Psychosocial factors, health behaviors and risk of cancer incidence: Testing interaction and effect modification in an individual participant data meta-analysis

Depression, anxiety and other psychosocial factors are hypothesized to be involved in cancer development. We examined whether psychosocial factors interact with or modify the effects of health behaviors, such as smoking and alcohol use, in relation to cancer incidence. Two-stage individual participant data meta-analyses were performed based on 22 cohorts of the PSYchosocial factors and CAncer (PSY-CA) study. We examined nine psychosocial factors (depression diagnosis, depression symptoms, anxiety diagnosis, anxiety symptoms, perceived social support, loss events, general distress, neuroticism, relationship status), seven health behaviors/behavior-related factors (smoking, alcohol use, physical activity, body mass index, sedentary behavior, sleep quality, sleep duration) and seven cancer outcomes (overall cancer, smoking-related, alcohol-related, breast, lung, prostate, colorectal). Effects of the psychosocial factor, health behavior and their product term on cancer incidence were estimated using Cox regression. We pooled cohort-specific estimates using multivariate random-effects meta-analyses. Additive and multiplicative interaction/effect modification was examined. This study involved 437,827 participants, 36,961 incident cancer diagnoses, and 4,749,481 person years of follow-up. Out of 744 combinations of psychosocial factors, health behaviors, and cancer outcomes, we found no evidence of interaction. Effect modification was found for some combinations, but there were no clear patterns for any particular factors or outcomes involved. In this first large study to systematically examine potential interaction and effect modification, we found no evidence for psychosocial factors to interact with or modify health behaviors in relation to cancer incidence. The behavioral risk profile for cancer incidence is similar in people with and without psychosocial stress.

The mediating role of health behaviors in the association between depression, anxiety and cancer incidence: an individual participant data meta-analysis

BACKGROUND

Although behavioral mechanisms in the association among depression, anxiety, and cancer are plausible, few studies have empirically studied mediation by health behaviors. We aimed to examine the mediating role of several health behaviors in the associations among depression, anxiety, and the incidence of various cancer types (overall, breast, prostate, lung, colorectal, smoking-related, and alcohol-related cancers).

METHODS

Two-stage individual participant data meta-analyses were performed based on 18 cohorts within the Psychosocial Factors and Cancer Incidence consortium that had a measure of depression or anxiety (N = 319 613, cancer incidence = 25 803). Health behaviors included smoking, physical inactivity, alcohol use, body mass index (BMI), sedentary behavior, and sleep duration and quality. In stage one, path-specific regression estimates were obtained in each cohort. In stage two, cohort-specific estimates were pooled using random-effects multivariate meta-analysis, and natural indirect effects (i.e. mediating effects) were calculated as hazard ratios (HRs).

RESULTS

Smoking (HRs range 1.04-1.10) and physical inactivity (HRs range 1.01-1.02) significantly mediated the associations among depression, anxiety, and lung cancer. Smoking was also a mediator for smoking-related cancers (HRs range 1.03-1.06). There was mediation by health behaviors, especially smoking, physical inactivity, alcohol use, and a higher BMI, in the associations among depression, anxiety, and overall cancer or other types of cancer, but effects were small (HRs generally below 1.01).

CONCLUSIONS

Smoking constitutes a mediating pathway linking depression and anxiety to lung cancer and smoking-related cancers. Our findings underline the importance of smoking cessation interventions for persons with depression or anxiety.

Depression, anxiety, and the risk of cancer: An individual participant data meta-analysis

BACKGROUND

Depression and anxiety have long been hypothesized to be related to an increased cancer risk. Despite the great amount of research that has been conducted, findings are inconclusive. To provide a stronger basis for addressing the associations between depression, anxiety, and the incidence of various cancer types (overall, breast, lung, prostate, colorectal, alcohol-related, and smoking-related cancers), individual participant data (IPD) meta-analyses were performed within the Psychosocial Factors and Cancer Incidence (PSY-CA) consortium.

METHODS

The PSY-CA consortium includes data from 18 cohorts with measures of depression or anxiety (up to N = 319,613; cancer incidences, 25,803; person-years of follow-up, 3,254,714). Both symptoms and a diagnosis of depression and anxiety were examined as predictors of future cancer risk. Two-stage IPD meta-analyses were run, first by using Cox regression models in each cohort (stage 1), and then by aggregating the results in random-effects meta-analyses (stage 2).

RESULTS

No associations were found between depression or anxiety and overall, breast, prostate, colorectal, and alcohol-related cancers. Depression and anxiety (symptoms and diagnoses) were associated with the incidence of lung cancer and smoking-related cancers (hazard ratios [HRs], 1.06-1.60). However, these associations were substantially attenuated when additionally adjusting for known risk factors including smoking, alcohol use, and body mass index (HRs, 1.04-1.23).

