Social support and physical activity for cancer survivors: a qualitative review and meta-study

Determinants and factors of physical activity and sedentary behaviors among post-treatment breast, colorectal, lung, and prostate cancer survivors living in France: Results from the DEFACTO study first phase

OBJECTIVE

This study aimed to investigate the facilitators and barriers to adopting an active lifestyle among post-treatment cancer survivors in France.

METHODS

Breast, colorectal, lung, and prostate cancer survivors were recruited. Participants completed a questionnaire covering sociodemographic and clinical factors, physical activity (PA) experiences, variables from the Transtheoretical model, types of motivation, knowledge of PA benefits, barriers to PA, and quality of life. We categorized participants into 4 profiles combining PA level and sedentary behaviors.

RESULTS

One hundred and seventy-five participants were included. Ordinal logistic regression revealed that the active lifestyle of cancer survivors is influenced by their professional situation (OR, 3.99; 95%CI, 1.76-9.10 and OR, 3.14; 95%CI, 1.45-6.77), the use of self-liberation (OR, 0.41; 95%CI, 0.20-0.82), helping relationships processes of change (OR, 2.45; 95%CI, 1.20-5.00), and quality of life (OR, 1.11; 95%CI, 1.04-1.18).

CONCLUSIONS

Identifying the factors associated with PA and sedentary behavior among cancer survivors in France will facilitate the adaptation of programs according to a whole-person approach. Semi-structured interviews will further enhance insights in this mixed-methods study.

PRACTICE IMPLICATIONS

Interventions aimed at promoting an active lifestyle among cancer survivors should be customized based on professional situation, the utilization of experiential behavior change processes, and perceived quality of life.

Social support, health behavior self-efficacy, and anxiety on physical activity levels among lung cancer survivors: a structural equation modeling

PURPOSE

The study aims to investigate the relationship among social support, health behavior self-efficacy, anxiety, and the physical activity (PA) levels of lung cancer survivors, and to analyze whether health behavior self-efficacy and anxiety mediate the relationship between social support and PA levels.

METHODS

In a cross-sectional study of 1128 lung cancer survivors from 16 Chinese hospitals, we collected demographic data and administered the Social Support Rating Scale (SSRS), Self-Rated Abilities for Health Practices Scale (SRAHP), Anxiety Scale (AS), and International Physical Activity Questionnaire (IPAQ). SPSS 25.0 was used for descriptive analyses, while the structural equation model in SPSS AMOS 24.0 was used to identify the direct, indirect, and total effects among variables.

RESULTS

There were significant correlations among SSRS, SRAHP, AS, and PA (P < 0.01). Model outcomes revealed a positive association between social support and health behavior self-efficacy (β = 0.732, P < 0.001). Health behavior self-efficacy positively correlated with PA levels (β = 0.228, P < 0.001) and negatively with anxiety (β=-0.252, P = 0.001). Moreover, health behavior self-efficacy was found to partially mediate the relationship between social support and PA (β = 0.174, P < 0.001).

CONCLUSIONS AND IMPLICATIONS FOR CANCER SURVIVORS

This study revealed a positive correlation between social support and health behavior self-efficacy, and between health behavior self-efficacy and PA levels among lung cancer survivors. Additionally, health behavior self-efficacy mediated the relationship between social support and PA levels. In future clinical practice, medical and nursing staff should assess social support and health behavior self-efficacy in lung cancer survivors to inform personalized PA interventions.

Exploring the reasons for wanting a peer partner to be physically active among women living with and beyond a cancer diagnosis: a content analysis

BACKGROUND

Initiating and maintaining exercise is challenging for women during and post-cancer treatment. Adopting a peer partner model to provide social support to be active may contribute to lasting behaviour change of both partners. Despite this, finding a "like peer" can be challenging.

PURPOSE

To explore women's reasons for seeking an online exercise partner following a diagnosis with cancer (through  www.activematch.ca ). We also examined women's potential sociodemographic and cancer-related differences by reported reasons for wanting an exercise partner.

METHODS

Individuals creating an ActiveMatch profile completed demographic and physical activity questions (N = 199, Mage(SD) = 51.9(10.8) years), including an open-ended question regarding their "reason for wanting an exercise partner". An inductive content analysis was completed focusing on the participants' peer exercise partner preferences. Additional chi-square tests were run to assess whether participants differed based on sociodemographic and cancer-related characteristics and their motivations to be active by category of "reason for wanting an exercise partner" endorsed in the open-ended question.

RESULTS

The participants' reasons for wanting an exercise partner were coded into seven categories, with most participants highlighting the reasons of motivation (52.3%), social support (48.7%), and accountability and adherence (26.6%). Women < 50 years of age were more likely to report accountability and adherence-related preferences for a partner. Those reporting endorsing weight loss as their primary reason for becoming active were more likely to be categorized as wanting a peer partner for motivation.

CONCLUSIONS

While finding a peer partner can be challenging, matching women living with and beyond a cancer diagnosis based on their reason for wanting an exercise partner, as well as their reasons for wanting to be active, may be important to build successful peer exercise partnerships.

Safety and efficacy evaluation of personalized exercise prescription during chemotherapy for lung cancer patients

BACKGROUND

To explore the safety and effectiveness of personalized exercise intervention during chemotherapy for lung cancer patients who were relatively weak and with compromised cardiopulmonary function.

METHODS

Thirty-eight lung cancer patients treated with chemotherapy at Peking University Third Hospital were enrolled in this prospective study. The exercise group (N = 21) received individualized exercise guidance based on personal test results and exercised regularly, while the control group (N = 17) only received exercise education and planed exercise methods according to their own preferences. Both groups underwent three fitness tests and clinical indicator assessments at 0, 6, and 12 weeks after starting the exercise, and the differences in trends of various indicators between the two groups were compared.

