Effects of Theory-Based Behavioral Interventions on Physical Activity Among Overweight and Obese Female Cancer Survivors: A Systematic Review of Randomized Controlled Trials

The Physical Activity and Cancer Control (PACC) framework: update on the evidence, guidelines, and future research priorities

BACKGROUND

We proposed the Physical Activity and Cancer Control (PACC) framework in 2007 to help organise, focus, and stimulate research on physical activity in eight cancer control categories: prevention, detection, treatment preparation/coping, treatment coping/effectiveness, recovery/rehabilitation, disease prevention/health promotion, palliation, and survival.

METHODS

This perspective paper provides a high-level overview of the scientific advances in physical activity research across cancer control categories, summarises current guidelines, updates the PACC framework, identifies remaining and emerging knowledge gaps, and provides future research directions.

RESULTS

Many scientific advances have been made that are reflected in updated physical activity guidelines for six of the cancer control categories apart from detection and palliation. Nevertheless, the minimal and optimal type, dose, and timing of physical activity across cancer control categories remain unknown, especially for the understudied population subgroups defined by cancer type, age, race/ethnicity, and resource level of regions/countries.

CONCLUSION

To achieve the full benefit of physical activity in cancer control, future research should use innovative study designs that include diverse at-risk populations and understudied cancer sites. Additionally, effective behaviour change strategies are needed to increase physical activity levels across populations that use implementation science to accelerate the translation from evidence generation into practical, real-world interventions.

Predicting Physical Activity in Survivors of Breast Cancer: the Health Action Process Approach at the Intrapersonal Level

BACKGROUND

Benefits have been established for regular physical activity (PA) and exercise after breast cancer, but a decline of PA has also been a reported result of breast cancer diagnosis and treatments. The Health Action Process Approach (HAPA) model has been shown to predict various health behaviors, but few studies have tested it at the intrapersonal level. The aim of the present study was to test whether the HAPA constructs that are well confirmed at the interpersonal level also hold at the intrapersonal level in a group of women survivors of breast cancer.

METHOD

PA behaviors (N = 338) by nine survivors of breast cancer were observed for 6 weeks, and the associations between the HAPA constructs and PA over time were examined. Participants completed a questionnaire with the HAPA constructs related to PA behavior (direct step count and self-reported).

RESULTS

A multilevel model of behavior prediction found that optimistic beliefs about ability to initiate and maintain PA (self-efficacy) were positively related to intentions to be active, and these intentions predicted plans to be active. PA was directly and positively predicted by planning and by confidence in the ability to resume PA after a break.

CONCLUSION

Self-efficacy and planning are associated with PA behavior within women survivors of breast cancer over time, which was not the case for the outcome expectancies, social support, and action control at this intrapersonal level. A multilevel approach for psychological predictors of PA can be useful in grounding interventions for survivors of breast cancer.

Identifying the effective behaviour change techniques in nutrition and physical activity interventions for the treatment of overweight/obesity in post-treatment breast cancer survivors: a systematic review

PURPOSE

Updated evidence for the treatment of obesity in cancer survivors includes behavioural lifestyle interventions underpinning at least one theoretical framework. The aim of this systematic review was to assess the effectiveness of theory-based lifestyle interventions for the treatment of overweight/obesity in breast cancer survivors and to report effective behavioural change techniques (BCTs) and components used in these interventions.

METHODS

Four databases were searched for RCTs published between database inception and July 2022. The search strategy included MeSH terms and text words, using the PICO-framework to guide the eligibility criteria. The PRISMA guidelines were followed. Risk-of-bias, TIDier Checklist for interventions' content, and the extent of behaviour change theories and techniques application were assessed. To evaluate the effectiveness of interventions, trials were categorised as "very," "quite," or "non" promising according to their potential to reduce body weight, and BCTs promise ratios were calculated to assess the potential of BCTs within interventions to decrease body weight.

RESULTS

Eleven RCTs met the inclusion criteria. Seven trials were classified as "very", three as "quite" and one study was "non" promising. Studies' size, design, and intervention strategies varied greatly, but the weight-loss goal in all studies was ≥ 5% of the initial body weight through a 500-1000 kcal/day energy deficit and a gradually increased exercise goal of ≥ 30 min/day. Social Cognitive Theory was the most commonly used theory (n = 10). BCTs ranged from 10 to 23 in the interventions, but all trials included behaviour goal setting, self-monitoring, instructions on the behaviour, and credible source. The risk-of-bias was "moderate" in eight studies and "high" in three.

CONCLUSION

The present systematic review identified the components of theory-based nutrition and physical activity behaviour change interventions that may be beneficial for the treatment of overweight/obesity in breast cancer survivors. The strategies mentioned, in addition to reported behavioural models and BCTs, should be considered when developing weight-loss interventions for breast cancer survivors.

