Protocol for a feasibility and early efficacy study of the Comprehensive Lifestyle Improvement Program for Prostate Cancer-2 (CLIPP2)

Background

Although androgen deprivation therapy (ADT) for prostate cancer demonstrates improved overall and disease-free survival, it is associated with adverse effects such as obesity and metabolic syndrome that increase risk of cardiometabolic disease and diabetes type 2. ADT also leads to fatigue, depression and erectile dysfunction, which reduce quality of life (QoL). Lifestyle modification has shown promise in reducing obesity, metabolic syndrome and diabetes type 2 in other disease types. However, there is a paucity of data regarding the utility of lifestyle modification in men receiving ADT for prostate cancer.

Methods

The primary aim of the Comprehensive Lifestyle Improvement Program for Prostate Cancer-2 (CLIPP2) is to test the feasibility of conducting a 24-week lifestyle modification intervention in men on ADT for prostate cancer. Additionally, it will also determine the effect of this intervention on weight loss, cardiometabolic markers (secondary aim and markers of interest: serum glucose, insulin resistance, hemoglobin A1C and lipid panel), and QoL (tertiary aim). The intervention will be delivered weekly via telephone for the first 10 weeks and bi-weekly for the remaining 14 weeks. Questionnaires and serum samples will be collected at baseline, week 12, and week 24. Anthropometric measurements will be collected at baseline, week 6, week 12, week 18 and week 24.

Results

We hypothesize that the CLIPP2 intervention will produce a 7% weight loss that will result in improved markers associated with cardiometabolic disease and type 2 diabetes in the study population.

Conclusion

Results will provide insight into the role of lifestyle modification in addressing ADT adverse effects as well as provide preliminary data to inform the development of future lifestyle interventions in this area.

Trial registration

NCT04228055 Clinicaltrials. gov.

Effects and moderators of coping skills training on symptoms of depression and anxiety in patients with cancer: Aggregate data and individual patient data meta-analyses

PURPOSE

This study evaluated the effects of coping skills training (CST) on symptoms of depression and anxiety in cancer patients, and investigated moderators of the effects.

METHODS

Overall effects and intervention-related moderators were studied in meta-analyses of pooled aggregate data from 38 randomized controlled trials (RCTs). Patient-related moderators were examined using linear mixed-effect models with interaction tests on pooled individual patient data (n = 1953) from 15 of the RCTs.

RESULTS

CST had a statistically significant but small effect on depression (g = -0.31,95% confidence interval (CI) = -0.40;-0.22) and anxiety (g = -0.32,95%CI = -0.41;-0.24) symptoms. Effects on depression symptoms were significantly larger for interventions delivered face-to-face (p = .003), led by a psychologist (p = .02) and targeted to patients with psychological distress (p = .002). Significantly larger reductions in anxiety symptoms were found in younger patients (p_interaction < 0.025), with the largest reductions in patients <50 years (β = -0.31,95%CI = -0.44;-0.18) and no significant effects in patients ≥70 years. Effects of CST on depression (β = -0.16,95%CI = -0.25;-0.07) and anxiety (β = -0.24,95%CI = -0.33;-0.14) symptoms were significant in patients who received chemotherapy but not in patients who did not (p_interaction < 0.05).

CONCLUSIONS

CST significantly reduced symptoms of depression and anxiety in cancer patients, and particularly when delivered face-to-face, provided by a psychologist, targeted to patients with psychological distress, and given to patients who were younger and received chemotherapy.

Effects and moderators of exercise on sleep in adults with cancer: Individual patient data and aggregated meta-analyses

OBJECTIVES

To evaluate the effects of exercise interventions on sleep disturbances and sleep quality in patients with mixed cancer diagnoses, and identify demographic, clinical, and intervention-related moderators of these effects.

METHODS

Individual patient data (IPD) and aggregated meta-analyses of randomized controlled trials (RCTs). Using data from the Predicting OptimaL cAncer RehabIlitation and Supportive care project, IPD of 2173 adults (mean age = 54.8) with cancer from 17 RCTs were analyzed. A complementary systematic search was conducted (until November 2018) to study the overall effects and test the representativeness of analyzed IPD. Effect sizes of exercise effects on self-reported sleep outcomes were calculated for all included RCTs. Linear mixed-effect models were used to evaluate the effects of exercise on post-intervention outcome values, adjusting for baseline values. Moderator effects were studied by testing interactions for demographic, clinical and intervention-related characteristics.

RESULTS

For all 27 eligible RCTs from the updated search, exercise interventions significantly decreased sleep disturbances in adults with cancer (g = -0.09, 95% CI [-0.16; -0.02]). No significant effect was obtained for sleep quality. RCTs included in IPD analyses constituted a representative sample of the published literature. The intervention effects on sleep disturbances were not significantly moderated by any demographic, clinical, or intervention-related factor, nor by sleep disturbances.

CONCLUSIONS

This meta-analysis provides some evidence that, compared to control conditions, exercise interventions may improve sleep disturbances, but not sleep quality, in cancer patients, although this effect is of a small magnitude. Among the investigated variables, none was found to significantly moderate the effect of exercise interventions on sleep disturbances.

Effects and moderators of psychosocial interventions on quality of life, and emotional and social function in patients with cancer: An individual patient data meta-analysis of 22 RCTs

Objective

This individual patient data (IPD) meta‐analysis aimed to evaluate the effects of psychosocial interventions (PSI) on quality of life (QoL), emotional function (EF), and social function (SF) in patients with cancer, and to study moderator effects of demographic, clinical, personal, and intervention‐related characteristics.

Methods

Relevant studies were identified via literature searches in 4 databases. We pooled IPD from 22 (n = 4217) of 61 eligible randomized controlled trials. Linear mixed‐effect model analyses were used to study intervention effects on the post‐intervention values of QoL, EF, and SF (z‐scores), adjusting for baseline values, age, and cancer type. We studied moderator effects by testing interactions with the intervention for demographic, clinical, personal, and intervention‐related characteristics, and conducted subsequent stratified analyses for significant moderator variables.Results: PSI significantly improved QoL (β = 0.14,95%CI = 0.06;0.21), EF (β = 0.13,95%CI = 0.05;0.20), and SF (β = 0.10,95%CI = 0.03;0.18). Significant differences in effects of different types of PSI were found, with largest effects of psychotherapy. The effects of coping skills training were moderated by age, treatment type, and targeted interventions. Effects of psychotherapy on EF may be moderated by cancer type, but these analyses were based on 2 randomized controlled trials with small sample sizes of some cancer types.

Conclusions

PSI significantly improved QoL, EF, and SF, with small overall effects. However, the effects differed by several demographic, clinical, personal, and intervention‐related characteristics. Our study highlights the beneficial effects of coping skills training in patients treated with chemotherapy, the importance of targeted interventions, and the need of developing interventions tailored to the specific needs of elderly patients.

Abstract P6-12-06: Effect and moderators of exercise on fatigue in patients with breast cancer: Meta-analysis of individual patient data

Background - Fatigue is one of the most common and disabling complaints in patients with breast cancer and can effectively be reduced by physical exercise, with small to moderate effect sizes. To identify heterogeneity in responses to exercise and to further personalize exercise prescriptions, moderators of exercise effects on fatigue should be investigated. However, most randomized controlled trials (RCTs) are not adequately powered for such analyses. Therefore we conducted meta-analyses using the individual patient data of several exercise RCTs. The aim is to investigate the effect and moderators of physical exercise on cancer-related fatigue in patients with breast cancer.