CONCLUSIONS

Depression and anxiety are not related to increased risk for most cancer outcomes, except for lung and smoking-related cancers. This study shows that key covariates are likely to explain the relationship between depression, anxiety, and lung and smoking-related cancers. PREREGISTRATION NUMBER: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=157677.

Exercise Programming Modelling a Standard of Care Approach Improves Physical Health and Patient-Reported Outcomes in Individuals Living with Breast Cancer: A Pilot Study

Controlled study designs widely report that exercise improves the health of individuals living with breast cancer. Still, many individuals living with breast cancer are not active enough to experience the benefits of exercise. The Activating Cancer Communities through an Exercise Strategy for Survivors study was developed to reach more individuals living with cancer. This report describes the effects of a 12-week individualized exercise program that models a standard-of-care approach on body composition, physical fitness, and patient-reported outcomes in individuals living with breast cancer. Individuals living with breast cancer were recruited for the study and completed an exercise program twice weekly overseen by a Clinical Exercise Physiologist. A total of 43 participants completed the exercise intervention, and 36 withdrew from the study. All participants had significantly improved aerobic fitness, waist circumference, hip circumference, lower body endurance, physical activity behaviour, health-related quality of life, emotional status, and fatigue levels after completing the program. Flexibility, balance, and sleep scores did not change. The results from the 12-week individualized exercise program largely align with the results from more controlled study designs. These results support future initiatives integrating exercise therapy into the standard of care for individuals living with breast cancer.

Use of Wearable Activity-Monitoring Technologies to Promote Physical Activity in Cancer Survivors: Challenges and Opportunities for Improved Cancer Care

The aim of this review was to explore the acceptability, opportunities, and challenges associated with wearable activity-monitoring technology to increase physical activity (PA) behavior in cancer survivors. A search of Medline, Embase, CINAHL, and SportDiscus was conducted from 1 January 2011 through 3 October 2022. The search was limited to English language, and peer-reviewed original research. Studies were included if they reported the use of an activity monitor in adults (+18 years) with a history of cancer with the intent to motivate PA behavior. Our search identified 1832 published articles, of which 28 met inclusion/exclusion criteria. Eighteen of these studies included post-treatment cancer survivors, eight were on active cancer treatment, and two were long-term cancer survivor studies. ActiGraph accelerometers were the primary technology used to monitor PA behaviors, with Fitbit as the most commonly utilized self-monitoring wearable technology. Overall, wearable activity monitors were found to be an acceptable and useful tool in improving self-awareness, motivating behavioral change, and increasing PA levels. Self-monitoring wearable activity devices have a positive impact on short-term PA behaviors in cancer survivors, but the increase in PA gradually attenuated through the maintenance phase. Further study is needed to evaluate and increase the sustainability of the use of wearable technologies to support PA in cancer survivors.

First-Year Implementation of the EXercise for Cancer to Enhance Living Well (EXCEL) Study: Building Networks to Support Rural and Remote Community Access to Exercise Oncology Resources

Barriers to exercise-oncology programs remain for those living with and beyond cancer in rural and remote communities, including geographic isolation and access to programs. The EXercise for Cancer to Enhance Living Well (EXCEL) study was designed to support exercise-oncology implementation in rural and remote communities across Canada. The purpose of this analysis was to evaluate the first-year reach, adoption, and implementation of the EXCEL study. Reach outcomes included participant characteristics, study enrolment, and referral type (self vs. healthcare-provider [HCP] referral). Adoption outcomes included the number of clinical contacts, trained qualified exercise professionals (QEPs), and QEPs delivering EXCEL exercise classes. Implementation outcomes included retention, adherence, assessment completion rates, and adverse-event reporting. A total of 290 individuals living with cancer enrolled in EXCEL in year one, with an 81.4% retention to the study intervention. Most participants self-referred to EXCEL (75.8%). EXCEL's HCP network consisted of 163 clinical contacts, and the QEP network included 45 trained QEPs, 22 of whom delivered EXCEL classes. Adherence to the exercise intervention was 78.2%, and only one adverse event (mild) was reported. Fitness assessment and patient-reported outcome completion rates were above 85% pre- and post-intervention. EXCEL has developed HCP and QEP networks supporting exercise referral and online delivery, and the intervention is meeting feasibility markers. These implementation findings will inform the continued gathering of feedback across stakeholders to ensure that best evidence informs best practices.

