMID: 28677077 DOI: 10.1007/s11136-017-1641-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2017] [Indexed: 12/17/2022]
Abstract
PURPOSE Physical activity (PA) is positively associated with numerous health benefits among cancer survivors. This study examined insufficiently investigated relationships among PA, health-related quality of life (HRQOL), and bowel function (BF) in rectal cancer survivors. METHODS RC survivors (n = 1063) ≥5 years from diagnosis in two Kaiser permanente regions were mailed a multidimensional survey to assess HRQOL and BF. PA was assessed by a modified Godin Leisure-Time Exercise Questionnaire. PA minutes were categorized into weighted categories based on guidelines: (1) not active (zero PA minutes); (2) insufficiently active (1-149 PA minutes); (3) meeting guidelines (150-299 PA minutes); and (4) above guidelines (≥300 PA minutes). Relationships of PA with HRQOL and BF were evaluated using multiple linear regression, stratified by sex and ostomy status for BF. Types of PA identified as helpful for BF and symptoms addressed were summarized. RESULTS Response rate was 60.5%. Of 557 participants, 40% met or exceeded PA guidelines, 34% were not active, and 26% were insufficiently active. Aerobic activities, specifically walking and cycling, were most commonly reported to help BF. Higher PA was associated with better psychological wellbeing and multiple SF12 scales, worse BF scores in men with ostomies, and better BF scores in women. CONCLUSIONS Meeting or exceeding PA guidelines was associated with higher HRQOL. Although the BF findings are exploratory, they suggest women may benefit from increased PA, whereas men with ostomies may face challenges that require more study. Identifying PA strategies that will lead to improved patient compliance and benefit are needed.
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22
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Cabilan CJ, Hines S. The short-term impact of colorectal cancer treatment on physical activity, functional status and quality of life: a systematic review. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2017; 15:517-566. [PMID: 28178025 DOI: 10.11124/jbisrir-2016003282] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Physical activity, functional status and quality of life (QoL) are important determinants of the quality of life (QoL) after colorectal cancer (CRC) treatment; however, little is known on how the treatment impacts these outcomes. Having this understanding could help clinicians develop and implement strategies that would enhance or maintain the QoL of CRC patients. OBJECTIVES To identify the impact of curative CRC treatment (surgery with or without radiotherapy and/or chemotherapy) on physical activity, functional status and QoL within one year of treatment or diagnosis. INCLUSION CRITERIA TYPES OF PARTICIPANTS Colorectal cancer survivors aged 18 years and over. TYPES OF INTERVENTIONS Curative CRC treatment, which was surgery with or without radiotherapy and/or chemotherapy. TYPES OF STUDIES Pre- and post-observational and experimental studies. OUTCOMES Physical activity, ability to perform activities of daily living (functional status) and QoL. SEARCH STRATEGY CINAHL, Embase, MEDLINE, OpenGrey and ProQuest Dissertations and Theses were used to obtain published and unpublished studies in English. The date range was the start of indexing to February 2015. METHODOLOGICAL QUALITY All studies were assessed independently by two reviewers for relevance, eligibility and methodological quality. DATA EXTRACTION Data from included papers were extracted using a modified data extraction tool. Data that were presented graphically were extracted using online software. DATA SYNTHESIS The differences between postoperative and baseline values were calculated using the Review Manager 5.3.5 (Copenhagen: The Nordic Cochrane Centre, Cochrane) calculator and expressed as mean difference and their corresponding 95% confidence interval. Where possible, study results were pooled in statistical meta-analysis. The physical activity, functional status and some QoL results are presented in a narrative and table form. RESULTS A total of 23 studies were included in this review: two studies (N = 2019 patients) evaluated physical activity, two studies (N = 6908 patients) assessed functional status and 22 studies (N = 2890 patients) measured QoL. Physical activity was observed to decrease at six months after treatment. The functional status of CRC patients decreased, particularly in the elderly (Summary of findings 1 and 2). As for QoL, only the physical and functional aspects were seen to decline up to six months, but scores almost returned to baseline levels at one year after treatment. The QoL studies that used the European Organization for Research and Treatment of Cancer QLQ-C30 tool were pooled in statistical meta-analysis and summarized in Summary of findings 2. The results must be interpreted carefully due to the heterogeneity of studies and scarcity of recent studies. CONCLUSION In spite of the limitations, it is likely that the physical and functional capacity of CRC survivors deteriorates after treatment. IMPLICATIONS FOR PRACTICE The period between diagnosis and treatment provides an opportunity for clinicians to implement interventions (e.g. exercise interventions) that could enhance or restore the physical and functional capacity of CRC survivors. IMPLICATIONS FOR RESEARCH The paucity of studies and heterogeneity need to be addressed. The outcomes for colon and rectal cancer survivors, ostomates and non-ostomates must be analyzed separately.
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Affiliation(s)
- C J Cabilan
- 1Nursing Research Centre, Mater Misericordiae Limited, and The Queensland Centre for Evidence Based Nursing and Midwifery: a Joanna Briggs Institute Centre of Excellence 2School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
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Fassier P, Zelek L, Partula V, Srour B, Bachmann P, Touillaud M, Druesne-Pecollo N, Galan P, Cohen P, Hoarau H, Latino-Martel P, Menai M, Oppert JM, Hercberg S, Deschasaux M, Touvier M. Variations of physical activity and sedentary behavior between before and after cancer diagnosis: Results from the prospective population-based NutriNet-Santé cohort. Medicine (Baltimore) 2016; 95:e4629. [PMID: 27749527 PMCID: PMC5059029 DOI: 10.1097/md.0000000000004629] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Physical activity (PA) but also reduced sedentary behavior may be associated with better prognosis and lower risk of recurrence in cancer patients. Our aim was to quantify the variations in PA and time spent sedentary between before and after diagnosis, relying on prospective data in French adults. We also investigated sociodemographic and lifestyle factors associated with these variations.Subjects (n = 942) were incident cancer cases diagnosed in the NutriNet-Santé cohort between 2009 and 2015. PA and sedentary behavior were prospectively collected with the 7-day short version of the IPAQ questionnaire every year since subjects' inclusion (i.e., an average of 2 year before diagnosis). All PA and sitting time points before and after diagnosis was compared by mixed model. Factors associated with decrease in PA and increase in sitting time were investigated using logistic regressions.Overall and vigorous PA decreased after diagnosis (P = 0.006, -32.8 ± 36.8 MET-hour/week on average, in those who decreased their overall PA and P = 0.005, -21.1 ± 36.8 MET-hour/week for vigorous PA, respectively), especially in prostate (-39.5 ± 36.3 MET-hour/week) and skin (-35.9 ± 38 MET-hour/week) cancers, in men (-40.8 ± 46.3MET-hour/week), and in those professionally inactive (-34.2 ± 37.1 MET-hour/week) (all P < 0.05). Patients with higher PA level before diagnosis were more likely to decrease their PA (odds ratio [OR]: 4.67 [3.21-6.81], P < 0.0001). Overweight patients more likely to decrease moderate PA (OR: 1.45 [1.11-1.89], P = 0.006) and walking (OR: 1.30 [1.10-1.70], P = 0.04). Sitting time increased (P = 0.02, +2.44 ± 2.43 hour/day on average, in those who increased their sitting time), especially in women (+2.48 ± 2.48 hour/day), older patients (+2.48 ± 2.57 hour/day), and those professionally inactive (2.41 ± 2.40 hour/day) (all P < 0.05). Patients less sedentary before diagnosis were more likely to increase their sitting time (OR: 3.29 [2.45-4.42], P < 0.0001).This large prospective study suggests that cancer diagnosis is a key period for change in PA and sedentary behavior. It provides insights to target the subgroups of patients who are at higher risk of decreasing PA and increasing sedentary behavior after cancer diagnosis.