Methods - Within the Predicting OptimaL cAncer RehabIlitation and Supportive care (POLARIS) consortium, principal investigators of 34 exercise RCTs worldwide have shared their individual patient data. Twenty-two of these RCTs included patients with breast cancer with a total sample size of 3,061. Different questionnaires to assess level of fatigue were used, which was acknowledged by using z-scores in the analysis. A one-step individual patient data meta-analysis, using a linear mixed-effect model adjusted for baseline fatigue, with a random intercept on study (to account for study clustering) was undertaken to investigate effect of exercise on fatigue. The result, a between-group difference in z-scores, corresponds to a Cohen's d effect size. An interaction term was included in the model to assess potential moderators including demographic (age, marital status, education), clinical (body mass index, presence of distant metastasis), intervention-related (intervention timing, delivery mode and duration), and exercise-related (exercise type, frequency, intensity, duration) characteristics.

Results – Exercise significantly reduced fatigue reported by women with breast cancer (β= -0.15, 95% CI -0.21;-0.09). This effect did not differ significantly between patients with different demographic and clinical characteristics (p-valuesinteraction &gt;0.05). Also, neither timing (during or post-treatment) and duration of the intervention, nor exercise-related factors moderated intervention effects on fatigue. Supervised exercise had significantly larger effects on fatigue than unsupervised exercise (βdifference= -0.17, 95%CI -0.28;-0.05). Compared to the control group, supervised exercise significantly improved fatigue (β = -0.21, 95%CI = -0.28;-0.14), while unsupervised exercise did not (β = -0.04, 95%CI = -0.14;0.06).

Conclusion – Exercise significantly reduces fatigue in patients with breast cancer across subgroups formed on the basis of age, marital status, education level, body mass index, and presence of distant metastasis. The effect of exercise is significantly larger when performed under supervision. Hence, exercise, and preferably supervised exercise, represents a viable intervention for the prevention and treatment of fatigue among patients with breast cancer.

Citation Format: van Vulpen JK, Sweegers MG, Kalter J, Peeters PH, Courneya KS, Newton RU, Aaronson NK, Jacobsen PB, Steindorf K, Stuiver MM, Hayes S, Mesters I, Knoop H, Goedendorp M, Mutrie N, Thorsen L, Schmidt M, Sonke GS, Bohus M, James EL, Oldenburg HS, Velthuis MJ, Nollet F, Wenzel J, Wiskemann J, Galvão DA, Chinapaw MJ, Irwin ML, Griffith KA, van Weert E, Daley AJ, McConnachie A, Schulz K-H, Short CE, Plotnikoff RC, Potthoff K, van Beurden M, van Harten WH, Schmitz KH, Winters-Stone KM, Taaffe DR, van Mechelen W, Kersten M-J, Verdonck-de Leeuw IM, Brug J, Buffart LM, May AM. Effect and moderators of exercise on fatigue in patients with breast cancer: Meta-analysis of individual patient data [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-12-06.

Designing more engaging computer-tailored physical activity behaviour change interventions for breast cancer survivors: lessons from the iMove More for Life study

BACKGROUND

Participating in regular physical activity is a recommended cancer recovery strategy for breast cancer survivors. However, tailored support services are not widely available and most survivors are insufficiently active to obtain health benefits. Delivering tailored programs via the Internet offers one promising approach. However, recent evaluations of such programs suggest that major improvements are needed to ensure programs meet the needs of users and are delivered in an engaging way. Understanding participants' experiences with current programs can help to inform the next generation of systems.

PURPOSE

The purposes of this study are to explore breast cancer survivor's perspectives of and experiences using a novel computer-tailored intervention and to describe recommendations for future iterations.

METHODS

Qualitative data from a sub-sample of iMove More for Life study participants were analysed thematically to identify key themes. Participants long-term goals for participating in the program were explored by analysing open-ended data extracted from action plans completed during the intervention (n = 370). Participants negative and positive perceptions of the website and recommendations for improvement were explored using data extracted from open-ended survey items collected at the immediate intervention follow-up (n = 156).

RESULTS

The majority of participants reported multi-faceted goals, consisting of two or more outcomes they hoped to achieve within a year. While clear themes were identified (e.g. 'being satisfied with body weight'), there was considerable variability in the scope of the goal (e.g. desired weight loss ranged from 2 to 30 kg). Participants' perceptions of the website were mixed, but clear indications were provided of how intervention content and structure could be improved.

CONCLUSIONS

This study provides insight into how to better accommodate breast cancer survivors in the future and ultimately design more engaging computer-tailored interventions.

Dose–response effects of aerobic exercise on energy compensation in postmenopausal women: combined results from two randomized controlled trials

Background/objectives:

Despite the clear health benefits of exercise, exercised-induced weight loss is often less than expected. The term ‘exercise energy compensation’ is used to define the amount of weight loss below what is expected for the amount of exercise energy expenditure. We examined the dose–response effects of exercise volume on energy compensation in postmenopausal women.

Participants/methods:

Data from Alberta Physical Activity and Breast Cancer Prevention (ALPHA) and Breast Cancer and Exercise Trial in Alberta (BETA) were combined for the present analysis. The ALPHA and BETA trials were two-centred, two-armed, 12-month randomized controlled trials. The ALPHA trial included 160 participants randomized to 225 min per week of aerobic exercise, and the BETA trial randomized 200 participants to each 150 and 300 min per week of aerobic exercise. All participants were aged 50–74 years, moderately inactive (<90 min per week of exercise), had no previous cancer diagnosis and a body mass index between 22 and 40 kg m⁻². Energy compensation was based on changes in body composition (dual-energy X-ray absorptiometry scan) and estimated exercise energy expenditure from completed exercise volume. Associations between Δenergy intake, ΔVO_2peak and Δphysical activity time with energy compensation were assessed.

Results:

No differences in energy compensation were noted between interventions. However, there were large inter-individual differences in energy compensation between participants; 9.4% experienced body composition changes that were greater than expected based on exercise energy expenditure, 64% experienced some degree of energy compensation and 26.6% experienced weight gain based on exercise energy expenditure. Increases in VO_2peak were associated with reductions in energy compensation (β=−3.44 ml kg⁻¹ min⁻¹, 95% confidence interval for β=−4.71 to −2.17 ml kg⁻¹ min⁻¹; P=0.0001).

Conclusions:

Large inter-individual differences in energy compensation were noted, despite no differences between activity doses. In addition, increases in VO_2peak were associated with lower energy compensation. Future studies are needed to identify behavioral and metabolic factors that may contribute to this large inter-individual variability in energy compensation.

Effect of aerobic training on the host systemic milieu in patients with solid tumours: an exploratory correlative study

Background:

Few studies have investigated the effects of exercise on modulation of host factors in cancer patients. We investigated the efficacy of chronic aerobic training on multiple host-related effector pathways in patients with solid tumours.

Patients and Methods:

Paired peripheral blood samples were obtained from 44 patients with solid tumours receiving cytotoxic therapy and synthetic erythropoietin (usual care; n=21) or usual care plus supervised aerobic training (n=23) for 12 weeks. Samples were characterised for changes in immune, cytokine and angiogenic factors, and metabolic intermediates. Aerobic training consisted of three supervised cycle ergometry sessions per week at 60% to 100% of peak oxygen consumption (VO_2peak), 30–45 min per session, for 12 weeks following a nonlinear prescription.

Results:

The between-group delta change in cardiopulmonary function was +4.1 ml kg ⁻¹ min⁻¹, favouring aerobic training (P<0.05). Significant pre–post between-group differences for five cytokine and angiogenic factors (HGF, IL-4, macrophage inflammatory protein-1β (MIP-1β), vascular endothelial growth factor (VEGF), and TNF-α) also favour the aerobic training group (P's<0.05). These reductions occurred in conjunction with nonsignificant group differences for T lymphocytes CD4⁺, CD8⁺, and CD8⁺/CD45RA (P<0.10). For these factors, circulating concentrations generally increased from baseline to week 12 in the aerobic training group compared with decreases or no change in the usual care group. No significant changes in any metabolic intermediates were observed.

