Mediators of physical activity adoption and maintenance among breast cancer survivors

Dietary Barriers Appear to Influence the Effects of a Dyadic Web-Based Lifestyle Intervention on Caloric Intake and Adiposity: A Mediation Analysis of the DUET Trial

Mechanisms that explain behavior change within web-based lifestyle interventions are not well-studied. This secondary analysis explores whether the effects of the DUET web-based lifestyle intervention on diet, physical activity, and/or adiposity are mediated through changes in self-efficacy, social support, and perceived barriers (key constructs of social cognitive theory). Data on mediators, diet quality, caloric intake, moderate-to-vigorous physical activity (MVPA), weight, and waist circumference (WC) were analyzed from 112 cancer survivors and their partners enrolled in the DUET intervention. Mediation analyses were performed using Mplus to execute regression analyses and determine associations. Mediation analyses supported an effect of the intervention on caloric intake (-3.52, 95% CI [-8.08 to -0.84]), weight (-1.60, CI [-3.84 to -0.47]), and WC (-0.83, CI [-1.77 to -0.18]), interpreting these negative associations as intervention induced reductions in dietary barriers. Higher social support was significantly and positively associated with, but not a mediator for, improvements in self-reported and accelerometry-measured MVPA (b = 0.69, CI [0.19, 1.24]) and (b = 0.55, CI [0.15, 1.00]), respectively. Self-efficacy did not appear to mediate the intervention's effects. Findings suggest that the effects of the DUET intervention on diet and adiposity stem from reducing perceived barriers to a healthful, low-calorie diet.

Mediators of physical activity maintenance during a 12-month randomized controlled trial among breast Cancer survivors

PURPOSE

To explore the theoretical constructs that functioned as mediators of interventions for moderate-to-vigorous physical activity (MVPA) maintenance among breast cancer survivors.

METHOD

161 survivors were randomized into 3 groups: Reach Plus, Reach Plus Message or Reach Plus Phone. All participants received a 3-month theory-based intervention delivered by volunteer coaches. During months 4-9, all participants monitored their MVPA and received feedback reports. Additionally, Reach Plus Message received weekly text/email messages and Reach Plus Phone received monthly calls from their coaches. Assessments of weekly MVPA minutes and theoretical constructs (self-efficacy, social support, physical activity [PA] enjoyment and PA barriers) were obtained at baseline, 3, 6, 9 and 12-months.

ANALYSES

Using a multiple mediator analysis with a product of coefficients approach, we examined mechanisms associated with between-group differences over time in weekly MVPA minutes.

RESULTS

Self-efficacy mediated effects of Reach Plus Message vs. Reach Plus at 6 (ab = 16.99) and 9 M (ab = 27.45); social support mediated effects at 6 (ab = 4.86), 9 (ab = 14.30) and 12 M (ab = 6.18). Self-efficacy mediated effects of Reach Plus Phone vs. Reach Plus at 6 (ab = 18.76), 9 (ab = 28.93) and 12 M (ab = 18.18). Social support mediated effects of Reach Plus Phone vs. Reach Plus Message at 6 (ab=-5.50) and 9 M (ab=-13.20); PA enjoyment mediated effects at 12 M (ab=-3.63).

CONCLUSIONS

PA maintenance efforts should focus on strengthening breast cancer survivors' self-efficacy and obtaining social support.The trial was registered at ClinicalTrials.Gov: NCT02694640 (Feb. 26, 2016).

Psychosocial Determinants of Lifestyle Change after a Cancer Diagnosis: A Systematic Review of the Literature

Simple Summary

Although cancer survivors may experience health benefits from favorable lifestyle changes, many cancer survivors do not adhere to lifestyle recommendations or make favorable lifestyle changes after cancer diagnosis. This systematic review of the literature aimed to provide an overview of the scientific literature on sociodemographic, psychological and social determinants that may facilitate or hamper lifestyle change after the diagnosis cancer. It provides a structured overview of the large variety of determinants of changes in different lifestyle behaviors (physical activity, diet, smoking, alcohol, sun protection, and multiple lifestyle behaviors) derived from the 123 included papers (71 quantitative and 52 qualitative). Findings demonstrate the important role of oncology healthcare professionals in promoting healthy lifestyle changes in cancer survivors and inform researchers and healthcare professionals about the methods and strategies they can use to promote healthy lifestyle changes in cancer survivors.