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Affiliation(s)
- Philippine Fassier
- Nutritional Epidemiology Research Team (EREN): Inserm U1153, Inra U1125, Cnam, Paris 5, 7 and 13 Universities, Sorbonne Paris Cité Epidemiology and Statistics Research Center, Bobigny, France
- French Network for Nutrition and Cancer Research (NACRe Network), www.inra.fr/nacre
- Correspondence: Philippine Fassier, EREN, Inserm U1153, SMBH Paris 13, 74 rue Marcel Cachin, F-93017 Bobigny, Cedex, France (e-mail: )
| | - Laurent Zelek
- Nutritional Epidemiology Research Team (EREN): Inserm U1153, Inra U1125, Cnam, Paris 5, 7 and 13 Universities, Sorbonne Paris Cité Epidemiology and Statistics Research Center, Bobigny, France
- French Network for Nutrition and Cancer Research (NACRe Network), www.inra.fr/nacre
- Oncology Department, Avicenne Hospital, Bobigny, France
| | - Valentin Partula
- Nutritional Epidemiology Research Team (EREN): Inserm U1153, Inra U1125, Cnam, Paris 5, 7 and 13 Universities, Sorbonne Paris Cité Epidemiology and Statistics Research Center, Bobigny, France
- French Network for Nutrition and Cancer Research (NACRe Network), www.inra.fr/nacre
| | - Bernard Srour
- Nutritional Epidemiology Research Team (EREN): Inserm U1153, Inra U1125, Cnam, Paris 5, 7 and 13 Universities, Sorbonne Paris Cité Epidemiology and Statistics Research Center, Bobigny, France
- French Network for Nutrition and Cancer Research (NACRe Network), www.inra.fr/nacre
| | - Patrick Bachmann
- French Network for Nutrition and Cancer Research (NACRe Network), www.inra.fr/nacre
- Léon Bérard Cancer Cancer, Lyon, France
| | - Marina Touillaud
- French Network for Nutrition and Cancer Research (NACRe Network), www.inra.fr/nacre
- Léon Bérard Cancer Cancer, Lyon, France
- Centre de Recherche en Cancérologie, Lyon, France
| | - Nathalie Druesne-Pecollo
- Nutritional Epidemiology Research Team (EREN): Inserm U1153, Inra U1125, Cnam, Paris 5, 7 and 13 Universities, Sorbonne Paris Cité Epidemiology and Statistics Research Center, Bobigny, France
- French Network for Nutrition and Cancer Research (NACRe Network), www.inra.fr/nacre
| | - Pilar Galan
- Nutritional Epidemiology Research Team (EREN): Inserm U1153, Inra U1125, Cnam, Paris 5, 7 and 13 Universities, Sorbonne Paris Cité Epidemiology and Statistics Research Center, Bobigny, France
- French Network for Nutrition and Cancer Research (NACRe Network), www.inra.fr/nacre
| | - Patrice Cohen
- French Network for Nutrition and Cancer Research (NACRe Network), www.inra.fr/nacre
- Sociology Department, University of Rouen, DySola, Rouen, France
| | - Hélène Hoarau
- French Network for Nutrition and Cancer Research (NACRe Network), www.inra.fr/nacre
- Sociology Department, University of Rouen, DySola, Rouen, France
| | - Paule Latino-Martel
- Nutritional Epidemiology Research Team (EREN): Inserm U1153, Inra U1125, Cnam, Paris 5, 7 and 13 Universities, Sorbonne Paris Cité Epidemiology and Statistics Research Center, Bobigny, France
- French Network for Nutrition and Cancer Research (NACRe Network), www.inra.fr/nacre
| | - Mehdi Menai
- Nutritional Epidemiology Research Team (EREN): Inserm U1153, Inra U1125, Cnam, Paris 5, 7 and 13 Universities, Sorbonne Paris Cité Epidemiology and Statistics Research Center, Bobigny, France
| | - Jean-Michel Oppert
- Nutritional Epidemiology Research Team (EREN): Inserm U1153, Inra U1125, Cnam, Paris 5, 7 and 13 Universities, Sorbonne Paris Cité Epidemiology and Statistics Research Center, Bobigny, France
- Sorbonne University, Pierre et Marie Curie University, Paris 6 University; Institute of Cardiometabolism and Nutrition; Department of Nutrition, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Serge Hercberg
- Nutritional Epidemiology Research Team (EREN): Inserm U1153, Inra U1125, Cnam, Paris 5, 7 and 13 Universities, Sorbonne Paris Cité Epidemiology and Statistics Research Center, Bobigny, France
- French Network for Nutrition and Cancer Research (NACRe Network), www.inra.fr/nacre
- Public Health Department, Avicenne Hospital, Bobigny, France
| | - Mélanie Deschasaux
- Nutritional Epidemiology Research Team (EREN): Inserm U1153, Inra U1125, Cnam, Paris 5, 7 and 13 Universities, Sorbonne Paris Cité Epidemiology and Statistics Research Center, Bobigny, France
- French Network for Nutrition and Cancer Research (NACRe Network), www.inra.fr/nacre
| | - Mathilde Touvier
- Nutritional Epidemiology Research Team (EREN): Inserm U1153, Inra U1125, Cnam, Paris 5, 7 and 13 Universities, Sorbonne Paris Cité Epidemiology and Statistics Research Center, Bobigny, France
- French Network for Nutrition and Cancer Research (NACRe Network), www.inra.fr/nacre
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Maxwell-Smith C, Zeps N, Hagger MS, Platell C, Hardcastle SJ. Barriers to physical activity participation in colorectal cancer survivors at high risk of cardiovascular disease. Psychooncology 2016; 26:808-814. [PMID: 27478009 DOI: 10.1002/pon.4234] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 07/22/2016] [Accepted: 07/26/2016] [Indexed: 11/08/2022]
Abstract
BACKGROUND Lifestyle factors including inadequate physical activity may contribute to increased risk of developing cardiovascular disease in colorectal cancer survivors. Identification of the barriers to physical activity is important for forming an evidence base of factors to target in future physical activity programs aimed at improving cardiovascular health in this population. METHODS Colorectal cancer survivors (N = 24) from St. John of God Subiaco Hospital participated in semi-structured interviews about their current physical activity behaviors and perceived barriers to physical activity. RESULTS Inductive thematic analysis of interviews revealed 5 overarching themes relating to barriers to physical activity: psychological barriers, environmental barriers, knowledge of guidelines, lack of practitioner support, and energy/age barriers. CONCLUSIONS Novel findings revealed participants' dependence on practitioner support, including a reliance on practitioners to recommend lifestyle change. Survivors also revealed that regular checkups to monitor cardiovascular risk replaced the need for healthy lifestyle changes. IMPLICATIONS With survivors holding the advice of clinicians in high regard, an opportunity exists for clinicians to facilitate lifestyle change. Health care professionals such as nurses can implement motivational strategies and provide additional health information during follow-up visits, to ensure long-term adherence. Individuals who reported psychological, motivational, and environmental barriers may benefit from interventions to improve self-regulation, planning, and problem-solving skills.
