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Home-based Exercise among Cancer Survivors: Adherence and its Predictors
Abstract
Evidence of the benefits of exercise for those treated for cancer has led to exercise interventions for this population. Some have questioned whether cancer patients offered a home-based intervention adhere to the exercise prescribed.
We examined exercise adherence in a randomized controlled trial of a 12-week, home-based exercise trial for breast cancer patients. Three adherence outcomes were examined: minutes of exercise participation/week, number of steps taken during planned exercise/week, and whether the participant met her weekly exercise goal. Predictors of adherence (e.g. demographic and medical variables, Transtheoretical Model variables, history of exercise) were examined.
Findings indicate that participants significantly increased their minutes of exercise and steps taken during planned exercise from Week 1 to 12. The percentage of participants achieving exercise goals was highest in the first few weeks. Exercise self-efficacy significantly predicted each adherence outcome. Baseline PA predicted mean exercise session steps over the 12 weeks.
Adherence to a home-based exercise intervention for breast cancer patients changes over time and may be related to baseline levels of exercise self-efficacy.
... The definition of adherence differs across exercise studies 7 and makes a comparison difficult. 6,[17][18][19] In our study, around half of intervention participants fulfilled ≥2/3 of the expected training (baseline activity +2.5 h intense PA/week). This threshold was also used by others 6 and seems to a be a reasonable approach, as it takes true life into account with periods when exercising is not possible, for example, family life with children, vacations, or acute infections. ...
... Approximately one in six of controls contaminated group allocation in our trial by increasing their intense PA by >60 min/week corresponding to a mean increase from their average baseline PA hours by 62%. These adherence and contamination issues have been consistently described in comparable RCTs (42%-91% for intervention, 6,8,[17][18][19] 22%-52% for control group participants 20,21 ) suggesting that compliance issues occur in both groups. These issues may be an important reason why a substantial amount of trials aiming to increase PA end with null findings. ...
... This is in agreement with most studies that reported a high adherence in short-term, but a striking loss of adherence in long-term PA trials. 9,17 Comparably, we also lost the non-adherents and dropouts very early. Interestingly, behavioral change was established by the fourth week, from which time point it was possible to distinguish between PA adherents and non-adherents based on their diary entries. ...
Purpose
Meeting intervention requirements is crucial in behavioral trials. We examined patterns and predictors of physical activity (PA) adherence and contamination in a 1‐year individualized randomized controlled PA behavioral intervention in childhood cancer survivors (CCS).
Methods
CCS aged ≥16 at enrolment, <16 at diagnosis, and ≥5 years in remission were identified from the Swiss Childhood Cancer Registry. We asked participants randomized to the intervention group to perform an additional ≥2.5 h of intense PA/week and controls to continue as usual. Adherence to the intervention was assessed by online diary (adherent if ≥2/3 of individual PA goal reached) and contamination for the control group by pre‐ and post‐questionnaire including PA levels (contaminated if >60 min increase/week in PA). Predictors of adherence/contamination including quality of life (36‐Item Short Form Survey) were assessed by questionnaire. We used logistic (control group) and mixed logistic regression models (exercise group) to estimate predictors of study adherence and contamination.
Results
One hundred and forty‐four survivors (30.4 ± 8.7 years old, 43% females) were included. Adherence was 48% (35/73) in the intervention group, while 17% (12/71) of controls contaminated group allocation. Predictors for PA adherence were female sex (OR 2.35, p = 0.03), higher physical (OR 1.34, p = 0.01) and mental quality of life (OR 1.37, p = 0.001), and week into the intervention (OR 0.98, p < 0.001). Clear differences in PA behavior of adherent and non‐adherent participants were seen from week four. No significant predictors for contamination were found for controls.
Conclusion
Adherence to PA behavior interventions remain challenging in both groups. Further long‐term trials should consider intense motivational support within the first month, more detailed data collection for the control group, adjustments to power calculations and other study designs to minimize non‐adherence and contamination.
... Six previous studies have explored factors associated with adherence to exercise interventions among post-treatment cancer survivors [25][26][27][28][29][30], although none was among ovarian cancer survivors. In the four exercise trials with unsupervised exercise components (similar to ours), lower BMI [25], higher stage of change [25], better exercise self-efficacy [26], receiving more frequent feedback [27], less social support [30], and lower baseline VO 2max [30] were associated with better adherence to the exercise intervention. ...
... Six previous studies have explored factors associated with adherence to exercise interventions among post-treatment cancer survivors [25][26][27][28][29][30], although none was among ovarian cancer survivors. In the four exercise trials with unsupervised exercise components (similar to ours), lower BMI [25], higher stage of change [25], better exercise self-efficacy [26], receiving more frequent feedback [27], less social support [30], and lower baseline VO 2max [30] were associated with better adherence to the exercise intervention. Among the above factors, only BMI was available in our study. ...
... While this was a statistically significant variable in our analysis for exercise duration, this effect size is small, indicating that regardless of baseline physical activity level, all ovarian cancer survivors have the potential to increase their exercise level through lifestyle counseling sessions. It is also important to consider that baseline physical activity level may reflect exercise selfefficacy of the participants [35], so our result may be consistent with Pinto et al.'s finding that greater exercise selfefficacy was associated with better adherence [26]. ...
Purpose
Factors associated with improving exercise in ovarian cancer survivors remain unknown. We explored characteristics associated with exercise adherence among women treated for ovarian cancer in the Women’s Activity and Lifestyle Study in Connecticut (WALC) randomized controlled trial.
Methods
We evaluated adherence among women randomized to the WALC exercise intervention (N = 74). Women had to be exercising ≤ 90 min/week and post-treatment. The intervention included 25 telephone-based exercise counseling sessions over 6 months. Adherence was defined as 150 min/week of moderate/vigorous-intensity exercise. We evaluated factors associated with exercise adherence and duration using multivariate logistic and linear regression. The number of sessions sufficient to achieve 150 min/week was modeled with an unadjusted receiver operating characteristic (ROC) curve.
Results
Women were 57.3 ± 8.8 years old and 1.7 ± 1.0 years since diagnosis. The mean exercise time over 6 months was 166.0 ± 66.1 min/week, and 64.9% of women met the 150 min/week goal. Women attended 22.8 ± 3.6 (92%) counseling sessions. No cancer recurrence during the study (OR = 9.15, 95% CI: 1.09–44.02) and greater session attendance (OR = 1.21, 95% CI: 1.02–1.43) were related to meeting the exercise goal. Greater session attendance (P < 0.01) and higher baseline activity level (P = 0.02) were associated with greater average weekly exercise duration. The ROC curve suggested attending 18 counseling sessions was optimal to meet the exercise goal.
Conclusions
Women attending more counseling sessions or with no cancer recurrence during the study were more likely to meet the exercise goal. More research is needed to understand ideal counseling intensity for ovarian cancer survivors.
Implications for Cancer Survivors
Eighteen counseling sessions are sufficient for ovarian cancer survivors to achieve 150 min/week exercise.
... Few studies in the field of exercise interventions have analysed the factors that influence exercise adherence, contamination bias and dropout rates among patients with lung or oesophageal cancer. Most studies that have analysed exercise adherence for home-based walking have primarily focused on patients with breast, prostate or colon cancer (Nyrop et al., 2018;Pinto et al., 2009;Shang et al., 2012). Nyrop et al. (2018) found that higher baseline anxiety levels and severe chemotherapy-related symptoms were negatively correlated with the number of daily steps. ...
... Nyrop et al. (2018) found that higher baseline anxiety levels and severe chemotherapy-related symptoms were negatively correlated with the number of daily steps. On the other hand, Pinto et al. (2009) found that self-efficacy and baseline physical activity (PA) (in minutes) predicted the number of pedometer steps. However, they concluded that demographic factors (such as age, education and marital status) and disease characteristics (such as cancer stage, number of days after initial diagnosis and exercise history) did not predict exercise adherence. ...
... For example, two studies conducted RCTs investigating home-based walking as an intervention for patients with breast and oesophageal cancers. However, contamination rates and predictors of contamination were neither identified nor reported (Chang et al., 2020;Pinto et al., 2009). ...
Objectives:
In this study, we examined predictors of exercise adherence, contamination and dropout in lung and oesophageal cancer patients who participated in two randomised controlled trials.
Methods:
We used data on 188 lung and oesophageal cancer patients from two previous studies (intervention: moderate-intensity walking for 12 weeks). Baseline measurements included demographic variables, disease characteristics, Hospital Anxiety and Depression Scale and Bouchard 3-day physical activity (PA) record. We used multiple linear and logistic regressions to analyse predictors of exercise adherence in the walking group, contamination in the control group and dropout in both groups.
Results:
Pre-intervention exercise habits and baseline depression scores predicted adherence, with an explanatory power of 16.7% (p < 0.0001). Pre-intervention exercise habits (odds ratio [OR] 19.65, 95% confidence interval [CI] 2.76-139.97), baseline moderate PA (min/day) (OR 1.03, 95% CI 1.01-1.05) and baseline vigorous PA (min/day) (OR 1.09, 95% CI 1.01-1.18) predicted contamination. Baseline mild PA (10 min/day) (OR 0.94, 95% CI 0.89-0.99) predicted dropout.
Conclusions:
Pre-intervention exercise habits and baseline depression levels predicted exercise adherence in the walking group. In the control group, pre-intervention exercise habits and baseline moderate and vigorous PA predicted contamination. Baseline mild PA predicted dropout rates in both groups.
... Commencing and continuing a physically active lifestyle can be difficult at any stage of life, but particularly after undergoing cancer treatment. Low adherence rates during both home-based exercise programs and supervised exercise interventions among this population have been reported, highlighting that sustained adherence to interventions is an ongoing challenge [13,14]. ...
... A novel finding is the concern expressed by several participants regarding the transition from a supervised environment to everyday life. Previous literature has identified that maintained adherence to exercise in a cancer population is an ongoing challenge, commenting that poor self-efficacy is a predictor of poor adherence [14]. It is unlikely that physical activity behavior change will be sustained without a targeted intervention. ...
... It is unlikely that physical activity behavior change will be sustained without a targeted intervention. Other evidence-based strategies are required, such as individualized patient education and motivational interviewing [14], peer support [26], or personal coaching [27] to improve self-efficacy and facilitate motivation to maintain exercise behaviors beyond the supervised classes. A study investigating a supervised exercise intervention combined with individualized counseling sessions identified significant improvements in self-efficacy, fatigue, depressive symptoms and post-treatment anxiety [28]. ...