Conclusions:

Aerobic training alters host availability of select immune–inflammatory effectors in patients with solid tumours; larger confirmatory studies in more homogenous samples are warranted.

The Alberta Diabetes and Physical Activity Trial (ADAPT): a randomized trial evaluating theory-based interventions to increase physical activity in adults with type 2 diabetes

BACKGROUND

Physical activity (PA) is associated with reduced morbidity and mortality in individuals with type 2 diabetes mellitus (T2DM); however, most T2DM adults are insufficiently active.

PURPOSE

To explore the effectiveness of two innovative/theoretically based behavioral-change strategies to increase PA and reduce hemoglobin A1c (A1c) in T2DM adults.

METHODS

Participants (n = 287) were randomly assigned to a control group or an intervention group (i.e., print-based materials/pedometer group or print-based materials/pedometer plus telephone-counseling group). Changes in PA and A1c and other clinical measures were examined by Linear Mixed Model analyses over 18 months, along with moderating effects for gender and age.

RESULTS

PA and A1c levels did not significantly change in intervention groups. Step counts significantly increased in the print-based materials and pedometer plus telephone counseling group, for women.

CONCLUSIONS

No significant effects were found for PA or A1c levels for T2DM adults. The multi-component strategy including telephone counseling may have potential for women. The trial was registered on ClinicalTrials.gov identifier: NCT00221234.

Abstract P4-08-01: Effects of exercise during adjuvant chemotherapy on clinical outcomes in early stage breast cancer

Background: Observational studies suggest that physical activity following a diagnosis of breast cancer may be associated with a lower risk of recurrence and death. Some studies also suggest possible effect modification by disease stage, body mass index, and receptor status. To date, however, there are no randomized trials examining the effects of exercise on disease outcomes in any cancer patient group. Here, we report an exploratory follow-up of disease outcomes from the Supervised Trial of Aerobic versus Resistance Training (START). Patients and Methods: The START Trial was a Canadian multicenter trial that randomized 242 breast cancer patients starting adjuvant chemotherapy to either usual care (n = 82) or supervised aerobic (n = 78) or resistance (n = 82) exercise for the duration of their chemotherapy. The primary efficacy endpoint for this exploratory analysis was disease-free survival (DFS). Secondary endpoints were overall survival (OS), distant disease-free survival (DDFS), and recurrence-free interval (RFI). The two exercise arms were combined for the analysis (n = 160) and selected subgroups were explored. Results: After a median follow-up of 89 months (IQR 81 to 96), there were 25/160 (15.6%) DFS events in the exercise groups and 18/82 (22.0%) in the control group (log-rank p = 0.21). Eight-year DFS was 82.7% for the exercise groups compared with 75.6% for the control group (Hazard ratio [HR] = 0.68, 95% CI = 0.37-1.24). There were 13/160 (8.1%) deaths in the exercise groups and 11/82 (13.4%) in the control group (log-rank p = 0.21). Eight-year OS was 91.2% in the exercise groups compared with 82.7% in the control group (HR = 0.60, 95% CI = 0.27 to 1.33. There were 20/160 (12.5%) DDFS events in the exercise groups and 16/82 (19.5%) in the control group (log-rank p = 0.15). Eight-year DDFS was 86.7% in the exercise groups compared with 78.3% in the control group (HR = 0.62, 95% CI = 0.32 to 1.19). Finally, there were 20/160 (12.5%) RFI events in the exercise groups and 17/82 (20.7%) in the control group (Gray's p = 0.095). Eight-year cumulative incidence of RFI was 12.6% in the exercise groups compared with 21.6% in the control group (HR = 0.58, 95% CI = 0.30 to 1.11). Subgroup analyses for DFS and RFI suggested stronger effects for women who were overweight/obese, had stage II/III cancer, receptor positive tumors, HER2 positive tumors, received taxane-based chemotherapies, and received at least 85% of their intended chemotherapy dose-intensity. The most notable subgroup effect was for patients who received optimal chemotherapy dosing with a borderline significant effect for DFS (HR = 0.50, 95% CI = 0.25 to 1.01) and a significant effect for RFI (HR = 0.38, 95% CI = 0.18 to 0.81). Conclusions: In this exploratory follow-up of the START Trial, there was a suggestion that exercise during adjuvant chemotherapy may improve several efficacy endpoints although none achieved statistical significance. Nevertheless, the magnitude of the effects appear to be meaningful with absolute 8-year survival differences between 7% and 9% and relative rate reductions between 30% and 40%. The START Trial provides the first randomized data to suggest that adding exercise to standard chemotherapy for breast cancer may improve outcomes. A definitive phase III trial is warranted.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P4-08-01.

Feasibility and efficacy of a supervised exercise intervention in de-conditioned cancer survivors during the early survivorship phase: the PEACH trial

PURPOSE

This study aims to evaluate the feasibility and efficacy of an 8-week supervised exercise program in de-conditioned cancer survivors within 2-6 months of chemotherapy completion.

METHODS

Participants were randomly assigned to an 8-week, twice-weekly, supervised aerobic exercise training regime (n = 23) or a usual care group (n = 20). Feasibility was assessed by recruitment rate, program adherence and participant feedback. The primary outcome was aerobic fitness assessed by the Modified Bruce fitness test at baseline (0 weeks), post-intervention (8 weeks) and at 3-month follow-up. Secondary outcomes included physical activity, waist circumference, fatigue and quality of life.

RESULTS

The recruitment rate was 81 % and adherence to the supervised exercise was 78.3 %. Meaningful differences in aerobic fitness between the exercise and usual care groups at both the 8-week [mean 3.0 mL kg(-1) min(-1) (95 % CI -1.1-7.0)] and 3-month follow-up [2.1 mL kg(-1) min(-1) (-2.3-6.6)] were found, although these differences did not achieve statistical significance (p values >0.14). Self-reported physical activity increased in the exercise group (EG) compared to the usual care group at both 8-week (p = 0.01) and 3-month follow-up (p = 0.03) and significant differences in favour of the EG were found for physical well-being at both the 8-week (p = 0.03) and 3-month follow-up (p = 0.04). Improvements in fatigue (p = 0.01), total quality of life plus fatigue (p = 0.04), and a composite physical functioning score (p = 0.01) at the 3-month follow-up were also found.

CONCLUSION

The PEACH trial suggests that 8 weeks of supervised aerobic exercise training was feasible and may improve aerobic fitness, fatigue and quality of life in de-conditioned cancer survivors during the early survivorship phase.

IMPLICATIONS FOR CANCER SURVIVORS

Exercise interventions commenced in the early survivorship phase appear safe, feasible and may lead to improvements in QOL and fatigue.

Feasibility and efficacy of a supervised exercise intervention in de-conditioned cancer survivors during the early survivorship phase: the PEACH trial

PURPOSE

This study aims to evaluate the feasibility and efficacy of an 8-week supervised exercise program in de-conditioned cancer survivors within 2-6 months of chemotherapy completion.

METHODS

Participants were randomly assigned to an 8-week, twice-weekly, supervised aerobic exercise training regime (n = 23) or a usual care group (n = 20). Feasibility was assessed by recruitment rate, program adherence and participant feedback. The primary outcome was aerobic fitness assessed by the Modified Bruce fitness test at baseline (0 weeks), post-intervention (8 weeks) and at 3-month follow-up. Secondary outcomes included physical activity, waist circumference, fatigue and quality of life.