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Affiliation(s)
- Chloe Maxwell-Smith
- Health Psychology and Behavioural Medicine Research Group, School of Psychology and Speech Pathology, Curtin University, Perth, Western Australia, Australia
| | - Nik Zeps
- Department of Oncology, St. John of God Hospital, Perth, Western Australia, Australia
| | - Martin S Hagger
- Health Psychology and Behavioural Medicine Research Group, School of Psychology and Speech Pathology, Curtin University, Perth, Western Australia, Australia
| | - Cameron Platell
- Department of Oncology, St. John of God Hospital, Perth, Western Australia, Australia
| | - Sarah J Hardcastle
- Health Psychology and Behavioural Medicine Research Group, School of Psychology and Speech Pathology, Curtin University, Perth, Western Australia, Australia
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25
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Kampshoff CS, Stacey F, Short CE, van Mechelen W, Chinapaw MJ, Brug J, Plotnikoff R, James EL, Buffart LM. Demographic, clinical, psychosocial, and environmental correlates of objectively assessed physical activity among breast cancer survivors. Support Care Cancer 2016; 24:3333-42. [PMID: 26970957 PMCID: PMC4917571 DOI: 10.1007/s00520-016-3148-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 02/22/2016] [Indexed: 01/07/2023]
Abstract
Purpose The aim of this study was to identify demographic, clinical, psychosocial, and environmental correlates of objectively assessed physical activity among breast cancer survivors. Methods Baseline data were utilized from 574 female breast cancer survivors who participated in three different intervention studies: Resistance and Endurance exercise After ChemoTherapy (REACT), Exercise and Nutrition Routine Improving Cancer Health (ENRICH), and Move More for Life (MM4L). Participants were eligible if they were aged ≥18 years and had completed primary cancer treatment. Physical activity was objectively assessed by accelerometers or pedometers. Participants completed self-reported questionnaires on demographic, psychosocial, and environmental factors. Information regarding clinical factors was obtained from medical records or patient self-report. Multivariable linear regression analyses were applied on the pooled dataset to identify factors that were significantly correlated with physical activity. In addition, the explained variance of the model was calculated. Results The multivariable regression model revealed that older age, (β = −0.01, 95 %CI = −0.02; −0.003), higher body mass index (β = −0.05, 95 %CI = −0.06; −0.03), lower self-efficacy (β = 0.2, 95 %CI = 0.08; 0.2), and less social support (β = 0.1, 95 %CI = 0.05; 0.2) were significantly correlated with lower physical activity. This model explained 15 % of the variance in physical activity. Conclusion Age, body mass index, self-efficacy, and social support were significantly correlated with objectively assessed physical activity in breast cancer survivors. It may therefore be recommended that physical activity intervention studies in these women target those who are older, and have a higher body mass index, and should operationalize behavior change strategies designed to enhance self-efficacy and social support. Trial registration The REACT study is registered at the Netherlands Trial Register [NTR2153]. The ENRICH study is registered at Australian New Zealand Clinical Trials Register [ANZCTRN12609001086257]. And the MM4L study is registered at Australian New Zealand Clinical Trials Register [ACTRN12611001061921]
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Affiliation(s)
- Caroline S Kampshoff
- Department of Public and Occupational Health and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
| | - Fiona Stacey
- School of Medicine and Public Health, Priority Research Centre for Health Behaviour, Priority Research Centre in Physical Activity and Nutrition, and Hunter Medical Research Institute, University of Newcastle, Callaghan, NSW, Australia
| | - Camille E Short
- School of Medicine, University of Adelaide, Adelaide, Australia
| | - Willem van Mechelen
- Department of Public and Occupational Health and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
| | - Mai Jm Chinapaw
- Department of Public and Occupational Health and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
| | - Johannes Brug
- Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Center, De Boelelaan 1089a, 1081 HV, Amsterdam, The Netherlands
| | - Ronald Plotnikoff
- School of Education and Arts, Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW, Australia
| | - Erica L James
- School of Medicine and Public Health, Priority Research Centre for Health Behaviour, Priority Research Centre in Physical Activity and Nutrition, and Hunter Medical Research Institute, University of Newcastle, Callaghan, NSW, Australia
| | - Laurien M Buffart
- Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Center, De Boelelaan 1089a, 1081 HV, Amsterdam, The Netherlands.