The Impact of Resistance Exercise on Muscle Mass in Glioblastoma in Survivors (RESIST): Protocol for a Randomized Controlled Trial

Background

Glioblastoma is the most common primary brain malignancy in adults, accounting for approximately 48% of all brain tumors. Standard treatment includes radiation and temozolomide chemotherapy. Glioblastomas are highly vascular and can cause vasogenic brain edema and mass effect, which can worsen the neurologic symptoms associated with the disease. The steroid dexamethasone (DEX) is the treatment of choice to reduce vasogenic edema and intracranial pressure associated with glioblastoma. However high-dose DEX or long-term use can result in muscle myopathy in 10%-60% of glioblastoma patients, significantly reducing functional fitness and quality of life (QOL). There is a wealth of evidence to support the use of exercise as an adjuvant therapy to improve functional ability as well as help manage treatment-related symptoms. Specifically, resistance training has been shown to increase muscle mass, strength, and functional fitness in aging adults and several cancer populations. Although studies are limited, research has shown that exercise is safe and feasible in glioblastoma populations. However, it is not clear whether resistance training can be successfully used in glioblastoma to prevent or mitigate steroid-induced muscle myopathy and associated loss of function.

Objective

The primary purpose of this study is to establish whether an individualized circuit-based program will reduce steroid-induced muscle myopathy, as indicated by maintained or improved functional fitness for patients on active treatment and receiving steroids.

Methods

This is a 2-armed, randomized controlled trial with repeated measures. We will recruit 38 adult (≥18 years) patients diagnosed with either primary or secondary glioblastoma who are scheduled to receive standard radiation and concurrent and adjuvant temozolomide chemotherapy postsurgical debulking and received any dose of DEX through the neurooncology clinic and the Nova Scotia Health Cancer Center. Patients will be randomly allocated to a standard of care waitlist control group or standard of care + circuit-based resistance training exercise group. The exercise group will receive a 12-week individualized, group and home-based exercise program. The control group will be advised to maintain an active lifestyle. The primary outcome, muscle myopathy (functional fitness), will be assessed using the Short Physical Performance Battery and hand grip strength. Secondary outcome measures will include body composition, cardiorespiratory fitness, physical activity, QOL, fatigue, and cognitive function. All measures will be assessed pre- and postintervention. Participant accrual, exercise adherence, and safety will be assessed throughout the study.

Results

This study has been funded by the Canadian Cancer Society Atlantic Cancer Research Grant and the J.D. Irving Limited–Excellence in Cancer Research Fund (grant number 707182). The protocol was approved by the Nova Scotia Health and Acadia University’s Research Ethics Boards. Enrollment is anticipated to begin in March 2022.

Conclusions

This study will inform how individualized circuit-based resistance training may improve functional independence and overall QOL of glioblastoma patients.

Trial Registration

ClinicalTrails.gov NCT05116137; https://www.clinicaltrials.gov/ct2/show/NCT05116137

International Registered Report Identifier (IRRID)

DERR1-10.2196/37709

Psychosocial factors and cancer incidence (PSY-CA): Protocol for individual participant data meta-analyses

OBJECTIVES

Psychosocial factors have been hypothesized to increase the risk of cancer. This study aims (1) to test whether psychosocial factors (depression, anxiety, recent loss events, subjective social support, relationship status, general distress, and neuroticism) are associated with the incidence of any cancer (any, breast, lung, prostate, colorectal, smoking-related, and alcohol-related); (2) to test the interaction between psychosocial factors and factors related to cancer risk (smoking, alcohol use, weight, physical activity, sedentary behavior, sleep, age, sex, education, hormone replacement therapy, and menopausal status) with regard to the incidence of cancer; and (3) to test the mediating role of health behaviors (smoking, alcohol use, weight, physical activity, sedentary behavior, and sleep) in the relationship between psychosocial factors and the incidence of cancer.

METHODS

The psychosocial factors and cancer incidence (PSY-CA) consortium was established involving experts in the field of (psycho-)oncology, methodology, and epidemiology. Using data collected in 18 cohorts (N = 617,355), a preplanned two-stage individual participant data (IPD) meta-analysis is proposed. Standardized analyses will be conducted on harmonized datasets for each cohort (stage 1), and meta-analyses will be performed on the risk estimates (stage 2).

CONCLUSION

PSY-CA aims to elucidate the relationship between psychosocial factors and cancer risk by addressing several shortcomings of prior meta-analyses.

The association between mental health and shift work: Findings from the Atlantic PATH study

We evaluated the relationship between mental health and shift work in the Atlantic Partnership for Tomorrow's Health (PATH) cohort study. In a matched study with 12,413 participants, including 4155 shift workers and 8258 non-shift workers, we utilized general linear models and logistic regression models to assess the differences in depression, anxiety, and self-rated health. Shift workers reported higher levels of each of the mental health-related domains compared to non-shift workers. There was a significant increased risk of depression (OR = 1.13, 95% CI, 1.00-1.27) and poor self-rated health (OR = 1.13, 95% CI, 1.14-1.55) among shift workers compared to non-shift workers. Shift workers were more likely to have increased rates of depression and poor self-rated health, as well as depressive and anxiety symptom scores compared to non-shift workers. As a result, shift workers may be at increased risk of comorbidity, poor quality of life, missed work, and early retirement.