PurposeExercise interventions for people with cancer and cancer survivors improve physical health, fatigue, and quality of life. Despite these benefits, poor adherence to exercise is an ongoing challenge among this population. In order to improve adherence in clinical services, this study aims to explore the benefits, challenges, barriers, and facilitators experienced by people with cancer and cancer survivors who participated in a hospital-based exercise program, specifically those who completed or did not complete the full program.Methods
This study involved a qualitative approach. People with a cancer diagnosis who did complete (completers, n = 11) and did not complete (non-completers, n = 4) a 12-session exercise program at a tertiary hospital were recruited. Semi-structured interviews were conducted and thematic analysis was employed to identify emergent themes.ResultsPerceived benefits of exercise was the most prominent theme to emerge, with most participants recognizing improvements in physical, mental, and/or social well-being. Non-completers focused on treatment-related side effects, whereas completers saw an opportunity to return to a healthy lifestyle. The transition from a supervised environment to everyday life presented as the most significant barrier to exercise beyond the program among both program completers and non-completers.Conclusions
Most people with cancer identified physical, mental, and social benefits from exercising. However, people with cancer and cancer survivors had difficulty maintaining exercise participation beyond completion of a supervised hospital-based program.ImplicationsImproving exercise participation in people with cancer and cancer survivors may require supervised exercise interventions plus the implementation of strategies to manage side effects and to facilitate the transition of exercise into everyday life to enhance long-term adherence.
... (iii) test for the overall treatment effect since single analysis do not offer estimate without further work and for each outcome it creates the questions of correcting the P-values for multiple comparisons [Pinto et al. (2009) and Bland and Altman (1995)]. ...
... Analyzing the outcomes separately do not require that the outcomes be measured on the same scale because each outcome was observed separately [Pinto et al. (2009)]. The data collected for this study are the ESs (correlations) with no missing data observed. ...
... In Table 2, we present the single and the combined approach for testing the model estimation. The multivariate test provides the overall treatment while individual tests raise the issue of adjusting the p-value for multiple comparisons [Pinto et al. (2009) and Bland and Altman (1995)]. Equations (1) and (2) are used in the model for estimation and the analysis of variance (ANOVA) tests the null hypothesis that the factor model is adequate for the data as shown in Table 2. ...
We apply fixed and random effects models for meta-analysis with multiple outcomes to provide meaningful results to agricultural research studies conducted in Sub-Saharan African countries. Oftentimes, factors involved in these studies are inherently correlated because of sharing similar ecological zones. Research in agricultural, health, social and related fields commonly use univariate meta-analysis in synthesizing effect sizes, assumed independent. However, in practice, studies in these fields report more than one outcome, resulting in effect sizes. First, we apply a multiple linear regression (MLR) approach to analyse various studies with multiple outcomes within a single model. Second, we propose a more efficient approach that explains the observed heterogeneity of the results from the Sub-Saharan African countries. The proposed approach is flexible and borrows strength among the variables. In addition, it has ability to explain any heterogeneity even when all the covariates are included. The aforementioned properties make the approach suitable, compared to other statistical techniques. We compare results from the fixed and random effects of the combined model to that of single-outcome models. Using a practical example, we demonstrate the application and use of the proposed model.
... This systematic review includes eight studies, comprising 195 patients, 89 COPD [41,45,46,48,51], 39 cancer patients [51], 43 cancer survivors [55], and 24 patients with HF [53]. Mendoza et al. recruited COPD patients with both I, II, III, and IV GOLD 2011 [56] classification [49]. ...
... In three studies, PA programs were based on step counts [49,51,54]; in other studies, the goal was expressed in minutes of activity [44,50,52,53,55]. PA programs were personalized and activity levels adjusted in four studies [49,[53][54][55] [52]. ...
... In three studies, PA programs were based on step counts [49,51,54]; in other studies, the goal was expressed in minutes of activity [44,50,52,53,55]. PA programs were personalized and activity levels adjusted in four studies [49,[53][54][55] [52]. Programs lasted a minimum of 8 weeks to a maximum of 2 years. ...
Background:The beneficial role of physical activity (PA) to manage the health condition of patients with chronic diseases is well known. However, adherence to PA guidelines in this group is still low. Monitoring and user-interface technology could represent a significant tool to increase exercise adherence to those particular groups who experience difficulties in adhering to regular and substantial physical activity, and could be supportive in increasing the success of PA programs and interventions. This systematic review aimed at evaluating the effect of physical activity monitoring technology in improving adherence to a PA program in patients with chronic diseases experiencing fatigue.
Methods:This systematic review was conducted according to PRISMA guidelines. The literature search was performed in Embase, Medline, Biosis, Scopus, and SPORTDiscus. We filtered the literature according to the question:“Does monitoring technology affect adherence to physical activity and exercise programs in patients with chronic diseases perceiving fatigue?”.
Results:The search resulted in 1790 hits; finally, eight studies were included, with a total number of 205 patients.Study quality was moderate except for one study of high quality. Only three disease types emerged, COPD, HF, and cancer. PA programs were rather short (from 8 to 13 weeks) except for one 3-year-long study. Five studies employed pedometers and two an activity monitor. Three studies based their adherence on steps, the remaining studies focused on active minutes. Adherence was explicitly reported in two studies, and otherwise derived. Four studies showed high adherence levels (85% week-10, 89% week-8, 81% week-13, 105% week-13, 83% averageweek-1–12) and three low levels (56% week-12, 41% year-2, 14 year-3).
Conclusion:The small number of studies identified did not allow to establish whether the use of monitoring technology could improve adherence to PA programs in patients with chronic diseases experiencing fatigue, but the current evidence seems to suggest that this is a field warranting further study, particularly into how monitoring technology can help to engage patients to adhere to PA programs.
... The most commonly used questionnaire was the Godin Leisure Time Exercise Questionnaire (GLTEQ). A pedometer to objectify exercise was used by six studies [32][33][34][35][36][37]. Being less fatigued predict better exercise adherence. ...
... Prognostic factors of exercise adherenceThe starting point for the prognostic factors of exercise adherence were the ve WHO domains. Patientrelated factors were evaluated by 51 studies[30,31,33,36, (Table 1), social-economic factors by 39 studies[30, 31, 34, 35, 44, 45, 48, 54, 55, 57, 61, 63-65, 70, 73, 75, 77, 80, 82-94], therapy-related factors by 11 studies[37,44,51,52,57,63,87,93,95], condition-related factors by 22 studies[32,37,38,43,55,58,63,64,85,88,89,[92][93][94][95][96][97]] and health-system factors by 11 studies[44, 51, 57, 63, 64, 66, 69, 73, ...
Introduction: Patients with a chronic disease may have an increased risk of non-adherence to prescribed home-based exercise therapy. We performed a systematic review with the aim to identify and grade the quality of variables associated with (non-)adherence to home-based exercise therapy in patients with chronic diseases.
Methods: Cohort studies, cross-sectional studies and the experimental arm of randomized trials were identified using a search strategy applied to PubMed, Embase, PsychINFO and CINAHL from inception until August 1th 2022. We included studies with participants ³ 18 years with a chronic disease as an indication for home-based exercise therapy and providing data (quantitative and qualitative) on prognostic factors of (non)adherence to home-based exercise. Risk of bias was assessed using the Quality in Prognostic Studies (QUIPS) tool for observational studies, the Quality Assessment Tool for Observational Cohort and Cross- sectional studies of the National Institutes of Health (NIH) for cross-sectional studies and the Critical Appraisal Skills Program (CASP) qualitative checklist for the qualitative studies. Prognostic factors of adherence were identified and graded for quality using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework for predictor studies. We performed a meta-analysis and best evidence synthesis of the obtained information.
Results: A total of 68 studies (11 qualitative and 57 quantitative) were included. Within patient-related factors moderate- and high-quality evidence suggested that more self-efficacy, exercise history, motivation and perceived behavioral control predicted higher adherence. Within social-economic factors moderate-quality evidence suggested more education and physical health to be predictive of higher adherence and within condition-related factors moderate- and low-quality evidence suggested that less comorbidities, depression and fatigue predicted higher adherence. For the domains therapy-related and health-system factors there was not enough information to determine the quality evidence of the prognostic factors.
Conclusion: These findings might aid the development of future home-based exercise programs as well as the identification of individuals who may require extra support to benefit from prescribed home-based exercise therapy.
Registration: The protocol of this systematic review is registered in PROSPERO with registration number CRD42021277003.
... According to the social cognitive theory, these two constructs are important predictors of PA [108]. Interestingly, exercise self-efficacy did not predict long-term PA maintenance in the study sample in Study IV, which is in contrast to previous studies that found a positive association between exercise self-efficacy and PA in cancer survivors [134,201,202]. However, a recurrent criticism against the social cognitive theory is its focus on factors that predict the initiation and adoption of behaviours rather than maintenance [203]. ...
... PA initiation, adoption, short/long-term maintenance) and that factors predicting the initiation of a behaviour such as selfefficacy may not necessarily predict long-term maintenance of this behaviour [203][204][205]. This could explain the results in Study IV regarding exercise selfefficacy, as most of the above-mentioned studies have examined the association between exercise self-efficacy and PA adoption [202] or short-term maintenance (six months post-intervention) [134,201] in contrast to Study IV that focused on long-term PA maintenance. Further, in Study IV, a negative association between baseline outcome expectations of exercise and long-term PA maintenance was found, indicating that participants who expected exercise to provide more health benefits at baseline (i.e. ...
Aims:The overall aim of this thesis was to increase knowledge about the promotion of physical activity (PA) in patients during and after curative cancer treatment. Methods: Study I investigated agreement between a 7-day diary and the SenseWear Armband mini (SWA) when assessing PA and sedentary time in 65 participants with breast cancer. Agreement was examined with Bland-Altman plots. Studies II-IV used data from an RCT, where participants about to start curative treatment for breast, prostate or colorectal cancer, were randomised to six months of high or low-to-moderate intensity exercise (supervised group-based resistance- and home-based endurance training), with or without self-regulatory behaviour change techniques (BCTs; e.g. goal-setting and action planning). In study II, participants randomised to the groups with self-regulatory BCTs answered a questionnaire (n=229) and took part in semi-structured interviews (n=18) after exercise programme completion. The interviews were analysed with thematic analysis. In Study III, all participants (n=577) randomised were included. Exercise adherence during the intervention was assessed with attendance records, training logs and heart rate monitors. Regression analyses were performed to determine the effect of self-regulatory BCTs on exercise adherence. In Study IV, participants (n=301) who provided data about their PA level at 12-month follow-up were included. Regression analyses were performed to determine the effect of self-regulatory BCTs on PA maintenance and potential baseline predictors. Results: There were mean differences and wide limits of agreement between the 7-day diary and the SWA when assessing PA and sedentary time. Participants described different incentives to exercise, which fostered feelings of autonomy, competence and relatedness and helped them find motivation to exercise during cancer treatment. Social support from coaches, feedback, self-registration of exercise and scheduled sessions at a public gym were useful for exercising. There was no effect of the self-regulatory BCTs on exercise adherence during the intervention; however, a positive effect was found on PA maintenance at 12-month follow-up. Baseline predictors of PA maintenance at 12-month follow-up were health-related quality of life, exercise motivation, expectations of exercise and being a former or current smoker/snus user. Conclusions: A 7-day diary and the SWA have limited agreement and cannot be used interchangeably in patients with breast cancer. Individual incentives and a positive and supportive environment are crucial to increase exercise motivation in patients undergoing curative cancer treatment, and can be promoted using specific support (i.e. social support, feedback, self-registration of exercise and scheduled exercise sessions). The addition of self-regulatory BCTs is not likely to improve exercise adherence in patients undergoing curative treatment for breast, prostate or colorectal cancer and participating in structured, well-controlled exercise interventions, but may improve long-term PA maintenance in this population. Patients with low health-related quality of life, low exercise motivation, high expectations of exercise or with a history of tobacco use at the start of their cancer treatment may be those most in need of such support to maintain PA.