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Hardcastle SJ, Maxwell-Smith C, Zeps N, Platell C, O'Connor M, Hagger MS. A qualitative study exploring health perceptions and factors influencing participation in health behaviors in colorectal cancer survivors. Psychooncology 2016; 26:199-205. [PMID: 26935994 DOI: 10.1002/pon.4111] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 02/08/2016] [Accepted: 02/10/2016] [Indexed: 11/07/2022]
Abstract
PURPOSE The purpose of the study was to explore colorectal cancer survivors' health perceptions following cessation of active treatment for cancer and to explore the factors influencing participation in health-promoting behaviors that may help reduce cardiovascular disease risk. METHODS Face-to-face interviews were conducted with participants that had completed active treatment for cancer within the previous 2 years. Participants were colorectal cancer survivors (N = 24, men = 11, women = 13, M age = 69.38 years, SD = 4.19) recruited from a private hospital in Perth, Australia on the basis that they had existing morbidities that put them at increased risk of cardiovascular disease. Interview transcripts were analyzed using thematic analysis. RESULTS Five main themes emerged: back to normal; the pleasures in life: 'is it worth it?'; beliefs about health behavior; skepticism of eating guidelines; and lack of motivation. The majority of participants felt they were in good health and had made a full recovery. Participants questioned whether it was worth changing their lifestyle given their life stage and referred to the desire to enjoy life. Lay health beliefs, skepticism of eating guidelines, and a lack of motivation were barriers to change. CONCLUSIONS Interventions should target lay beliefs and skepticism in relation to health behaviors in order to reinforce the importance and value of participating in health-related behavior. IMPLICATIONS FOR CANCER SURVIVORS Findings may inform the development of effective, patient-centered interventions that target lay health beliefs and build motivation for health behavior change. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Sarah J Hardcastle
- Health Psychology and Behavioural Medicine Research Group, School of Psychology and Speech Pathology, Curtin University, Perth, Australia
| | - Chloe Maxwell-Smith
- Health Psychology and Behavioural Medicine Research Group, School of Psychology and Speech Pathology, Curtin University, Perth, Australia
| | - Nik Zeps
- Department of Oncology, St John of God Hospital, Subiaco, Australia
| | - Cameron Platell
- Department of Oncology, St John of God Hospital, Subiaco, Australia
| | - Moira O'Connor
- Health Psychology and Behavioural Medicine Research Group, School of Psychology and Speech Pathology, Curtin University, Perth, Australia
| | - Martin S Hagger
- Health Psychology and Behavioural Medicine Research Group, School of Psychology and Speech Pathology, Curtin University, Perth, Australia.,School of Applied Psychology and Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia.,Finnish Distinguished Professor (FiDiPro) Programme, School of Sport Sciences, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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27
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Functional Impairment and Physical Activity Adherence Among Gynecologic Cancer Survivors. Int J Gynecol Cancer 2016; 26:381-8. [DOI: 10.1097/igc.0000000000000620] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
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Patterns and correlates of accelerometer-assessed physical activity and sedentary time among colon cancer survivors. Cancer Causes Control 2015; 27:59-68. [DOI: 10.1007/s10552-015-0683-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 10/13/2015] [Indexed: 12/28/2022]
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Gjerset GM, Loge JH, Gudbergsson SB, Bye A, Fosså SD, Oldervoll LM, Kiserud CE, Demark-Wahnefried W, Thorsen L. Lifestyles of cancer survivors attending an inpatient educational program-a cross-sectional study. Support Care Cancer 2015; 24:1527-36. [PMID: 26370221 DOI: 10.1007/s00520-015-2936-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 09/02/2015] [Indexed: 12/16/2022]
Abstract
PURPOSE Cancer survivors have increased risk for adverse health effects, but the risk can be reduced by adopting a healthy lifestyle. Knowledge of lifestyle in terms of physical activity (PA), diet (intake of fruit and vegetables [F&V]) and smoking behaviors of cancer survivors enrolled in an inpatient educational program and identification of subgroups not meeting the lifestyle guidelines are needed to set up more targeted programs. METHODS We invited 862 cancer survivors, ≥18 years, diagnosed within the last 10 years and about to attend a 1-week educational program, to participate in this cross-sectional study. Sixty-seven percent (n = 576) returned the questionnaire before the start of the program. PA, F&V intake (5-A-Day) and smoking behaviors were self-reported. Logistic regression analyses were used to identify the characteristics of those not meeting the guidelines. RESULTS Sixty-three percent were women, median age was 60 years (range 28-83), 52 % had high education and median time since diagnosis was 12 months (range 2-119). Fifty-five percent did not meet the PA guidelines, 81 % did not meet the 5-A-Day guidelines and 12 % were current smokers. In multivariate analyses, age ≥60 years and low education were associated with not meeting the PA guidelines, and male gender and low education were associated with not meeting the 5-A-Day guidelines. Living alone was associated with smoking. CONCLUSIONS The majority of cancer survivors attending an educational program do not meet the public guidelines for PA and diet. Special attention should be given to those who are male, over age 60 years and with low education.
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Affiliation(s)
- Gunhild M Gjerset
- National Advisory Unit on Late Effects after Cancer Treatment, Department of Oncology, Oslo University Hospital, Oslo, Norway.
| | - Jon H Loge
- Regional Centre for Excellence in Palliative Care, Department of Oncology, Oslo University Hospital and Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Sævar B Gudbergsson
- Montebello-Center, The Norwegian Resource Center for Coping with Cancer, Mesnali, Norway
| | - Asta Bye
- Regional Centre for Excellence in Palliative Care, Department of Oncology, Oslo University Hospital and Department of Health, Nutrition and Management, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - S D Fosså
- National Advisory Unit on Late Effects after Cancer Treatment, Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Line M Oldervoll
- Centre for Health Promotion and Resources, Department of Social Work and Health Science, NTNU, Trondheim and Research and Development Group, LHL Clinics, LHL Clinics, Oslo, Norway
| | - Cecilie E Kiserud
- National Advisory Unit on Late Effects after Cancer Treatment, Department of Oncology, Oslo University Hospital, Oslo, Norway
| | | | - Lene Thorsen
- National Advisory Unit on Late Effects after Cancer Treatment, Department of Oncology, Oslo University Hospital, Oslo, Norway
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Weaver KE, Palmer N, Lu L, Case LD, Geiger AM. Rural-urban differences in health behaviors and implications for health status among US cancer survivors. Cancer Causes Control 2013; 24:1481-90. [PMID: 23677333 DOI: 10.1007/s10552-013-0225-x] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Accepted: 05/04/2013] [Indexed: 12/19/2022]
Abstract
PURPOSE Rural US adults have increased risk of poor outcomes after cancer, including increased cancer mortality. Rural-urban differences in health behaviors have been identified in the general population and may contribute to cancer health disparities, but have not yet been examined among US survivors. We examined rural-urban differences in health behaviors among cancer survivors and associations with self-reported health and health-related unemployment. METHODS We identified rural (n = 1,642) and urban (n = 6,162) survivors from the cross-sectional National Health Interview Survey (2006-2010) and calculated the prevalence of smoking, physical activity, overweight/obesity, and alcohol consumption. Multivariable models were used to examine the associations of fair/poor health and health-related unemployment with health behaviors and rural-urban residence. RESULTS The prevalence of fair/poor health (rural 36.7 %, urban 26.6 %), health-related unemployment (rural 18.5 %, urban 10.6 %), smoking (rural 25.3 %, urban 15.8 %), and physical inactivity (rural 50.7 %, urban 38.7 %) was significantly higher in rural survivors (all p < .05); alcohol consumption was lower (rural 46.3 %, urban 58.6 %), and there were no significant differences in overweight/obesity (rural 65.4 %, urban 62.6 %). All health behaviors were significantly associated with fair/poor health and health-related unemployment in both univariate and multivariable models. After adjustment for behaviors, rural survivors remained more likely than urban survivors to report fair/poor health (OR = 1.21, 95 % CI 1.03-1.43) and health-related unemployment (OR = 1.49, 95 % CI 1.18-1.88). CONCLUSIONS Rural survivors may need tailored, accessible health promotion interventions to address health-compromising behaviors and improve outcomes after cancer.