RESULTS

No exercise-related adverse events occurred during the 12-week exercise period. After 12 weeks of exercise training, in terms of fitness, the exercise group showed significant improvements in 6-min walk test (6MWT) (p < 0.001), peak oxygen consumption (VO2peak) (p = 0.005), muscle content (p < 0.001), muscle percentage (p < 0.001), and grip strength (p = 0.008) compared to the control group. In terms of clinical indicators, the exercise group showed significant improvements in vital capacity (p = 0.018), D-dimer (p = 0.031), and C-reactive protein (CRP) (p = 0.01), uric acid (p = 0.003), triglycerides (p < 0.001), functional average score (p < 0.001), and main symptom average score (p = 0.004) compared to the control group in trends over time.

CONCLUSION

Rehabilitation exercises using individualized exercise prescriptions tailored by exercise prescription specialists during chemotherapy are safe for lung cancer patients. Adhering to exercise can achieve comprehensive improvements in physical fitness and quality of life at 12 weeks.

Examining the role of social relationships on health and health behaviors in African American men with prostate cancer: a qualitative analysis

PURPOSE

Cancer survivor cohort studies document the positive impact of health behaviors on cancer survivorship by influencing quality of life, comorbidity burden, and cancer recurrence. Social networks can be instrumental in supporting health behavior changes. This study used qualitative interviews to explore how social networks may impact health and health behaviors of African American Prostate Cancer Survivors (AAPCS) enrolled in Men Moving Forward (MMF), a lifestyle intervention designed with and for AAPCS. Specifically, we sought to understand how different relationships within social networks influence health and health behaviors, and to identify potential mechanisms for this influence.

METHODS

Eighteen men who completed the MMF intervention participated in a semi-structured interview which explored social connections, health and health behaviors, stress, and the cancer experience. Interviews were recorded and transcribed, and thematic analysis was performed by two coders.

RESULTS

Participants described robust social networks of friends and family. Four distinct yet overlapping themes were identified that described how relationships influence health and health behaviors among AAPCS: (1) provision of knowledge, (2) health and behavior history, (3) encouragement and support, and (4) shared behavior.

CONCLUSIONS

These results provide initial insight into the types of relationships that influence health, and the intersecting and multifaceted mechanisms through which this influence occurs.

Physical activity behaviour change in black prostate cancer survivors: a qualitative study using the Behaviour Change Wheel

PURPOSE

Black individuals have a higher cancer burden and face greater obstacles to access cancer care resources when compared to White individuals. Radical prostatectomy is the standard surgical treatment and a common treatment option for prostate cancer; however, when compared to their White counterparts, Black individuals treated for prostate cancer often experience higher treatment-related side effects, resulting in a difficult recovery period. Physical activity is effective in alleviating treatment-related side effects; however, little is known about the barriers and facilitators to physical activity experienced by Black individuals after surgical management of prostate cancer to inform the design of physical activity interventions.

METHODS

Twelve Black individuals underwent radical prostatectomy for prostate cancer participated in a focus group study. We used the Behaviour Change Wheel, which incorporates Capability, Opportunity, Behaviour (COM-B) model and the complementary Theoretical Domains Framework (TDF), as our guiding theoretical framework. Data was analyzed using deductive qualitative analysis.

RESULTS

Facilitators and barriers were identified for all components of the Behaviour Change Wheel. Capability appeared to be a central factor to how participants described their physical activity engagement. Opportunity and motivation were described as both barriers and facilitators for behaviour change when occurring in isolation; however, when co-occurring with the presence of capability, they were described as facilitators that influence participants' physical activity engagement.

CONCLUSIONS

Our results demonstrate barriers and facilitators that are recognized among Black individuals who have undergone radical prostatectomy for prostate cancer. The design of a physical activity intervention needs to consider the physical and psychological capabilities as the fundamental basis with the additional support of physical activity opportunity and motivation.

IMPLICATIONS FOR CANCER SURVIVORS

Intersectionality across capability, opportunity, and motivation is essential to intervention design and development to increase physical activity in Black individuals surgically treated for prostate cancer.

Expectations and Experiences of Participating in a Supervised and Home-Based Physical Exercise Intervention in Patients with Head and Neck Cancer during Chemoradiotherapy: A Qualitative Study

(1) Background: Chemoradiotherapy (CRT) for head and neck cancer (HNC) is associated with severe toxicity resulting in fatigue and weight loss, including loss of skeletal muscle mass. Exercise interventions might positively affect physical fitness and quality of life. Sufficient adherence and compliance rates are necessary for optimal effects. This study aimed to gain insight into expectations and experiences and factors influencing adherence, retention and compliance of HNC patients participating in exercise intervention during CRT. (2) Methods: Consecutive participants were invited for semi-structured interviews, conducted pre- and post-intervention. A deductive approach was used to identify themes and factors influencing adherence, retention and compliance. (3) Results: Thematic saturation was reached after interviewing 14 patients pre-intervention. Five themes were identified: planning and time management, treatment toxicity, motivation to exercise, exercise intervention and supervision by a physiotherapist. The intensity of the treatment schedule and treatment toxicity were important barriers. Facilitators mentioned were physical and emotional benefits, social support as well as the simplicity and home-based setting of the intervention. (4) Conclusions: A personalised approach, considering the individual facilitators and barriers of HNC patients, is important to increase adherence, retention and compliance to exercise intervention and to reap the optimal effects of the program.

Prescribing pre- and post-operative physical activity interventions for people undergoing breast cancer surgery: A qualitative systematic review

INTRODUCTION

Undertaking physical activity, pre- and post-operatively, can benefit recovery time and improve post-surgical outcomes. One cohort of patients that have reported these benefits are those undergoing surgery for breast cancer. Yet, what remains unclear is the level to which physical activity interventions are implemented into standard surgical care for patients with breast cancer.