... However, in the last fifteen years, different approaches of supervision to PA and exercise have emerged in BCSs [24,26], and the term "supervision" has been used with different meanings and without proper specificity. In fact, it is sometimes intended as the clinical follow-up of self-managed or home-based exercise training programs and remote monitoring through wearable sensors or video recording [24,[27][28][29][30][31][32][33][34][35][36][37][38][39][40], while sometimes it is used to also mean the direct on-site supervision of the training sessions [24,[41][42][43][44][45]. As a consequence, studies on PA and exercise training adherence used different assessment parameters (e.g., average, median, range, number or percentage of participants completing all or a certain percentage or number of sessions; number of participants meeting PA guidelines; minutes of PA achieved per week; etc.) [24,37,39,40,42] and reported mixed results with an adherence ranging, on average, from 50% to 80% [24,36,37,39,40,42,46-49]. ...
... Our results are partially consistent with previous studies on BCSs [41][42][43][44][45]60]. In the Intervention arm, that received 8 weeks of supervised exercise, the PA levels improved compared to Control arm. ...
Given the benefits of physical activity for breast cancer survivals, this pilot study aims to assess the feasibility of the MOTIVE program at achieving and maintaining the recommended physical activity level in women diagnosed and treated breast cancer, over 16 weeks. We conduct a pilot-controlled study of 20 women diagnosed with breast cancer stage I, II or IIIa. In this study, women of Intervention Arm (n=10) received the MOTIVE program. This group was compared to women of Control Arm (n=10) who received only counselling. Health-related fitness measures, and quality of lifewere assessed at baseline (t0) and after 4 (t1), 8 (t2) and 16 (t3) weeks. Intervention Arm women reached the recommended physical activity guidelines at t1 and t2 (eff.size=1.9 [1.0-3.1]), and 90% continued to be active, autonomously, at t3 (eff.size=1.12 [0.21-2.12]). Intervention Arm participants’ arm strength, fitness levels and quality of life also improved over time. No significant improvements in outcome measures were observed in Control Arm participants. These results are encouraging and suggest that the MOTIVE program may be a viable, well tolerated and effective option to help breast cancer women reaching a stable physical activity level over time, which meets prevention-related goals.
... Model. The theoretical model on which the studies were based was the TTM, but in the case of Pinto et al. (2009), Pinto et al. (2013, and Kindred et al. (2020) it was combined with the Social Cognitive Model (Bandura, 1986). ...
... Regarding the follow-up periods after the intervention, 8 (61.5%) evaluated it: Loprinzi et al. (2012) and Daley et al. (2007) at 6 months; Pinto et al. (2005), Rabin et al. (2006), Pinto et al. (2008), and Pinto et al. (2009) at 6 and 9 months; and Pinto et al. (2013) and Kindred et al. (2020) ...
... PA has been shown to improve health-related quality of life, cancer-related fatigue, biomarkers of metabolic syndrome, cardiotoxicity, and other adverse effects caused by adjuvant treatments in breast cancer survivors [5][6][7][8][9]. Adherence to PA prescriptions (i.e., the extent to which a person's PA level corresponds to the recommendations/ prescribed PA goals) [10] in this population, however, may be difficult to achieve and can vary depending on the PA prescription itself and baseline characteristics of the participants [11][12][13][14]. Specifically, a study by Kampshoff et al. [11] assessed predictors of adherence to high (70-85% of heart rate reserve, HRR) versus low-moderate (40-55% of HRR) intensity PA prescriptions in a sample of cancer survivors. ...
... Having higher self-efficacy and lower psychosocial distress was associated with greater adherence to the higher intensity PA prescription, whereas being a non-smoker and having a higher body mass index (BMI) were associated with greater adherence to the low-moderate intensity PA prescription [15]. Other studies also identified cancer stage and treatment history, self-efficacy, BMI, baseline VO 2max , baseline PA levels, and body fat % as being common baseline predictors of adherence to PA interventions in breast cancer survivors [12][13][14]16]. ...
PurposeThe first aim is to examine adherence to a lower versus higher intensity physical activity (PA) prescription in breast cancer survivors in the Breast Cancer & Physical Activity Level (BC-PAL) Trial. The second aim is to assess associations between baseline characteristics with mean PA adherence in both intervention groups combined.Methods
Forty-five participants were randomized to a 12-week, home-based lower (300 min/week, 40-59% heart rate reserve (HRR)) or higher (150 min/week, 60-80% HRR) intensity PA intervention, or no intervention/control. Both intervention groups received Polar A360® trackers and were included in this analysis (n=30). Study outcomes assessed on a weekly basis with the Polar A360® activity tracker throughout the intervention included relative adherence to the prescribed PA interventions (% of PA prescription goal met), and the absolute amount of PA time ≥40% of HRR. Baseline predictors of adherence included demographic characteristics, cardiorespiratory fitness, habitual PA and sedentary time, quality of life measures, and motivational variables from the Theory of Planned Behavior. For our primary aim, a linear mixed model was used to assess the effects of randomization group, time (intervention weeks 1-12), and the interaction of these factors on the natural logarithm of PA adherence. For our secondary aim, the association between each baseline predictor with the natural logarithm of mean weekly PA adherence was assessed, with randomization group added as a covariate.ResultsHigher relative time within the prescribed HRR zone was noted in the lower versus higher intensity PA groups (eβ=3.12, 95% CI=1.97, 4.95). No differences in adherence across time were noted. Social support was inversely associated with relative PA time within the prescribed HRR zone (eβ=0.83, 95% CI=0.72, 0.97) and absolute PA time ≥40% of HRR (eβ= 0.82, 95% CI: 0.71, 0.93). Baseline VO2max was inversely associated with relative PA adherence (eβ=0.98, 95% CI=0.95, 0.99). No other baseline measures were associated with PA adherence.Conclusions
There were no significant changes in absolute PA time ≥40% of HRR across time or between groups. However, the lower intensity PA group averaged over 3 times the relative amount of PA within the prescribed HRR zone compared to the higher intensity PA group. Finally, lower peer support and cardiorespiratory fitness at baseline were associated with higher PA adherence.Implications for Cancer SurvivorsThe recent rise in popularity of commercially available activity trackers provides new opportunities to promote PA participation remotely, and these devices can be used to continuously and objectively measure PA levels as an indicator of intervention adherence. Future studies are needed to explore baseline predictors, facilitators, and barriers to sustained activity tracker use to promote PA behavior change and intervention adherence in cancer survivors.Trial registrationThis study was registered at www.clinicaltrials.gov (No. NCT03564899) on June 21, 2018.
... 18 Previous studies give mention to the importance of self-efficacy but do not include it as an outcome measure or a predictor of change. 11,12,19 Identifying as a physically active individual is also reported to be an indicator of physical activity in cancer survivors with those physically active before cancer diagnosis more likely to be so afterwards. 20 A 2014 systematic review found no association between the time since diagnosis, treatment received or treatment status, tumour site, cancer stage or comorbidities with physical activity adherence in cancer survivors. ...
... It was hypothesised that those with greater prediagnosis physical activity levels and with higher baseline self-efficacy would be more likely to improve physical activity after receipt of the Move More Pack. This was not the case, in contrast to the findings from Pinto et al. 19 A positive trend is reported in self-efficacy over 12 weeks with a greater increase from the Move More Pack than the standard letter recommendation; however, no differences are reported between groups. It is favourable to note that selfefficacy continued to rise between 12 weeks and 24 weeks in those receiving the Move More Pack. ...
OBJECTIVE:
The objective of this study was to evaluate the effectiveness of a print-based intervention supported by Internet tools at improving physical activity in cancer survivors compared with a standard letter recommendation. Prediagnosis physical activity and self-efficacy were hypothesised to predict physical activity improvement.
STUDY DESIGN:
Waiting list randomised control trial and cost-consequence analysis.
METHODS:
Adult cancer survivors who could become physically active without prior medical approval were randomised to receive either a print-based intervention supported by Internet tools (intervention, n = 104) or a standard letter recommendation (control, n = 103). Physical activity was assessed at 12 weeks with maintenance assessed at 24 weeks in the intervention arm. The number needed to treat was calculated, and a cost-consequence analysis completed.
RESULTS:
Participants in receipt of a print-based intervention supported by Internet tools improved their physical activity by 36.9% over 12 weeks compared with 9.1% in the control arm. Physical activity was maintained at 24 weeks in the intervention arm. A total of 6.29 cancer survivors needed to receive the intervention for one cancer survivor to improve their physical activity over a standard letter recommendation. Intervention delivery cost £8.19 per person. Prediagnosis physical activity and self-efficacy did not predict physical activity improvement.
CONCLUSION:
A print-based intervention supported by Internet tools offers a promising low-cost means to intervene to improve physical activity in cancer survivors. The study was registered with the International Standard Randomised Controlled Trials Number registry (registration number: 66418871), and ethical approval was received from the University of Surrey (reference: UEC/2017/023/FHMS).
... 8 Though telephone counseling interventions are commonly based on behavior change theories, the theory-based mechanisms of behavior change elicited in telephone counseling interventions have seldom been explored. [12][13][14][15][16][17] It appears, however, that telephone counseling interventions targeting key behavioral regulations show the greatest promise in promoting large increases in aerobic exercise behavior for cancer survivors. 12,13 Perhaps this is because behavioral regulations are needed to translate good intentions into actual exercise behavior, whereas interventions that focus primarily on helping survivors form exercise intentions may not adequately prepare participants to bridge the intention-behavior gap. ...
... Furthermore, in the few trials that explicitly measured social cognitive variables, assessments of prepost intervention changes were notably absent. 16,17 Rather, baseline self-efficacy was shown to influence adherence rates 16 or moderated the intervention effect of a telephone counseling program on exercise behavior change. 17 Therefore, to our knowledge, this investigation serves as the first study to quantify the impact of telephone counseling on motivational processes, behavioral regulations, and reflexive processes in cancer survivors, and to explore how changes in these social cognitive variables influence changes in aerobic exercise behavior. ...
Background:
Theory-based telephone counseling exercise (TCE) interventions can increase aerobic exercise behavior in cancer survivors. Few studies, however, assess intervention effects on social cognitive variables. Here, the authors examined changes in social cognitive variables from a TCE intervention based on the multi-process action control framework in hematologic cancer survivors.
Methods:
A total of 51 hematologic cancer survivors were randomized to weekly TCE (n = 26) or self-directed exercise (n = 25) for 12 weeks. Participants self-reported on demographic and cancer variables, as well as motivational, regulatory, and reflexive ratings pertaining to aerobic exercise at baseline and post-intervention.