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Affiliation(s)
- Kathryn E Weaver
- Division of Public Health Sciences, Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
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Singh F, Newton RU, Galvão DA, Spry N, Baker MK. A systematic review of pre-surgical exercise intervention studies with cancer patients. Surg Oncol 2013; 22:92-104. [PMID: 23434347 DOI: 10.1016/j.suronc.2013.01.004] [Citation(s) in RCA: 130] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Revised: 01/22/2013] [Accepted: 01/28/2013] [Indexed: 12/19/2022]
Abstract
BACKGROUND Recent reviews suggest that enhancing fitness and functional capacity prior to surgery can accelerate post-surgery recovery and reduce mortality. However, the effect of pre-surgical exercise interventions in cancer patients is not fully explained. The aim of this paper is to systematically review the available literature regarding pre-surgery exercise training interventions in cancer patients and examine their effects on physiological outcomes as well as quality of life (QOL) and length of hospital stay. METHODS Relevant studies were identified through a search on MEDLINE, PreMEDLINE, AMED, MEDLINE Daily Update, CINAHL and SPORTDiscus. All randomized controlled trials (RCTs) and non-RCTs that had some form of physical exercise undertaken prior to surgery were included. Descriptive characteristics such as participant characteristics, study design, types of cancer, length of study, and primary outcomes were extracted. Methodological rigour was assessed using a modified Delphi List. Due to the heterogeneity and the dearth of pre-surgical studies, we were limited to a systematic review rather than a meta-analysis. RESULTS Eighteen studies were included consisting of a total of 966 participants. Lung cancer studies were the predominant group represented. Most of the studies prescribed an aerobic intervention programs done prior to surgery. Mode, frequency, duration, and intensity of exercise intervention varied across the different cancer groups. The majority of studies showed preliminary positive change in clinical outcomes with significant improvements in the rate of incontinence, functional walking capacity and cardiorespiratory fitness. CONCLUSION Pre-surgical exercise may benefit cancer patients through positive effects on function and physical capacity. Surgical oncologists may consider pre-surgical exercise interventions as a potential adjuvant therapy to improve patients' outcomes.
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Affiliation(s)
- Favil Singh
- Edith Cowan University Health and Wellness Institute, Edith Cowan University, 270 Joondalup Drive, Joondalup, Perth, Western Australia 6027, Australia.
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Contribution of taking part in sport to the association between physical activity and quality of life. Qual Life Res 2013; 22:2021-9. [DOI: 10.1007/s11136-013-0355-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2013] [Indexed: 10/27/2022]
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Skeps R, McMullen CK, Wendel CS, Bulkley J, Grant M, Mohler J, Hornbrook MC, Krouse RS, Herrinton LJ. Changes in body mass index and stoma related problems in the elderly. J Geriatr Oncol 2013; 4:84-9. [PMID: 24071496 PMCID: PMC3564631 DOI: 10.1016/j.jgo.2012.10.172] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Revised: 08/10/2012] [Accepted: 10/04/2012] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Weight gain can cause retraction of an intestinal stoma, possibly resulting in difficulty with wafer and pouch fit, daily care challenges, and discomfort. This cross-sectional study examined the association between body mass index (BMI) and ostomy-related problems among long-term (>5years post-diagnosis) colorectal cancer (CRC) survivors. MATERIALS AND METHODS CRC survivors from three Kaiser Permanente Regions completed a mailed survey. The response rate for those with an ostomy was 53% (283/529). Questions included stoma-related problems, and time to conduct daily ostomy care. Poisson regression evaluated associations between report of problems and change in BMI. Our analysis sample included 235 survivors. RESULTS Sample was 76% ≥65years of age. Since their surgeries, BMI remained stable (ST) in 44% (103), decreased (DE) in 20% (48), and increased (IN) in 36% (84). Compared to ST, male IN (RR 2.15 [1.09-4.25]) and female DE (RR 5.06 [1.26-25.0]) were more likely to spend more than 30min per day on stoma care. IN (vs. ST) were more likely to report interference with clothing (RR 1.51 [1.06-2.17]) and other stoma-related problems (RR 2.32 [1.30-4.14]). Survivors who were obese at time of survey were more likely to report interference with clothing (RR 1.88 [1.38-2.56]) and other stoma-related problems (RR 1.68 [1.07-2.65]). CONCLUSION A change in BMI is associated with ostomy-related problems among long-term CRC survivors. Equipment and care practices may need to be adapted for changes in abdominal shape. Health care providers should caution that a significant increase or decrease in BMI may cause ostomy-related problems.
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Affiliation(s)
| | - Carmit K. McMullen
- The Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Christopher S. Wendel
- University of Arizona, Arizona Center on Aging, Tucson, AZ
- Southern Arizona Veterans Affairs Health Care System, Tucson, AZ
| | - Joanna Bulkley
- The Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Marcia Grant
- City of Hope National Medical Center/Beckman Research Institute, Duarte, CA
| | - Jane Mohler
- University of Arizona, Arizona Center on Aging, Tucson, AZ
| | - Mark C. Hornbrook
- The Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Robert S. Krouse
- University of Arizona Cancer Center, Tucson, AZ
- Southern Arizona Veterans Affairs Health Care System, Tucson, AZ
- University of Arizona College of Medicine, Tucson, AZ
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Physical activity participation and barriers for people with multiple myeloma. Support Care Cancer 2012; 21:927-34. [PMID: 23052913 DOI: 10.1007/s00520-012-1607-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Accepted: 09/10/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE This study aims to examine, for people treated for multiple myeloma, (1) differences between prediagnosis and postdiagnosis levels of physical activity, (2) perceived barriers and likelihood of attending a physical activity program, and (3) factors that influence whether or not respondents are meeting physical activity guidelines. METHODS This was a quantitative cross-sectional study; data were gathered from a larger Australian population-wide survey. Respondents completed the survey in hard copy, online, or over the telephone. Demographic and clinical variables included age, gender, locality, time since diagnosis, and marital status. The Godin Leisure-Time Questionnaire measured physical activity; barriers and likelihood of participating in a physical activity program were assessed using a five-point Likert scale. Data were analyzed using descriptive, bivariate, and multivariate analyses. RESULTS Of the 229 respondents, 53.1 % were male, 42 % aged 60-69 years, and 75.7 % were married or in a de facto relationship. Participation in physical activity declined significantly from prediagnosis levels. Fatigue, injuries, and pain were the strongest perceived barriers to participation; 41 % reported they were likely to attend an exercise program if offered. Respondents who were sufficiently active before diagnosis were 4.79 times more likely to be sufficiently active posttreatment. CONCLUSIONS People with multiple myeloma reported very low levels of physical activity across all levels of intensity; however, they were interested in attending a physical activity program. To increase physical activity among people with multiple myeloma, interventions should target perceived barriers with a particular focus on those who were not physically active prior to diagnosis.