AIMS

This systematic review aimed to examine existing qualitative evidence focusing on pre- and post-operative physical activity interventions to better understand the benefits and shortcomings of physical activity within the surgical journey.

METHODS

A systematic literature search was undertaken in November 2022, across five databases: MEDLINE, PsycINFO, Embase, CINAHL, and Scopus. Qualitative studies involving people with breast cancer who had undertaken a physical activity intervention, either pre- and/or post-operatively, were included for analysis. The review was registered on PROSPERO: CRD42022372466 and performed according to PRISMA guidelines. The Critical Appraisal Skills Programme qualitative study checklist was used to assess study quality.

RESULTS

Fourteen studies were included, comprising the perspectives of 418 people receiving surgery for breast cancer. One study implemented preoperative physical activity interventions; the remaining studies focused on post-operative interventions. A narrative systematic review was undertaken due to heterogeneity in reported results. Four themes were developed by thematic analysis, centring on: (1) factors promoting engagement with physical activity interventions; (2) factors preventing engagement with physical activity interventions; (3) the impact of pre- and post-operative interventions on physical and psychological health; and (4) participant recommendations for pre- and post-operative interventions.

CONCLUSION

Pre- and post-operative physical activity interventions were well-accepted. Patients recognised factors which promoted or prevented engagement with interventions, as well as pre- and post-operative physical and psychological benefits that arose as a result. Evidence based co-design studies may further inform successful implementation of prescribed physical activity into standard care for surgical breast cancer patients.

Home-based versus supervised group exercise in men with prostate cancer on androgen deprivation therapy: A randomized controlled trial and economic analysis

INTRODUCTION

Differences between health outcomes, participation/adoption, and cost-effectiveness of home-based (HOME) interventions and supervised group-based training (GROUP) in men with prostate cancer (PC) on androgen deprivation therapy (ADT) are currently unknown. The objective of this study was to assess the clinical efficacy, adherence, and cost-effectiveness of HOME versus GROUP in men on ADT for PC.

MATERIALS AND METHODS

This was a multicentre, 2-arm non-inferiority randomized controlled trial and companion cost-effectiveness analysis. Men with PC on ADT were recruited from August 2016 to March 2020 from four Canadian centres and randomized 1:1 to GROUP or HOME. All study participants engaged in aerobic and resistance training four to five days weekly for six months. Fatigue [Functional Assessment of Cancer Therapy-Fatigue (FACT-F)] and functional endurance [6-min walk test (6MWT)] at six months were the co-primary outcomes. Secondary outcomes included quality of life, physical fitness, body composition, blood markers, sedentary behaviour, and adherence. Between-group differences in primary outcomes were compared to margins of 3 points for FACT-F and 40 m for 6MWT using a Bayesian analysis of covariance (ANCOVA). Secondary outcomes were compared with ANCOVA, Costs included Ministry of Health costs, program costs, patient out-of-pocket, and time costs.

TRIAL REGISTRATION

#NCT02834416.

RESULTS

Thirty-eight participants (mean [standard deviation (SD)] age, 70 [9.0] years) were enrolled (GROUP n = 20; HOME n = 18). There was an 89.8% probability that HOME was non-inferior to GROUP for both fatigue and functional endurance and a 9.5% probability that HOME reduced fatigue compared to GROUP (mean [SD] change, 12.1 [8.1] vs 3.6 [6.1]; p = 0.040) at six months. Adherence was similar among study arms. HOME was cost-saving (mean difference: -$4122) relative to GROUP.

DISCUSSION

A HOME exercise intervention appears non-inferior to GROUP for fatigue and functional endurance and requires fewer resources to implement. HOME appears to ameliorate fatigue more than GROUP, but has comparable effects on other clinically relevant outcomes. Although limited by sample size and attrition, these results support further assessment of home-based programs.

Implementation of a Mindful Walking Intervention in Breast Cancer Patients After Their Primary Oncologic Treatment: Results of a Qualitative Study Within a Randomized Controlled Trial

BACKGROUND

Breast cancer survivors often suffer from diagnosis- and therapy-related long-term side effects, such as cancer related fatigue, restricted stress resilience and quality of life. Walking as a physical activity and mindfulness practice have been shown to be helpful in studies. The aim of this study was to compare the individual experiences and subjectively perceived effects of walking in combination with mindfulness practice with moderate walking alone in breast cancer patients. This paper focuses on the qualitative results of a mixed-methods pilot study.

METHODS

Breast cancer patients who had finished their primary oncologic treatment at least 6 months ago were randomized to an 8-week group intervention program of either mindful walking or moderate walking. Within the qualitative study part, semi-structured focus group interviews (2 interviews per study arm) were conducted and analyzed using a qualitative content analysis approach. Audio recorded interviews were transcribed verbatim and pseudonymized. The subsequent data analysis was performed by using MAXQDA®.

RESULTS

A total of 51 women (mean age 55.8 [SD 10.9] years) were included in the RCT, among these 20 (mean age 56.7 [SD 12.0] years) participated in the focus group interviews (n = 11 patients of the mindful walking group; n = 9 patients of the walking group). Breast cancer patients in both groups described different effects in the complex areas of self-efficacy, coping, body awareness and self-reflection. While mindful walking primarily promoted body awareness and inner strength by mindfulness in breast cancer patients, moderate walking promoted self-efficacy by a confidence of their body and an easily integrated and accepted way of physical activity.

CONCLUSIONS

Study interventions and the study setting triggered processes and reflections on one's own health and situation. However, mindful walking and moderate walking seem to address different resources. This important knowledge may help oncologists and other therapists to assess what type of interventions can best meet the needs and requirements of individual patients.

TRIAL REGISTRATION

DKRS00011521; prospectively registered 21.12.2016; https://drks.de/search/de/trial/DRKS00011521.