Results:
Small-to-large between-group differences in all variables favored the TCE group. The most prominent effects were noted for differences in coping planning (adjusted mean between-group difference [MBGDadj] = 1.4, 95% confidence interval [CI], 0.7 to 2.2, d = 1.04), instrumental attitude (MBGDadj = 0.5, 95% CI, 0.1 to 1.0, d = 1.11), affective attitude (MBGDadj = 0.6, 95% CI, 0.1 to 1.2, d = 0.71), and perceived opportunity (MBGDadj = 0.4, 95% CI, -0.3 to 1.2, d = 0.50). Changes in coping planning (b = 24.98, β = 0.18, 95% CI, -0.03 to 0.56), perceived opportunity (b = 17.95, β = 0.13, 95% CI, 0.01 to 0.36), exercise identity (b = 17.43, β = 0.12, 95% CI, -0.05 to 0.41), and habit (b = 14.64, β = 0.10, 95% CI, -0.01 to 0.42) accounted for the largest mediating effects on aerobic exercise behavior.
Conclusions:
Multi-process action control framework-based TCE interventions may strengthen motivational, regulatory, and reflexive profiles that translate into increased aerobic exercise behavior in hematologic cancer survivors.
... Studies examining the determinants of exercise adherence primarily focus on patients with breast, prostate, or colon cancer [8][9][10][11][12][13], and only a few studies focus on exercise adherence among older patients with cancer [12,14,15]. Furthermore, despite strong correlations between exercise habits and lower prevalence and severity of a host of symptoms [16], studies generally focus on alleviating symptoms such as pain, fatigue, shortness of breath, and poor appetite [8,17], and relatively fewer studies assess exercise habits as an outcome. ...
Purpose
Exercise may ameliorate treatment-related symptoms, but older adults have lower exercise adherence compared to their younger counterparts due to treatment-related symptoms.
Methods
We recruited older patients with myeloid neoplasms receiving chemotherapy to a pilot study of a mobile health exercise intervention. Participants entered their steps and resistance data into the app daily, and symptom data twice a week, over an 8–12 week period. In this proof-of-concept analysis, we used a linear mixed-effects model to assess the association of symptoms from the previous week with exercise adherence in the current week among older adults with myeloid neoplasms.
Results
Mean age was 74.3 (SD = 5.0) years (N = 7). At baseline, patients on average walked 2564 daily steps (SD = 1816), which increased to 2967 (SD = 3448) post-intervention. Patients on average performed 3.5 (SD = 2.6) days of resistance training weekly, with mean duration of 21.5 min (SD = 11.6) and rated perceived exertion of 3.68 (SD = 1.78) on a 0–10 scale. Lower average steps in the current week was associated with greater interference with daily activities from pain (β = − 203.13, p = 0.05), memory (β = − 492.29, p = 0.09), numbness (β = − 353.57, p = 0.07), and sadness (β = − 403.03, p = 0.09) in the previous week. Similarly, lower average resistance minutes in the current week were associated with greater pain, sadness, and anxiety in the previous week.
Conclusions
We found that greater pain, sadness, and anxiety were associated with lower exercise adherence. Symptom monitoring and management in older adults with myeloid neoplasms receiving chemotherapy can promote exercise adherence and in turn improve symptoms.
Trial Registration
ClinicalTrials.gov Identifier: NCT04035499. Registered 7/29/2019.
... We found that although the minutes of exercise increased gradually, the adherence to the goal we set declined gradually. We expected, based on a previous study by Pinto et al. [23], that sedentary breast cancer survivors could start with 20 min and gradually increase to 150 min by week 11. It is possible that the goal we set for these participants was not appropriate for them and that we might need to reconsider our goal set for an exercise program in breast cancer patients. ...
Background
Breast cancer patients are recommended to engage in regular exercise. In developing countries, where there is a lack of facilities to offer specialized, supervised exercise for this population, regularly exercising might be a challenge. We aimed to evaluate the effectiveness of a home-based intervention in this population.
Methods
Breast cancer survivors were randomly assigned to either the home-based exercise program or the usual care group. Exercise intervention included walking, balance, and stretch exercises, along with weekly follow-up telephone calls. Quality of life (QOL) was evaluated using EORTC QLQ-C30 and EORTC QLQ-BR23 questionnaires and the predicted VO2 peak was measured using the Ebbeling submaximal treadmill test.
Results
Eighty-nine patients were enrolled in the study. Reported minutes of exercise gradually increased from 40.7 min per week in week 1 to 116.9 min per week in week 12. This intervention improved global QOL (P = 0.001), social functioning (P = 0.04), and the predicted VO2 peak (P = 0.01).
Conclusion
This home-based exercise regime effectively increased quality of life and physical activity levels.
Trial registry
Iranian Registry of Clinical Trials identifier: IRCT20140810018746N1, prospectively registered 08/01/2018, https://en.irct.ir/trial/27959.
... At-home programs may be more feasible but may inevitably result in loss of accountability and a drop in adherence. Evidence suggests that adherence to at-home exercise programs may be related to self-efficacy at baseline and may thus be a better option for patients with high self-efficacy and motivation [50]. In contrast, another study included in this review that utilized group exercise found a significant increase in the well-being of patients [35]. ...
Advanced-stage lung cancer (LC) causes significant morbidity and impacts patients’ quality of life (QoL). Exercise has been proven to be safe, feasible, and beneficial for symptom reduction and QoL improvement in many types of cancers, but research is limited in advanced-stage LC patients. This systematic review evaluates the effect of exercise interventions on the symptoms and QoL in patients with advanced-stage LC. Twelve prospective studies (744 participants) were included, evaluating different combinations of exercises and training such as aerobics, tai chi, strength, inspiratory muscle training, and relaxation. Studies found outcomes including but not limited to improved QoL, symptom burden, psychosocial health, functional status, and physical function. The results of this review support that exercise is safe and feasible with evidence supporting improved QoL and symptom mitigation. Integration of exercise should be considered in the individualized management of advanced-stage LC patients under the guidance of their healthcare providers.
... To date, most home-based exercise oncology interventions have been unsupervised and report lower adherence rates compared to in-person supervised settings [12][13][14]. The synchronous delivery of online exercise programming by a trained professional may address barriers to PA maintenance (e.g., accessibility to facilities and time constraints). ...
Purpose
The primary objective was to investigate the feasibility of a synchronous, online-delivered, group-based, supervised, exercise oncology maintenance program supported with health coaching.
Methods
Participants had previously completed a 12-week group-based exercise program. All participants received synchronous online delivered exercise maintenance classes, and half were block randomized to receive additional weekly health coaching calls. A class attendance rate of ≥ 70%, a health coaching completion rate of ≥ 80%, and an assessment completion rate of ≥ 70% were set as markers of feasibility. Additionally, recruitment rate, safety, and fidelity of the classes and health coaching calls were reported. Post-intervention interviews were performed to further understand the quantitative feasibility data. Two waves were conducted — as a result of initial COVID-19 delays, the first wave was 8 weeks long, and the second wave was 12 weeks long, as intended.
Results
Forty participants (n8WK = 25; n12WK = 15) enrolled in the study with 19 randomized to the health coaching group and 21 to the exercise only group. The recruitment rate (42.6%), attrition (2.5%), safety (no adverse events), and feasibility were confirmed for health coaching attendance (97%), health coaching fidelity (96.7%), class attendance (91.2%), class fidelity (92.6%), and assessment completion (questionnaire = 98.8%; physical functioning = 97.5%; Garmin wear-time = 83.4%). Interviews highlighted that convenience contributed to participant attendance, while the diminished ability to connect with other participants was voiced as a drawback compared to in-person delivery.
Conclusion
The synchronous online delivery and assessment of an exercise oncology maintenance class with health coaching support was feasible for individuals living with and beyond cancer. Providing feasible, safe, and effective exercise online to individuals living with cancer may support increased accessibility. For example, online may provide an accessible alternative for those living in rural/remote locations as well as for those who may be immunocompromised and cannot attend in-person classes. Health coaching may additionally support individuals’ behavior change to a healthier lifestyle.
Trial registration
The trial was retrospectively registered (NCT04751305) due to the rapidly evolving COVID-19 situation that precipitated the rapid switch to online programming.
... Although our review did not identify any studies specifically examining the impact of physical activity interventions on CRF in TNBC patients treated with immunotherapy, there is considerable literature suggesting that increasing energy expenditure has a beneficial effect. Numerous studies of pedometer-based exercise programs reported the intervention's effect on patients' level of CRF (147)(148)(149)(150)(151)(152). Studies have confirmed a beneficial effect of physical activity to minimize CRF and improve psychosocial health (149)(150)(151), and another found that Functional Assessment of Cancer Therapy-Breast scores improved in the intervention arm (147). ...
Cancer cells cannot proliferate without sufficient energy to generate biomass for rapid cell division, as well as to fuel their functions at baseline. For this reason, many recent observational and interventional studies have focused on increasing energy expenditure and/or reducing energy intake during and after cancer treatment. The impact of variance in diet composition and in exercise on cancer outcomes has been detailed extensively elsewhere and is not the primary focus of this review. Instead, in this translational, narrative review we examine studies of how energy balance impacts anticancer immune activation and outcomes in triple-negative breast cancer (TNBC). We discuss preclinical, clinical observational, and the few clinical interventional studies on energy balance in TNBC. We advocate for the implementation of clinical studies to examine how optimizing energy balance-through changes in diet and/or exercise-may optimize the response to immunotherapy in people with TNBC. It is our conviction that by taking a holistic approach that includes energy balance as a key factor to be considered during and after treatment, cancer care may be optimized, and the detrimental effects of cancer treatment and recovery on overall health may be minimized.
... Of note, these trials implemented structured exercise interventions.While there is substantial evidence supporting behavioral interventions for increasing physical activity among breast cancer survivors, [20] few trials have reported depressive symptom outcomes and evidence from these trials is mixed. Rogers et al. [21] report a significant reduction in depressive symptoms following a 3-month physical activity intervention but note that prior studies [22,23] of physical activity interventions did not yield significant reductions in depressive symptoms. ...
Background:
Depressive symptoms result in considerable burden for breast cancer survivors. Increased physical activity may reduce these burdens but existing evidence from physical activity interventions in equivocal. Furthermore, physical activity intervention strategies may differentially impact depressive symptoms, which should be considered in designing and optimizing behavioral interventions for breast cancer survivors.
Methods:
The Physical Activity for Cancer Survivors (PACES) trial enrolled 336 participants breast cancer survivors, who were 3 months to 10 years post-treatment, and insufficiently active (< 150 min of moderate-to-vigorous physical activity per week). Participants were randomly assigned to a combination of 4 intervention strategies in a full-factorial design: 1) supervised exercise sessions, 2) facility access, 3) Active Living Every Day, and 4) Fitbit self-monitoring. Depressive symptoms were assessed at baseline, mid-intervention (3 months), and post-intervention (6 months) using the Quick Inventory for Depressive Symptoms. Change in depressive symptoms were analyzed using a linear mixed-effects model.
