Correlates of exercise motivation and behavior in a population-based sample of endometrial cancer survivors: an application of the Theory of Planned Behavior

Quality of life and physical activity levels among colorectal cancer patients: An observational study

This study investigated the influence of physical activity on the quality of life of patients with postsurgical colorectal cancer in Jordan. A total of 108 colorectal cancer patients aged ≥18 years who underwent surgery at the King Hussein Cancer Center participated voluntarily. The exclusion criteria were severe comorbidities, absolute contraindications to physical activity, and concurrent cancers. Data collection involved phone interviews using The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire and the Godin Leisure Time Exercise Questionnaire due to coronavirus disease 2019 restrictions. Significant positive differences in the quality of life subcategory "physical score" were observed between active and less active patients, favoring the active group. However, no significant differences were found in the impact of physical roles on quality of life between active and less active patients. Participation in physical activity is associated with enhanced physical function in both active and less active colorectal cancer patients. We recommend the implementation of physical activity programs and clinics at King Hussein Cancer Center. Future experimental studies assessing the impact of tailored physical activity training on quality of life are warranted.

Psychosocial correlates of physical activity in cancer survivors: a systematic review and meta-analysis

BACKGROUND

Physical activity (PA) is a non-pharmacological approach to optimize health benefits in cancer survivors and is recommended as part of care. However, most cancer survivors fail to meet PA recommendations. The current systematic review and meta-analysis aimed to identify psychosocial correlates of free-living PA in cancer survivors.

METHODS

Three electronic databases were searched (PubMed, PsycINFO, and SportDiscus). Meta-analyses were conducted for psychosocial correlates tested ≥ 3 times.

RESULTS

Sixty-four articles were included. Eighty-eight different free-living PA correlates were identified. Meta-analyses (n = 32 studies) tested 23 PA correlates, of which 16 were significant (p < 0.05). Larger effect sizes (0.30 < ES > 0.45) were found for exercise self-efficacy, perceived behavioral control, intention, lower perceived barriers for exercise, enjoyment, perceived PA benefits, and attitudes. Small-to-moderate effects (0.18 < ES < 0.22) were found for subjective norms, physical functioning, quality of life, depression, and mental health. These findings were generally in line with narrative results.

CONCLUSIONS

This systematic review highlights important psychosocial correlates of free-living PA that can be targeted in future PA promotion interventions for cancer survivors. Constructs mainly from SCT and TPB were the most studied and appear to be associated with free-living PA in this population. However, we cannot currently assert which frameworks might be more effective. Further studies of better methodological quality, per correlate and theory, exploring longer-term associations and across different types of cancer, are needed.

IMPLICATIONS FOR CANCER SURVIVORS

Having higher exercise self-efficacy, perceived behavioral control, intention, enjoyment and perceived PA benefits, more positive attitudes towards PA, and lower perceived barriers for exercise, can help increase PA in cancer survivors.

Mixed-method approach to informing a lifestyle intervention to improve the survivorship of patients with endometrial cancer

OBJECTIVES

To identify endometrial cancer survivors' (ECS) barriers and facilitators for participation in lifestyle interventions to improve their dietary and exercise behaviors. Our secondary objective is to determine baseline information: physical activity level, quality of life (QoL), and impact of COVID-19 on exercise, diet, and mental health.

METHODS

Obese, early-stage ECS participated in 2-part mixed-methods data collection; Part 1: survey gathering sample characteristics, QoL, exercise, and basic endometrial cancer- related knowledge. Part 2: virtual focus group or individual interviews using a brainwriting premortem protocol. Statistical analysis was performed using SAS (version 8.3). Qualitative data were analyzed using deductive thematic coding guided by the RE-AIM framework.

RESULTS

Twenty percent (70/358) of ECS from a survivorship database and clinic recruitment completed the survey; 16 ECS provided qualitative feedback. Common barriers to intervention participation included time and resource costs, meeting frequency, and pessimism about weight loss maintenance. Facilitators included an opportunity to connect with other survivors and a focus on health rather than weight loss. Most ECS could not identify exercise guidelines (60%) and 83% were not meeting these guidelines. Higher BMI was correlated with a lower confidence in completing in moderate physical activity (p-value = 0.0206). Post-COVID-19 pandemic, physical activity, nutritional decisions, and/or mental health worsened for 67% of ECS.

CONCLUSION

ECS are a disparate population, with worsening behaviors and mental health following the pandemic. The identified ECS-specific barriers and facilitators to behavioral intervention participation are being used to simultaneously improve the reach of and adherence to a lifestyle intervention aimed at improving their health and QoL.

Barriers to and facilitators of a healthy lifestyle for patients with gynecological cancer: a systematic review of qualitative and quantitative research with healthcare providers and patients

The prevalence of an unhealthy lifestyle among patients with gynecological cancer is high and associated with increased risk of all-cause mortality. Although lifestyle changes have the potential to improve outcomes, lifestyle counseling is not routinely integrated into standard care. This review explores research on the barriers to and facilitators of both the promotion of healthy lifestyles by healthcare providers (HCPs) and healthy lifestyle changes by patients with gynecological cancer. The Theoretical Domains Framework (TDF) was used to deductively code the identified factors for a comprehensive understanding of the barriers and facilitators. A search across five databases yielded a total of 12,687 unique studies, of which 43 were included in the review. Of these 43, 39 included gynecological cancer patients and only 6 included HCPs. Among the barriers identified for HCPs, most studies evaluated barriers regarding weight loss counseling. Limited knowledge, reluctance to address weight loss, skepticism about the benefits, and workload concerns were commonly reported barriers for HCPs. HCPs will benefit from education and training in lifestyle counseling, including effective communication skills like motivational interviewing. Gynecological cancer patients lacked tools, support, knowledge, and faced mental health issues, environmental constraints, and physical limitations. The review emphasizes the importance of addressing these barriers and utilizing identified facilitators, such as social support, to promote and support healthy lifestyle behaviors on the part of patients and their promotion by HCPs. Future research should focus not only on patients but also on supporting HCPs and implementing necessary changes in current practices.

Social-cognitive, demographic, clinical, and health-related correlates of physical activity and sedentary behaviour in newly diagnosed women with breast cancer

PURPOSE

Identifying correlates of physical activity and sedentary behaviour allows for the identification of factors that may be targeted in future behaviour change interventions. This study sought to determine the social-cognitive, demographic, clinical, and health-related correlates of physical activity and sedentary behaviour in individuals recently diagnosed with breast cancer.

METHODS

Data were collected from 1381 participants within 90 days of diagnosis in the Alberta Moving Beyond Breast Cancer (AMBER) Cohort Study. Physical activity and sedentary behaviour were measured with ActiGraph GT3X+® and activPALTM devices, respectively, for seven consecutive days. Correlates were collected via a self-reported questionnaire, medical record extraction, or measured by staff.

RESULTS

Multivariable models were fitted for sedentary behaviour, light physical activity, and moderate-to-vigorous physical activity. Greater sedentary behaviour was associated with higher body fat percentage (BF%) (ß=0.044; p<0.001) and being single (ß=0.542; p<0.002). Lower light physical activity was associated with higher BF% (ß=-0.044; p<0.001), higher body mass index (ß=-0.039; p<0.001), greater disease barrier influence (ß=-0.006; p<0.001), a HER2-positive diagnosis (ß=-0.278; p=0.001), and being single (ß=-0.385; p= 0.001). Lower moderate-to-vigorous physical activity was associated with higher BF% (ß =-0.011; p=0.001), greater disease barrier influence (ß=-0.002; p<0.001), and being of Asian (ß=-0.189; p=0.002) or Indian/South American (ß=-0.189; p=0.002) descent. Greater moderate-to-vigorous physical activity was associated with having greater intentions (ß=0.049; p=0.033) and planning (ß=0.026; p=0.015) towards physical activity.