Healthy Behaviors Among Non-Hispanic Black and Hispanic People Affected by Cancer During the Posttreatment Survivorship: A Qualitative Study

BACKGROUND

There are disparities in health behaviors across racial and ethnic groups. However, limited studies focus on cancer survivors' experiences developing and maintaining healthy behaviors, particularly in non-Hispanic Black (NHB) and Hispanic people.

OBJECTIVE

This study aimed to understand the experiences of NHB and Hispanic people affected by cancer in developing and maintaining positive health behaviors beyond a cancer diagnosis.

METHODS

The data were collected in a mixed-method study through semistructured interviews with 29 NHB and Hispanic cancer survivors between June and October 2022. Conventional content analysis was used.

RESULTS

The lived experiences of cancer survivors were narrated in 3 themes: impact of a cancer diagnosis on oneself, facilitators and barriers to health and health behaviors, and utilization of available sources for health. Facilitators and barriers to health and health behaviors were further explored as biological (eg, symptoms, comorbidities), behavioral (eg, help-seeking behavior, sleep pattern), physical/built (eg, available sources, neighborhood), and sociocultural environment (eg, income, transportation, knowledge, culture, upbringing, household and community composition, social and family network), and healthcare system-related factors (eg, insurance coverage, personal preferences, perceived discrimination, and stigma).

CONCLUSION

Non-Hispanic Black and Hispanic people, specifically those living in disadvantaged neighborhoods with limited sources or where they feel discriminated and stereotyped, those with limited income and transportation, and those with physical, social, or mental health problems, seemed to have challenges prioritizing health behaviors and maintaining healthy living.

IMPLICATIONS FOR PRACTICE

Biological, behavioral, and psychosocial determinants of health behaviors should be addressed through multilevel collaborations among different levels of partners.

Effects of an urban forest healing program on cancer-related fatigue in cancer survivors

PURPOSE

This study aimed to examine the effects of an eight-session structured urban forest healing program for cancer survivors with fatigue.

BACKGROUND

Cancer-related fatigue (CRF) is a complex and multifactorial common symptom among cancer survivors that limits quality of life (QoL). Although health benefits of forest healing on physiological, physical, and psychological aspect as well as on the immune system have been reported in many studies, there is limited evidence on the efficacy of specialized forest program for cancer survivors.

METHOD

A single-blinded, pre-test and post-test control group clinical trial was conducted with -75 cancer survivors assigned to either the forest healing group or the control group. The intervention was an eight-session structured urban forest program provided at two urban forests with easy accessibility. Each session consists of three or four major activities based on six forest healing elements such as landscape, phytoncides, anions, sounds, sunlight, and oxygen. Complete data of the treatment-adherent sample (≥ 6 sessions) was used to examine whether sociodemographic, clinical, physiological (respiratory function, muscle strength, balance, 6-min walking test) and psychological (distress, mood state, sleep quality, QoL) characteristics at baseline moderated the intervention effect on fatigue severity at 9 weeks.

RESULTS

Significant time-group interactions were observed muscle strength, balance, 6-min walking test, distress, fatigue, moods, and QoL. The mean difference in fatigue between pre- and post-forest healing program was 9.1 (95% CI 6.2 to 11.9), 11.9 (95% CI 7.6 to 16.1) in moods, and -93.9 (95% CI -123.9 to -64.0) in QoL, showing significant improvements in forest healing group, but no significant improvements in the control group.

CONCLUSION

This study suggests that a forest healing program positively impacts the lives of cancer survivors, by addressing both physical and psychological challenges associated with CRF.

TRIAL REGISTRATION NUMBER

KCT0008447 (Date of registration: May 19, 2023).

"It has to be more than exercise": exploring multiple perspectives to community-based exercise program design for persons with breast cancer

PURPOSE

Connecting persons with cancer to exercise resources and/or supports requires a diverse team of professionals. As such, there is merit to engaging multiple individuals or "partners" along the cancer pathway to explore the relevant features of community-based exercise program (CBEP) design. The purpose of this study was to explore multi-partner perspectives to CBEP design for persons diagnosed with breast cancer (PWBC) to inform the implementation of a CBEP in a local setting.

METHODS

PWBC, health care professionals and qualified exercise professionals participated in one of four 60-min focus group discussions. Rich dialogue about preferred program environments, program delivery teams, and core program practices was encouraged using a semi-structured discussion guide. Focus groups were audio recorded, transcribed verbatim, and analyzed using inductive thematic analysis.

RESULTS

Five main themes were identified based on focus group discussions, each pointing to an important feature of CBEP design for PWBC. Themes included the desire for CBEPs to incorporate elements designed to improve cancer literacy, provide opportunities to participate with peers, foster self-efficacy, prioritize program accessibility, and meaningfully integrate CBEPs within a network of supportive cancer care.

CONCLUSION

The collective effect of fostering such elements in CBEPs may serve to increase the uptake and maintenance of exercise among PWBC; ultimately enhancing their overall well-being and quality of life.

Impact of post-treatment symptoms on supportive care needs among breast cancer survivors in South Korea

Objective

The aim of this study is to investigate the factors influencing the supportive care needs of survivors of breast cancer who have completed major treatment.

Methods

A total of 121 survivors of breast cancer from an online community in South Korea participated in this study. The study variables were supportive care needs, physical symptoms, anxiety, and depression. Independent t-tests, one-way Analysis of Variance (ANOVA), Pearson's correlation, and hierarchical regression analyses were performed.

Results

The highest rankings of supportive care needs of survivors of breast cancer were medical system and information needs, patient care and support needs, psychological needs, sexual needs, and physical and daily life needs. Hierarchical regression analysis revealed that the participants' supportive care needs were explained by physical symptoms (P ​< ​0.001) and anxiety (P ​< ​0.001), accounting for 52.1% of the variance.