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Carmack CL, Basen-Engquist K, Gritz ER. Survivors at higher risk for adverse late outcomes due to psychosocial and behavioral risk factors. Cancer Epidemiol Biomarkers Prev 2012; 20:2068-77. [PMID: 21980014 DOI: 10.1158/1055-9965.epi-11-0627] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Cancer survivors face significant morbidity and mortality associated with their disease and treatment regimens, some of which can be improved through modifying behavioral and psychosocial risk factors. This article examines risk factors for adverse late effects that contribute to morbidity and mortality in cancer survivors, provides a literature review on interventions to modify these risks factors, and summarizes the national recommendations and associated current practices for identifying and managing these risk factors. Finally, future directions for research and clinical practice are discussed.
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Affiliation(s)
- Cindy L Carmack
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX 77230, USA.
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Abstract
Colorectal cancer survivorship begins at diagnosis and continues throughout life. After diagnosis, survivors face the possibility of second cancers, long-term effects of cancer treatment, and comorbid conditions. Interventions that can provide primary, secondary, and tertiary prevention in this population are important. Physical activity has been shown to decrease colon cancer incidence and recurrence risk as well as improve quality of life and noncancer health outcomes including cardiovascular fitness in colon cancer survivors. The data are less robust for rectal cancer incidence and recurrence, although improvements in quality of life and health outcomes in rectal cancer survivors are also seen. Potential mechanisms for this benefit may occur through inflammatory or insulin-like growth factor pathways. The issues of colorectal cancer survivorship and the impact of physical activity on these issues are reviewed, with discussion of possible biologic mechanisms, barriers to physical activity intervention studies, and future research directions for physical activity in this burgeoning survivor population.
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Abstract
Physical activity (PA) participation has been shown to be helpful in improving physical and mental well-being among cancer survivors. The purpose of this chapter is to review the literature on the determinants of physical activity motivation and behavior among cancer survivors. Using theories of behavior change, researchers have sought to identify the correlates of motivation that predict the participation in regular physical activity in observational studies, while intervention studies have focused on manipulating those factors to support the initiation of physical activity. The majority of this work has been conducted with breast cancer survivors, and there is an interest in expanding this work to survivors of others cancers (e.g., prostate, lung, and colorectal cancer). Results suggest that constructs from the Theory of Planned Behavior (TPB), Transtheoretical Model (TTM), and Social Cognitive Theory (SCT) are associated with greater motivation for physical activity, and some of these constructs have been used in interventions to promote physical activity adoption. There is scope for understanding the determinants of physical activity adoption in various cancer survivor populations. Much more needs to done to identify the determinants of maintenance of physical activity.
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Affiliation(s)
- Bernardine M Pinto
- Centers for Behavioral and Preventive Medicine, Coro Bldg, Suite 500, One Hoppin Street, Providence, RI, 02903, USA.
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Exercise behavior in cancer survivors and associated factors. J Cancer Surviv 2010; 5:35-43. [PMID: 20890674 PMCID: PMC3040309 DOI: 10.1007/s11764-010-0148-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Accepted: 08/30/2010] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Physical activity is an important component in promoting a healthy life style in cancer survivors. We estimated the proportion of cancer survivors who are physically active, defined as meeting public health exercise guidelines, and changes in level of physical activity (LPA) from before diagnosis to after treatment. We also identified medical and demographic factors associated with LPA and its changes. METHODS A cross-sectional survey assessing LPA before diagnosis and after treatment, together with demographic and medical variables in 975 cancer survivors. RESULTS Forty-five percent of the cancer survivors were physically active after treatment. Before diagnosis and after treatment 33% were active, whereas 40% were inactive at both time points. Fifteen percent were active before diagnosis but inactive after treatment, and 12% were inactive before diagnosis but active after treatment. Increasing age and weight, low education, comorbidity and smoking were associated with physical inactivity after treatment. Change in LPA from active to inactive was associated with comorbidity, distant disease and smoking, while a change from inactive to active was associated with high education. CONCLUSIONS Less than half of cancer survivors were physically active. Almost three quarters of cancer survivors remained stable in LPA. The remaining quarter changed LPA, with slightly more cancer survivors becoming inactive than active. Age, weight, education, comorbidity, disease stage and smoking can identify survivors at risk of physical inactivity after treatment. IMPLICATIONS FOR CANCER SURVIVORS Recognizable variables can be used to identify physically inactive cancer survivors after treatment and give these survivors support to start or maintain LPA.
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Campbell MK, Carr C, Devellis B, Switzer B, Biddle A, Amamoo MA, Walsh J, Zhou B, Sandler R. A randomized trial of tailoring and motivational interviewing to promote fruit and vegetable consumption for cancer prevention and control. Ann Behav Med 2010; 38:71-85. [PMID: 20012809 DOI: 10.1007/s12160-009-9140-5] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Healthful dietary patterns, including eating fruits and vegetables (F&V) and avoiding obesity, may decrease the risk of cancer and other chronic diseases. In addition to promoting health for the general population, a cancer diagnosis may provide a "teachable moment," facilitating the adoption of more healthful eating habits and leading to lower risk of chronic disease and better overall health. PURPOSE This study was designed to test the effectiveness of two health communication interventions in increasing F&V consumption and physical activity in a sample of older adults (average age of 66 years), including both colorectal cancer (CRC) survivors and noncolorectal cancer-affected (N-CRC) individuals. METHODS CRC survivors and N-CRC individuals were recruited from a population-based case-control study and randomly assigned to four conditions using a 2 x 2 design. We tested two different methods of communicating and promoting health behavior change alone or in combination: tailored print communication (TPC) and brief telephone-based motivational interviewing (TMI). RESULTS A significant increase in F&V consumption was found for the combined intervention group in the entire sample (p < 0.05). When stratified by cancer survivor status, the effect was concentrated in the N-CRC subset (p < 0.01) versus CRC survivors. The combined intervention was also found to be most cost-effective for the N-CRC group, with TPC more cost-effective than TMI. For physical activity, none of the interventions produced statistically significant improvements. CONCLUSIONS This study indicates that combining tailoring and motivational interviewing may be an effective and cost-effective method for promoting dietary behavior change among older healthy adults. More research is needed to identify the optimal dose and timing for intervention strategies to promote dietary and physical activity change among both CRC survivors and the general population.
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Affiliation(s)
- Marci Kramish Campbell
- Department of Nutrition, UNC Gillings School of Global Public Health, Chapel Hill, NC, USA.