CONCLUSION

Tailoring interventions to increase physical activity for individuals recently diagnosed with breast cancer may improve long-term outcomes across the breast cancer continuum.

Correlates of Physical Activity Participation among Individuals Diagnosed with Cancer: An Application of the Multi-Process Action Control Framework

BACKGROUND

The purpose of this study was to test Multi-Process Action Control (M-PAC) processes as correlates of physical activity (PA) intention formation and translation (i.e., action control) in individuals diagnosed with cancer.

METHODS

This study was a cross-sectional survey, completed from July to November of 2020 during the COVID-19 pandemic. PA and M-PAC processes were self-reported using the Godin Leisure-Time Exercise Questionnaire and questionnaires for reflective (instrumental/affective attitudes, perceived opportunity/capability), regulatory (e.g., goal-setting, planning), and reflexive processes (habit, identity). Separate hierarchical multinomial logistic regression models determined correlates of intention formation and action control.

RESULTS

Participants (n = 347; M_age= 48.2 ± 15.6) were primarily diagnosed with breast cancer (27.4%) and at a localized stage (85.0%). Most participants intended to perform PA (70.9%), yet only 50.4% met guidelines. Affective judgements (p < 0.001) and perceived capability (p < 0.01) were significantly associated with intention formation. Preliminary models indicated employment, affective judgements, perceived capability, and self-regulation to be significant (ps < 0.05) correlates of action control, but in the final model, only surgical treatment (p = 0.02) and PA identity (p < 0.001) were significantly associated with action control.

CONCLUSION

Reflective processes were associated with PA intention formation, while reflexive processes were associated with PA action control. Behavior change efforts for individuals diagnosed with cancer should extend beyond social-cognitive approaches to include regulatory and reflexive processes of PA behavior (i.e., PA identity).

Effects of supervised high-intensity interval training on motivational outcomes in men with prostate cancer undergoing active surveillance: results from a randomized controlled trial

Background

Understanding the motivational effects of supervised aerobic high-intensity interval training (HIIT) may help men with prostate cancer undergoing active surveillance initiate and maintain exercise behavior, however, few studies have addressed this question. This report explored exercise motivation in men with prostate cancer undergoing active surveillance participating in a randomized exercise trial.

Methods

The Exercise during Active Surveillance for Prostate Cancer (ERASE) trial randomized 52 men with prostate cancer on active surveillance to the HIIT exercise group or the usual care (UC) group. The exercise program was supervised aerobic HIIT conducted three times per week for 12 weeks. The motivation questions were developed using the Theory of Planned Behavior and included motivational constructs, anticipated and experienced outcomes, and barriers to HIIT during active surveillance.

Results

The HIIT group attended 96% of the planned exercise sessions with 100% compliance to the exercise protocol. Motivation outcome data were obtained in 25/26 (96%) participants in the HIIT group and 25/26 (96%) participants in the UC group. At baseline, study participants were generally motivated to perform HIIT. After the intervention, the HIIT group reported that HIIT was even more enjoyable (p < 0.001; d = 1.38), more motivating (p = 0.001; d = 0.89), more controllable (p < 0.001; d = 0.85), and instilled more confidence (p = 0.004; d = 0.66) than they had anticipated. Moreover, compared to UC, HIIT participants reported significantly higher perceived control (p = 0.006; d = 0.68) and a more specific plan (p = 0.032; d = 0.67) for performing HIIT over the next 6 months. No significant differences were found in anticipated versus experienced outcomes. Exercise barriers were minimal, however, the most often reported barriers included pain or soreness (56%), traveling to the fitness center (40%), and being too busy and having limited time (36%).

Conclusion

Men with prostate cancer on active surveillance were largely motivated and expected significant benefits from a supervised HIIT program. Moreover, the men assigned to the HIIT program experienced few barriers and achieved high adherence, which further improved their motivation. Future research is needed to understand long-term exercise motivation and behavior change in this setting.

Trial registration

Clinicaltrials.gov, NCT03203460. Registered on June 29, 2017.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-022-01365-2.

Application of the theory of planned behavior to understand physical activity intentions and behavior among Korean breast cancer survivors

PURPOSE

The purpose of this study was to apply the theory of planned behavior (TPB) to understand physical activity intentions and behaviors among Korean breast cancer survivors.

METHODS

A total of 286 Korean breast cancer survivors (M_age52.3 ± 8.3) completed a self-reported survey administered face to face by a trained interviewer. The survey assessed the physical activity frequency and intensity in a typical week after breast cancer diagnosis, demographic factors, and theory of planned behavior variables including attitude, subjective norm, perceived behavioral control (PBC), planning, and intentions to participate in physical activity. We used structural equation modeling to examine the direct and indirect effects of the TPB variables on physical activity intentions and behavior. Covariates included age, cancer stage, and clinical treatment.

RESULTS

Confirmatory factor analyses indicated a satisfactory model fit. We observed direct effects for instrumental attitude (ß = 0.34, p < 0.001), subjective norm (ß = 0.12, p < 0.05), and PBC (ß = 0.57, p < 0.001) on physical activity intentions. PBC (ß = .17, p < 0.01) and physical activity intentions (ß = 0.46, p < 0.01) had direct effects on planning. PBC (ß = 0.28, p < 0.01) and planning (ß = 0.22, p < 0.01) had direct effects on physical activity behavior.

CONCLUSION

The TPB was a useful model for understanding Korean breast cancer survivors' physical activity intentions and behavior. Interventions that can enhance attitudes, subjective norm, PBC, intention, and planning may facilitate physical activity intentions and behaviors in this population.

What Predicts the Physical Activity Intention-Behavior Gap? A Systematic Review

BACKGROUND

Intention is theorized as the proximal determinant of behavior in many leading theories and yet intention-behavior discordance is prevalent.

PURPOSE

To theme and appraise the variables that have been evaluated as potential moderators of the intention-physical activity (I-PA) relationship using the capability-opportunity-motivation- behavior model as an organizational frame.

METHODS

Literature searches were concluded in August 2020 using seven common databases. Eligible studies were selected from English language peer-reviewed journals and had to report an empirical test of moderation of I-PA with a third variable. Findings were grouped by the moderator variable for the main analysis, and population sample, study design, type of PA, and study quality were explored in subanalyses.

RESULTS

The search yielded 1,197 hits, which was reduced to 129 independent studies (138 independent samples) of primarily moderate quality after screening for eligibility criteria. Moderators of the I-PA relationship were present among select variables within sociodemographic (employment status) and personality (conscientiousness) categories. Physical capability, and social and environmental opportunity did not show evidence of interacting with I-PA relations, while psychological capability had inconclusive findings. By contrast, key factors underlying reflective (intention stability, intention commitment, low goal conflict, affective attitude, anticipated regret, perceived behavioral control/self-efficacy) and automatic (identity) motivation were moderators of I-PA relations. Findings were generally invariant to study characteristics.

CONCLUSIONS

Traditional intention theories may need to better account for key I-PA moderators. Action control theories that include these moderators may identify individuals at risk for not realizing their PA intentions. Prospero # CRD42020142629.

The Impact of Educational Intervention Based on Theory of Planned Behavior for Promoting Physical Activity Among Middle-Aged Women Referring to Karaj (Iran) Health Centers

BACKGROUND

Physical activity is the most critical determinant of physical health which reduces the health risks during life. This designed study aims to evaluate the effect of educational intervention based on the theory of planned behavior on promoting physical activity among middle-aged women attending the health centers in Karaj city during 2017-2018.

METHODS

This research was a quasi-experimental controlled trial, and the study incorporated 140 Middle-Aged Women Referring to Karaj Health Centers assigned randomly to a control and intervention group (70 each group). Participants enrolling in the survey were asked to complete the International Physical Activity Questionnaire and also the theory of planned behavior measures at the baseline and the end of the study. The SPSS software were used, to analyze the data. The study applied Nonparametric Wilcoxon and Mann-Whitney tests and ANCOVA to interpret the results.