Conclusions

Supportive care needs of survivors of breast cancer have a high level of medical system and information needs, and posttreatment conditions are related to high physical symptoms and anxiety. In the future, it will be necessary to identify supportive care needs and apply interventions to reduce their physical symptoms and anxiety.

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).

Women's experiences with yoga after a cancer diagnosis: a qualitative meta-synthesis-part I

BACKGROUND

Qualitative research on women's experiences participating in yoga after a cancer diagnosis is growing; systematic synthesis and integration of results are necessary to facilitate the transfer and implementation of knowledge among researchers and end-users. Thus, the purpose of this meta-synthesis was to: (1) integrate findings from qualitative studies, (2) compare and contrast findings to elucidate patterns or contradictions in conclusions, and (3) develop an overarching interpretation of women's experiences participating in yoga after a cancer diagnosis.

METHODS

Using meta-study methodology, six electronic databases were searched using a sensitive search strategy in November 2020, a supplemental scan of reference lists was conducted in August 2021, and the database search was replicated in October 2021. Two reviewers independently screened titles/abstracts and full-texts to determine eligibility.

RESULTS

The searches yielded 6804 citations after de-duplication. Data from 24 articles meeting the eligibility criteria were extracted, and the results, methods, and theoretical approach(es) were analyzed. The analysis revealed that there was a predominant focus on two focal points in the primary articles: (1) women's well-being and quality of life (QoL; part I) and (2) intervention preferences (part II). Five overarching categories emerged related to well-being and QoL: (1) yoga can support improvements in multiple dimensions of QoL in women diagnosed with cancer, (2) women diagnosed with cancer experience an interaction between QoL dimensions, (3) elements of yoga that support improvements in QoL dimensions, (4) breathwork and meditation are integral elements of yoga, and (5) yoga practice may support lifestyle behavior change. The articles reviewed had notable limitations related to: (1) reporting about instructor(s), content of the intervention, and environmental characteristics of the setting, (2) identifying and incorporating optimal features in the intervention design, (3) incorporating theory and real-world considerations into the study procedures, and (4) including positive and negative conceptualizations of QoL as an interconnected and multidimensional concept.

CONCLUSION

Moving forward, it remains critical to identify the ideal structure and content of yoga programs for promoting well-being and QoL among women diagnosed with cancer, as well as to explore barriers and facilitators to sustainable program implementation.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42021229253.

Experiences of breast cancer survivors with exercise rehabilitation: qualitative systematic review and meta-synthesis

PURPOSE

This study aimed to synthesize and evaluate the available qualitative literature on posttreatment participation in exercise rehabilitation among breast cancer survivors.

METHODS

This systematic review followed the Joanna Briggs Institute (JBI) meta-aggregation approach guided by ENTREQ, graded according to the ConQual approach, and evaluated using the JBI Qualitative Assessment and Review Instrument (JBI-QARI). We searched qualitative or mixed methods studies related to the experiences of exercise rehabilitation among breast cancer survivors conducted until April 13, 2023, in nine English and Chinese databases. The selected studies were reviewed independently, and the data were collaboratively synthesized into core themes.

RESULTS

A total of 24 studies were included, and 88 findings resulted in five synthesis findings: (a) benefits of participating in exercise rehabilitation, (b) facilitators of participation in exercise rehabilitation, (c) obstacle factors for participating in exercise rehabilitation, (d) evaluation of the exercise program, and (e) recommendations.

CONCLUSION

Breast cancer survivors need exercise to recover physically and mentally and to transition from cancer treatment to a normal life. The factors affecting exercise participation in breast cancer survivors are complex. Breast cancer survivors require timely and continuous effective exercise intervention forms, including online, offline, instrumental, and emotional support from others, especially healthcare providers and family members. Moreover, multidisciplinary collaboration is required to develop more effective and convenient exercise interventions.

The Streaming Web-Based Exercise at Home Study for Breast and Prostate Cancer Survivors: A Feasibility Study Protocol

BACKGROUND

Despite the known benefits of physical activity in cancer survivors, adherence to exercise guidelines remains low. Known barriers to adhering to guidelines include a lack of time and an unwillingness to return to treatment facilities. Virtual exercise programming could assist in mitigating these barriers. This protocol presents a single arm pilot study exploring the feasibility of personalized Zoom-delivered exercise training for breast and prostate cancer survivors. A secondary objective is to determine the preliminary efficacy of participation on body composition, estimated VO_2max, hand grip, one repetition maximum leg press, resting heart rate, resting blood pressure, exercise self-efficacy, and intentions to remain active.

METHODS

Breast (n = 10) and prostate (n = 10) cancer survivors will participate in a 24-week feasibility study, including (1) 12 weeks of one-on-one virtual personal training with an exercise physiologist (EP) via Zoom, and (2) individual exercise for a 12-week follow-up period using recordings of Zoom sessions for guidance. Physical assessments and surveys will be implemented at baseline, 12 weeks, and at the end of the study (24 weeks from baseline).

CONCLUSIONS

While virtual exercise programming became popularized during the pandemic, evidence is still required to understand whether it can successfully address barriers and promote participation.

Linking social and built environmental factors to leisure-time physical activity in rural cancer survivors

BACKGROUND

This study explored associations between social and built environmental factors and leisure-time physical activity (LTPA) in rural cancer survivors (RCS) and whether these associations differed by exercise stage of change (SOC).

METHOD

RCS (n = 219) completed questionnaires assessing LTPA, SOC, and social (social status, connectedness, support) and environmental (home environment, neighborhood environment) factors. Linear regression models examined associations between social and built environmental factors and LTPA and tested for moderation by SOC.