Associations between Neighborhood Walkability, Physical Activity, and Chronic Disease in Nova Scotian Adults: An Atlantic PATH Cohort Study

Background: While neighborhood walkability has been shown to positively influence health behaviors, less is known about its impact on chronic disease. Our aim was to examine the association between walkability and self-reported physical activity in relation to chronic health conditions in an Atlantic Canadian population. Methods: Using data from the Atlantic Partnership for Tomorrow's Health, a prospective cohort study, we employed both a cross-sectional and a prospective analytical approach to investigate associations of walkability and physical activity with five prevalent chronic diseases and multimorbidity. Results: The cross-sectional data show that participants with the lowest neighborhood walkability were more likely to have reported a pre-existing history of cancer and depression and least likely to report chronic respiratory conditions. Participants with low physical activity were more likely to have a pre-existing history of diabetes, chronic respiratory disease, and multimorbidity. Follow-up analyses showed no significant associations between walkability and chronic disease incidence. Low levels of physical activity were significantly associated with diabetes, cancer and multimorbidity. Conclusions: Our data provides evidence for the health protective benefits of higher levels of physical activity, and a reduction in prevalence of some chronic diseases in more walkable communities.

Physical Activity and Cancer Care in the Atlantic Canadian Provinces: an Examination of Provider Beliefs, Practices, Resources, Barriers, and Enablers

Despite the well-established benefits of physical activity for cancer survivors, the vast majority of survivors are not sufficiently active to reap these benefits. While cancer-specific physical activity guidelines exist, it remains unclear whether there are sufficient resources to support these recommendations. The purpose of this qualitative study was to describe the available cancer-specific physical activity programs for cancer survivors in Atlantic Canada and explore barriers and enablers to program implementation. Interviews were conducted with a purposefully selected sample of oncology healthcare professionals, administrators, and cancer-specific physical activity program leaders to examine the attitudes and practices of key stakeholders with respect to physical activity and cancer-specific programming. Thirty participants, including 7 oncologists, 7 nurses, 6 allied healthcare professionals, 5 administrators, and 5 program leaders, completed an interview. Three over-arching themes emerged, including (1) knowledge, attitudes and need for physical activity; (2) implementation barriers; and (3) implementation enablers. The results of this study suggest that cancer survivors in Atlantic Canada may require additional resources and support with respect to physical activity throughout their cancer care journey.

After Childhood Cancer: a Qualitative Study of Family Physician, Parent/Guardian, and Survivor Information Needs and Perspectives on Long-Term Follow-up and Survivorship Care Plans

Despite support for the provision of a survivorship care plan (SCP) to every cancer survivor, there is a lack of understanding of the needs and preferences of key stakeholders. We examined perspectives of a novel personalized SCP for childhood cancer survivors (CCS), their family, and family physicians (FP). We conducted semi-structured telephone interviews with a purposefully selected sample of CCS, parents/guardians, and FPs. Data included responses to stakeholder cancer care information needs, concerns with or gaps in communication, the perceived role of the FP in the long-term management of CCS care, utility of the SCP, preferred format, and suggestions for improvement. A deductive content analysis was conducted. Twenty-four participants including 8 CCS, 10 parents/guardians, and 6 FPs completed an interview. Four main and several sub-categories emerged. Core categories were coded as (1) informative reference, (2) coordination of follow-up, (3) barriers to follow-up care, and (4) suggestions for improvement and future implementation. The majority of participants preferred an electronic- or web-based format. Overall, the SCP was seen as an informative and concise resource. The SCP was thought to be a valuable tool to foster communication and empower CCSs to become more fully engaged in their own cancer-related health care. FPs viewed the SCP as a useful resource to facilitate and guide the long-term management of the CCS. In addition to the treatment summary, a comprehensive follow-up timeline, personalized lifestyle information, and details on how to access additional psychosocial support were highlighted as important components.

Rural-Urban Disparities in Total Physical Activity, Body Composition, and Related Health Indicators: An Atlantic PATH Study

PURPOSE

To describe and compare the sociodemographic and lifestyle characteristics of urban and rural residents in Atlantic Canada.

METHODS

Cross-sectional analyses of baseline data from the Atlantic Partnership for Tomorrow's Health cohort were conducted. Specifically, 17,054 adults (35-69 years) who provided sociodemographic characteristics, measures of obesity, and a record of chronic disease and health behaviors were included in the analyses. Multiple linear regression and logistic regression models were used to calculate the multivariable-adjusted beta coefficients (β), odds ratios (OR), and related 95% confidence intervals (CI).

FINDINGS

After adjusting for age, sex, and province, when compared to urban participants, rural residents were significantly more likely to: be classified as very active (OR: 1.19, CI: 1.11-1.27), be obese (OR: 1.13, 1.05-1.21), to present with abdominal obesity (OR: 1.08, CI: 1.01-1.15), and have a higher body fat percentage (β: 0.40, CI: 0.12-0.68) and fat mass index (β: 0.32, CI: 0.19-0.46). Rural residents were significantly less likely to be regular or habitual drinkers (OR: 0.83, CI: 0.78-0.89). Significant differences remained after further adjustment for confounding sociodemographic, lifestyle, and health characteristics. No significant differences in smoking behavior, fruit and vegetable intake, multimorbidity, or waist circumference were found.