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Siegel EM, Ulrich CM, Poole EM, Holmes RS, Jacobsen PB, Shibata D. The effects of obesity and obesity-related conditions on colorectal cancer prognosis. Cancer Control 2010; 17:52-7. [PMID: 20010519 DOI: 10.1177/107327481001700107] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Colorectal cancer is the second-leading cause of cancer death in the United States among men and women combined. Refinements in screening, staging, and treatment strategies have improved survival from this disease, with over 65% of patients diagnosed with colorectal cancer surviving over 5 years after diagnosis. In the prognosis of colorectal cancer, clinicopathological factors are important. However, modifiable prognostic factors are emerging as significant contributors to cancer outcomes, including obesity and obesity-related inflammation and metabolic conditions. METHODS This report reviews the literature on obesity and obesity-related inflammation and metabolic disturbances and colorectal cancer outcomes (recurrence, disease-free survival, and/or mortality). A PubMed search was conducted of all English-language papers published between August 2003 and 2009 and cited in MEDLINE. RESULTS Primary research papers were reviewed for colorectal cancer outcomes related to obesity, inflammation, or metabolic conditions. An association between body size and colorectal cancer recurrence and possibly survival was found; however, reports have been inconsistent. These inconsistent findings may be due to the complex interaction between adiposity, physical inactivity, and dietary intake. Circulating prognostic markers such as C-reactive protein, insulin-like growth factor, and insulin, alone or in combination, have been associated with prognosis in observational studies and should be evaluated in randomized trials and considered for incorporation into surveillance. CONCLUSIONS The literature suggests that obesity and obesity-related inflammation and metabolic conditions contribute to the prognosis of colorectal cancer; however, comprehensive large scale trials are needed. Interventions to reduce weight and control inflammation and metabolic conditions, such as diabetes, need to be evaluated and rapidly translated to behavior guidelines for patients.
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Affiliation(s)
- Erin M Siegel
- Risk Assessment, Detection and Intervention Program, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA.
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Sellar CM, Courneya KS. Physical activity and gastrointestinal cancer survivorship. Recent Results Cancer Res 2010; 186:237-53. [PMID: 21113767 DOI: 10.1007/978-3-642-04231-7_10] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Research examining physical activity in gastrointestinal cancer survivors is in its early stages and has focused primarily on colorectal cancer. Moreover, the majority of the research to date has been observational in nature, with very little interventional research. Though limited, the results of this research have been promising in nature, showing positive associations between physical activity and quality of life as well as disease outcomes, including improved disease-free and overall survival. The potential benefits of physical activity for gastrointestinal cancer survivors warrant further research on the underlying mechanisms of the relationship between physical activity and colorectal cancer disease outcomes, to determine if these associations extend to other gastrointestinal cancers, and to determine appropriate physical activity interventions to realize any potential supportive care benefits in various gastrointestinal cancer survivor groups.
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Affiliation(s)
- Christopher M Sellar
- Behavioural Medicine Lab, E4-88 Van Vliet Centre, University of Alberta, Edmonton, AB, Canada, T6G 2H9
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Hawkes AL, Pakenham KI, Courneya KS, Gollschewski S, Baade P, Gordon LG, Lynch BM, Aitken JF, Chambers SK. A randomised controlled trial of a tele-based lifestyle intervention for colorectal cancer survivors ('CanChange'): study protocol. BMC Cancer 2009; 9:286. [PMID: 19689801 PMCID: PMC2746814 DOI: 10.1186/1471-2407-9-286] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2009] [Accepted: 08/18/2009] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Colorectal cancer survivors may suffer from a range of ongoing psychosocial and physical problems that negatively impact on quality of life. This paper presents the study protocol for a novel telephone-delivered intervention to improve lifestyle factors and health outcomes for colorectal cancer survivors. METHODS/DESIGN Approximately 350 recently diagnosed colorectal cancer survivors will be recruited through the Queensland Cancer Registry and randomised to the intervention or control condition. The intervention focuses on symptom management, lifestyle and psychosocial support to assist participants to make improvements in lifestyle factors (physical activity, healthy diet, weight management, and smoking cessation) and health outcomes. Participants will receive up to 11 telephone-delivered sessions over a 6 month period from a qualified health professional or 'health coach'. Data collection will occur at baseline (Time 1), post-intervention or six months follow-up (Time 2), and at 12 months follow-up for longer term effects (Time 3). Primary outcome measures will include physical activity, cancer-related fatigue and quality of life. A cost-effective analysis of the costs and outcomes for survivors in the intervention and control conditions will be conducted from the perspective of health care costs to the government. DISCUSSION The study will provide valuable information about an innovative intervention to improve lifestyle factors and health outcomes for colorectal cancer survivors. TRIAL REGISTRATION ACTRN12608000399392.
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Affiliation(s)
- Anna L Hawkes
- Viertel Centre for Research in Cancer Control, Cancer Council Queensland, Brisbane, Australia
- School of Public Health, Queensland University of Technology, Brisbane, Australia
| | | | - Kerry S Courneya
- Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Canada
| | - Sara Gollschewski
- Viertel Centre for Research in Cancer Control, Cancer Council Queensland, Brisbane, Australia
| | - Peter Baade
- Viertel Centre for Research in Cancer Control, Cancer Council Queensland, Brisbane, Australia
| | - Louisa G Gordon
- Queensland Institute of Medical Research, Brisbane, Australia
| | - Brigid M Lynch
- Cancer Prevention Research Centre, The University of Queensland, Brisbane, Australia
| | - Joanne F Aitken
- Viertel Centre for Research in Cancer Control, Cancer Council Queensland, Brisbane, Australia
| | - Suzanne K Chambers
- Viertel Centre for Research in Cancer Control, Cancer Council Queensland, Brisbane, Australia
- Griffith Institute for Health and Medical Research, Griffith University, Brisbane, Australia
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Perceived barriers to physical activity for colorectal cancer survivors. Support Care Cancer 2009; 18:729-34. [PMID: 19636595 DOI: 10.1007/s00520-009-0705-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2009] [Accepted: 07/14/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE Promoting physical activity among cancer survivors is a high priority. Understanding barriers to physical activity provides an evidence base to inform relevant strategies for doing so. METHODS Telephone interviews were conducted with colorectal cancer survivors at 5 (n = 538) and 12 months post-diagnosis (n = 403). We used an ecological model of health behaviour to classify participants' perceived barriers to physical activity into four sub-categories: physical environment, social environment, personal attributes, and disease-specific barriers. RESULTS Disease-specific barriers were perceived as the greatest challenge to colorectal cancer survivors being more physically active, closely followed by personal attributes. The physical environment presented the least salient perceived barriers; however, the physical environment was most closely associated with achieving sufficient levels of physical activity at 5 months post-diagnosis. The difficulties most frequently reported by participants at both time points were belief that they were already active enough, not feeling well enough to be physically active, and experiencing fatigue. CONCLUSIONS These findings suggest potential points for intervention to influence physical activity among colorectal cancer survivors.