Results:
Results from the linear mixed-effects model indicated that depressive symptoms decreased significantly across the entire study sample over the 6-month intervention (F = 4.09, p = 0.044). A significant ALED x time interaction indicated participants who received the ALED intervention experienced greater reductions in depressive symptoms (F = 5.29, p = 0.022). No other intervention strategy significantly impacted depressive symptoms.
Conclusions:
The ALED intervention consists of strategies (i.e., goal setting, social support) that may have a beneficial impact on depressive symptoms above and beyond the effect of increased physical activity. Our findings highlight the need to consider secondary outcomes when designing and optimizing physical activity interventions.
Trial registration:
ClinicalTrials.gov NCT03060941. Posted February 23, 2017.
... Interesting, not meeting the PA recommendations of 150 min per week at the baseline was a significant predictor of physical exercise adherence in our study. This finding differs from other studies [46,47], which suggests that greater active women at baseline were those who showed greater adherence to exercise. One hypothesis for this finding is that these inactive women from our study felt more motivated and challenged to adhere to mat Pilates or belly dance intervention. ...
Background
Breast cancer treatment leads to several side effects. Exercise can help to reduce these side effects. However, it is unknown whether a mat Pilates or a belly dance intervention can improve the patient-reported outcomes of these women.
Objective
Examine the effects of a 16-week exercise intervention (mat Pilates or belly dance) on patient reported outcomes (PROs) among breast cancer survivors, at 16 weeks, six months, and 12 months; and investigate sociodemographic and clinical predictors of intervention adherence.
Methods
Seventy-four breast cancer survivors who were receiving hormone therapy were randomly allocated into mat Pilates (n = 25), belly dance (n = 25) or control group (educational sessions) (n = 24). Mat Pilates and belly dance groups received a 16-week intervention, delivered three days a week and 60 minutes a session. The control group received three education sessions and continue usual care. The patient reported outcomes assessed were depressive symptoms (Beck Depression Inventory), stress (Perceived Stress Scale), optimism (Life Orientation Test), fatigue (FACT-F), sleep quality (Pittsburgh Sleep Quality Index) and pain (VAS), clinical and sociodemographic characteristics, and habitual physical activity (IPAQ short).
Results
All three groups showed a significant improvement in fatigue, and this effect was maintained during follow-up. No significant effects were found for depressive symptoms, optimism, stress, or pain. A history of exercise prior to breast cancer and be inactive after diagnosis were significant predictors of adherence to interventions.
Conclusion
Mat Pilates, belly dance and a few educational sessions can be effective in improving fatigue after 16 weeks of intervention.
Registration
ClinicalTrials.gov (NCT03194997).
... Non-compliance to exercise programs affects the effectiveness of the intervention [12], might prolong the rehabilitation time unnecessarily, increases the risk of recurrent injury or flare-ups [13] and increase levels of pain and impairment [14]. Pinto et al. [15] found that adherence to prescribed exercises it is directly correlated to achieving treatment goals and obtaining desired increases in physical function. Non-compliance to home exercise programs is common with over 50% of the patients only partially adhering to their program and over 15% not adhering at all [16]. ...
Background
To compare the performance (as determined by lower extremity kinematics) of knee exercises in healthy middle-aged and older individuals immediately after instruction and one week later.
Methods
This is a cross-sectional study in a laboratory setting. Nineteen healthy volunteers (age [y] 63.1 ± 8.6, mass [kg] 76.3 ± 14.7, height [m] 1.7 ± 0.1) participated in this study. High speed video and reflective markers were used to track motion during four exercises. The exercises were knee flexion, straight leg raise, and “V “in supine position, and hip abduction in side lying position. All participants received verbal and tactile cues during the training phase and the therapist observed and, if necessary, corrected the exercises. Upon return a week later the participants performed the same exercises without any further instructions. Knee and hip sagittal and rotational angles were extracted from the motion capture. A repeated measures t-test was used to compare the motions between two visits.
Results
Participants demonstrated more knee flexion during straight leg raise and “V in” exercises at the 2nd visit compared to the 1st visit (both p < 0.05). During the “V out” exercise, they performed more external rotation ( p < 0.05) while they showed more internal rotation during the “V in” exercise at the 2nd visit compared to the 1st visit.
Conclusions
Exercise performance declined significantly in healthy middle-aged and older individuals one week after instruction. This decline occurred despite an instructional exercise sheet being given to every participant. Other approaches designed to help individuals retain the ability to perform rehabilitative exercises correctly need to be explored.
... To date, most home-based exercise oncology interventions have been unsupervised and reported lower adherence rates compared to in-person supervised settings [12][13][14] . The synchronous delivery of online exercise programming by a trained professional may address barriers to PA maintenance (e.g., accessibility to facilities and time constraints). ...
Purpose: The primary objective was to investigate the feasibility of a synchronous, online delivered, group-based, supervised, exercise oncology maintenance program supported with health coaching.
Methods: All participants had previously completed a 12-week group-based exercise study. In the current study, participants were randomized to a 12-week exercise oncology maintenance class with or without health coaching. The primary outcome was feasibility, assessed as intervention attendance, safety and fidelity, study recruitment, attrition and outcome assessment completion. Additionally, semi-structured interviews at the end of the intervention provided participants' perspectives on intervention feasibility.
Results: Forty participants (n8WK=25; n12WK=15) enrolled in the study. Feasibility was confirmed for recruitment rate (42.6%), attrition rate (2.5%), safety (no adverse events), health coaching attendance (97%), health coaching fidelity (96.7%), class attendance (91.2%), class fidelity (92.6%), and assessment completion (questionnaire=98.8%; physical functioning=97.5%). Based on the qualitative feedback, feasibility was facilitated by the convenience, while the diminished ability to connect with other participants online was a drawback compared to in-person delivery.
Conclusion: The synchronous online delivery of an exercise oncology maintenance class, the additional health coaching support, and the tools used to measure the intervention effectiveness were feasible for individuals living with and beyond cancer.
Keywords
health coaching, exercise, physical activity, maintenance, cancer survivors, online-delivery, mHealth
... Exercise stage progression is mediated by exercise self-efficacy, decisional balance, and POCs [67]. Furthermore, stage progression and self-efficacy in exercise are also significant positive predictors for exercise adherence [68]. In addition, the counseling brochures of the 12-week TTM-based exercise program, which were given to the intervention group, detailed the barriers to and facilitators of PA at each stage; these brochures thus contributed to the better performance of the intervention group in terms of exercise behaviors and adherence. ...
PurposeThis study aims to investigate the effectiveness of the transtheoretical model (TTM)–based exercise training on TTM variables, exercise adherence, and physical function in patients in the early stages after bariatric surgery (BS).Materials and Methods
We conducted a single-blinded, prospective, randomized controlled trial (RCT) to evaluate the effects of TTM-based exercise training on BS patients immediately after surgery. Participants (n = 120) were randomized into a TTM-based exercise training group (n = 60) and a control group (n = 60). Main outcomes included TTM variables (measured by exercise stages of change (ESCs), exercise self-efficacy (ESE), and decisional balance), exercise adherence, and physical function (determined by the 6-min walk distance (6MWD)). Secondary outcomes were physical activity, anthropometrics, and body composition. We performed all analyses in accordance with the intention-to-treat principle.ResultsRetention rates for the interventions were 91.7% for the intervention group and 90.0% for the control group. Compared with the control group, the 12-week TTM-based intervention significantly helped participants advance through ESCs, demonstrate higher ESE, perceive more benefits and fewer barriers to exercise, and show higher exercise adherence and better physical function afterward (all P < 0.05). However, we observed no statistically significant difference between the two groups in anthropometric parameters or body composition after intervention.Conclusion
The TTM-based exercise intervention had significant positive effects on the TTM variables, which could further help increase patients’ exercise adherence and physical function immediately after BS.Trial RegistrationThis study was retrospectively registered at the Chinese Clinical Trial Registry (website: www.chictr.org.cn, registry number: ChiCTR2000039319).
... Similar results have been observed in cancer populations [38,39]. SE (more specifically general state SE and exercise SE) has furthermore proven to be positively associated with the level of PA, both in non-cancer [32,[40][41][42] and cancer populations [43,44]. Being positively associated with both work (e.g., RTW, work ability, and work status) and PA, SE may play a mediating role [45] in the possible association between PA and work status. ...
Background
Numerous studies emphasize the positive effects of physical activity on health and well-being in cancer patients. The effects of physical activity on the working lives of cancer patients have received less attention. The aim of the present study was to examine the association between physical activity and work status in employees with cancer, and the mediating role of return to work self-efficacy (RTWSE) in this association.
Methods
Data from questionnaires (physical activity, RTWSE, performance status, sociodemographic), patient records, and Danish national registries (work status, education) were collected for 217 employees initiating chemotherapy for cancer. The associations of physical activity at baseline with work status at baseline and at twelve months follow-up, respectively, were estimated with logistic regression. The mediating role of RTWSE was investigated using the Sobel Goodmann test.
Results
Employees with moderate (> 30 min/day) or high (> 150 min/day) levels of current daily activity at baseline had significantly increased odds for working at baseline (OR = 2.83, 95%CI = 0.73–10.96 and OR = 6.13, 95%CI = 1.68–22.40, respectively) and at twelve months (OR = 3.90, 95%CI = 1.19–12.77 and OR = 3.43, 95%CI = 1.12–10.51, respectively), compared to sedentary employees. Likewise, employees, physically active in their leisure time (light or vigorous psychical activity) for 2–4 h/week or > 4 h/week of light activity at baseline, had increased odds for working at twelve months (OR range = 1.20 (95%CI = 0.40–3.61)–5.39(95%CI = 0.78–37.32)), compared to sedentary employees. RTWSE was not found to mediate the observed associations.
Conclusions
Physical activity appears positively associated with work status in employees undergoing treatment for cancer in the twelve months period after initiating chemotherapy.
... The literature suggests conducting longer-term assessments; therefore, the long-term effects of the intervention should be examined in future studies. Studies on the relationship between self-efficacy and exercise adherence have shown that self-efficacy is associated with exercise behavior at the end of an exercise intervention [76][77][78]. The present study showed that the ERVE app was associated with both self-efficacy belief and health outcomes (e.g., reducing the BMI and promoting the physical activity). ...
Introduction
Physical inactivity has a major negative health effect worldwide. Mobile health apps may help promote active living. This study aimed to examine the effects of a smartphone app based on the American College of Sports Medicine (ACSM) guidelines and a theory called exercise prescription and education (ERVE as abbreviated in the original Turkish) on physical activity, quality of life, self-efficacy, and exercise motivation for inactive people.
Methods
The study was conducted as a randomized controlled trial (RCT). The 128 participants were randomly allocated to either the experimental group or control group in a 1:1 ratio. Participants in the experimental group received the ERVE smartphone app. No intervention was applied to the participants in the control group. The primary outcomes included self-efficacy, health-related quality of life, and motivational orientation for exercise. Secondary outcomes were body mass index (BMI) and levels of physical activity.