RESULTS

The results revealed participants' age range between 30 to 50 years with the mean and standard deviation scores 40.07 (8.750) in training and 45.81 (8.513) at the control group. The intervention improved the theory of planned behavior measures and the physical activities of participants. The results showed a significant difference in the attitude score, the perceived behavioral control score, and the level of subjective norms between two training and non-training groups (P < 0.001). The followed-up physical activity score also showed an improvement in the IPAQ score of participants in the training group (p < 0.001).

CONCLUSIONS

The results of this specific study support the effectiveness of the theory of planned behavior for promoting the physical activity of women.

Changes in Body Mass Index and Physical Activity Predict Changes in Vitality During a Weight Loss Trial in Breast Cancer Survivors

Background

Breast cancer survivors rank fatigue (e.g., decreased vitality) as their number one concern affecting quality of life. Excess adiposity is associated with decreased vitality in breast cancer survivors, yet weight loss intervention trials report inconsistent effects on this parameter.

Methods

This is a secondary analysis of the Exercise and Nutrition to Enhance Recovery and Good Health for You trial, in which 692 overweight or obese breast cancer survivors ≤5 years from diagnosis, initiated weight loss interventions, and completed assessments semi-annually for 2 years. Assessments included the Godin Leisure-Time Exercise Questionnaire and the SF-36 MOS vitality subscale as an inverse measure of fatigue. Multilevel structural equation models estimated the direct effects of physical activity on vitality and indirect effects through body mass index (BMI) changes.

Results

Within-person findings show that at assessments with greater physical activity, BMI was significantly lower (B = -0.07, p < 0.001) and vitality was higher (B = 0.22, p < 0.001). However, there was no direct relationship between lower BMI and higher vitality (B = -0.11, p = 0.262) after controlling for the relationship of physical activity with BMI and physical activity with vitality. The between-person indirect effect of physical activity change through BMI change to vitality was significant (B = 0.03, p < 0.001). Participants whose physical activity was above the mean (B = 0.37, p < 0.001) and whose BMI was below the mean (B = -1.05, p < 0.001) were more likely to report greater vitality.

Conclusion

Improvements in vitality are primarily associated with increases in physical activity rather than BMI changes in this trial. Vitality was lower among survivors with higher BMI, although within-individual changes in BMI had no effect on vitality. Physical activity and weight loss share mechanistic links to vitality with physical activity potentially increasing (e.g., in an additive or synergistic manner) the effect of BMI reduction on vitality.

The role of social support in physical activity for cancer survivors: A systematic review

OBJECTIVE

Social support is conceptualized and operationalized in many ways, making it challenging to understand what types of support best predict physical activity (PA) in cancer survivors. This review examined associations between social support and PA among cancer survivors.

METHODS

Following PRISMA guidelines, we searched eight databases for studies that reported an association between social support and PA among adult cancer survivors. We conducted an appraisal and a narrative synthesis of the findings from quantitative studies.

RESULTS

Fifty studies representing 28 366 participants were included. Studies collectively included concepts addressing the presence of relationships, others' PA behavior, perceptions of being supported, and function/quality. Findings were mixed in suggesting a positive or null association with PA.

CONCLUSIONS

While results are not definitive, this review takes a step toward mapping the social support literature in PA for cancer survivors. Limitations include the homogeneity of the participants in extant studies, and the secondary focus on testing the effects of social support on outcomes. Future research systematically testing the effects of social support is important for facilitating PA in this population.

Intense Exercise for Survival among Men with Metastatic Castrate-Resistant Prostate Cancer (INTERVAL-GAP4): a multicentre, randomised, controlled phase III study protocol

INTRODUCTION

Preliminary evidence supports the beneficial role of physical activity on prostate cancer outcomes. This phase III randomised controlled trial (RCT) is designed to determine if supervised high-intensity aerobic and resistance exercise increases overall survival (OS) in patients with metastatic castrate-resistant prostate cancer (mCRPC).

METHODS AND ANALYSIS

Participants (n=866) must have histologically documented metastatic prostate cancer with evidence of progressive disease on androgen deprivation therapy (defined as mCRPC). Patients can be treatment-naïve for mCRPC or on first-line androgen receptor-targeted therapy for mCRPC (ie, abiraterone or enzalutamide) without evidence of progression at enrolment, and with no prior chemotherapy for mCRPC. Patients will receive psychosocial support and will be randomly assigned (1:1) to either supervised exercise (high-intensity aerobic and resistance training) or self-directed exercise (provision of guidelines), stratified by treatment status and site. Exercise prescriptions will be tailored to each participant's fitness and morbidities. The primary endpoint is OS. Secondary endpoints include time to disease progression, occurrence of a skeletal-related event or progression of pain, and degree of pain, opiate use, physical and emotional quality of life, and changes in metabolic biomarkers. An assessment of whether immune function, inflammation, dysregulation of insulin and energy metabolism, and androgen biomarkers are associated with OS will be performed, and whether they mediate the primary association between exercise and OS will also be investigated. This study will also establish a biobank for future biomarker discovery or validation.

ETHICS AND DISSEMINATION

Validation of exercise as medicine and its mechanisms of action will create evidence to change clinical practice. Accordingly, outcomes of this RCT will be published in international, peer-reviewed journals, and presented at national and international conferences. Ethics approval was first obtained at Edith Cowan University (ID: 13236 NEWTON), with a further 10 investigator sites since receiving ethics approval, prior to activation.

TRIAL REGISTRATION NUMBER

NCT02730338.

Demographic, clinical, lifestyle-related, and social-cognitive correlates of physical activity in head and neck cancer survivors

PURPOSE

The purpose of the study is to identify demographic, clinical, lifestyle-related, and social-cognitive correlates of physical activity (PA) intention and behavior in head and neck cancer (HNC) survivors using the theory of planned behavior (TPB).

METHODS

Data from two cross-sectional studies on correlates of PA in HNC survivors were pooled. Both studies used self-reports to assess PA and social-cognitive correlates. Potential correlates were collected via self-report or medical records. Univariable and multivariable multilevel linear mixed-effects models were built to identify correlates of PA intention and PA behavior (Z scores). Structural equation model analyses were conducted to study the full TPB model in one analysis, taking into account relevant covariates.

RESULTS

In total, 416 HNC survivors were surveyed. Their mean (SD) age was 66.6 (9.4) years; 64% were men, and 78% were diagnosed with laryngeal cancer. The structural equation model showed that PA intention was significantly higher in HNC survivors with a history of exercising, who had a more positive attitude, subjective norm, and perceived behavioral control. Patients with higher PA intention, higher PBC, a lower age, and without unintentional weight loss or comorbidities had higher PA behavior. The model explained 22.9% of the variance in PA intention and 16.1% of the variance in PA behavior.

CONCLUSIONS

Despite significant pathways of the TPB model, the large proportion variance in PA intention and behavior remaining unexplained suggests the need for better PA behavior (change) models to guide the development of PA promotion programs, particularly for the elderly. Such programs should be tailored to comorbidities and nutritional status.

The effect of a randomized controlled physical activity trial on health related quality of life in metabolically unhealthy African-American women: FIERCE STUDY

PURPOSE

African-American women (AAW) are more likely to be metabolically unhealthy than White women (WW). Metabolic syndrome (MetS) is associated with increased breast cancer risk and mortality from breast cancer is greater in AAW compared to WW. Data show MetS affects health-related quality of life (HRQoL). Exercise studies report improvements in MetS, however, no study to date has examined HRQoL in metabolically unhealthy AAW enrolled in an exercise trial.

METHODS

This report examined the effect of a 6-month, 3-arm (supervised exercise, home-based exercise, control) randomized exercise controlled trial on HRQoL among 213 obese, metabolically unhealthy, postmenopausal AAW at high risk for breast cancer.