Abstract

The aim of this study is to provide a systematic overview of the scientific literature on sociodemographic, psychological and social determinants that may facilitate or hamper lifestyle change after the diagnosis cancer. Four databases (PubMed, PsychINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Web of Science) were searched for relevant papers up to October 2021. Of the 9586 references yielded by the literature search, 123 papers were included: 71 quantitative and 52 qualitative papers. Findings showed a large variety of determinants influencing lifestyle change after cancer diagnosis, with differences between lifestyle behaviors (physical activity, diet, smoking, alcohol, sun protection, and multiple lifestyle behaviors) and findings from quantitative vs. qualitative studies. Findings demonstrate the important role of oncology healthcare professionals in promoting healthy lifestyle changes in cancer survivors. In addition, findings inform researchers involved in the development of health promotion programs about the methods and strategies they can use to promote healthy lifestyle changes in cancer survivors. Favorable lifestyle changes are expected to have beneficial effects on cancer risk and overall health in cancer survivors.

Theoretical Explanation of Upper Limb Functional Exercise and Its Maintenance in Postoperative Patients With Breast Cancer

Background: Upper limb functional exercise (ULFE) has a positive effect on promoting the rehabilitation of upper limb function. However, little is known, about what drives postoperative patients to engage in and even maintain the advised exercises. This study integrated the health action process approach (HAPA) and the theory of planned behavior theory (TPB) to investigate the psychosocial determinants on the initiation and maintenance of ULFE in breast cancer patients. In addition, this study also tests key hypotheses relating to reasoned and implicit pathways to ULFE and its maintenance among postoperative patients with breast cancer. Methods: Purposive sampling was used to recruit patients from two breast cancer wards in a provincial hospital in Jiangsu, China. Patients (N = 430) completed self-reported questionnaire about constructs from integrated theories concerning ULFE at an initial time point (T1): task self-efficacy, positive outcome expectations, negative outcome expectations, risk perception, attitude behavior, subjective norm, perceived behavioral control, behavioral intention, and ULFE-in hospital (ULFE-IH). Three months later (T2), patients self-reported: maintenance self-efficacy, action planning, coping planning, recovery self-efficacy, and ULFE-maintenance (ULFE-M). Results: The model has a good fit (GoF = 0.48). For behavioral intention of ULFE, subjective norm (β = 0.35) and perceived behavioral control (β = 0.61) were positively directly related to behavioral intention. Regarding the initiation of ULFE, perceived behavioral control (β = 0.47) and behavioral intention (β = 0.42) had a direct positive relation to ULFE-IH. In the maintenance of ULFE, action planning (β = 0.30), coping planning (β = 0.21), maintenance self-efficacy (β = 0.32), and recovery self-efficacy (β = 0.09) all had significant positive relation on ULFE-M. In addition, maintenance self-efficacy had a significant positive association on action planning (β = 0.80), coping planning (β = 0.74), and recovery self-efficacy (β = 0.67). Coping planning was significantly predicted by behavioral intention (β = 0.07). Additionally, behavioral intention is a mediator of subjective norm (β = 0.14) and perceived behavioral control (β = 0.25) to ULFE-IH. Action planning, coping planning, and recovery self-efficacy are mediators of maintaining self-efficacy to ULFE-M (β = 0.46). Conclusions: This study presents the first attempt to integrate the health behavior model in ULFE in postoperative patients with breast cancer. The study has shown that the HAPA-TPB integrated model has good applicability and effectiveness to explain and predict ULFE initiation and maintenance. Future work can be considered to develop appropriate intervention strategies based on this integrated behavioral theory.