Results
The per-protocol analysis revealed that participants in the experimental group reported an increase in behavior initiation, physical functioning, vitality, mental health, general health perception, and intrinsic regulation compared to the control group. Also, the app showed efficacy in reducing the BMI of the participants in the experimental group (p < .05).
Conclusions
The ERVE smartphone-based app seems to be a promising tool to promote physical activity, improve the quality of life, increase self-efficacy beliefs in the initiation of behaviors, and provide intrinsic motivation in sedentary individuals, at least in the short-term.
... Thus, defining the test-retest group by the respondents' own indication of stability on the GPC is considered a strength in the present study.However, a number of limitations should also be noted. First of all, previous research has shown that patients with cancer voluntarily participating in rehabilitation and physical activity programmes tend to have higher levels of SE compared with patients that do not participate in these programmes(Phillips & McAuley, 2013;Pinto et al., 2009). Hence, the sample in the present study TA B L E 5 Correlation between total scores of the Return To Work Self-Efficacy-19 DK questionnaire (RTWSE-19 DK ) and cancerrelated self-efficacy, work ability, depression, anxiety and test date, respectively, at baseline (t1) may have had a high level of SE compared to the general population of cancer patients. ...
Objective
Several Return To Work Self‐Efficacy (RTWSE) questionnaires have been developed and found relevant to understanding the return to work (RTW) process of employees with various health problems, including employees with cancer. The aim of the present study was to examine the reliability and validity of the Danish 19‐item RTWSE questionnaire (RTWSE‐19DK) in a sample of employees with cancer.
Methods
Employees undergoing treatment for cancer completed the RTWSE‐19DK at baseline (n = 68) and at 1 week (n = 49). Additional questionnaires measured work ability, cancer‐related self‐efficacy and psychological distress. Internal consistency, test–retest reliability and construct validity were examined.
Results
The total and the three subscales of the RTWSE‐19DK showed good internal consistencies with Cronbach's alphas between 0.90 and 0.97 and high test–retest reliability with Intraclass Correlation Coefficients between 0.84 and 0.90. Examining construct validity, the RTWSE‐19DK showed medium and large correlations with cancer‐related self‐efficacy (r = 0.54), mental work ability (r = 0.51), and general work ability (r = 0.35), small correlations with physical work ability (r = 0.26) and anxiety (r = −0.10), and no correlations with depression (r = −0.08) and test date (r = 0.03).
Conclusion
The RTWSE‐19DK showed good reliability and adequate validity in employees undergoing cancer treatment. In clinical practice, the RTWSE‐19 questionnaire may help practitioners identify areas of concern in the RTW process of cancer patients.
... 10,19 Dessa forma, o exercício físico domiciliar evidencia-se como uma terapêutica de empoderamento segura, eficaz, reprodutível e de baixo custo para idosos em tratamento para câncer mama. [20][21][22][23][24] Além disso, a incorporação de programas de exercícios físicos domiciliares apresenta vantagens à saúde pública, especialmente para países em desenvolvimento, como baixo custo, facilidade de aplicação, supervisão, reprodutibilidade, fácil complacência e mitigação das dificuldades de transporte e deslocamento relacionadas ao câncer e tratamentos enfrentados por esta população específica. 18,23,24 Entretanto, até o presente, não foram identificados estudos realizados no Brasil que abordassem essa temática envolvendo idosas com câncer de mama em tratamento de hormonioterapia. ...
Objetivo: Avaliar os efeitos de um programa de exercícios físicos domiciliares na aptidão física de idosas com câncer de mama em tratamento. Métodos: Ensaio clínico randomizado com 75 idosas com câncer de mama, realizado em um Hospital Geral do Recife, Brasil, de abril a novembro de 2015. 38 foram alocadas para um programa de exercícios físicos domiciliares, durante 12 semanas, e 37 para o Grupo Controle, o qual recebeu palestras mensais sobre a importância da manutenção de um estilo de vida ativo. Um manual de exercícios físicos e DVD foi previamente desenvolvido e distribuído para o Grupo Intervenção. Foi utilizada a bateria Senior Fitness Test para avaliar a aptidão física. Resultados: Foi observada melhora significativa da força muscular, flexibilidade, equilíbrio e resistência aeróbica no Grupo Intervenção, de acordo com os itens da SFT; Flexão de Antebraço (13,74 - 17,10 repetições, p <0,01); Levantar e Sentar (12,03 - 14,55 repetições, p <0,01); Ir e Vir (6,85 - 6,00 segundos, p <0,01), marcha estacionária de 2 minutos (79,08 - 123,37 duplas passadas, p <0,01); Alcançar as Costas (-8,74 a -0,42 centímetros, p <0,01); e Sentar e Alcançar (-6,76 a 4,76 centímetros, p <0,01). Não foram observadas melhoras com relação ao IMC e força de preensão manual. Conclusão: O programa de exercícios físicos domiciliares mostrou eficácia para melhorar a aptidão física em idosas com câncer de mama em tratamento.
... Self-efficacy is defined as one's perception about his/her ability to perform a particular behavior; individuals may be more likely to engage in physical activity if they believe that they can exercise despite potential constraints and impediments [22]. Previous studies have shown that exercise selfefficacy is an influential predictor of actual physical activity in a broad range of populations [23][24][25][26], including cancer survivors [27,28]. Interventions that aimed to increase exercise self-efficacy in cancer survivors have demonstrated an increase in exercise intention [29] and subsequent physical activity [20]. ...
Background
Previous studies have shown affective and physiological states in response to exercise as predictors of daily exercise, yet little is known about the mechanism underlying such effects.
Purpose
To examine the mediating effects of self-efficacy and outcome expectancy on the relationships between affective and physiological responses to exercise and subsequent exercise levels in endometrial cancer survivors.
Methods
Ecological momentary assessment (EMA) surveys were delivered up to eight 5- to 7-day periods over 6 months. Participants (n = 100) rated their affective and physiological states before and after each exercise session (predictors) and recorded their self-efficacy and outcome expectancy each morning (mediators). Exercise (outcome) was based on self-reported EMA surveys and accelerometer measures. A 1-1-1 multilevel mediation model was used to disaggregate the within-subject (WS) and between-subject (BS) effects.
Results
At the WS level, a more positive affective state after exercise was associated with higher self-efficacy and positive outcome expectation the next day, which in turn was associated with higher subsequent exercise levels (ps < .05). At the BS level, participants who typically had more positive affective and experienced less intense physiological sensation after exercise had higher average self-efficacy, which was associated with higher average exercise levels (ps < .05).
Conclusions
In endometrial cancer survivors, affective experience after exercise, daily self-efficacy and positive outcome expectation help explain the day-to-day differences in exercise levels within-person. Findings from this study highlight potentials for behavioral interventions that target affective experience after exercise and daily behavioral cognitions to promote physical activity in cancer survivors’ everyday lives.
... Traditionally most investigators report adherence as a percentage of the number of sessions attended out of a total possible number of prescribed sessions (Knols et al., 2005;Pinto et al., 2009). However, this approach provides limited insight into how well the prescribed exercise dose was achieved (Nilsen et al., 2018). ...
Stereotactic Ablative Radiotherapy (SABR) is increasingly replacing thoracotomy for resection of lung cancers and oligometastatic lung lesions but it is not known whether exercise can be maintained during SABR, the major side-effect of which is fatigue. This case study describes a 57-year-old male who exercised regularly (above American College of Sports Medicine minimum weekly exercise guidelines) and continued to exercise during SABR for a renal cell metastasis in his left lung. His exercise program included 5x60-minute moderate intensity aerobic exercise sessions and 3x45-minute resistance exercise sessions per week for 12 weeks post-treatment. Cardiorespiratory fitness and strength, as well as self-reported fatigue, depression, anxiety, physical wellbeing and sleep quality were assessed at baseline and fortnightly. Exercise adherence was 98% and no adverse events occurred. Fatigue was elevated from Weeks 2-8, which adversely impacted exercise intensity perception. Minimal changes were observed in cardiorespiratory fitness, depression, anxiety and sleep quality, but strength decreased, and physical wellbeing was improved above baseline levels. This is the first reported clinical case of exercise during SABR for a lung carcinoma. The data suggest that exercise may be feasible for patients undergoing SABR and may improve physical wellbeing. Larger controlled studies are needed to confirm these findings.
... However, some survivors, even those with relatively few cancer sequelae, may lack self-efficacy for lifestyle behavior change after cancer. 94,95 These individuals may be more comfortable with a program that can address their specific needs and concerns, as well as reinforce the survivor-specific benefits of improved lifestyle factors. 96 Clearly, cancer survivors need wider availability of a range of programs. ...
Observational evidence has consistently linked excess adiposity and inactivity to increased breast cancer risk and to poor outcomes in individuals diagnosed with early-stage, potentially curable breast cancer. There is less information from clinical trials testing the effect of weight management or physical activity interventions on breast cancer risk or outcomes, but a number of ongoing trials will test the impact of weight loss and other lifestyle changes after cancer diagnosis on the risk of breast cancer recurrence. Lifestyle changes have additional benefits beyond their potential to decrease primary or secondary breast cancer risk, including improvements in metabolic parameters, reduction in the risk of comorbidities such as diabetes and heart disease, improvement of physical functioning, and mitigation of side effects of cancer therapy. Despite these myriad benefits, implementation of lifestyle interventions in at-risk and survivor populations has been limited to date. This article reviews the evidence linking lifestyle factors to breast cancer risk and outcomes, discusses completed and ongoing randomized trials testing the impact of lifestyle change in primary and secondary breast cancer prevention, and reviews efforts to implement and disseminate lifestyle interventions in at-risk and breast cancer survivor populations.
... Self-efficacy is one of the most important predictors of adherence to lifestyle interventions, particularly physical ac-tivity, in older adults [28,31,[35][36][37][38]. It was not measured in either MAPT or FINGER, but in FINGER, participants' initial perception of the study, which is the closest proxy, was not significantly associated with adherence to physical activity, although it was associated with adherence to cognitive training and with simultaneous adherence to all intervention components. ...
Introduction:
Multidomain interventions, targeting multiple risk factors simultaneously, could be effective dementia prevention strategies, but may be burdensome and not universally acceptable.
Methods:
We studied adherence rates and predictors in the Finnish Geriatric Intervevntion Study to Prevent Cognitive Impairment and Disability and Multidomain Alzheimer Preventive Trial prevention trials, for all intervention components (separately and simultaneously). Finnish Geriatric Intervevntion Study to Prevent Cognitive Impairment and Disability participants received a 2-year multidomain lifestyle intervention (physical training, cognitive training, nutritional counseling, and cardiovascular monitoring). Multidomain Alzheimer Preventive Trial participants received a 3-year multidomain lifestyle intervention (cognitive training, physical activity counseling, and nutritional counseling) with either an omega-3 supplement or placebo.