Motivational interviewing interventions aiming to improve health behaviors among cancer survivors: a systematic scoping review

PURPOSE

The scoping review aimed to map out the literature on the utilization of motivational interviewing (MI) to improve health behaviors (i.e., physical activity, nutrition) in adult cancer survivors.

METHODS

This scoping review was conducted following the methods and protocol outlined by the Joanna Briggs Institute Methods Manual. Five databases, including PubMed, CINAHL, Web of Science, and SPORTDiscus, were searched in February 2022 to identify MI interventions to improve health behaviors among cancer survivors.

RESULTS

The review included 22 interventions mostly designed to optimize exercise/physical activity (50%). The number of sessions ranged from 2 to 19, and most MI sessions were offered via telephone calls combined with face-to-face sessions (31.8%). Of the interventions, 81.8% improved at least one outcome measurement. Most studies used principles of MI such as empathy expression, developing discrepancy, roll with resistance, and supporting self-efficacy.

CONCLUSION

The use of MI appears to have the potential to improve health behaviors in various settings for individuals on different cancer care trajectories.

IMPLICATIONS FOR CANCER SURVIVORS

Healthcare providers can use MI to support physical activity and a healthy diet. Future research should focus on providing evidence on the utilization of MI with minimum standards and longitudinal outcome assessment for developing and maintaining sustainable healthy behaviors.

Promoting physical activity among cancer survivors: an umbrella review of systematic reviews

PURPOSE

Exercise is the core element of rehabilitation for cancer patients. However, most of the patients' exercise levels failed to meet the indicators recommended by the guidelines or even decreased. Therefore, this umbrella review aims to provide an overview of review articles addressing the evidence of interventions to promote physical activity behavior change and increase physical activity among cancer patients.

METHODS

We searched nine databases from inception to 12 May 2022 to obtain systematic reviews and meta-analyses of interventions to promote physical activity among cancer patients. The AMSTAR-2 was used for the quality assessment.

RESULTS

Twenty-six individual systematic reviews including 13 studies performed meta-analyses. A total of 16 studies' designs were all in randomized controlled trial. Most reviews included studies that were mainly delivered in home settings. The most frequent and mean duration of the interventions was 12 weeks. Interventions mainly included electronic, wearable health technology-based, behavior change techniques (BCTs), and theory-based strategies.

CONCLUSIONS

Electronic, wearable health technology-based, BCTs, and theory-based interventions were effective and feasible in promoting physical activity in cancer survivors. Clinical practitioners should take corresponding intervention measures according to the characteristics of patients in different groups.

IMPLICATIONS FOR CANCER SURVIVORS

Future research may benefit cancer survivors by more comprehensively applying electronic, wearable health technology-based, BCTs, and theory-based interventions.

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.

The Effects of Lifestyle Modifications Including Dietary and Physical Interventions with Cognitive-Behavioral Therapy on Quality of Life and Cancer-Recurrence Rate among Patients with Breast Cancer and Survivors: A Protocol for a Systematic Review and Meta-Analysis of Randomized Controlled Trial

Context: Lifestyle modifications consist of three components including diet, exercise, and cognitive-behavioral therapy which can reduce side effects of breast cancer. Cognitive-behavioral therapy is a complementary strategy that promotes new skills for any treatment. Published trials have investigated the co-efficacies of the two or three components of lifestyle modifications, especially dietary and cognitive-behavioral interventions in breast cancer survivors. Evidence Acquisition: This protocol is about a meta-analysis which will systematically report the simultaneous effects of dietary intervention or physical activity with cognitive-behavioral therapy, or three of them on quality of life, the recurrence levels and anthropometric measurements among patients with breast cancer and survivors. It was prepared in accordance with the PRISMA-P checklist and will be performed in accordance with the Cochrane Handbook for Systematic reviews of intervention. Cochrane Central Register of Controlled trials, PubMed, EMBASE and ISI web of science will be searched for peer-reviewed literature using defined MeSH terms. Included randomized controlled trials on the combination effects of cognitive-behavioral therapy with either dietary or physical interventions will be assessed. Continuous data will be meta-analyzed using the STATA and will be gathered using random-effects models. The effect size will be reported as standardized mean difference with 95%CIs. Heterogeneity assessment, publication bias, and sensitivity analysis will be performed. The heterogeneity between some trials may be a limitation of this study. Conclusions: This meta-analysis will provide beneficial guidance for healthcare providers and family members to improve the current understanding of the role of lifestyle modification on alleviating the important problems of patients with breast cancer.