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Peel JB, Sui X, Adams SA, Hébert JR, Hardin JW, Blair SN. A prospective study of cardiorespiratory fitness and breast cancer mortality. Med Sci Sports Exerc 2009; 41:742-8. [PMID: 19276861 PMCID: PMC3774121 DOI: 10.1249/mss.0b013e31818edac7] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE Physical activity may protect against breast cancer. Few prospective studies have evaluated breast cancer mortality in relation to cardiorespiratory fitness (CRF), an objective marker of physiologic response to physical activity habits. METHODS We examined the association between CRF and risk of death from breast cancer in the Aerobics Center Longitudinal Study. Women (N = 14,811), aged 20 to 83 yr with no prior breast cancer history, received a preventive medical examination at the Cooper Clinic in Dallas, Texas, between 1970 and 2001. Mortality surveillance was completed through December 31, 2003. CRF was quantified as maximal treadmill exercise test duration and was categorized for analysis as low (lowest 20% of exercise duration), moderate (middle 40%), and high (upper 40%). At baseline, all participants were able to complete the exercise test to at least 85% of their age-predicted maximal heart rate. RESULTS A total of 68 breast cancer deaths occurred during follow-up (mean = 16 yr). Age-adjusted breast cancer mortality rates per 10,000 woman-years were 4.4, 3.2, and 1.8 for low, moderate, and high CRF groups, respectively (trend P = 0.008). After further controlling for body mass index, smoking, drinking, chronic conditions, abnormal exercise ECG responses, family history of breast cancer, oral contraceptive use, and estrogen use, hazard ratios (95% CI) for breast cancer mortality across incremental CRF categories were 1.00 (referent), 0.67 (0.35-1.26), and 0.45 (0.22-0.95) (trend P = 0.04). CONCLUSIONS These results indicate that CRF is associated with a reduced risk of dying from breast cancer in women.
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Affiliation(s)
- J. Brent Peel
- University of South Carolina, Arnold School of Public Health, Department of Exercise Science, Columbia, SC
| | - Xuemei Sui
- University of South Carolina, Arnold School of Public Health, Department of Exercise Science, Columbia, SC
| | - Swann A. Adams
- University of South Carolina, Arnold School of Public Health, Department of Epidemiology and Biostatistics, Columbia, SC
- Statewide Cancer Prevention and Control Program, University of South Carolina, Columbia, SC
| | - James R. Hébert
- University of South Carolina, Arnold School of Public Health, Department of Epidemiology and Biostatistics, Columbia, SC
- Statewide Cancer Prevention and Control Program, University of South Carolina, Columbia, SC
| | - James W. Hardin
- University of South Carolina, Arnold School of Public Health, Department of Epidemiology and Biostatistics, Columbia, SC
- University of South Carolina, Center for Health Services and Policy Research, Columbia, SC
| | - Steven N. Blair
- University of South Carolina, Arnold School of Public Health, Department of Exercise Science, Columbia, SC
- University of South Carolina, Arnold School of Public Health, Department of Epidemiology and Biostatistics, Columbia, SC
- University of North Texas, Department of Kinesiology, Health Promotion, and Recreation, Denton, TX
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A telephone-delivered lifestyle intervention for colorectal cancer survivors ‘CanChange’: a pilot study. Psychooncology 2009; 18:449-55. [DOI: 10.1002/pon.1527] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Thompson D, Batterham AM, Markovitch D, Dixon NC, Lund AJS, Walhin JP. Confusion and conflict in assessing the physical activity status of middle-aged men. PLoS One 2009; 4:e4337. [PMID: 19183812 PMCID: PMC2629570 DOI: 10.1371/journal.pone.0004337] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2008] [Accepted: 12/15/2008] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Physical activity (including exercise) is prescribed for health and there are various recommendations that can be used to gauge physical activity status. The objective of the current study was to determine whether twelve commonly-used physical activity recommendations similarly classified middle-aged men as sufficiently active for general health. METHODS AND FINDINGS We examined the commonality in the classification of physical activity status between twelve variations of physical activity recommendations for general health in ninety men aged 45-64 years. Physical activity was assessed using synchronised accelerometry and heart rate. Using different guidelines but the same raw data, the proportion of men defined as active ranged from to 11% to 98% for individual recommendations (median 73%, IQR 30% to 87%). There was very poor absolute agreement between the recommendations, with an intraclass correlation coefficient (A,1) of 0.24 (95% CI, 0.15 to 0.34). Only 8% of men met all 12 recommendations and would therefore be unanimously classified as active and only one man failed to meet every recommendation and would therefore be unanimously classified as not sufficiently active. The wide variability in physical activity classification was explained by ostensibly subtle differences between the 12 recommendations for thresholds related to activity volume (time or energy), distribution (e.g., number of days of the week), moderate intensity cut-point (e.g., 3 vs. 4 metabolic equivalents or METs), and duration (including bout length). CONCLUSIONS Physical activity status varies enormously depending on the physical activity recommendation that is applied and even ostensibly small differences have a major impact. Approximately nine out of every ten men in the present study could be variably described as either active or not sufficiently active. Either the effective dose or prescription that underlies each physical activity recommendation is different or each recommendation is seeking the same prescriptive outcome but with variable success.
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Affiliation(s)
- Dylan Thompson
- School for Health, University of Bath, Bath, United Kingdom.
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Lynch BM, Steginga SK, Hawkes AL, Pakenham KI, Dunn J. Describing and predicting psychological distress after colorectal cancer. Cancer 2008; 112:1363-70. [PMID: 18318044 DOI: 10.1002/cncr.23300] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Psychological distress in cancer survivors can be detrimental to treatment adherence and self-care tasks and is associated with poor health behaviors and decreased overall quality of life. The prevalence, course, and predictors of psychological distress after the diagnosis of colorectal cancer are to date not well described. METHODS A prospective survey of 1822 colorectal cancer patients was undertaken assessing psychological distress and hypothesized predictors including optimism, cancer threat appraisal, social support, and physical activity at 6 and 12 months postdiagnosis. Logistic regression identified correlates of psychological distress at 12 months postdiagnosis. RESULTS The prevalence of global psychological distress was low: 8.3% and 6.7% at 6 and 12 months postdiagnosis, respectively. When baseline measures of independent variables were included in a logistic regression model, distress at 6 months postdiagnosis (odds ratio [OR]=10.84), comorbidities (OR=1.64), optimism (OR=0.93), cancer threat appraisal (OR=0.92), and social support (OR=0.94) were significantly associated with distress at 12 months postdiagnosis. A second logistic regression model that included concurrent measures of cancer threat appraisal, social support, and physical activity found that distress at 6 months postdiagnosis (OR=12.49), comorbidities (OR=1.64), optimism (OR=0.94), and concurrent cancer threat appraisal (OR=0.85) were significantly associated with distress at 12 months postdiagnosis. CONCLUSIONS Distress screening at regular intervals is needed to efficiently detect colorectal cancer patients who require in-depth psychological intervention. Threat appraisal is a modifiable variable that should be included in interventions for colorectal cancer survivors. Further research is needed to investigate the potential for physical activity to reduce distress after cancer.
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Affiliation(s)
- Brigid M Lynch
- Viertel Center for Research in Cancer Control, The Cancer Council Queensland, Australia
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