Results:
Adherence decreased with increasing intervention complexity and intensity: it was highest for cardiovascular monitoring, nutritional counseling, and the omega-3 supplement, and lowest for unsupervised computer-based cognitive training. The most consistent baseline predictors of adherence were smoking and depressive symptoms.
Discussion:
Reducing participant burden, while ensuring that technological tools are suitable for older individuals, maintaining face-to-face contacts, and taking into account participant characteristics may increase adherence in future trials.
... However, it is important to note the distinction between unsupervised and home-based programs. Home-based programs can include motivational support, guidance and counseling [88,89] through m-health, e-health and telephone-based interventions. Similarly, a program can be center-based and unsupervised. ...
Background:
Physical activity (PA) participation and adherence among cancer survivors is low, despite research indicating numerous physical, psychological and emotional health benefits of exercise. Tailoring exercise programs specific to the PA preferences in cancer survivors has merit for increasing PA participation and adherence to accrue these benefits. This systematic review identifies and differentiates PA programming and counseling preferences of adult cancer survivors across various cancer survivor groups.
Methods:
PubMed, SPORTDiscus, Scopus, PsycINFO, EMBASE, Web of Science and CINAHL were electronically searched (inception to Oct 2017) and articles were identified using PRISMA guidelines. Two reviewers independently assessed identified articles to determine eligibility and then individually performed a quality assessment on all final studies. Extracted and analyzed data included participant characteristics, interest in exercise counseling and programming, as well as specific exercise and counseling preferences (e.g. location, timing, intensity).
Results:
Forty-one articles were included in this systematic review. Most studies assessed mixed cancer survivor groups or breast cancer survivors. Most cancer survivors felt able and interested in participating in a PA program, though starting a PA program after or before treatment was preferred. Walking was the strongest PA modality preference, and most cancer survivors preferred moderate intensity PA. Cancer survivors also indicated preferences for home-based PA that could take place in the morning. Slight preferences were found towards physical activity counseling delivered by a fitness expert from a cancer center. Both quantitative and qualitative studies were found to be of moderate to high quality based on the Appraisal Tool for Cross-Sectional Studies (AXIS) and the Consolidated Criteria for Reporting Qualitative Research (COREQ), respectively.
Conclusion:
Cancer survivors have an interest in participating in PA programs with walking as the primary modality. Additionally, morning-based PA programs that can be tapered to home-based programs are desirable. However, there was wide variation in other PA preference variables, suggesting multiple program options would be beneficial. Many cancer survivors felt interested and able to participate in PA, and therefore designing PA programs that are tailored to cancer survivors is integral for optimizing recruitment and adherence, as well as enhancing health outcomes in cancer survivors.
... 14,15 Still, physical activity levels remain low among those diagnosed with cancer, 16,17 and most AYAs significantly reduce the time spent in physical activity following their diagnosis. 17 In response, there has been a surge in the number of studies focused on elucidating antecedents and correlates of physical activity among individuals diagnosed with cancer to inform the content of behavior change interventions and to underpin possible techniques and modes of delivery that are likely to be effective (eg, Courneya et al, Daley et al, Mcneely et al, and Pinto et al [18][19][20][21] ). ...
Objective
Physical activity can improve health, functional capacity, and quality of life in children and adults with cancer. Physical activity may also offer important benefits to adolescents and young adults diagnosed with cancer (AYAs). We conducted a scoping review to determine the extent, range, and nature of published studies on physical activity among AYAs, identify knowledge gaps, and provide directions for future research.
Methods
We searched four electronic databases for published studies. Two authors independently scanned the titles, abstracts, and full‐texts against inclusion criteria: original research with humans; published in an English‐language peer‐reviewed journal; ≥50% of participants were diagnosed with cancer between the ages of 15 and 39 years; included at least one measure of physical activity behaviour. Data were extracted from studies meeting these criteria and subsequently summarized.
Results
Our search yielded 4,729 articles; 32 met inclusion criteria. These included 18 cross‐sectional and four longitudinal studies that explored descriptive (i.e., sociodemographic or medical), physical, personal/psychological, social, other health behaviours, and/or other factors as antecedents or correlates of physical activity. The remaining 10 were intervention studies that focused on changing physical activity behaviour or the effects of physical activity.
Conclusions
We can conclude that physical activity is not well researched among AYAs. More high‐quality research adopting longitudinal or intervention study designs that incorporate a range of descriptive, physical, personal/psychological, social, and environmental measures are warranted to better inform the development of behaviour change interventions as well as to establish the benefits of physical activity for AYAs.
Background:
Among patients with breast cancer undergoing radiation therapy (RT), post-treatment cardiovascular disease and worsened quality of life (QOL) are leading causes of morbidity and mortality. To overcome these negative RT effects, this prospective, randomized clinical trial pilots a 12-week Stay on Track exercise and diet intervention for overweight patients with non-metastatic breast cancer undergoing whole-breast RT.
Methods:
The intervention group (n=22) participated in three personal exercise and dietary counseling sessions, and received three text reminders/week to adhere to recommendations. The control group (n=22) was administered a diet/exercise information binder. All patients received a Fitbit, and at baseline, 3, and 6 months, measurements of biomarkers, dual-energy X-ray absorptiometry scans, quality of life and physical activity surveys, and food frequency questionnaires were obtained. A satisfaction survey was administered at three months.
Results:
Stay on Track was well received, with high rates of adherence and satisfaction. The intervention group showed an increase in self-reported physical activity and preserved QOL, a decrease in BMI and visceral fat, and higher ACS/AICR dietary adherence. The control participants had reduced QOL, anti-inflammatory markers, and increased metabolic syndrome markers. Both groups had decreased overall body mass. These changes were within group effects. When comparing the intervention and control groups over time, there were notable improvements in dietary adherence in the intervention group.
Conclusions:
Targeted lifestyle interventions during RT are feasible and could decrease cardiovascular comorbidities in patients with breast cancer. Larger-scale implementation with longer follow-up can better determine interventions that influence cardiometabolic health and QOL.
Background
Little is known about improving physical activity (PA) and diet during and after chemotherapy for breast cancer. This secondary analysis examines changes in PA and diet quality during a yearlong intervention for patients with breast cancer undergoing chemotherapy and evaluates factors associated with these changes.
Methods
Newly diagnosed patients with breast cancer ( N = 173) undergoing chemotherapy were randomized to a year‐long nutrition and exercise intervention ( n = 87) or usual care (UC, n = 86). Mixed models compared 1‐year changes in PA and diet quality via the Healthy Eating Index (HEI)‐2015 by study arm. Among the intervention group, baseline factors associated with change in PA and diet were assessed with multivariable linear and logistic regression.
Results
At 1 year, compared with UC, the intervention arm increased PA more (mean difference = 136.1 minutes/week; 95% CI, 90.2–182.0), participated in more strength training (56% vs. 15%; p < .001), and had suggestive improvements in HEI‐2015 (mean difference = 2.5; 95% CI, –0.3 to 5.3; p = .08). In the intervention arm, lower fatigue was associated with improved PA ( p = .04) and higher education was associated with improved HEI‐2015 ( p = .001) at 1 year. Higher HEI‐2015 ( p = .04) and married/living with someone ( p = .05) were associated with higher odds of participating in strength training at 1 year.
Conclusions
This year‐long lifestyle intervention for patients with breast cancer undergoing chemotherapy resulted in increases in PA and suggestive improvements in diet quality. Behavior change was associated with baseline fatigue, diet quality, education, and married/living with someone. Addressing these factors in interventions may improve uptake of lifestyle behaviors in trials during and after chemotherapy.
Background
Global Cancer Statistics 2020 reported that breast cancer had exceeded lung cancer as the most frequently diagnosed cancer. Surgery is the primary treatment modality for breast cancer, but postoperative upper limb dysfunction often occurs; functional exercise can alleviate this and restore upper limb function. However, exercise compliance is low in postoperative breast cancer patients; thus, many studies have been conducted in recent years to improve patient compliance with exercise.
Objective
The aim of this study was to compare the effectiveness of different interventions to improve exercise adherence in postoperative breast cancer patients.
Methods
We searched PubMed, Cochrane Library, Web of Science, EMBASE, Wan Fang, CNKI, VIP, and CBM databases for eligible studies. Exercise adherence rate and quality-of-life difference were assessed as outcomes. Sensitivity analysis and inconsistency detection were performed to evaluate whether the exclusion of high-risk studies affected the validity. Risk of bias was assessed using the risk-of-bias table in RevMan 5.4. Surface under the cumulative ranking was used to estimate the rankings among different interventions.
Results
Twenty-five randomized controlled trials involving 9 interventions were included, and the network meta-analysis results showed that patients in the pedometer + counseling group had the best exercise adherence.
Conclusion
Pedometer + counseling care measures are recommended to improve exercise adherence in postoperative breast cancer patients.
Implications for Practice
Oncology nurses can improve patients’ exercise compliance through counseling and by giving them pedometers to wear.
The purpose of this study is to conduct validity and reliability testing of a new instrument, the Preferences and Self-Efficacy of Diet and Physical Activity Behaviors Questionnaire for Latina Women (PSEDPALW), which is for women who identify as Latina and are breast cancer survivors. PSEDPALW measures preferences and self-efficacy for four behaviors: physical activity (PA), fruit and vegetable (FV) intake, dietary fat (DF) intake, and added sugar (AS) intake (eight scales in total). Validity testing was conducted through an expert panel review and a cognitive interviewing focus group (n = 4). Reliability was tested via internal consistency reliability (n = 118) and test–retest reliability (n = 30). Validity testing was used to refine PSEDPALW. Reliability testing was conducted on three versions with 104, 47, and 41 items. PA scales had acceptable Cronbach’s α (>0.70) but low ICC (NS). FV and DF scales had acceptable Cronbach’s α (>0.70), with preferences for the shorter (47- and 41-item) versions (Cronbach’s α < 0.70), and all scales had moderate ICC (p < 0.05, except the FV scale on the 104-item version (p = 0.07)). The AS preferences scale had Cronbach’s α < 0.70, with self-efficacy > 0.70 for all versions and ICC moderate for all versions (p ≤ 0.01). PSEDPALW may be useful to assess diet and physical activity preferences and self-efficacy in theory-based diet and physical activity interventions in women who identify as Latina and are breast cancer survivors.
Introduction. Hormonal therapy has adverse effects that hinder breast cancer survivors' functional performance and quality of life. Physical activity (PA) can counteract these adverse effects, and home-based exercise interventions might be a potential solution to foster PA adoption in this population. This study aimed to investigate home-based exercise intervention effects on functional performance, quality of life and PA of breast cancer survivors’ undergoing hormonal therapy. Adherence to the intervention and adverse events were also reported.
Method. This study was a 12-week randomised controlled trial comprising a home-based exercise intervention supported by an exercise booklet including six exercise groups and a weekly online exercise group session. Eighteen women were recruited from Hospital Universitário do Barlavento Algarvio.
Results. Significant time-by-group effects in functional performance (sit-to-stand (p=.033), arm curl (p=.011), and timed up-and-go (.009) tests), quality of life (insomnia (p=.007) and breast symptoms (p=.035)), and PA (vigorous PA (p=.033), walking (p=.005), and total PA (p=.034)), favouring the intervention group were found. Attendance to the supervised component of the program was high (80%).