RESULTS

The recruitment rate was 81 % and adherence to the supervised exercise was 78.3 %. Meaningful differences in aerobic fitness between the exercise and usual care groups at both the 8-week [mean 3.0 mL kg(-1) min(-1) (95 % CI -1.1-7.0)] and 3-month follow-up [2.1 mL kg(-1) min(-1) (-2.3-6.6)] were found, although these differences did not achieve statistical significance (p values >0.14). Self-reported physical activity increased in the exercise group (EG) compared to the usual care group at both 8-week (p = 0.01) and 3-month follow-up (p = 0.03) and significant differences in favour of the EG were found for physical well-being at both the 8-week (p = 0.03) and 3-month follow-up (p = 0.04). Improvements in fatigue (p = 0.01), total quality of life plus fatigue (p = 0.04), and a composite physical functioning score (p = 0.01) at the 3-month follow-up were also found.

CONCLUSION

The PEACH trial suggests that 8 weeks of supervised aerobic exercise training was feasible and may improve aerobic fitness, fatigue and quality of life in de-conditioned cancer survivors during the early survivorship phase.

IMPLICATIONS FOR CANCER SURVIVORS

Exercise interventions commenced in the early survivorship phase appear safe, feasible and may lead to improvements in QOL and fatigue.

Medical, demographic and social cognitive correlates of physical activity in a population-based sample of colorectal cancer survivors

Physical activity (PA) improves quality of life in colorectal cancer survivors (CRC) and may reduce the risk of disease recurrence and early death. Few studies, however, have examined the correlates of PA in CRC survivors. Using the Alberta Cancer Registry, 2000 randomly selected CRC survivors were mailed a self-reported questionnaire assessing medical, demographic, behavioural and social cognitive variables from the theory of planned behaviour (TPB). Of the 600 survivors who responded, 33% were meeting public health PA guidelines and almost half were completely sedentary. Higher PA was reported by survivors who were younger, unmarried, better educated, wealthier, employed, non-smokers, social drinkers, not treated with radiation therapy, disease-free, in better health and less comorbidity. In multivariate path analysis, these variables were not directly associated with PA after controlling for the TPB variables. The TPB explained 34% (P < 0.001) of the variance in PA behaviour with direct associations for intention (β= 0.22; P= 0.015) and planning (β= 0.18; P= 0.001). Intention, in turn, had 62% (P < 0.001) of its variance explained by perceived behavioural control (β= 0.43; P < 0.001), affective attitude (β= 0.25; P < 0.001) and instrumental attitude (β= 0.15; P < 0.001). The TPB may be a useful framework for developing population-based interventions to increase PA in CRC survivors.

Interest and preferences for exercise counselling and programming among Norwegian cancer survivors

To be able to make suitable exercise intervention programmes for cancer survivors, we need more information about exercise preferences. The primary aim of the study was to investigate the interest and preferences for exercise among Norwegian cancer survivors. A secondary aim was to identify demographic and medical characteristics associated with interest in exercise counselling. A questionnaire was completed by 1284 cancer survivors. Overall, 76% of participants were interested or maybe interested in receiving exercise counselling at some point during their cancer experience. Logistic regression analyses indicated that the interest in exercise counselling in men was associated with younger age, presence of comorbidity and having received chemotherapy. In women, the interest was associated with younger age, higher education and change in physical activity level. The participants preferred face-to-face exercise counselling with an exercise specialist from a cancer centre, at a hospital, immediately after treatment. Most cancer survivors were interested in an exercise programme, walking as activity, at moderate intensity and they wanted to start immediately after treatment. The knowledge from this study can contribute to make suitable physical rehabilitation available to cancer patients in the future.

Adiposity changes after a 1-year aerobic exercise intervention among postmenopausal women: a randomized controlled trial

Objective:

We examined the effects of an aerobic exercise intervention on adiposity outcomes that may be involved in the association between physical activity and breast cancer risk.

Design:

This study was a two-centre, two-armed, randomized controlled trial. The 1-year-long exercise intervention included 45 min of moderate-to-vigorous aerobic exercise five times per week, with at least three of the sessions being facility based. The control group was asked not to change their activity and both groups were asked not to change their diet.

Subjects:

A total of 320 postmenopausal, sedentary, normal weight-to-obese women aged 50–74 years who were cancer-free, nondiabetic and nonhormone replacement therapy users were included in this study.

Measurements:

Anthropometric measurements of height, weight and waist and hip circumferences; dual energy X-ray absorptiometry measurements of total body fat; and computerized tomography measurements of abdominal adiposity were carried out.

Results:

Women in the exercise group exercised a mean of 3.6 days (s.d.=1.3) per week and 178.5 min (s.d.=76.1) per week. Changes in all measures of adiposity favored exercisers relative to controls (P<0.001). The mean difference between groups was: −1.8 kg for body weight; −2.0 kg for total body fat; −14.9 cm² for intra-abdominal fat area; and −24.1 cm² for subcutaneous abdominal fat area. A linear trend of greater body fat loss with increasing volume of exercise was also observed.

Conclusion:

A 1-year aerobic exercise program consistent with current public health guidelines resulted in reduced adiposity levels in previously sedentary postmenopausal women at higher risk of breast cancer.

The Colon Health and Life-Long Exercise Change trial: a randomized trial of the National Cancer Institute of Canada Clinical Trials Group

Background

Observational studies indicate that physical activity (pa) is strongly associated with improved disease outcomes in colon cancer survivors, but a randomized controlled trial is needed to determine whether the association is causal and whether new policies to promote exercise are justified.

Purpose

The co.21 Colon Health and Life-Long Exercise Change (challenge) trial undertaken by the National Cancer Institute of Canada Clinical Trials Group (ncic ctg) is designed to determine the effects of a structured pa intervention on outcomes for survivors of high-risk stage ii or iii colon cancer who have completed adjuvant therapy within the previous 2–6 months.

Methods

Trial participants (n = 962) will be stratified by centre, disease stage, body mass index, and performance status, and will be randomly assigned to a structured pa intervention or to general health education materials. The pa intervention will consist of a behavioural support program and supervised pa sessions delivered over a 3-year period, beginning with regular face-to-face sessions and tapering to less frequent face-to-face or telephone sessions. The primary endpoint is disease-free survival. Important secondary endpoints include multiple patient-reported outcomes, objective physical functioning, biologic correlative markers, and an economic analysis.

Summary

Cancer survivors and cancer care professionals are interested in the potential role of PA to improve multiple disease-related outcomes, but a randomized controlled trial is needed to provide compelling evidence to justify changes in health care policies and practice.

Exercise stage of change, barriers, expectations, values and preferences among breast cancer patients during treatment: a pilot study

With increasing evidence supporting physical activity benefits during breast cancer treatment, addressing exercise adherence with consideration of the unique exercise barriers, outcome expectations and preferences of cancer patients is needed. Our pilot study aimed to determine the following during breast cancer treatment: (1) exercise barriers, outcome expectations/values and associations with exercise stage of change and (2) exercise preferences. A cross-sectional survey was administered to 23 breast cancer patients during treatment. Participants were primarily aged 50-60 years (52%), Caucasian (91%), with stage I (30%), II (44%) or III (26%) disease. A total of 48% were receiving chemotherapy. In total, 50% were in the pre-contemplation/contemplation stage of change, with 34% in action/maintenance. Common exercise adherence barriers (i.e. lack of priority, self-discipline, procrastination and fatigue) demonstrated statistically significant negative associations with exercise. Frequent outcome expectations included improving heart/lungs, reducing disease risk, building muscle strength and losing weight. Important outcomes included improving state of mind, reducing fatigue and avoiding injury. Outcome expectations (i.e. less depression, boredom and nausea) were positively associated with exercise. The majority preferred walking (100%), moderate-intensity (61%), home-based (78%) exercise. Among breast cancer patients during treatment, exercise adherence barriers are general and disease specific. Outcome expectations are physical benefits, with the most important outcomes being psychological or avoidance of risk (i.e. injury).