Decisional balance, self-leadership, self-efficacy, planning, and stages of change in adopting exercise behaviors in patients with stomach cancer: A cross-sectional study

PURPOSE

Previous studies have suggested the benefits of regular exercise in motivating the survivors of cancer; however, most survivors are insufficiently active, showing high rates of nonadherence to physical activity guidelines. Using the I-Change model, this study sought to determine the association of decisional balance and self-efficacy for exercise, planning, and self-leadership with the stages of change in exercise behavior among patients with stomach cancer.

METHODS

This cross-sectional study was conducted in February 2021 and included 145 patients diagnosed with primary stomach cancer via quota sampling in South Korea. Sociodemographics, comorbidity, decisional balance for exercise, self-efficacy for exercise, planning, self-leadership, and stages of change in exercise behavior were assessed.

RESULTS

Of the participants, 4% were in the precontemplation stage of exercise behavior, 10% contemplation, 37% preparation, 23% action, and 27% maintenance. The male sex (p = 0.043), higher self-efficacy for resisting relapse (p < 0.0001), higher coping planning (p = 0.029), and higher self-leadership for behavior awareness and volition (p = 0.023) were associated with more readiness for changes in exercise behavior.

CONCLUSIONS

From the results obtained using the I-Change model, self-efficacy for resisting relapse to previous habits, coping planning, and behavior awareness and volition were associated with more readiness for changes in exercise behavior. These findings may help reduce stomach cancer survivors' nonadherence to physical activity guidelines.

Evaluation of the Healthy Living after Cancer text message-delivered, extended contact intervention using the RE-AIM framework

Background

Text message-delivered interventions have potential to prevent weight regain and maintain diet and physical activity behaviours through extending contact with participants following initial weight loss, lifestyle interventions. Using the RE-AIM Framework, this study evaluated the adoption, reach, implementation, effectiveness, and maintenance of an extended contact text-message intervention following the Healthy Living after Cancer (HLaC) program. HLaC was a 6-month, telephone-delivered intervention targeting healthy diet, physical activity and weight loss for adult cancer survivors, offered by Cancer Councils (CCs) in Australia.

Methods

HLaC completers (n = 182) were offered extended contact via text messages for 6-months (HLaC+Txt). Text message content/frequency was individually tailored to participant’s preferences, ascertained through two telephone-tailoring interviews with CC staff. Adoption (HLaC+Txt uptake among eligible CCs), reach (uptake by HLaC completers) and implementation (intervention cost/length; text dose) were assessed. The effectiveness of extended contact relative to historic controls was quantified by pre-to-post HLaC+Txt changes in self-reported: weight, moderate-vigorous physical activity (MVPA), fruit and vegetable intake, fat and fibre behaviour. Maintenance, following 6-months of noncontact for the intervention cohort, was assessed for these same variables. Semi-structured interviews with CC staff and participants contextualised outcomes.

Results

HLaC+Txt was adopted by all four CCs who had delivered HLaC. In total, 115 participants commenced HLaC+Txt, with reach ranging across CCs from 47 to 80% of eligible participants. The mean number of weeks participants received the text message intervention ranged across CCs from 18.5–22.2 weeks. Participants received (median, 25th,75th percentile) 83 (48, 119) texts, ranging across CCs from 40 to 112. The total cost of HLaC+Txt delivery was on average $AUD85.00/participant. No meaningful (p < 0.05) differences in self-reported outcomes were seen between HLaC+Txt and control cohorts. After 6-months no contact the intervention cohort had maintained weight, fruit intake, fat and fibre index scores relative to end of HLaC+Txt outcomes. Participants/CC staff perceived an important intervention component was maintaining accountability.

Conclusions

While feasible to implement, HLaC+Txt was not effective in the short term. However, intervention effects during the non-contact period suggest the program supports longer term maintenance of weight and diet behaviour. Intervention delivery in this real-world context highlighted key considerations for future implementation.

Trial registration

Australian and New Zealand Clinical Trials Registry (ANZCTR) - ACTRN12615000882527 (registered on 24/08/2015).

Supplementary Information

The online version contains supplementary material available at 10.1186/s12885-021-08806-4.