RESULTS

Certain baseline participant characteristics were related to baseline HRQoL dimensions. The "exercise group" (supervised group combined with the home-based group) showed significantly greater improvement in health change scores (M = 13.6, SD = 3.1) compared to the control group (M = 0.7, SD = 4.4) (p = 0.02) over the 6-month study period. There were no significant differences in HRQoL change scores between the 3 study groups, however, although non-significant, data indicated most HRQoL change scores were more favorable in the supervised group.

CONCLUSION

While significant improvement occurred in health change scores in the combined supervised and home-based group compared to the control group, we did not observe any significant differences on HRQoL change scores between all three study groups. However, while non-significant, there was a trend for more favorable HRQoL change scores in the supervised group versus the home-based and control groups. Additional research is needed to further explore this topic.

Motivation for Different Types and Doses of Exercise During Breast Cancer Chemotherapy: a Randomized Controlled Trial

BACKGROUND

Exercise is beneficial for breast cancer patients during chemotherapy, but their motivation to perform different types and doses of exercise is unknown.

PURPOSE

The purpose of this study was to examine the anticipated and experienced motivation of breast cancer patients before and after three different exercise programs during chemotherapy.

METHODS

Breast cancer patients initiating chemotherapy (N = 301) were randomized to a standard dose of 25-30 min of aerobic exercise, a higher dose of 50-60 min of aerobic exercise, or a combined dose of 50-60 min of aerobic and resistance exercise. Patient preference and motivational outcomes from the theory of planned behavior (i.e., perceived benefit, enjoyment, support, difficulty, and motivation) were assessed before and after the interventions.

RESULTS

At pre-randomization, breast cancer patients were significantly (p < 0.001) more likely to prefer the combined program (80.1 %); however, after the interventions there was a significant (p < 0.001) increase in the number of patients preferring the high volume program and having no preference. At pre-randomization, breast cancer patients anticipated more favorable motivational outcomes for the combined program and less favorable motivational outcomes for the high volume program (all p < 0.001). After the interventions, the motivational outcomes experienced exceeded the anticipated motivational outcomes significantly more in the high volume group than the standard or combined groups.

CONCLUSIONS

Anticipated motivational outcomes for different types and doses of exercise during chemotherapy varied considerably at pre-randomization, but the motivational outcomes experienced after the three interventions were similar. Clinicians can recommend any of the three exercise interventions to breast cancer patients knowing that positive motivational outcomes will result. Clinicaltrials.gov identifier: NCT00249015 .

Motivating Older Adults with Cancer to Keep Moving: the Implications of Lifestyle Interventions on Physical Activity

PURPOSE OF REVIEW

The purposes of this review are to describe the unique needs and preferences of older adults with cancer regarding physical activity and to outline the essential characteristics associated with increased physical activity resulting from lifestyle interventions in older adults.

RECENT FINDINGS

Functional decline is accelerated in inactive and sedentary older adults. Even a modest increase in physical activity can improve physical function for older cancer survivors. Participation in physical activity is influenced by diverse individual-level factors, behavioral characteristics and skills and social and environmental factors. Thus, programs that are tailored to older adults' preferences provide social support and remove obstacles to participation may be more effective, particularly for older adults with low physical activity and sedentary lifestyle.

Cancer and heart attack survivors' expectations of employment status: results from the English Longitudinal Study of Ageing

Background

Sociodemographic, health- and work-related factors have been found to influence return to work in cancer survivors. It is feasible though that behavioural factors, such as expectation of being at work, could also affect work-related outcomes. Therefore, the effect of earlier identified factors and expectation of being at work on future employment status in cancer survivors was explored. To assess the degree to which these factors specifically concern cancer survivors, a comparison with heart attack survivors was made.

Methods

Data from the English Longitudinal Study of Ageing were used. Cancer and heart attack survivors of working age in the UK were included and followed up for 2 years. Baseline characteristics of both cancer and heart attack survivors were compared regarding employment status. Univariate and multivariate regression analyses were performed in survivors at work, and the interaction between independent variables and diagnose group was assessed.

Results

In cancer survivors at work (N = 159), alcohol consumption, participating in moderate or vigorous sport activities, general health and participation were univariate associated with employment status at two-year follow-up. Only fair general health (compared to very good general health) remained statistically significant in the multivariate model (OR 0.31; 95% CI 0.13–0.76; p = 0.010). In heart attack survivors at work (N = 78), gender, general health and expectation of being at work were univariate associated with employment status at follow-up. Female gender (OR 0.03; 95% CI 0.00–0.57; p = 0.018) and high expectation of being at work (OR 10.68; 95% CI 1.23–93.92; p = 0.033) remained significant in the multivariate model. The influence of gender (p = 0.066) and general health (p = 0.020) regarding employment status was found to differ significantly between cancer and heart attack survivors.

Conclusions

When predicting future employment status in cancer survivors in the UK, general health is the most relevant factor to consider. While expectation of being at work did not show any significant influence in cancer survivors, in heart attack survivors, it should not be disregarded though, when developing interventions to affect their employment status. Future research should focus on more specific measures for expectation, and additional behavioural factors, such as self-efficacy, and their effect on employment status.

Randomized Trial of a Lifestyle Physical Activity Intervention for Breast Cancer Survivors: Effects on Transtheoretical Model Variables

This study examined whether a physical activity intervention affects transtheoretical model (TTM) variables that facilitate exercise adoption in breast cancer survivors. Sixty sedentary breast cancer survivors were randomized to a 6-month lifestyle physical activity intervention or standard care. TTM variables that have been shown to facilitate exercise adoption and progress through the stages of change, including self-efficacy, decisional balance, and processes of change, were measured at baseline, 3 months, and 6 months. Differences in TTM variables between groups were tested using repeated measures analysis of variance. The intervention group had significantly higher self-efficacy ( F = 9.55, p = .003) and perceived significantly fewer cons of exercise ( F = 5.416, p = .025) at 3 and 6 months compared with the standard care group. Self-liberation, counterconditioning, and reinforcement management processes of change increased significantly from baseline to 6 months in the intervention group, and self-efficacy and reinforcement management were significantly associated with improvement in stage of change. The stage-based physical activity intervention increased use of select processes of change, improved self-efficacy, decreased perceptions of the cons of exercise, and helped participants advance in stage of change. These results point to the importance of using a theory-based approach in interventions to increase physical activity in cancer survivors.

Organizational theory for dissemination and implementation research

Background

Even under optimal internal organizational conditions, implementation can be undermined by changes in organizations’ external environments, such as fluctuations in funding, adjustments in contracting practices, new technology, new legislation, changes in clinical practice guidelines and recommendations, or other environmental shifts. Internal organizational conditions are increasingly reflected in implementation frameworks, but nuanced explanations of how organizations’ external environments influence implementation success are lacking in implementation research. Organizational theories offer implementation researchers a host of existing, highly relevant, and heretofore largely untapped explanations of the complex interaction between organizations and their environment. In this paper, we demonstrate the utility of organizational theories for implementation research.

Discussion

We applied four well-known organizational theories (institutional theory, transaction cost economics, contingency theories, and resource dependency theory) to published descriptions of efforts to implement SafeCare, an evidence-based practice for preventing child abuse and neglect. Transaction cost economics theory explained how frequent, uncertain processes for contracting for SafeCare may have generated inefficiencies and thus compromised implementation among private child welfare organizations. Institutional theory explained how child welfare systems may have been motivated to implement SafeCare because doing so aligned with expectations of key stakeholders within child welfare systems’ professional communities. Contingency theories explained how efforts such as interagency collaborative teams promoted SafeCare implementation by facilitating adaptation to child welfare agencies’ internal and external contexts. Resource dependency theory (RDT) explained how interagency relationships, supported by contracts, memoranda of understanding, and negotiations, facilitated SafeCare implementation by balancing autonomy and dependence on funding agencies and SafeCare developers.