CONCLUSIONS

As expected, obesity prevalence was higher in rural Atlantic Canadians. In contrast to much of the existing literature, we found that rural participants were more likely to report higher levels of total physical activity and lower alcohol consumption. Findings suggest that novel obesity prevention strategies may be needed for rural populations.

Yoga for Young Adults With Noncurative Cancer: A Brief Report

Background

The practice of yoga has been shown to improve disease- and treatment-related side effects in the noncurative cancer patient.

Objective

This user experience study aimed to examine the feasibility and usefulness of a DVD-based yoga program for young adult cancer patients with a noncurative diagnosis.

Methods

Participants were asked to partake in a 7-week DVD-based yoga program and complete measures of program use and usefulness.

Results

Nine patients expressed study interest and 5 consented to participate. Four completed the full study protocol. Participants reported being satisfied with the program and described that it provided an opportunity for self-care. Improvements in functional, physical, and spiritual well-being and overall quality of life were found. Barriers included competing time demands and feeling unwell. No adverse events were reported.

Conclusion

The program was viewed as an accessible and useful activity option; however, a desire for greater social support from relatable others was highlighted.

Multimorbidity in Atlantic Canada and association with low levels of physical activity

Owing to an aging population and medical advances, the anticipated growth and prevalence of multimorbidity has been recognized as a significant challenge and priority in health care settings. Although physical activity has been shown to play a vital role in the primary and secondary prevention of chronic disease, much less is known about the relationship between physical activity and multimorbidity. The objective of the present study was to examine the relationship between physical activity levels and multimorbidity in male and female adults after adjusting for key demographic, geographical, and lifestyle factors. The study drew data from a prospective cohort in Atlantic Canada (2009-2015). The sample included 18,709 participants between the ages of 35-69. Eighteen chronic diseases were identified. Physical activity levels were estimated based on the long form of the International Physical Activity Questionnaire. Using logistic regression analysis, we found that multimorbid individuals were significantly more likely to be physically inactive (OR=1.26; 95% CI 1.10, 1.44) after adjusting for key sociodemographic and lifestyle characteristics. Additional stratified analyses suggest that the magnitude of the effect between multimorbidity and physical activity was stronger for men (OR=1.41; 95% CI 1.12, 1.79) than women (OR=1.18; CI 1.00, 1.39) and those living in rural (OR=1.43; CI 1.10, 1.85) versus urban (OR=1.20; CI 1.02, 141) areas. Given the generally low levels of physical activity across populations and a growing prevalence of multimorbidity, there is a need for a prospective study to explore causal associations between physical activity, multimorbidity, and health outcomes.

Environments Associated with Moderate-to-Vigorous Physical Activity and Sedentary Behavior of Colorectal Cancer Survivors

PURPOSE

Physical activity (PA) is an effective intervention for improving the quality of life of colorectal cancer survivors (CRC) and may reduce the risk of cancer recurrence and cancer specific and all-cause mortality. However, most CRC survivors are not sufficiently active to receive these benefits. Sedentary behavior (SB) has also been linked to morbidity and mortality risk independent of activity level, thereby presenting an additional opportunity to improve health outcomes of CRC survivors. The built environment is known to influence PA and SB; however, little is known about where CRC survivors engage in PA and SB. The objective of this exploratory study was to objectively identify locations where CRC survivors engage in PA and SB in order to inform health promoting interventions.

METHOD

Activity and location of CRC survivors (n = 31) was monitored for 1 week between January 2014 and April 2015 in Nova Scotia, Canada. Bouts of PA and SB were time-matched with GPS data to attribute bouts to specific geographic locations.

RESULTS

Participants' home environment was the main location for both time spent in PA bouts (73.7 %) and time spent in SB bouts (90.5 %).

CONCLUSION

This study is the first to objectively identify environments where CRC survivors are active and sedentary. These findings highlight the importance of considering the home environment when developing intervention strategies to increase PA and reduce SB in CRC survivors.

Ties That Bond: Youth Sport as a Vehicle for Social Identity and Positive Youth Development

An emerging area of research has focused on understanding how the group dynamics of a sport team influence positive youth development (PYD). The identities that youth form through their membership in sport teams (i.e., social identities) have been found to influence teammate behavior and team performance. Yet, minimal work exists on social identity and PYD in youth sport.

PURPOSE

The purpose of this study was to investigate the relationship between social identity and PYD in sport.