RESULTS

Half (50.7%) of RCS were physically active, and 49.3% were not active. Social factors positively associated with LTPA included subjective social status in the community (B = 89.0, P = .014) and in the United States (B = 181.3, P < .001), social connectedness (B = 122.3, P = .024), and social support for physical activity from family (B = 41.9, P < .001) and friends (B = 44.3, P < .001). Environmental factors positively associated with LTPA included the home environment (B = 111.2, P < .001), perceived environmental support for PA (B = 355.4, P = .004), and neighborhood attributes, including bicycling infrastructure (B = 191.3, P = .003), proximity to recreation facilities (B = 140.1, P = .021), traffic safety (B = 184.5, P = .025), and aesthetics (B = 342.6, P < .001). SOC statistically significantly moderated the association between social status in the United States and LTPA (B = 160.3, P = .031).

CONCLUSIONS

Social and built environmental factors were consistently linked with LTPA and provide context for multilevel interventions promoting LTPA in RCS.

Matched and moving: exploring daily social support among women partnered for exercise after a breast cancer diagnosis

PURPOSE

Exercise and social support are non-pharmacological strategies that improve health and wellbeing in women treated for breast cancer (WTBC). However, strategies to facilitate support and exercise in WTBC are typically resource intensive. The purpose of this study was to examine whether various forms of social support received from a matched peer were associated with increased exercise among WTBC.

METHODS

A daily diary study was conducted to examine naturally occurring social support as it relates to daily exercise behavior. Forty-six WTBC were matched (23 pairs) and completed pre-screening survey assessing eligibility and baseline levels of exercise. Participants were given Fitbit devices to track physical activity behavior and completed daily surveys across 3 weeks assessing perceptions of exercise-related social support at fixed times at the end of each day.

RESULTS

Mixed models accounting for day of study, baseline support, and baseline exercise levels revealed that higher levels of daily exercise-related tangible social support were associated with more daily steps (b = 506, SE = 143) and more light physical activity (LPA) minutes (b = 7.01, SE = 3.15). Informational social support was associated with higher moderate to vigorous physical activity (MVPA) minutes (b = 3.18, SE = 1.60).

CONCLUSIONS

Overall, peer matching programs aimed at increasing exercise-related social support among WTBC might encourage exercise behaviors, especially among women who share exercise-specific information (e.g., benefits, type, activities).

Social Support Behaviours and Barriers in Group Online Exercise Classes for Adults Living with and beyond Cancer: A Qualitative Study

Social support can be facilitated through exercise programs for people living with cancer, but there is limited research on how best to foster it in online exercise oncology classes. This study examined current training that fitness professionals receive on the provision and facilitation of social support, experiences people living with cancer have with social support, and supportive behaviours and barriers for providing and obtaining support in online group exercise oncology programs in Calgary, Alberta, Canada. Guided by interpretive description methodology, training materials were reviewed, observations of fitness professional training and online exercise classes (n = 10) were conducted, and adults living with and beyond cancer (n = 19) and fitness professionals (n = 15) were interviewed. These data were collected from January 2021 to June 2021. Analysis of the data collected resulted in the identification of three themes: Creating a welcoming environment, helping improve exercise ability and reach goals, and learning to provide and facilitate support online. A catalogue of supportive behaviours that can help to provide and facilitate and barriers that can hinder the provision and obtaining of social support in exercise oncology classes is presented. The findings provide guidance when structuring online classes and inform developing strategies for fitness professionals to use in online classes to foster social support by considering the wants and needs of participants, facilitating support between participants with similar experiences and interests, and integrating support into physical activity.

Moderators of physical activity and quality of life response to a physical activity intervention for breast cancer survivors

PURPOSE

Moderate-to-vigorous physical activity (MVPA) can improve the quality of life (QoL) for breast cancer survivors (BCS), yet, most do not achieve 150 + weekly minutes of MVPA. This study investigated moderators of response to a physical activity (PA) behavior change intervention for BCS.

METHODS

BCS (N = 222) were randomized to the 3-month intervention (BEAT Cancer) or usual care. Measurements occurred at baseline, post-intervention, and 3 months post-intervention. Measures included accelerometry, self-reported MVPA, and Functional Assessment of Cancer Therapy (FACT-General, FACT-Breast, physical well-being (PWB), social well-being (SWB), emotional well-being (EWB), functional well-being (FWB), additional concerns (AC), and Trial Outcome Index (TOI)).

RESULTS

Adjusted linear mixed-model analyses indicated individuals ≤ 24 months post-diagnosis and who were single reported smaller increases in weekly self-reported MVPA than those > 24 months (44.07 vs 111.93) and partnered (- 16.24 vs. 49.16 min), all p < 0.05. As for QoL, participants < 12 months post-diagnosis who received chemotherapy experienced smaller improvements than those ≥ 12 months in FACT-General, FACT-Breast, PWB, and SWB scores. Survivors with a history of chemotherapy had smaller improvements in FACT-General, FACT-Breast, PWB, SWB, TOI, and AC scores, all p < 0.05.

CONCLUSION

These findings indicate that being < 2 years post-diagnosis, single, and prior chemotherapy may limit MVPA and QOL responses to a PA intervention. Further studies are needed to determine if and/or what additional PA supports and resources these subgroups of BCS might find beneficial and effective.

TRIAL REGISTRATION

ClinicalTrials.gov number: NCT00929617.

Determinants of exercise adherence and maintenance for cancer survivors: Implementation of a community-based group exercise program. A qualitative feasibility study

Objective

Despite verified knowledge that physical exercise plays an important part in recovery after cancer treatment, multiple studies have shown that maintaining a physically active lifestyle after cancer is challenging. There is a need for qualitative studies to increase understanding into patient experiences and perspectives, and facilitate the design of more sustainable exercise program. This qualitative descriptive feasibility study explores experiences from the implementation of a novel four-month community-based group exercise program for cancer survivors within municipality health service after completion of rehabilitation in the specialist health care service.

Methods

Fourteen cancer survivors participated in focus group interviews after completing Rehabilitation: Physical activity and Coping - feasibility study. Data were analyzed using the systematic text condensation method.