Summary

In addition to the retrospective application of organizational theories demonstrated above, we advocate for the proactive use of organizational theories to design implementation research. For example, implementation strategies should be selected to minimize transaction costs, promote and maintain congruence between organizations’ dynamic internal and external contexts over time, and simultaneously attend to organizations’ financial needs while preserving their autonomy. We describe implications of applying organizational theory in implementation research for implementation strategies, the evaluation of implementation efforts, measurement, research design, theory, and practice. We also offer guidance to implementation researchers for applying organizational theory.

Changes in awareness of cancer risk factors among adult New Zealanders (CAANZ): 2001 to 2015

Behaviour change, specifically that which decreases cancer risk, is an essential element of cancer control. Little information is available about how awareness of risk factors may be changing over time. This study describes the awareness of cancer risk behaviours among adult New Zealanders in two cross-sectional studies conducted in 2001 and 2014/5.Telephone interviews were conducted in 2001 (n = 436) and 2014/5 (n = 1064). Participants were asked to recall things they can do to reduce their risk of cancer. They were then presented with a list of potential risk behaviours and asked if these could increase or decrease cancer risk.Most New Zealand adults could identify at least one action they could take to reduce their risk of cancer. However, when asked to provide specific examples, less than a third (in the 2014/5 sample) recalled key cancer risk reduction behaviours such as adequate sun protection, physical activity, healthy weight, limiting alcohol and a diet high in fruit. There had been some promising changes since the 2001 survey, however, with significant increases in awareness that adequate sun protection, avoiding sunbeds/solaria, healthy weight, limiting red meat and alcohol, and diets high in fruit and vegetables decrease the risk of developing cancer.

Physical activity-related differences in body mass index and patient-reported quality of life in socioculturally diverse endometrial cancer survivors

PURPOSE

The purpose of this study was to describe physical activity-related differences in body composition, quality of life, and behavioral variables among a socioculturally diverse sample of endometrial cancer survivors.

METHODS

Ambulatory, English-speaking endometrial cancer survivors (6 months to 5 years post-treatment), who were residents of Bronx, NY, were recruited to complete questionnaires about physical activity (PA), quality of life (QoL), and psychosocial characteristics. Body weight and height were obtained from medical records to determine body mass index (BMI). ANOVA and independent sample t tests were used to determine differences between racial/ethnic groups and active versus insufficiently active, respectively.

RESULTS

Sixty-two participants enrolled in the study. Recruitment rate was 7% for mailed questionnaires and 92% in clinic. Mean age was 63 ± 10 years. Sixty-five percent of the sample was obese (mean BMI: 34.2 ± 8.6 kg·m^-2). BMI was significantly higher in non-Hispanic black women (37.8 ± 10.2 kg·m^-2) than non-Hispanic white women (31.2 ± 7.8 kg·m^-2; d = 0.73, p = 0.05). Forty-seven percent reported being physically active, with no differences by race/ethnicity. Physically active endometrial cancer survivors had higher QoL scores (d = 0.57, p = 0.02). There was a moderate effect size for BMI for the active (32.4 ± 5.6 kg·m^-2) compared to the insufficiently active group (35.7 ± 10.2 kg·m^-2; d = 0.40, p = 0.06). Walking self-efficacy was a significant predictor of physical activity (χ² = 13.5, p = 0.02).

CONCLUSIONS

Physically active endometrial cancer survivors reported higher QoL, lower BMI, and more positive walking self-efficacy. These data suggest that a physically active lifestyle has a benefit in socioculturally diverse endometrial cancer survivors.

Physical Activity Enjoyment and Self-Efficacy As Predictors of Cancer Patients' Physical Activity Level

BACKGROUND

Physical activity (PA) can support cancer patients during medical treatment by reducing side-effects and increasing quality of life. However, PA levels mostly decline after diagnosis. Which factors can explain if patients are able to remain or even increase their PA level? Self-efficacy is an important cognitive factor that has been linked to cancer patients' PA across many studies. In contrast, affective factors such as PA enjoyment have rarely been examined. We compare the influence of self-efficacy and PA enjoyment on cancer patients' PA levels after completion of an exercise or stress-management intervention.

METHODS

Outpatient cancer patients [N = 72; 54% female; M = 56 years, SD = 12.34; most with breast or colon cancer (34%, 15%)] were enrolled in the MOTIVACTION study, a 4-week intervention (1 h counseling followed by weekly phone calls), with pre-test (T1), post-test (T2), and a 10-week follow-up (T3). Participants were randomized to either an exercise intervention (emphasizing self-regulatory strategies for behavior change) or to a stress management intervention (coping and relaxation techniques). Sixty-seven patients remained in the study and completed the SQUASH assessment of PA, a measure of maintenance self-efficacy (7 items, Cronbach's α = 0.88) and PA enjoyment (2 items, Cronbach's α = 0.89). Regression analyses were calculated with PA level (at T2 and T3) as dependent variable and relative weight analyses were conducted. The study was registered at clinicalTrials.gov (unique identifier:NCT01576107; URL: https://clinicaltrials.gov/ct2/show/NCT01576107?term=motivaction&rank=1).

RESULTS

Baseline self-efficacy and change in PA enjoyment significantly predicted cancer patients' PA level at T2 adjusting for baseline PA and type of intervention. Relative weight (RW) analysis revealed that PA enjoyment (baseline and change together) explained 34.3% of the dependent variable, self-efficacy (baseline and change) explained 38.4%. At follow-up, self-efficacy was still a significant predictor of PA (RW = 74.6%), whereas PA enjoyment was no longer a relevant factor (RW = 5.2%).

CONCLUSION

The affective factor PA enjoyment was equally important as self-efficacy for predicting cancer patient' PA level directly after completion of the intervention. Reasons for the reduced relevance at follow-up and a broader range of affective factors should be analyzed in future studies on cancer patients' PA level.

Demographic, clinical, psychosocial, and environmental correlates of objectively assessed physical activity among breast cancer survivors

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]

Cancer-related impairments influence physical activity in uterine cancer survivors

INTRODUCTION

The extent to which physical activity (PA) participation among uterine cancer survivors may be limited by physical and functional impairments (PFI) related to cancer treatment is unknown. We sought to describe PA participation, characterize the prevalence of PFI, and examine the association between PFI status and PA participation within this population.

METHODS

We conducted a study using a mailed survey among uterine cancer survivors who received treatment at a university hospital. We asked about PA and PFI using validated self-report questionnaires. PA was calculated using MET-hours per week (MET·h·wk). PFI was defined as having one or more of the following symptoms: lower limb lymphedema, general pain, fatigue, or severe bladder, bowel, or pelvic issues. Ordinal logistic regression was used to quantify the odds ratio (OR) between PA and PFI.

RESULTS

The response rate to our survey was 43%. Among the 213 study participants, 40%, 13%, 13%, 12%, and 23% reported participating in <3.0, 3.0-8.9, 9.0-17.9, 18.0-26.9, and ≥27.0 MET·h·wk of PA, respectively. Walking is the preferred mode of exercise for physically active uterine cancer survivors. Of the survivors, 53% experience at least one PFI. The most common PFI is lower limb lymphedema (36.2%), followed by general pain (22.5%). The OR of PFI decreased as MET-hours per week of PA increased (OR, 0.51; 95% confidence interval, 0.31-0.84; P = 0.009).

CONCLUSIONS

The majority of uterine cancer survivors experience PFI that significantly reduce the likelihood of PA participation. PA recommendations for uterine cancer survivors should take into account treatment-related impairments that can affect PA participation.

Intervention markers of physical activity maintenance in older adults

OBJECTIVES

To identify intervention components that may promote longterm changes of physical activity among older adults in a behavioral theory-based physical activity trial.