Effects of presurgical exercise training on exercise capacity in operable lung cancer: A pilot study

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Background: Exercise capacity is a strong independent predictor of surgical outcome in patients with operable NSCLC and thus an established clinical tool to assess preoperative eligibility. The purpose of this study was to determine the effects of preoperative exercise training on exercise capacity in operable lung cancer. Methods: Using a single-group design, participants with suspected operable lung cancer were screened for eligibility at the time of diagnosis. Twenty-six patients were recruited and offered exercise training until surgical resection. Exercise training consisted of 5 endurance cycle ergometry sessions per week at 60 to 100% of patient’s baseline exercise capacity. Patients underwent cardiopulmonary exercise testing (CPET) including peak oxygen consumption (VO2peak), six minute walk distance (6MWD), and a pulmonary function test at baseline, immediately prior and 30 days post surgical resection. Results: The mean time from diagnosis to resection was 67 ± 27 days. During this time, 6 patients were deemed ineligible and were removed from the analysis. Of the remaining 20 patients, 18 completed exercise training and 13 performed CPET post resection. The overall adherence rate was 72% (range 0%–100%) with patients completing a mean of 30 exercise sessions (range 0–75). Intention-to-treat analysis indicated that VO2peak and 6MWD increased by 2.3 mL · kg−1 · min−1 [95% CI, 1.0 to 3.7; p = .002] and 40m [95% CI, 16 to 64; p=.003] respectively, from baseline to presurgery but decreased from pre to post resection [VO2peak, −2.7 mL · kg−1 · min−1, 95% CI, −3.9 to −1.6; p < .001; 6 MWD, −44 m, 95% CI, −94 to 6.4; p = .082]. There were no differences between baseline and postsurgical exercise capacity. Per protocol analyses indicated that patients who achieved acceptable exercise adherence (≥80% of prescribed sessions, n = 12) increased VO2peak and 6MWD by 3.2 mL · kg−1 · min−1 [95% CI, 1.1 to 5.4; p = .005] and 49 meters [95% CI, 12 to 85; p = .013], respectively. Conclusion: Preoperative exercise training is associated with improvements in exercise capacity in patients with operable NSCLC, particularly if acceptable adherence is achieved. This benefit may have important implications for surgical outcome and postsurgical recovery in this population.

No significant financial relationships to disclose.

Cardiovascular risk profile of breast cancer patients treated with anthracycline-taxane containing adjuvant chemotherapy and/or trastuzumab

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Background: With improving longevity, post-treatment cardiovascular disorders will become an increasingly important indicator of competing mortality in early-stage breast cancer. As such, we conducted a pilot study to comprehensively evaluate the CVD profile of a subset of early-stage breast cancer patients treated with adjuvant taxane-anthracycline containing chemotherapy and/or trastuzumab. Methods: Twenty-six breast cancer patients (mean 20 months post chemotherapy) who participated in Breast Cancer International Research Group 006 clinical trial and 10 healthy age-matched women were studied. We measured 14 metabolic and vascular established CVD risk factors, BMI, VO2peak and left ventricular systolic function. All assessments were performed within a 14-day period. Results: Cardiac abnormalities were suggested by LVEF <50% in 10% of patients, LVEF remained >10% below pre-treatment values in 38% while 50% presented with resting sinus tachycardia. BNP was significantly elevated in 40% and was correlated with LVEF (r = -0.72, p=<.001). For the majority of CVD risk factors, similar proportions of patients and controls (35% to 60%) were classified as ‘undesirable.’ A significantly higher proportion of patients were classified with low VO2peak (46% vs. 0%, p<0.01), being overweight/obese (72% vs. 50%, p<0.05), and having resting sinus tachycardia (50% vs. 0%, p<0.01) compared with controls. VO2peak and BMI were correlated with CV risk factors (r = -0.64 to 0.63, p<0.05; r = -0.63 to 0.67, p<0.05, respectively). Exploratory analyses revealed several differences between CVD risk factors based on chemotherapy regimen. Conclusions: Breast cancer survivors treated with adjuvant chemotherapy are at a higher risk of developing late-occurring CVD than age matched controls due to direct and indirect treatment-related toxicity.

No significant financial relationships to disclose.

Exercise preferences among a population-based sample of non-Hodgkin's lymphoma survivors

In the present study, we examined the exercise preferences of a population-based sample of non-Hodgkin's lymphoma (NHL) survivors. A secondary purpose was to explore the association between various demographic, medical, and exercise behaviour variables and elicited exercise preferences. Using a retrospective survey design, 431 NHL survivors residing in Alberta, Canada completed a mailed questionnaire designed to assess exercise preferences, past exercise behaviour, and various demographic variables. Overall, 77% of participants preferred or maybe preferred to receive exercise counselling at some point after their NHL diagnosis. An overwhelming majority indicated that they would possibly be interested (81%) and able (85%) to participate in an exercise programme designed for NHL survivors. The majority of participants (55%) listed walking as their preferred choice of exercise. Logistic regression analyses indicated that NHL survivors' exercise preferences were influenced by body mass index (BMI), exercise behaviour, and gender. Eliciting exercise preferences from the population in question yields important information for cancer care professionals designing exercise programmes for NHL survivors. Furthermore, tailoring exercise programmes to the preferences of NHL survivors may be one method to potentially enhance exercise adherence in this population both inside and outside of clinical trials.

Case-control study of lifetime total physical activity and prostate cancer risk

A population-based case-control study of physical activity and prostate cancer risk was conducted in Alberta, Canada, between 1997 and 2000. A total of 988 incident, histologically confirmed cases of stage T2 or greater prostate cancer were frequency matched to 1,063 population controls. The Lifetime Total Physical Activity Questionnaire was used to measure occupational, household, and recreational activity levels from childhood until diagnosis. Multivariable logistic regression analyses were conducted. No association for total lifetime physical activity and prostate cancer risk was found (odds ratio (OR) for > or =203 vs. <115 metabolic equivalent-hours/week/year=0.87, 95% confidence interval (CI): 0.65, 1.17). By type of activity, the risks were decreased for occupational (OR=0.90, 95% CI: 0.66, 1.22) and recreational (OR=0.80, 95% CI: 0.61, 1.05) activity but were increased for household (OR=1.36, 95% CI: 1.05, 1.76) activity when comparing the highest and lowest quartiles. For activity performed at different age periods throughout life, activity done during the first 18 years of life (OR=0.78, 95% CI: 0.59, 1.04) decreased risk. When activity was examined by intensity of activity (i.e., low, <3; moderate, 3-6; and vigorous, >6 metabolic equivalents), vigorous activity decreased prostate cancer risk (OR=0.70, 95% CI: 0.54, 0.92). This study provides inconsistent evidence for the association between physical activity and prostate cancer risk.