Results

We identified a main category, Determinants for exercise adherence and maintenance and four subcategories: peer-support, environment, structure and knowledge.

Conclusion

A social and supportive exercise environment promotes exercise adherence and maintenance among cancer survivors. This knowledge can be useful for further efforts to implement high quality community-based group exercise programs for cancer survivors.

Innovation

This study adds knowledge of survivors' experience of a novel community-based group exercise program in clinical practice and can promote the implementation of sustainable community-based exercise programs for cancer survivors.

Exploring the perceived impact of social support on the health behaviours of people living with and beyond cancer during the COVID-19 pandemic: a qualitative study

PURPOSE

Social support facilitated healthy behaviours in people living with and beyond cancer (LWBC) before the COVID-19 pandemic. Little is known about how social support impacted their health behaviours during the pandemic when social restrictions were imposed. The aim of this study was to qualitatively explore how social support was perceived to impact the health behaviours of people LWBC during the COVID-19 pandemic.

METHODS

Semi-structured interviews were conducted via telephone with 24 adults living with and beyond breast, prostate and colorectal cancer. Inductive and deductive framework analysis was used to analyse the data.

RESULTS

Five themes developed. These were (1) Companionship and accountability as motivators for physical activity, (2) Social influences on alcohol consumption, (3) Instrumental support in food practices, (4) Informational support as important for behaviour change and (5) Validation of health behaviours from immediate social networks.

CONCLUSION

This study described how companionship, social influence, instrumental support, informational support and validation were perceived to impact the health behaviours of people LWBC during the COVID-19 pandemic. Interventions for people LWBC could recommend co-participation in exercise with friends and family; promote the formation of collaborative implementation intentions with family to reduce alcohol consumption; and encourage supportive communication between partners about health behaviours. These interventions would be useful during pandemics and at other times. Government policies to help support clinically extremely vulnerable groups of people LWBC during pandemics should focus on providing access to healthier foods.

Older adults with advanced cancer are selective in sharing and seeking information with social networks

BACKGROUND

Little is known about how older adults (OA) with advanced cancer interact with social network members (NM), and the nature of communication. This qualitative study aimed to characterize the processes by which OAs with cancer engage with NMs regarding their illness.

METHODS

OAs 65 + with advanced cancer and considering treatment (n = 29) and NMs (n = 18) underwent semi-structured interviews asking 1) about their illness understanding; 2) to identify NMs with whom OAs discuss health-related matters; and 3) to describe the content, process, and impact of those illness-related conversations. Three coders analyzed transcribed interviews. Codes were categorized and emergent themes were identified to generate hypotheses.

RESULTS

OAs seek NMs with medical backgrounds for cancer-related information and NMs with personal experience of a serious illness for emotional support. Patients characterize geographical location, frequency of communication, and length of NM relationship as factors that influence the nature of support the NM provides. Additionally, differences emerged between OA and NM perspectives on the depth of conversations and decision-making.

CONCLUSIONS

A better characterization of how OAs' seek and share information and support may improve medical communication, disease understanding, and support goals-concordant care.

Chinese Translation and Psychometric Testing of the Simplified Version of Social Support Scale for Physical Activity

Purpose

Sallis et al’s social support scale for physical activity (SSSPH) is one of the most widely used scales to measure exercise-related social support yet has never been translated and validated in Chinese. The current study aims to simplify, translate, and validate a short form of SSSPH in a Chinese population.

Patients and Methods

A simplified Chinese version of the SSSPH (SSSPH-SC) retaining 6 items was achieved after the translation and back-translation process, which showed good content validity. The scale was then assessed among a convenience sample of 266 Chinese adults from various backgrounds. Internal consistency was tested by calculating Cronbach’s α. The a priori two-factor structure was tested with confirmatory factor analysis (CFA). Concurrent validity was examined by investigating the correlation of the SSSPH-SC with general social support, quality of life, and self-rated health.

Results

The SSSPH-SC full scale and subscales showed good internal consistency with Cronbach’s alpha ranging from 0.87 to 0.92. The CFA supported the a priori two-factor structure: family support and friend support, with χ2/df=2.93, CFI = 0.98, TLI = 0.98, RMSEA = 0.07, SRMR = 0.035. The concurrent validity of the SSSPH-CS was further supported by its significant positive correlations with social support (r=0.26, p<0.001), quality of life (r=0.25, p<0.001), and self-rated general health depression (r=0.23, p<0.001).

Conclusion

The SSSPH-SC had good reliability and validity and could be used as a simple and effective tool for assessing social support for physical activity in Chinese adults. The scale can be used as an effective tool to guide future health promotion programs as well as an evaluation tool to assess intervention effects.

Effects of physical exercise on body fat and laboratory biomarkers in cancer patients: a meta-analysis of 35 randomized controlled trials

BACKGROUND

A growing number of articles had reported the beneficial effects of physical exercise on reduced risks of cancer recurrence and mortality. However, the associations between physical exercise and laboratory biomarkers still had controversy. As we knew, this meta-analysis of randomized controlled trials (RCTs) was the first time for us to comprehensively clarify their relationships in cancer patients.

METHODS

We comprehensively searched the PubMed, Cochrane Central, EMBASE, Web of Science, and SportDiscus online databases to identify eligible articles, up to June 1, 2021. Pooled standardized mean differences (SMDs) with 95% confidence intervals (CIs) were utilized to clarify their associations. Sensitivity analysis was performed to assess the impact of the individual on overall and Begg's/Egger's plot was utilized to evaluate potential publication bias.