METHODS

Participants (N = 24; aged 65 ± 8.79 years) shared perceptions of intervention components at the end of the intervention and physical activity was assessed at 18 months. Mixed-methods analyses using a pragmatic content analysis of interview data were conducted.

RESULTS

Active study participants (25%) cited more specific goals/actions to achieve goals and more social support from family/friends, and had significantly higher self-determined motivation mean scores at 18 months than insufficiently active study participants (75%).

CONCLUSIONS

Specific goal-setting behaviors and social support from family/friends may be key elements of physical activity maintenance in older adults.

Social-ecological correlates of physical activity in kidney cancer survivors

PURPOSE

Previous studies in cancer survivors have examined behavioral correlates of physical activity (PA), but no study to date has adopted a broader social-ecological framework in understanding PA. This study examined the associations among demographic, medical, social-cognitive, and environmental correlates of meeting PA guidelines among kidney cancer survivors (KCS).

METHODS

All 1985 KCS diagnosed between 1996 and 2010 identified through a Canadian provincial registry were mailed a survey that consisted of medical, demographic, and social-cognitive measures, as well as PA as measured by the Godin Leisure Time Exercise Questionnaire. Environmental constructs were also assessed for both self-report and objective measures using geographic information systems (GIS). A series of binary logistic regression analyses were conducted in this cross-sectional study.

RESULTS

Completed surveys with geographical information were received from 432 KCS with M age = 64.4 ± 11.1 years, 63.2 % male, and 82.2 % having localized kidney cancer. In the final multivariate model, meeting PA guidelines was associated with disease stage (OR = 0.25, p = .005), having drug therapy (OR = 3.98, p = .009), higher levels of instrumental attitudes (OR = 1.66, p = .053), higher levels of intention (OR = 1.72, p = .002), and the perceived presence of many retail shops in the neighborhood (OR = 1.37, p = .032).

CONCLUSIONS

Meeting PA guidelines in KCS were associated with various aspects of the social-ecological model.

IMPLICATIONS FOR CANCER SURVIVORS

Understanding the social-ecological correlates for PA can provide insight into future interventions designed to increase PA in KCS. Prime targets for PA promotion should consider treatment-related factors, promote the benefits of PA, and enhance positive perceptions of the built environment.

Predictors of health behavior change after an integrative medicine inpatient program

BACKGROUND

Health behavior change can improve physical and psychosocial outcomes in internal medicine patients.Purpose This study aims to identify predictors for health behavior change after an integrative medicine inpatient program.

METHOD

German internal medicine patients' (N =2,486; 80 %female; 53.9±14.3 years) practice frequency for aerobic exercise(e.g., walking, running, cycling, swimming), meditative movement therapies (e.g., yoga, tai ji, qigong), and relaxation techniques(e.g., progressive relaxation, mindfulness meditation,breathing exercises, guided imagery) was assessed at admission to a 14-day integrative medicine inpatient program, and 3, 6, and 12 months after discharge. Health behavior change was regressed to exercise self-efficacy, stage of change, and health locus of control (internal, external-social, external-fatalistic).

RESULTS

Short-term increases in practice frequency were found for aerobic exercise: short- and long-term increases for meditative movement therapies and relaxation techniques (all p <0.01). After controlling for sociodemographic characteristics,clinical characteristics, and health status, exercise self-efficacy or interactions of exercise self-efficacy with stage of change predicted increased practice frequency of aerobic exercise at 6 months; of meditative movement therapies at 3 and 6 months; and of relaxation techniques at 3, 6, and 12 months (all p <0.05). Health locus of control predicted increased practice frequency of aerobic exercise at 3 months and of relaxation techniques at 3, 6, and 12 months (all p <0.05).

CONCLUSION

Health behavior change after an integrative medicine inpatient program was predicted by self-efficacy,stage of change, and health locus of control.Considering these aspects might improve adherence to health-promoting behavior after lifestyle modification programs.

An exercise trial targeting African-American women with metabolic syndrome and at high risk for breast cancer: Rationale, design, and methods

BACKGROUND

Metabolic syndrome and obesity are known risk factors for breast cancers. Exercise interventions can potentially modify circulating biomarkers of breast cancer risk but evidence in African-Americans and women with metabolic syndrome is lacking.

METHODS/DESIGN

The Focused Intervention on Exercise to Reduce CancEr (FIERCE) trial is a prospective, 6-month, 3-arm, randomized controlled trial to examine the effect of exercise on obesity, metabolic syndrome components, and breast cancer biomarkers among African-American women at high risk of breast cancer. Two hundred-forty inactive women with metabolic syndrome and absolute risk of breast cancer ≥ 1.40 will be randomized to one of the three trial arms: 1) a supervised, facility-based exercise arm; 2) a home-based exercise arm; and 3) a control group that maintains physical activity levels through the course of the trial. Assessments will be conducted at baseline, 3 months, and 6 months. The primary outcome variables are anthropometric indicators of obesity, metabolic syndrome components, and inflammatory, insulin-pathway, and hormonal biomarkers of breast cancer risk.

DISCUSSION

The FIERCE trial will provide evidence on whether a short-term exercise intervention might be effective in reducing breast cancer risk among African-American women with comorbidities and high breast cancer risk--a group traditionally under-represented in non-therapeutic breast cancer trials.

CLINICAL TRIAL REGISTRATION NUMBER

NCT02103140.

Identification and evaluation of the salient physical activity beliefs of colorectal cancer survivors

BACKGROUND

Physical activity (PA) has been associated with lower risk of disease recurrence and longer survival in colorectal cancer (CRC) survivors; however, less than one-third of CRC survivors are meeting PA guidelines. Interventions to promote PA in CRC survivors need to understand the most critical beliefs that influence PA behavior.

OBJECTIVE

The objective of this study was to examine the strength of associations between the most common PA beliefs of CRC survivors and motivational constructs from the Theory of Planned Behavior (TPB) as well as PA behavior.

INTERVENTION/METHODS

Colorectal cancer survivors (n = 600) residing in Alberta, Canada, completed self-report questionnaires assessing medical and demographic variables, PA beliefs, constructs from the TPB, and PA behavior.

RESULTS

Colorectal cancer survivors identified improved fitness (69.5%), family members (67.3%), and medical/health problems (8.8%) as the most prevalent behavioral, normative, and control beliefs, respectively. All PA beliefs were significantly correlated with all TPB constructs and PA.

CONCLUSIONS

Physical activity interventions for CRC survivors should target many salient beliefs including behavioral, normative, and control beliefs.

IMPLICATIONS FOR PRACTICE

Insights into the salient beliefs for PA in CRC survivors can guide nurses in developing successful strategies to promote PA in this population and likely improve quality of life and possibly disease outcomes.

What explains the intention to be physically active in cancer patients? Different determinants for active and insufficiently active patients

In a qualitative elicitation study with 61 cancer patients, a broad range of attitudes toward physical activity could be obtained, especially negative attitudes among insufficiently active patients. Based on these results, a second quantitative study was conducted; 64 patients [40 men; 42% insufficiently active (<150 minutes/week)] completed a Theory of Planned Behavior (TPB) questionnaire. Regression analyses revealed that different variables of the TPB are relevant for explaining the intention to exercise for physically active (subjective norm) and insufficiently active (attitudes) cancer patients. Health professionals should adapt their support to the special needs of insufficiently active and active cancer patients.

Factors influencing physical activity behaviors in colorectal cancer survivors

PURPOSE

To elucidate factors that impact intention (INT) to be active as well as actual physical activity (PA) behavior in colorectal cancer survivors (CRC-S) using the theory of planned behavior (TpB). Planning for PA was explored as a mediator of the INT-behavior relationship. Chemotherapy-induced neuropathy and fatigue were also explored.

DESIGN

A cross-sectional quantitative mailed survey was used.

SETTING

The study was conducted among community-dwelling adults living in Pennsylvania when diagnosed with colorectal cancer (CRC).