A randomized trial of exercise and quality of life in colorectal cancer survivors

We conducted a randomized controlled trial to determine the effects of a home-based exercise intervention on change in quality of life (QOL) in recently resected colorectal cancer survivors, most of whom were receiving adjuvant therapy. Participants were randomly assigned in a 2:1 ratio to either an exercise (n = 69) or control (n = 33) group. The exercise group was asked to perform moderate intensity exercise 3-5 times per week for 20-30 min each time. The primary outcome was change in QOL as measured by the Functional Assessment of Cancer Therapy-Colorectal (FACT-C) scale. Adherence in the exercise group was good (75.8%) but contamination in the control group was problematic (51.6%). Intention-to-treat analysis revealed no significant differences between groups for change in the FACT-C (mean difference, -1.3; 95% CI, -7.8 to 5.1; P = 0.679). In an 'on-treatment' ancillary analysis, we compared participants who decreased versus increased their cardiovascular fitness over the course of the intervention. This analysis revealed significant differences in favour of the increased fitness group for the FACT-C (mean difference, 6.5; 95% CI, 0.4-12.6; P = 0.038). These data suggest that increased cardiovascular fitness is associated with improvements in QOL in colorectal cancer survivors but better controlled trials are needed.

Predicting exercise stage transitions over two consecutive 6-month periods: a test of the theory of planned behaviour in a population-based sample

OBJECTIVES

To predict exercise stage transitions over two consecutive 6-month periods using the theory of planned behaviour (TPB). It was hypothesized that different social cognitive constructs would predict different stage transitions.

DESIGN

Prospective and longitudinal in order to predict multiple stage transitions over time. Assessments were made at baseline, 6 months and 1 year.

METHOD

Participants were a randomly selected population-based sample of 683 adults who completed two telephone interviews (baseline and 6 months) that assessed exercise stage, intention, perceived behavioural control, attitude, subjective norm, and social support, and a mailed survey (1 year) that assessed exercise stage.

RESULTS

Progression from pre-contemplation was predicted by intention, attitude and subjective norm; progression/regression from contemplation was predicted by intention, perceived behavioural control, attitude, and social support; progression/regression from preparation was predicted by intention and attitude; and regression from action/maintenance was predicted by intention, attitude and social support.

CONCLUSIONS

Different social cognitive constructs predicted different stage transitions, which indicates that exercise behaviour change may be represented by a series of stage transitions. Moreover, the TPB may be a useful model for highlighting the key social cognitive constructs that are important for exercise stage transitions.

Framework PEACE: an organizational model for examining physical exercise across the cancer experience

The primary purpose of this article is to provide a framework for organizing research on physical exercise and cancer control. A secondary purpose is to use this framework to provide an overview of the extant literature and to offer directions forr future research. The proposed framework, entitled Physical Exercise Across the Cancer Experience (PEACE), divides the cancer experience into 6 time periods: 2 prediagnosis (i.e., prescreening and screening/diagnosis) and 4 postdiagnosis (i.e., pretreatment, treatment, posttreatment, and resumption). Based on these time periods, 8 general cancer control outcomes are highlighted. Two cancer control outcomes occur prediagnosis (i.e., prevention and detection), and 6 occur postdiagnosis (i.e., buffering, coping, rehabilitation, health promotion, palliation, and survival). An overview of the physical exercise literature indicates that only I time period (i.e., prescreening) and cancer control outcome (i.e., prevention) has received significant research attention. Some time periods (i.e., treatment and resumption) and cancer control outcomes (i.e., coping and health promotion) have received modest research attention, whereas other time periods (i.e., screening/diagnosis, pretreatment, and posttreatment) and cancer control outcomes (i.e., detection, buffering, rehabilitation, palliation, and survival) have received only minimal attention. It is hoped that Framework PEACE will stimulate a more comprehensive and in-depth inquiry into the role of physical exercise in cancer control.

Validating motivational readiness for exercise behavior with adolescents

The stages of motivational readiness as conceptualized by the Transtheoretical Model have been widely used among adult samples to assess readiness for adopting exercise behavior. To date, little research has been conducted using a staging framework with adolescent samples. There is a need for validation of the staging framework prior to a substantial amount of research with this age group. The current article presents two studies assessing stage and reported exercise behavior (Study 1: n = 819; M age = 15.0 years, SD = 1.2; 51% men; Study 2: n = 184; M age = 18.6 years, SD = .5; 45% men). As hypothesized in both studies, reported exercise consistently varied as a function of stage classification; those in earlier stages of readiness reported less exercise than those in later stages. Staging algorithms showed good sensitivity to detect reported exercise; however, specificity was distinctly better with the algorithm that used a specific activity criterion and immediate intention, as opposed to irregular behavior, in defining the preparation stage. Results support the validity of the staging framework for measuring motivational readiness for exercise behavior among North American adolescents.

Exercise and the transtheoretical model: a longitudinal test of a population sample

BACKGROUND

The purpose of this study was to test the ability of the Transtheoretical Model (TTM) to predict exercise stage transition of individuals in a large, untreated-population-based, random sample of Canadian adults (18-65 years of age) over two consecutive time periods.

METHODS

Assessments of TTM's stage of exercise behavior change, self-efficacy, pros, cons, experiential processes, and behavioral processes were made at baseline (time 1), 6 months (time 2), and 1 year (time 3). Six hundred eighty-three men and women, identified through random-digit telephone dialing, completed all measures across the three time points. Within each time period (time 1-2; time 2-3) participants were categorized as having regressed (moved back at least on stage), remained (no stage change), or progressed (moved forward at least one stage). Baseline TTM constructs were analyzed for their ability to predict change transition across the two time periods.

RESULTS

Of 40 possible predictions (20 for each time period) 18 (45%) were supported.

CONCLUSIONS

Overall, the findings demonstrate partial support for the internal validation of TTM in the exercise domain. Implications of the findings are discussed and future directions for researchers, practitioners, and program planners are provided.

Effects of acute exercise on state anxiety in breast cancer survivors

PURPOSE/OBJECTIVES

To examine the effects of an acute bout of exercise on state anxiety in breast cancer survivors.

DESIGN

A two-group (high and low state anxiety) by two-time (pre- and postexercise) mixed factorial design.

SETTING

Exercise physiology lab at the University of Alberta.

SAMPLE

34 stage I or II breast cancer survivors ranging in age from 39-65 (X = 50.50; SD = 6.62).

METHODS

Participants completed the State Anxiety Inventory prior to and five minutes following an acute bout of exercise.

MAIN RESEARCH VARIABLES

State anxiety.

FINDINGS

A main effect resulted for group (p < 0.01) and time showing that state anxiety significantly decreased from pre- to postexercise (p < 0.03). Group by time interaction showed that state anxiety for the low state anxiety group did not change from pre- to postexercise (p > 0.05); however, state anxiety significantly decreased in the high state anxiety group (p < 0.03).

CONCLUSION

Acute exercise may be an effective intervention in reducing state anxiety in breast cancer survivors, especially those with high state anxiety.

IMPLICATIONS FOR NURSING PRACTICE

Oncology nurses should be aware that in addition to other traditional anxiolytic therapies (e.g., relaxation therapy) commonly prescribed, acute exercise is an effective method for reducing state anxiety in breast cancer survivors.

Influence of physical activity in different age and life periods on the risk of breast cancer

We conducted a population-based case-control study of 1,237 incident breast cancer cases and 1,241 controls in Alberta between 1995 and 1997 to examine the effect of physical activity performed at different ages and life periods on breast cancer risk. In this study, we measured all types of physical activity done throughout life with a questionnaire developed and tested specifically for this study. We found that breast cancer risk was most associated with a risk reduction for activity done later in life, particularly between menopause and the reference year, for which we observed an odds ratio of 0.70 (95% confidence interval = 0.52-0.95). We also stratified the study participants into four categories according to their patterns of physical activity performed before and after menopause. For the women who sustained physical activity throughout life vs those who were never active, we found an odds ratio of 0.58 (95% confidence interval = 0.41-0.83). This study suggests that sustained activity throughout life and particularly activity done later in life may have the most benefit in reducing breast cancer risk.