METHOD

Youth engaged in recreational sport (N = 219; M_age = 11.61 years, SD = 1.39 years) completed measures of social identity and PYD in sport. The social identity measure assessed 3 dimensions including ingroup ties (IGT; perceptions of similarity, bonding, belongingness), cognitive centrality (importance of being a team member), and ingroup affect (IGA; feelings associated with group membership). A regression analysis was performed separately for 4 PYD outcomes (personal and social skills, goal setting, initiative, negative experiences) with the 3 dimensions of social identity entered as predictors.

RESULTS

Regression analyses revealed that IGT and IGA were positively associated with personal and social skills (R² Adj. = .29). Further, IGT predicted initiative (R² Adj. = .16), whereas IGA was positively associated with goal setting (R² Adj. = .17) and negatively associated with negative experiences (R² Adj. = .08).

CONCLUSION

The findings extend previous research highlighting the benefits of social identity on teammate behavior and team performance and demonstrate how social identity may contribute to PYD through sport.

Cardiovascular disease and physical activity in adult cancer survivors: a nested, retrospective study from the Atlantic PATH cohort

PURPOSE

The study aimed to examine the relationship between cardiovascular disease (CVD) and physical activity (PA) levels in cancer survivors (CS).

METHODS

Using a nested, retrospective follow-up design, this study presents the self-reported prevalence of CVD in an Atlantic Canadian population-based cohort of 1526 CS and 6034 age-sex matched, non-cancer controls ranging from 35 to 69 years of age. Univariate and multiple logistic regression models were used to explore the association between CVD and PA.

RESULTS

Overall, CS were 30% more likely to have ever experienced a CVD event than controls (OR = 1.3; 95% CI 1-1.7, p = .07). Survivors were also significantly more likely to report having hypertension (OR = 1.60; 95% CI 1.03-1.3, p = .02) and diabetes (OR = 1.27; 95% CI 1.03-1.16, p = .02). Compared to controls, CS were significantly less likely to engage in high levels of PA. For survivors, compared to those who were least physically active, the odds of having a CVD risk factor was 35% lower for those who were moderately active (OR = 0.65; 95% CI 0.48-0.88) and 45% lower in the most highly active group (OR = 0.55; 95% CI 0.4-0.73). For controls, the odds of having a CVD risk factor was 25% lower for those in the moderately active group (OR = 0.75; 95% CI 0.64-0.88) and 30% lower for those in the high active group (OR = 0.70; 95% CI 0.6-0.81).

CONCLUSION

Low active survivors appear to be at a high risk of CVD-related comorbidity.

IMPLICATIONS FOR CANCER SURVIVORS

PA is associated with lower CVD-related comorbidity in CS, suggesting that interventions directed at increasing PA should be implemented to improve long-term health outcomes.

EXercise to prevent AnthrCycline-based Cardio-Toxicity (EXACT) in individuals with breast or hematological cancers: a feasibility study protocol

BACKGROUND

Anthracyclines (AC), widely used and effective anticancer agents, are known to induce both acute and chronic declines in cardiovascular health, ranging in severity from asymptomatic, subclinical dysfunction to substantial cardiomyopathy leading to congestive heart failure and death. There is substantial evidence that physical activity, higher levels of cardiorespiratory fitness, and exercise therapy can help prevent cardiovascular disease. Moreover, animal studies have shown that exercise performed concomitantly with AC treatment may attenuate early cardiac damage that results from AC exposure. Our primary objective is to assess the feasibility of a 12-week aerobic exercise training (AET) program in patients receiving AC-based chemotherapy.

METHODS/DESIGN

This is a prospective, single-arm (pre-post-test design), feasibility study of a supervised 12-week progressive, light-to-moderate to moderate-to-vigorous intensity AET program for patients (18-65 years) receiving AC chemotherapeutic treatment for a primary/non-recurrent breast cancer or hematological malignancy. Both feasibility (e.g., participant recruitment, program adherence, safety) and intervention outcome (e.g., biological markers of cardiotoxicity, aerobic capacity, quality of life) measures will be collected. The AET program will include two, 45-min community-based exercise sessions (treadmill or cycle) per week for a total of 12 weeks. All exercise sessions will be supervised by trained exercise specialists.

DISCUSSION

Data from the EXACT study will be evaluated to determine the need to refine patient recruitment methods and general acceptability of the AET program. Preliminary data on the effects of the AET intervention on pertinent cardiac and health outcomes will also be evaluated and used to inform future studies in terms of the most appropriate outcome measure(s) to adopt and sample size estimation.

TRIAL REGISTRATION

ClinicalTrails.gov, NCT02471053.

An Examination of Physical Activity Behaviors in a Sample of Adolescent Cancer Survivors

With a growing consensus of the importance of physical activity across a number of health outcomes, the current study investigated the impact of a cancer diagnosis on adolescent physical activity behavior. Participants (n = 97) completed a mailed, self-administered questionnaire in which they recalled their physical activity behaviors across the cancer experience. Examination of the data revealed that adolescents treated for cancer experience significant declines in physical activity that are not recovered following treatment completion. It is not clear if the sustained reduction in posttreatment physical activity is attributable to the lingering effects of cancer treatment, but the long-term implications of a reduction in physical activity may be far-reaching.