SUBJECTS

Subjects comprised 843 CRC-S diagnosed with CRC in Pennsylvania in 2009.

MEASURES

The survey included questions about planning for PA, TpB constructs, medical and social variables, and PA as measured by a modified Godin Leisure Time Questionnaire.

ANALYSIS

Descriptive statistics were used to characterize the sample. A mediation analysis was used to determine if planning mediated the relationship between INT and actual PA behavior. A stepwise regression was used to determine predictors of INT and PA.

RESULTS

Ninety-six CRC-S responded, with 25% meeting PA recommendations for health promotion, suggesting that CRC-S are insufficiently active. Perceived behavioral control (PBC) and social norm (SN) accounted for 43% of the variance in INT, whereas 30% of the variance in PA was explained by PBC and age. Neuropathy negatively impacted PA behavior (p = .008). Both action and coping planning partially mediated the INT-behavior relationship (β = 20.08, p = .007; β = 22.85, p = .001, respectively).

CONCLUSION

Survivors at risk for inactivity are those with low PBC, low SN, and neuropathy, and those who are older.

Response to an exercise intervention after endometrial cancer: differences between obese and non-obese survivors

OBJECTIVE

The objective of this paper is to describe baseline differences between obese and non-obese endometrial cancer survivor in anthropometrics, exercise behavior, fitness, heart rate and blood pressure, and quality of life, and to analyze whether the effect of a home-based exercise intervention on these outcomes differed for obese and non-obese participants.

METHODS

One hundred post-treatment Stage I-IIIa endometrial cancer survivors participated in a single arm 6month study in which they received a home-based exercise intervention. Cardiorespiratory fitness, anthropometrics, and exercise behavior were measured every two months, and quality of life (QOL) and psychological distress were measured at baseline and 6months.

RESULTS

Adjusting for potential confounders, at baseline obese survivors had poorer cardiorespiratory fitness (p=.002), higher systolic blood pressure (p=.018), and lower physical functioning (p<.001) and ratings of general health (p=.002), and more pain (p=.037) and somatization (.002). Significant improvements were seen in exercise behavior, resting heart rate, systolic blood pressure, and multiple QOL domains over the course of the intervention. Obese survivors had less improvement in exercise behavior and cardiorespiratory fitness than non-obese survivors, but there were no differences with regard to improvements in QOL and stress.

CONCLUSIONS

Home based exercise interventions are beneficial to endometrial cancer survivors, including those whose BMI is in the obese range. While obese survivors have lower levels of physical activity and fitness, they experienced similar activity, fitness, quality of life and mental health benefits. Exercise should be encouraged in endometrial cancer survivors, including those who are obese.

The Alberta moving beyond breast cancer (AMBER) cohort study: a prospective study of physical activity and health-related fitness in breast cancer survivors

Background

Limited research has examined the association between physical activity, health-related fitness, and disease outcomes in breast cancer survivors. Here, we present the rationale and design of the Alberta Moving Beyond Breast Cancer (AMBER) Study, a prospective cohort study designed specifically to examine the role of physical activity and health-related fitness in breast cancer survivorship from the time of diagnosis and for the balance of life. The AMBER Study will examine the role of physical activity and health-related fitness in facilitating treatment completion, alleviating treatment side effects, hastening recovery after treatments, improving long term quality of life, and reducing the risks of disease recurrence, other chronic diseases, and premature death.

Methods/Design

The AMBER Study will enroll 1500 newly diagnosed, incident, stage I-IIIc breast cancer survivors in Alberta, Canada over a 5 year period. Assessments will be made at baseline (within 90 days of surgery), 1 year, and 3 years consisting of objective and self-reported measurements of physical activity, health-related fitness, blood collection, lymphedema, patient-reported outcomes, and determinants of physical activity. A final assessment at 5 years will measure patient-reported data only. The cohort members will be followed for an additional 5 years for disease outcomes.

Discussion

The AMBER cohort will answer key questions related to physical activity and health-related fitness in breast cancer survivors including: (1) the independent and interactive associations of physical activity and health-related fitness with disease outcomes (e.g., recurrence, breast cancer-specific mortality, overall survival), treatment completion rates, symptoms and side effects (e.g., pain, lymphedema, fatigue, neuropathy), quality of life, and psychosocial functioning (e.g., anxiety, depression, self-esteem, happiness), (2) the determinants of physical activity and health-related fitness including demographic, medical, social cognitive, and environmental variables, (3) the mediators of any observed associations between physical activity, health-related fitness, and health outcomes including biological, functional, and psychosocial, and (4) the moderators of any observed associations including demographic, medical, and biological/disease factors. Taken together, these data will provide a comprehensive inquiry into the outcomes, determinants, mechanisms, and moderators of physical activity and health-related fitness in breast cancer survivors.

Correlates of physical activity in a population-based sample of kidney cancer survivors: an application of the theory of planned behavior

Background

Over half of kidney cancer survivors (KCS) are completely inactive and only a quarter are meeting physical activity (PA) guidelines. This highlights the need to identify and understand the determinants of PA in this understudied population. The purpose of this study is to determine the social cognitive correlates of PA intention and behavior in KCS using the Theory of Planned Behavior (TPB).

Methods

All 1,985 KCS diagnosed between 1996 and 2010 in Alberta, Canada were mailed a self-report survey that consisted of the Godin Leisure Time Exercise Questionnaire and standard TPB items for intention, planning, perceived behavioral control (PBC), affective and instrumental attitudes, and descriptive and injunctive norms. Standard demographic and medical variables were also collected.

Results

Completed surveys were received from 703 of 1,654 (43%) eligible KCS. The TPB was tested using structural equation modelling and demonstrated an adequate-to-good fit to the data [χ² = 256.88, p < .001; TLI = 0.97; CFI = 0.98; RMSEA = 0.06, 90% CI = 0.05-0.06].

There were significant pathways to PA from PBC (ß = 0.18, p = 0.02), planning (ß = 0.22, p < 0.01), and intention (ß = 0.31, p < 0.01); and to planning from intention (ß = 0.81, p < 0.01). In addition, there were significant model pathways to intention from instrumental attitude (ß = 0.28, p = 0.03), descriptive norm (ß = 0.09, p = 0.01), and PBC (ß = 0.52, p < 0.01). Overall, the TPB accounted for 69%, 63%, and 42% of the variance in intention, planning and PA, respectively.

Conclusion

The TPB appears to be a useful model for explaining PA in KCS. All TPB constructs except injunctive norm and affective attitude were useful for explaining intention with PBC emerging as the largest correlate. Developing PA interventions based on the TPB may be effective in promoting PA in KCS and may lead to important improvements in health.

Predictors of physical activity among rural and small town breast cancer survivors: an application of the theory of planned behaviour

The primary objective of this study was to investigate the utility of the two-component theory of planned behaviour (TPB) in understanding physical activity intentions and behaviour in rural and small town breast cancer survivors. The secondary objective was to elicit the most common behavioural, normative and control beliefs of rural and small town survivors regarding physical activity. Using a cross-sectional survey design, 524 rural and small town breast cancer survivors completed a mailed survey that assessed physical activity and TPB variables. Physical activity intention explained 12% of the variance in physical activity behaviour (p < 0.01) while the TPB constructs together explained 43% of the variance in physical activity intention (p < 0.01). Unique behavioural, normative and control beliefs were elicited from the sample. The two-component TPB framework appears to be a suitable model to initiate an understanding of physical activity determinants among rural and small town breast cancer survivors. These data can be used in the development and establishment of physical activity behaviour interventions and health promotion materials designed to facilitate physical activity behaviour among rural and small town breast cancer survivors.