Relation between intensity of physical activity and breast cancer risk reduction

PURPOSE

To examine the influence of frequency, duration, and intensity of physical activity on risk of breast cancer and to compare breast cancer risks associated with self-reported versus assigned intensity levels of activity.

METHODS

A population-based case-control study of 1233 incident breast cancer cases and 1241 controls was conducted in Alberta between 1995 and 1997. The frequency, duration and intensity of occupational, household, and recreational activities were measured throughout lifetime using the Lifetime Total Physical Activity Questionnaire and cognitive interviewing methods. Unconditional logistic regression analyses were used to estimate odds ratios and a full assessment of confounding and effect modification was undertaken. Odds ratios for self-reported and compendium-based assigned levels of activity were compared for lifetime total activity and by type of activity.

RESULTS

Breast cancer risk reductions were comparable when self-reported and assigned intensity values were used, although the results and trends were more evident with the assigned intensity data. Moderate-intensity occupational and household activities decreased breast cancer risk, whereas recreational activity, at any intensity level, did not contribute to a breast cancer risk reduction.

CONCLUSION

This study found that moderate-intensity activities were the major contributors to the decrease in breast cancer risk found in this study and that risk reductions were more evident when the frequency and duration of activity alone were modeled. Of the three types of activity considered, the greatest risk reductions observed were for occupational and household activities.

Personality and exercise participation across the breast cancer experience

The purpose of this study was to investigate the relationship between personality and exercise participation across the breast cancer experience. Based on the Five-Factor Model and previous exercise research, it was hypothesized that high scores of extraversion (E) and conscientiousness (C), and low scores of neuroticism (N) would discriminate exercise stage during and following cancer treatment as well as changes in exercise stage across the cancer experience (i.e. from prediagnosis through treatment to posttreatment). Participants were 175 non-metastatic breast cancer survivors who completed a mailed questionnaire that assessed demographic and medical information, personality (the NEO-Five Factor Inventory), and exercise stage recalled for three time periods (prediagnosis, during treatment, and posttreatment). Multivariate analysis of variance showed differences in personality based on exercise stage both during cancer treatment and posttreatment and also for exercise pattern across the cancer experience. Univariate F-tests and post hoc analyses identified N, E, and C as the key personality dimensions. N was associated with earlier exercise stages and a maladaptive exercise pattern whereas E and C were associated with more advanced exercise stages and adaptive exercise patterns. It was concluded that personality may be an important determinant of exercise following breast cancer diagnosis.

Exercise adherence in breast cancer survivors training for a dragon boat race competition: a preliminary investigation

Recent research has applied the theory of planned behavior (TPB) to understanding exercise after a cancer diagnosis, but studies are few and have been limited by retrospective designs, self-report measures of exercise and varied results. In the present study, we extended this research by using a prospective design and an objective measure of exercise adherence. Participants were a convenience sample of 24 breast cancer survivors attending a twice weekly, 12-week training program in preparation for a dragon boat race competition. Participants completed a baseline questionnaire that assessed demographic and medical variables, past exercise, and the TPB (i.e. beliefs, subjective norm, attitude, perceived behavioral control and intention). Program attendance was monitored over a 12-week period by the class instructor. Overall, participants attended 66% of the training sessions. Multiple regression analyses indicated that: (a) intention was the sole determinant of program attendance and explained 35% of the variance; (b) the TPB constructs explained 49% of the variance in intention with subjective norm being the most important determinant; and (c) the key underlying beliefs were support from physician, spouse, and friends, and confidence in being able to attend the training class when having limited time, no one to exercise with, fatigue, and other health problems. Based on this preliminary study, it was concluded that the TPB may provide a good framework on which to base interventions designed to promote exercise in breast cancer survivors.

Case-control study of lifetime physical activity and breast cancer risk

A population-based case-control study of 1,233 incident breast cancer cases and 1,237 controls was conducted in Alberta, Canada, in 1995-1997 to examine the effect of lifetime physical activity patterns on breast cancer risk. No associations between physical activity and breast cancer were found for premenopausal women. For postmenopausal women in the highest quartile (> or =161 metabolic equivalent (MET)-hours/week per year) versus the lowest quartile (<104.8 MET-hours/week per year) of lifetime total physical activity, the adjusted odds ratio was 0.70 (95% confidence interval (CI): 0.52, 0.94). When the risks associated with each type of activity were examined for postmenopausal women, household and occupational activity conferred the largest risk reductions (odds ratio (OR) = 0.57, 95% CI: 0.41, 0.79 and OR = 0.59, 95% CI: 0.44, 0.81, respectively, for highest vs. lowest quartiles of activity), while recreational activity was not associated with any risk reductions. For postmenopausal women, the authors found stronger risk reductions for those who were also nonsmokers (OR = 0.64, 95% CI: 0.46, 0.88), non-alcohol-drinkers (OR = 0.39, 95% CI: 0.11, 0.77), or nulliparous (OR = 0.22, 95% CI: 0.07, 0.70) when they compared the highest with the lowest quartile of lifetime total physical activity. This study provides evidence that lifetime total activity reduces risk of postmenopausal breast cancer.

Exercise interventions during cancer treatment: biopsychosocial outcomes

More than 1.2 million Americans are diagnosed with cancer each year, and many receive intensive medical treatments. Currently, exercise is not considered a standard quality-of -life intervention for cancer patients. In this article, 11 studies are reviewed that have examined exercise interventions concurrent with cancer treatment. The key conclusion is that exercise improves a wide range of biopsychosocial outcomes in cancer patients, but much more reserch is needed.

Feeling state responses to acute exercise of high and low intensity

The purpose of the present study was to examine the effects of exercise intensity on feeling states following two acute bouts of exercise (i.e., 50% and 80% of age-predicted maximal heart rate reserve: HRR) in highly fit and unfit females. It was hypothesized that highly fit females would have increased positive well-being and/or reduced psychological distress post-exercise (high intensity) compared to unfit females while both groups would experience similar feeling states following moderate intensity exercise. Twelve highly fit and 12 unfit females completed 3 conditions: attention control and fitness test, and two acute bouts of exercise (30 minutes on a bicycle ergometer) at 50% and 80% age-predicted HRR. Pre- and post-exercise feeling states were measured via the Subjective Experiences Exercise Scale (McAuley & Courneya, 1994). Analyses indicated a time x condition x fitness interaction F(2,21)=6.07, p<.01 (eta2 =.37) for psychological distress. Follow-up univariate analyses revealed no change in the 50% or control conditions, however, psychological distress significantly increased for the unfit participants F(1,11)=4.68,p<.05 (eta2 =.29) while there was no change for the highly fit participants F(1,11)=2.14,p>.05 (eta2 =.16) in the 80% intensity condition. No fitness differences emerged with respect to positive well-being or fatigue. Therefore, the present study's results substantiate the need to consider fitness level in dose-response studies, particularly ones which examine negative feeling states.

Examination of the transtheoretical model and exercise in 3 populations

OBJECTIVE

To examine differences in the processes of change and self-efficacy for exercise across the stages of change in 3 populations to determine its suitability for use in diverse groups.

METHODS

Cross-sectional survey design with population as a between-subjects variable: high school students (n = 168), university undergraduate students (n = 215), and employed adults (n = 63).

RESULTS

ANOVAs revealed main effects of stage (p < .0001) and population (p < .001) in process use and self-efficacy but no population by stage interaction.

CONCLUSIONS

The consistency of patterns of the TTM variables supports its potential for effective intervention in diverse populations.

Coping with cancer: can exercise help?