The impact of yoga on quality of life and psychological distress in caregivers for patients with cancer

PURPOSE/OBJECTIVES

To assess the effects of a six-week Vinyasa yoga (VY) intervention on caregivers' overall quality of life (QOL) and psychological distress.

DESIGN

A single-group, pre- and post-test pilot study.

SETTING

University public recreational facility.

SAMPLE

12 informal caregivers for patients with cancer.

METHODS

Caregivers participated in a six-week VY intervention and completed measures of QOL and psychological distress pre- and postintervention. Program satisfaction was measured with open-ended survey questions.

MAIN RESEARCH VARIABLES

QOL, psychological distress, and program satisfaction.

FINDINGS

Significant improvements were found in the mental component score of overall QOL and in overall psychological distress. Several subdomains of QOL and psychological distress were also improved significantly. Open-ended survey question responses revealed participants perceived physical and mental benefit from the intervention, highlighting improvements in flexibility, core and upper-body strength, balance, breathing, and energy.

CONCLUSIONS

Informal caregivers may benefit mentally and physically from participating in VY.

IMPLICATIONS FOR NURSING

Caregivers of patients with cancer characterize a group worthy of attention, research, and interventions focusing on their healthcare needs.

Contributions of After School Programs to the Development of Fundamental Movement Skills in Children

Fundamental movement skill (FMS) proficiency or the ability to perform basic skills (e.g., throwing, catching and jumping) has been linked to participation in lifelong physical activity. FMS proficiency amongst children has declined in the previous 15 years, with more children performing FMS at a low-mastery level. These declines may help explain the insufficient levels of participation in health promoting physical activity seen in today's youth. The after school time period (e.g., 3 to 6 p.m.), is increasingly considered an opportune time for physical activity interventions. To date, little research has examined the potential for after school programming to improve FMS proficiency. Participants (n=40, 6-10 years) of two existent physical activity based after school programs, a low-organized games and a sports-based program, were pre- and post-tested for FMS proficiency using the Test of Gross Motor Development-2 (TGMD-2) over an 11-week period. The sports-based program participants showed no improvement in FMS over the 11-week study (p=0.91, eta²=0.00) and the games-based program participants significantly improved their proficiency (p=0.00, eta²=0.30). No significant (p=0.13, eta² = 0.06), differences were found in change in FMS scores between the low-organized games program participants and the sport-based program participants. These results suggest that after school programs with a low-organized games-based focus may support a moderate improvement in FMS proficiency in young children. Better training of after school program leaders on how to teach FMS may be necessary to assist children in acquiring sufficient proficiency in FMS.

Comparing the Effects of a Novel and a Traditional Proprioceptive Balance Training Program on Activity Adherence and Balance Control in a Healthy University Population: A Preliminary Study

OBJECTIVE

This study explored balance performance and participant adherence to either the Wii Fit™ (Nintendo of America, Redmond, WA) or a proprioceptive BOSU(®) (Ashland, OH) ball balance program.

MATERIALS AND METHODS

Twenty university-aged participants were randomly allocated to either a Wii Fit or BOSU ball balance training program. Participants engaged in one of the two training regimens for 20 minutes, three times a week, for 4 weeks. Adherence was measured by recording attendance and time spent at each session. Motivational factors associated with adherence were assessed using the Physical Activity Enjoyment Scale. Balance was measured using a stabilometer.

RESULTS

No significant difference in participant adherence was found between the groups. Significantly higher levels of activity enjoyment were reported from participants assigned to the Wii Fit intervention, and a positive correlation was found between physical activity enjoyment and adherence. A significant main effect for time demonstrating improved balance scores for both groups was found. No significant interaction between program type and time was found.

DISCUSSION

Although both interventions led to balance improvements, Wii Fit participants reported significantly higher levels of activity enjoyment. Although these higher levels of enjoyment did not lead to a statistically significant difference between the groups with regard to the number of sessions attended, participants assigned to the Wii Fit group spent more time engaged in the balance training activities than those allocated to the BOSU group. Although this study is preliminary and has the limitations of being statistically underpowered and dissimilar from the unsupervised home-based programs often prescribed by health professionals, results suggest that exergaming-based balance training may be an important adjunct to traditional training programs.

An examination of the beliefs, attitudes and counselling practices of paediatric oncologists toward physical activity: A provincial survey

BACKGROUND

With an increasing population of childhood cancer survivors and a growing recognition of the long-term effects of diagnosis and treatment, it is imperative that modifiable risk factors for long-term health and disease comorbidity be identified and addressed. Physical activity is one therapy that is gaining credibility in enhancing quality of life and reducing the burden of disease.

OBJECTIVES

To examine the beliefs, attitudes and counselling practices of a group of Alberta-based paediatric oncologists.