RESULTS

Finally, 35 randomized controlled trials (RCTs) were finally enrolled in this meta-analysis. Our results indicated that physical exercise could significantly reduce BMI (pooled SMD = -0.32 - 0.56 to -0.09)), body weight (pooled SMD = -0.31 (-0.54 to -0.08)), body fat (pooled SMD = -0.44 (-0.70 to -0.18)), waist circumference (pooled SMD = -0.50 (-0.76 to -0.23)), hip circumference (pooled SMD = -0.54 (-0.80 to -0.28)), triglyceride (pooled SMD = -0.35 (-0.69 to -0.02)), fasting insulin (pooled SMD = -0.38 (-0.54 to -0.22)), glucose (pooled SMD = -0.56 (-0.84 to -0.28)), insulin resistance (pooled SMD = -0.40 (-0.72 to -0.07)), CRP (pooled SMD = -0.97 (-1.48 to -0.46)), IGF-1 levels (pooled SMD = -0.56 (-0.83 to -0.29)) and remarkably increase IGFBP-3 levels (pooled SMD = 0.81 (0.45 to 1.17)). Further sensitivity analysis and Begg's or Egger's test suggested that our results were robust with no significant publication bias.

CONCLUSIONS

Our results shed light on the beneficial effects of physical exercise on cancer patients by means of BMI/weight change and various biomarkers alteration (insulin-glucose pathways or inflammatory biomarkers). Our results were anticipated for clinical application to improve cancer patients' prognosis.

Promoting moderate-to-vigorous physical activities in patients with advanced lung cancer: preferences and social cognitive factors, and the mediating roles

PURPOSE

The purpose of this study is to assess the prevalence and preferences of moderate-to-vigorous physical activities (MVPA) in patients with advanced lung cancer, explore the social cognitive factors that were associated with MVPA and interest in PA counseling and program, and examine the mediating role of social cognitive factors.

METHODS

This was a cross-sectional study. Questionnaires on PA levels, PA counseling and programming preferences, and social cognitive variables (social support and self-efficacy) were administered to 105 patients with advanced lung cancer. Linear regression model was used to explore the social cognitive factors associated with MVPA, and logistic regression model was used to explore the factors associated with interest in PA counseling and program. Mediation analysis was used to examine the mediating role of self-efficacy on social support and MVPA.

RESULTS

Merely 30.5% of patients met the recommended level of MVPA; however, the majority of patients (89.5%) were interested in PA program. Social support (β = 0.60; p = 0.007) and self-efficacy (β = 1.06; p = 0.027) were positively associated with MVPA. Specifically, self-efficacy mediated the relationship between social support and MVPA (β = 0.63, p = 0.004).

CONCLUSION

The majority of the patients with advanced lung cancer did not meet the recommended level of MVPA; however, they are interested in receiving PA counseling and joining PA programs. Social support was key to promoting higher levels of MVPA, and the association was mediated by self-efficacy. The established mediating model provides insights into designing PA programs and targeting the mediating variable, self-efficacy, to enhance the level of MVPA.

“I want to get myself as fit as I can and not die just yet” – Perceptions of exercise in people with advanced cancer and cachexia: a qualitative study

Cachexia is a prevalent muscle wasting syndrome among people with advanced cancer that profoundly impacts patient quality of life (QoL) and physical function. Exercise can improve QoL, physical function, and overall health in people with cancer and may be an important addition to treatment approaches for cancer cachexia. Greater understanding of patients’ perception of exercise can help elucidate the feasibility of implementing exercise interventions for cancer cachexia and facilitate the design of patient-centered interventions. We aimed to describe the perception of exercise in patients with advanced cancer and cachexia, and capture exercise motivators, barriers, and preferences, to inform the feasibility of exercise interventions. Individual interviews (n = 20) with patients with locally advanced or metastatic cancer with cachexia were conducted and analyzed using reflexive thematic analysis. Main themes from interviews were: 1) Life is disrupted by cancer and cachexia; 2) Exercise offers hope; 3) Exercise barriers are multifaceted; and 4) Exercise access and support are important. Participants reported that their cancer and cachexia had intensely altered their lives, including ability to exercise. Exercise was perceived as important and participants described a hope for exercise to improve their health and wellbeing. Yet, several complex exercise barriers, such as burdensome cancer symptoms and the overwhelming impact of the COVID-19 pandemic, hindered exercise participation and prevented participants from fully realizing the perceived benefits of exercise. Factors believed to improve exercise engagement and overcome exercise barriers included increased exercise support (e.g., professional supervision) and accessibility (e.g., convenient locations). Patient-reported exercise barriers and preferences can inform the design of exercise interventions, particularly within future research studies aiming to establish exercise feasibility and efficacy in people with advanced cancer and cachexia.

Effects of remotely-delivered physical activity education on exercise beliefs and intentions of active and nonactive cancer survivors and their partners

Physical activity (PA) is recommended for cancer survivors and their romantic partners yet cancer couples may be unaware of the benefits of PA specific to them. Exercise interventions targeting survivors and partners simultaneously may prove effective at increasing exercise knowledge, intentions, and outcomes. To examine the effects of a remotely-delivered cancer-specific exercise education video on cancer survivors’ and their partners’ exercise knowledge, beliefs, and intentions. Cancer survivors (N = 209) and their romantic partners (N = 155) completed an online survey with an embedded education video randomized to half the sample. Group differences (education vs. control) on study constructs among the whole sample and on a subset of the sample not meeting exercise guidelines [i.e., less than 150 min of moderate to vigorous physical activity (MVPA) per week; 50.5% survivors, 45.1% partners] were examined. Group differences on study constructs were also tested between survivors and partners meeting exercise guidelines or not. Survivors and partners in the education condition were more likely to correctly report the MVPA guidelines. The education increased survivors’ personal exercise importance, outcome expectations, and likelihood of joining an individual exercise program. Participants meeting guidelines were significantly different on multiple exercise beliefs compared to those who were not. Among those not meeting guidelines, the education increased survivors’ belief in the importance of exercising with their partner. A remotely-delivered exercise education video increased exercise knowledge and beliefs, which represents an important step in the development of couples’ exercise interventions for cancer survivors and their romantic partners.