The effectiveness of an exercise programme for elders with dementia in a Taiwanese day-care centre

The purpose was to examine the effectiveness of an exercise programme for elders with dementia in Taiwan aimed to maintain their activities of daily living such as feeding, dressing, grooming, washing and toileting. This was a single study group, repeated measure research design. Twenty-six dementia elders were recruited from a day-care centre located in southern Taiwan. Caregivers of the day-care centre provided all subjects an exercise programme. The exercise programme consisted of stretching and walking five times per week, and leg-weight bearing at least three times per week for 20-30 min each. The data were obtained three times (baseline, 2 months post intervention and 4 months post intervention). Results showed slight changes in the scores of one-leg-standing, 30 s chair rise, functional reach and get up and go test but were not statistically significant. Results also indicated that scores in the performance of activities of daily living were significantly higher than at baseline and at 4 months post intervention. In conclusion, this study provides information for dementia day-care centres in Taiwan about how elders with dementia can maintain physical fitness and perform activities of daily living.

Peer volunteers improve long-term maintenance of physical activity with older adults: a randomized controlled trial

BACKGROUND

Using peer volunteers as delivery agents may improve translation of evidence-based physical activity promotion programs for older adults. This study examined whether tailored support from older peer volunteers could improve initiation and long-term maintenance of physical activity behavior.

METHODS

Participants were randomized to 2 16-week, group-based programs: (1) peer-delivered, theory-based support for physical activity behavior change; or (2) an intervention typically available in community settings (basic education, gym membership, and pedometer for self-monitoring), attention-matched with health education. Moderate-to-vigorous physical activity (MVPA) was assessed via daily self-report logs at baseline, at the end of the intervention (16 weeks), and at follow-up (18 months), with accelerometry validation (RT3) in a random subsample.

RESULTS

Seven peer volunteers and 81 sedentary adults were recruited. Retention at the end of the trial was 85% and follow-up at 18 months was 61%. Using intent-to-treat analyses, at 16 weeks, both groups had similar significant improvements in MVPA. At 18 months, the group supplemented with peer support had significantly more MVPA.

CONCLUSIONS

Trained peer volunteers may enhance long-term maintenance of physical activity gains from a community-based intervention. This approach has great potential to be adapted and delivered inexpensively in community settings.

Pilot evaluation of an Iyengar yoga program for breast cancer survivors

BACKGROUND

With continual improvements in screening uptake and adjuvant cancer treatments, the number of Canadian women surviving breast cancer continues to grow. Preliminary findings suggest yoga can improve quality of life (QoL) in breast cancer survivors, but few studies have focused on Iyengar yoga (IY).

OBJECTIVE

The purpose of this pilot study was to evaluate the impact of IY on QoL and psychosocial functioning in a select sample of breast cancer survivors.

METHODS

Breast cancer survivors (N = 24) participating in IY classes completed a questionnaire measuring generic and disease-specific QoL and psychosocial functioning, before and after the 12-week classes.

RESULTS

Postprogram questionnaires were completed by 17 participants (71%) who attended an average of 78.9% of the IY sessions. Several indicators of generic QoL improved significantly, including mental health (mean change, +4.2; P = .045), vitality (mean change, +4.9; P = .033), role-emotional (mean change, +6.4; P = .010), and bodily pain (mean change, +4.4; P = .024). Other improvements in QoL and psychosocial functioning were meaningful but were not statistically significant. Findings were further substantiated by participant's evaluation of the program's benefits and motivational value.

CONCLUSION

In this pilot study of breast cancer survivors participating in IY, we found improvements in QoL and psychosocial functioning. Moreover, positive program evaluation and motivational profile provide support for the acceptability of IY with breast cancer survivors. Randomized controlled trials comparing IY to usual care and other forms of yoga in breast cancer survivors are warranted.

IMPLICATIONS FOR PRACTICE

Nurses may consider IY as a possible intervention strategy to help breast cancer survivors improve their QoL and psychosocial functioning.

Body mass index, physical activity, and health-related quality of life in cancer survivors

PURPOSE

To determine the independent and interactive associations among body mass index (BMI), physical activity (PA), and health-related quality of life (HRQoL) in breast, prostate, colorectal, bladder, uterine, and skin melanoma cancer survivors.

METHODS

A total of 3241 cancer survivors completed a national cross-sectional survey that included PA questions and the RAND-36 Health Status Inventory.

RESULTS

Compared with healthy-weight survivors, obese breast, prostate, bladder, and skin melanoma cancer survivors were significantly less likely to meet the PA guideline. Furthermore, healthy-weight and/or overweight breast, prostate, colorectal, uterine cancer, and skin melanoma survivors reported significantly better physical functioning compared with their obese counterparts, whereas overweight colorectal cancer survivors reported significantly better mental health compared with obese survivors. Finally, hierarchical linear regressions showed that none of the BMI × PA interactions was significant for the physical or mental component composite scores across the cancer types.

CONCLUSIONS

The percentage of cancer survivors meeting the American Cancer Society's PA guideline seems to vary by weight status in breast, prostate, bladder, and skin melanoma cancer survivors. In addition, BMI and PA have independent associations with HRQoL; however, the interactive association of BMI and PA on HRQoL was negligible. Clarifying the relationship between BMI and PA across different cancer types will help identify potential target groups for future PA interventions that will help ameliorate the negative side effects of cancer and improve HRQoL.

Design of the Steps to Health Study of Physical Activity in Survivors of Endometrial Cancer: Testing a Social Cognitive Theory Model

Physical activity has been shown to benefit cancer survivors' physical functioning, emotional well-being, and symptoms. Physical activity may be of particular benefit to survivors of endometrial cancer because they are more likely to be obese and sedentary than the general population, as these are risk factors for the disease, and thus experience a number of related co-morbid health problems. However, there is little research systematically studying mechanisms of physical activity adherence in cancer survivor populations. This paper describes the design of the Steps to Health study, which applies a Social Cognitive Theory-based model of endometrial cancer survivors' adoption and maintenance of exercise in the context of an intervention to increase walking or other moderate intensity cardiovascular activity. In Steps to Health we will test the influence of self-efficacy and outcome expectations on adherence to exercise recommendations, as well as studying the determinants of self-efficacy. Endometrial cancer survivors who are at least 6 months post-treatment are provided with an intervention involving print materials and telephone counseling, and complete assessments of fitness, activity, self-efficacy and outcome expectations, and determinants of self-efficacy every two months for a six month period. In addition to testing an innovative model, the Steps to Health study employs multiple assessment methods, including ecological momentary assessment, implicit tests of cognitive variables, and ambulatory monitoring of physical activity. The study results can be used to develop more effective interventions for increasing physical activity in sedentary cancer survivors by taking into account the full complement of sources of self-efficacy information and outcome expectations.

Understanding physical activity intentions among French Canadians with type 2 diabetes: an extension of Ajzen's theory of planned behaviour

BACKGROUND

Regular physical activity is considered a cornerstone for managing type 2 diabetes. However, in Canada, most individuals with type 2 diabetes do not meet national physical activity recommendations. When designing a theory-based intervention, one should first determine the key determinants of physical activity for this population. Unfortunately, there is a lack of information on this aspect among adults with type 2 diabetes. The purpose of this cross-sectional study is to fill this gap using an extended version of Ajzen's Theory of Planned Behavior (TPB) as reference.

METHODS

A total of 501 individuals with type 2 diabetes residing in the Province of Quebec (Canada) completed the study. Questionnaires were sent and returned by mail.

RESULTS

Multiple hierarchical regression analyses indicated that TPB variables explained 60% of the variance in intention. The addition of other psychosocial variables in the model added 7% of the explained variance. The final model included perceived behavioral control (beta = .38, p < .0001), moral norm (beta = .29, p < .0001), and attitude (beta = .14, p < .01).

CONCLUSION

The findings suggest that interventions aimed at individuals with type 2 diabetes should ensure that people have the necessary resources to overcome potential obstacles to behavioral performance. Interventions should also favor the development of feelings of personal responsibility to exercise and promote the advantages of exercising for individuals with type 2 diabetes.