A comprehensive review of the recent literature reveals that exercise has a positive effect on a broad range of quality-of-life parameters after patients are diagnosed as having cancer. The general exercise prescription is moderate-intensity exercise, 3 to 5 days per week, 20 to 30 minutes per session. Conditions that warrant prescription modification include fatigue periods during treatment, acute or chronic physical impairments that may have resulted from surgery or adjuvant therapy, and the presence of bone cancer. Research suggests that physicians who prescribe exercise improve motivation and adherence in their patients who have cancer.

Physical exercise and quality of life in cancer patients following high dose chemotherapy and autologous bone marrow transplantation

Preliminary evidence indicates that physical exercise may be an effective strategy for the rehabilitation of cancer patients following high dose chemotherapy (HDC) and bone marrow transplantation (BMT), but the focus of this research has been on physical fitness and medical outcomes. In the present study, we employed a prospective design to examine the relationship between physical exercise and various quality of life (QOL) indices in 25 BMT patients. Participants completed weekly self-administered questionnaires upon being admitted to hospital, and monitored the frequency and duration of their exercise during hospitalization. Statistical analyses indicated that exercise during hospitalization was significantly correlated with almost all QOL indices, including physical well-being, psychological well-being, depression, anxiety and days hospitalized. Moreover, only some of the correlations were attenuated after controlling for relevant demographic and medical variables. It was concluded that physical exercise may be related to QOL in BMT patients, but that experimental research is needed before any definitive conclusions can be drawn.

Leisure-time physical activity and psychosocial well-being in adolescents after cancer diagnosis

This preliminary study examined the relationship between leisure time physical activity (LTPA) and psychosocial well-being in 53 adolescents who were previously diagnosed with cancer. Participants completed a mailed, self-administered questionnaire in which they recalled their LTPA (including leisure time exercise and organized sport) at three time points (prediagnosis, treatment, and posttreatment). They also reported their current psychosocial well-being by using measures of depression and self-concept. Examination of the LTPA data revealed four main patterns across the cancer experience that were labeled maintainers (active at all three time points), temporary relapsers (active prediagnosis, inactive during treatment, active posttreatment), permanent relapsers (active prediagnosis, inactive during treatment, inactive posttreatment), and nonparticipants (inactive at all three time points). Multivariate analyses of variance indicated that self-concept differed significantly across the four organized sport patterns. Follow-up univariate analyses revealed significant differences for general self-concept, physical abilities, parental relations, same sex relations, and opposite sex relations with effect sizes ranging from medium-large to large. Post hoc tests generally showed that the maintainers exhibited superior scores on psychosocial well-being compared with the other three patterns. It was concluded that LTPA patterns across the cancer experience may be related to psychosocial well-being in adolescents after cancer diagnosis but that further research is warranted.

Physical exercise and quality of life following cancer diagnosis: a literature review

With almost 8 million Americans alive today who have been through the cancer experience, it is important to develop interventions to maintain quality of life (QOL) following cancer diagnosis. Physical exercise is an intervention that may address the broad range of QOL issues following cancer diagnosis including physical, functional, psychological, emotional, and social well-being. The purpose of the present article was to provide a comprehensive and critical review of the topic and to offer suggestions for future research. The review located 24 empirical studies published between 1980 and 1997. Eighteen of the studies were interventions (i.e. quasi-experimental or experimental) but most of these were preliminary efficacy studies that suffered from the common limitations of such designs. Overall, however, the studies have consistently demonstrated that physical exercise has a positive effect on QOL following cancer diagnosis, including physical and functional well-being (e.g. functional capacity, muscular strength, body composition, nausea, fatigue) and psychological and emotional well-being (e.g. personality functioning, mood states, self-esteem, and QOL). Besides overcoming the limitations of past research, recommendations for future research included: (a) extending the research beyond breast and early-stage cancers; (b) comparing and integrating physical exercise with other QOL interventions; (c) examining resistance exercises, the timing of the intervention, and contextual factors; (d) expanding the breadth of the QOL indicators examined; and (e) investigating the rates and determinants of recruitment and adherence to an exercise program following cancer diagnosis.

Utility of the theory of planned behavior for understanding exercise during breast cancer treatment

Preliminary evidence indicates that physical exercise may be an effective strategy for helping cancer patients cope with the negative side-effects of their treatment. The purpose of the present study was to examine the utility of the theory of planned behavior in understanding cancer patients' motivation to exercise during treatment. A total of 164 women who had been diagnosed with breast cancer within the previous 2 years participated in the study. A retrospective design was used wherein these women were asked to recall their beliefs and exercise behavior during cancer treatment using a self-administered, mailed questionnaire. Results showed that: (1) the salient beliefs of breast cancer patients concerning exercise were different from those of the healthy population; (2) intention and perceived behavioral control were significant determinants of exercise during cancer treatment; and, (3) attitude and subjective norm were significant determinants of intention. It was concluded that the theory of planned behavior may be a viable framework on which to base interventions designed to promote exercise during cancer treatment. The results of this study are preliminary, however, and more sophisticated research designs to examine this question are warranted.

Transtheoretical Model: examining adolescent exercise behavior

PURPOSE

The entire Transtheoretical Model, consisting of stages of change, processes of change, self-efficacy, and decisional balance, was tested for its applicability to understanding exercise behavior in an adolescent population.

METHODS

Students (n = 819) from five community high schools (Grades 9-12) completed self-administered questionnaires, all of which were adapted from previous literature. Stage of exercise behavior change served as the dependent variable.

RESULTS

Distribution of the sample across the stages was: precontemplation, n = 17 (2.1%); contemplation, n = 34 (4.2%); preparation, n = 235 (28.7%); action, n = 129 (15.7%); and maintenance, n = 404 (49.3%). Univariate analyses of variance (p < 0.0038) followed up with Tukey's post-hoc analyses revealed that all of the constructs differed significantly across stages. Profile analysis indicated that pros and cons intersected in the action stage using t scores; however, when analyzing raw scores, this intersection was found to be in the precontemplation stage.

DISCUSSION

Preliminary evidence was found for the applicability of the Transtheoretical Model to adolescents. The low rate of adolescents in the precontemplation and contemplation stages was not deemed a major limitation, owing to the purpose of the investigation.

The lifetime total physical activity questionnaire: development and reliability

OBJECTIVE

To develop and test the intra-rater reliability of an interview-administered questionnaire that assesses lifetime patterns of total physical activity including occupational, household, and exercise/sports activities.

METHODS

The questionnaire was developed and pretested using cognitive interviewing techniques on a sample of women with and without previous breast cancer diagnoses. A pilot study was conducted with 115 women who were interviewed twice, 6 to 8 wk apart by interviewers trained in cognitive interviewing methods. Respondents used recall calendars to record their education, occupations, life events, and physical activity patterns before the interviews. Interviewers helped respondents recall their lifetime exposures, including their occupational, household, and exercise/sports activities, using these calendars and memory-probing strategies. Activity levels were estimated as the average number of hours of activity per week over different time periods. Means and correlation coefficients were estimated and compared for the two time periods.

RESULTS

The questionnaire was found to be highly reliable. The test-retest correlations for hours per week spent in total lifetime physical activity was 0.74, for lifetime occupational activity was 0.87, for household activity was 0.77, and for exercise/sports activities was 0.72.

CONCLUSIONS

This is the first questionnaire to measure lifetime physical activity by collecting data on each type of physical activity separately over lifetime and by measuring frequency, intensity, and duration of each activity. It is also the first physical activity questionnaire to be developed, refined, and administered using cognitive-based methods employed in survey research. Respondents were able to reliably recall their lifetime physical activity patterns. This instrument can be used for any disease outcome for which physical activity may be a risk factor.