METHODS

All Alberta-based physicians with a known specialty in paediatric oncology were approached and asked to complete a onetime, mail-out survey.

RESULTS

All responding physicians regarded both personal exercise and physical activity for childhood cancer survivors as moderately to extremely important. Importantly, one-half of the respondents believed that there is no adverse risk associated with physical activity in this survivor group. While the bulk of physicians report prescribing physical activity, few believe that their patients actually follow these recommendations.

CONCLUSIONS

Responding oncologists acknowledge the importance of physical activity for all survivors; however, future research is needed to better understand how to best promote healthy active living within this group.

A theory-driven approach to encourage physical activity in pediatric cancer survivors: a pilot study

The present study examined the efficacy of a theory-based intervention designed to positively influence physical activity (PA) behavior in a group of pediatric cancer survivors. Ten survivors participated in a 16-week PA intervention that targeted the main theoretical tenets of the theory of planned behavior (TPB). Survivors were followed over a course of 1 year and completed measures of attitudes, subjective norms, perceived control, intentions for PA, and self-reported PA behavior at five different times. While the magnitude of change varied across the key theoretical constructs, it appears that the intervention had a small yet meaningful impact, particularly for overall behavioral intentions. Overall, this study provides preliminary data to suggest that the TPB may be a viable framework from which to build interventions for pediatric cancer survivors. Future research will be required to further identify and target the key elements and theoretical constructs within a behavioral intervention.

Understanding physical activity in adolescent cancer survivors: an application of the theory of planned behavior

Notwithstanding the remarkable achievements in survival, there is a growing recognition that pediatric cancer survivors are faced with a variety of chronic health problems that may be exacerbated by maladaptive health behaviors. The purpose of the present study was to examine the utility of the theory of planned behavior (TPB) in understanding adolescent survivors' motivation to engage in physical activity. A group of adolescent cancer survivors recalled their beliefs, attitudes, norms, perceptions of control, intentions and post-treatment physical activity behaviors using a self-administered, mailed questionnaire in a retrospective design. Multiple regression analyses revealed that the TPB explained 29.1% of the variance in physical activity behavior, with the significant independent correlates being intention (beta=0.31,p=0.023) and self-efficacy (beta=0.42,p=0.04). For intention, 33.7% of the variance was explained by the TPB, with affective attitude (beta=0.32,p=0.016) and instrumental attitude (beta=0.31, p=0.037) making significant unique contributions. The present study has provided some of the first data toward understanding physical activity behavior in adolescent cancer survivors. Specifically, the results suggest that interventions designed to promote physical activity in this population should focus on the development of a positive attitude as well as fostering an enhanced sense of self-efficacy.

Benefits of a physical activity intervention for men with prostate cancer

The purpose of the current study was to examine the viability of conducting a theory-based physical activity (PA) intervention on men with prostate cancer, and the impact of PA on quality of life (QOL). Participants were 31 men, average age of 67 years, with localized or metastatic prostate cancer undergoing androgen deprivation therapy (ADT). Global QOL, fatigue, and PA measures were conducted at baseline and following the 12-week intervention. An additional follow-up testing was conducted 4 months following the intervention (n = 18). Both moderate and strenuous bouts of exercise, as well as functional capacity, increased significantly from pre- to posttest. Both fatigue severity and resting heart rate decreased significantly at posttest. A trend toward improved global QOL was also noted. It was concluded that a 12-week home-based PA intervention may provide health and QOL benefits for prostate cancer patients undergoing ADT. Practitioners are encouraged to promote PA for prostate cancer survivors.

An effective group psychoeducational intervention for improving compliance with vaginal dilation: a randomized controlled trial

PURPOSE

Although vaginal dilation is often recommended to minimize or prevent vaginal scarring after pelvic radiotherapy, compliance with this recommendation has historically been very low. Therefore, effective intervention strategies are needed to enhance compliance with vaginal dilation after radiotherapy for gynecologic cancer.

METHODS AND MATERIALS

This study was a randomized controlled clinical trial of a psychoeducational intervention specifically designed to increase compliance with vaginal dilation. The information-motivation-behavioral skills model of enhancing compliance with behavioral change was the basis for the intervention design. Forty-two sexually active women, 21 to 65 years of age, diagnosed with Stages Ic-III cervical or endometrial cancer, who received pelvic radiotherapy, were randomized to either the experimental psychoeducational group or the information-only control group. Assessment via questionnaire occurred before treatment and at 6-week, 6-month, 12-month, 18-month, and 24-month follow-up. Assessment via interview also occurred at 6-month, 12-month, 18-month, and 24-month follow-up.

RESULTS

The psychoeducational intervention was successful in increasing compliance with vaginal dilation.

CONCLUSIONS

This study is the first randomized controlled study to demonstrate the effectiveness of an intervention in increasing compliance with the use of vaginal dilators.

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.