Conclusion. This home-based exercise intervention was well tolerated and accepted by participants and led to significant improvements in functional performance and PA levels. These findings further support the effectiveness of this type of intervention, which is a more affordable and viable strategy to raise PA levels and enhance functional performance in breast cancer survivors. Exercise professionals may use these programs to promote active lifestyles while reducing barriers to practice.
Background:
Patients with a chronic disease may have an increased risk of non-adherence to prescribed home-based exercise therapy. We performed a systematic review with the aim to identify variables associated with adherence to home-based exercise therapy in patients with chronic diseases and to grade the quality of evidence for the association between these prognostic factors and adherence.
Methods:
Cohort studies, cross-sectional studies and the experimental arm of randomized trials were identified using a search strategy applied to PubMed, Embase, PsychINFO and CINAHL from inception until August 1, 2022. We included studies with participants ≥18 years with a chronic disease as an indication for home-based exercise therapy and providing data on prognostic factors of adherence to home-based exercise. To structure the data, we categorized the identified prognostic factors into the five WHO-domains; (1) Patient-related, (2) Social/economic, (3) Therapy-related, (4) Condition-related, and (5) Health system factors. Risk of bias was assessed using the Quality in Prognostic Studies (QUIPS) tool. Prognostic factors of adherence were identified and the quality of the evidence between the prognostic factors and adherence were graded using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework for predictor studies. We performed a meta-analysis of the obtained information.
Results:
A total of 57 studies were included. Within patient-related factors moderate- and high-quality evidence suggested that more self-efficacy, exercise history, motivation and perceived behavioral control predicted higher adherence. Within social-economic factors moderate-quality evidence suggested more education and physical health to be predictive of higher adherence and within condition-related factors moderate- and low-quality evidence suggested that less comorbidities, depression and fatigue predicted higher adherence. For the domains therapy-related and health-system factors there was not enough information to determine the quality evidence of the prognostic factors.
Conclusion:
These findings might aid the development of future home-based exercise programs as well as the identification of individuals who may require extra support to benefit from prescribed home-based exercise therapy.
Systematic review registration:
https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=277003, identifier PROSPERO CRD42021277003.
Background and Purpose
Home exercise programs (HEPs) improve quality of life (QoL), physical function, and fatigue in individuals recovering from cancer; however, they often lack supervision and individualization. Use of a weekly telephone call by a physical therapist (PT) may provide substantial guidance to improve outcomes and adherence. The purpose of this study was to determine the effect of weekly calls in addition to an individualized HEP on physical function, QoL, fatigue, and adherence in people with cancer.
Methods
A prospective 2-armed single-cohort design implemented with survivors of cancer in early recovery. Control and intervention groups received in-home instruction of a PT-prescribed, 8-week HEP. The intervention group received weekly phone calls while the control group had no formal follow-up or program monitoring. Outcome measures assessed pre-/postintervention: 6-minute walk test (6MWT), Fullerton Advanced Balance Scale, European Organization of Research and Treatment of Cancer QoL Questionnaire (EORTC QLQ-C30), and Functional Assessment of Chronic Illness Therapy Fatigue Scale (FACIT). Nonparametric statistics were used to analyze changes within and between groups.
Results
Fifteen participants (n = 7 intervention and n = 8 control) completed the study. The intervention group improved significantly in all outcomes except the 6MWT ( P < .05). The control group did not demonstrate any significant improvements. Between groups, there was a significant difference at program completion in the FACIT ( P = .007) and EORTC QLQ-C30 physical function subscale ( P = .042).
Limitations
A small, heterogeneous sample.
Conclusions
An individualized HEP with weekly calls may be a safe and effective way to improve outcomes of physical function, QoL, and fatigue in individuals with cancer during early recovery.
Medical advances in the treatment of cancer have contributed to less invasive and more targeted strategies, as well as increasing effectiveness in terms of survival. However, receiving cancer treatment is also associated with a range of side effects, which persist throughout the post-treatment cancer survivorship phase or which may appear months to years after treatment cessation. Further, persistent and late treatment-related side effects, alongside disease- and treatment-related adverse changes in function and quality of life, are interrelated and influence survival. Physical activity, including exercise, represents an efficacious strategy for improving quality of survival, through prevention and better management of treatment-related sequelae and improvements in function, quality of life, and pre-existing comorbidities or other chronic disease, and has potential for improving quantity of survival (all-cause and cancer-specific mortality). This chapter will introduce survivorship concerns experienced during the post-treatment phase and will briefly discuss the role of physical activity, including exercise, post-treatment to end of life.
A growing body of evidence supports exercise for cancer survivors and has led to the development of guidelines and exercise interventions. It is important to identify changes in practice, policy, and research that will help us develop and implement the most efficient and effective strategies to deliver exercise interventions to cancer survivors through both healthcare and community-based settings. In this chapter, we incorporate recommendations for developing diverse programming options that will reflect and address the diverse needs and preferences of cancer survivors, establishing screening and referral approaches to effectively match survivors to physical activity services, and setting research priorities focused on dissemination and implementation to help move research findings into practice. Addressing these priorities will help ensure that all cancer survivors benefit from physical activity to maximize quality of life throughout the continuum of cancer survivorship.
Objective:
We conducted meta-analyses and meta-analytic structural equation modeling of longitudinal studies among cancer survivors to (a) quantify associations between psychosocial predictors and physical activity, (b) test how psychosocial predictors combine to influence physical activity, and (c) identify study, demographic, and clinical characteristics that moderate associations.
Method:
Eligible studies used a longitudinal, observational design, included a sample of cancer survivors, and measured both a psychosocial predictor at baseline and physical activity at a later time-point. Of 2,431 records located through computerized searches, 25 independent tests (N = 5,897) met the inclusion criteria for the review. Random effects meta-analyses and meta-analytic structural equation modeling were conducted.
Results:
Eight psychosocial predictors of physical activity were identified. Self-efficacy (r+ = 0.26) and intentions (r+ = 0.33) were the strongest predictors in bivariate analyses. The structural equation models included attitudes, injunctive norms, self-efficacy, intentions, and physical activity (k = 22, N = 4,385). The model with the best fit, χ2(2) = 0.11, p = .95, root mean square error of approximation = .00, comparative fit index = 1.00, Tucker-Lewis index = 1.00, indicated that all specified paths were significant. Intentions were the strongest predictor of physical activity (β = 0.27, p < .001), and attitudes and self-efficacy were strong predictors of intentions (both βs = 0.29, ps < .001). Few significant moderators were observed.
Conclusion:
This review indicates that self-efficacy and intentions are direct predictors of physical activity in cancer survivors. Further, attitudes and norms predict physical activity through intentions. Findings inform intervention development to increase physical activity engagement among cancer survivors. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
La littérature apporte de plus en plus de preuves du bénéfice de la pratique d'une activité physique dans le cadre des préventions secondaire et tertiaire du cancer du sein, cancer le plus fréquent chez la femme. Ces travaux de thèse sont nés de la collaboration entre une équipe experte de la prise en charge clinique et de la nutrition de patients atteints de cancer (Centre de Lutte contre le Cancer Léon Bérard de Lyon) et une équipe experte de l'activité physique (Centre de Recherche et d'Innovation sur le Sport EA647). Cette approche " recherche-action " a permis d'implanter des programmes novateurs d'activité physique adaptée (APA) auprès des patientes atteintes de cancer du sein et ce, de manière concomitante aux traitements adjuvants. Les programmes d'APA complétés d'une prise en charge diététique apparaissent comme un moyen faisable et peu coûteux de lutter contre les facteurs reconnus de mauvais pronostic que sont la prise de poids, les risques métaboliques, mais aussi la problématique de l'inactivité physique et de la sédentarité qui s'installent dès le diagnostic de la maladie. Les résultats originaux de ce travail de thèse fournissent des avancées importantes pour promouvoir l'intégration de l'APA en tant que soin de support des patients atteints de cancer, tout au long des traitements et dans la phase de réhabilitation. Ces travaux permettent de fixer les modalités de prise en charge de ce public spécifique, mettant à disposition des professionnels du secteur un panel de connaissances scientifiques et pratiques. Ils démontrent ainsi la compatibilité et l'applicabilité directe de la recherche en milieu professionnel.
Background
The impact of prehabilitation on physical fitness and postoperative course after hepato-pancreato-biliary (HPB) surgeries for malignancy is unknown. The current study aimed to investigate the effect of preoperative exercise and nutritional therapies on nutritional status, physical fitness, and postoperative outcomes of patients undergoing an invasive HPB surgery for malignancy.
Methods
Patients who underwent open abdominal surgeries for HPB malignancies (major hepatectomy, pancreatoduodenectomy, or hepato-pancreatoduodenectomy) between 2016 and 2017 were subjected to prehabilitation. Patients before the introduction of prehabilitation were included as historical control subjects for 1:1 propensity score-matching (no-prehabilitation group). The preoperative nutritional status and postoperative course were compared between the two groups.
Results
The prehabilitation group consisted of 76 patients scheduled to undergo HPB surgeries for malignancy. An identical number of patients were selected as the no-prehabilitation group after propensity score-matching. During the waiting period, serum albumin levels were significantly deteriorated in the no-prehabilitation group, whereas this index did not deteriorate or even improved in the prehabilitation group. By performing prehabilitation, a 6-min walk distance and total muscle/fat ratio were significantly increased during the waiting period. Although the overall incidence of postoperative complications did not differ between the two groups, the postoperative hospital stay was shorter in the prehabilitation group than in the no-prehabilitation group (median, 23 vs 30 days; p = 0.045).
Conclusion
The introduction of prehabilitation prevented nutritional deterioration, improved physical fitness before surgery, and shortened the postoperative hospital stay for the patients undergoing HPB surgeries for malignancy.
Background:
This is an updated version of the original Cochrane Review published in the Cochrane Liibrary 2013, Issue 9. Despite good evidence for the health benefits of regular exercise for people living with or beyond cancer, understanding how to promote sustainable exercise behaviour change in sedentary cancer survivors, particularly over the long term, is not as well understood. A large majority of people living with or recovering from cancer do not meet current exercise recommendations. Hence, reviewing the evidence on how to promote and sustain exercise behaviour is important for understanding the most effective strategies to ensure benefit in the patient population and identify research gaps.
Objectives:
To assess the effects of interventions designed to promote exercise behaviour in sedentary people living with and beyond cancer and to address the following secondary questions: Which interventions are most effective in improving aerobic fitness and skeletal muscle strength and endurance? Which interventions are most effective in improving exercise behaviour amongst patients with different cancers? Which interventions are most likely to promote long-term (12 months or longer) exercise behaviour? What frequency of contact with exercise professionals and/or healthcare professionals is associated with increased exercise behaviour? What theoretical basis is most often associated with better behavioural outcomes? What behaviour change techniques (BCTs) are most often associated with increased exercise behaviour? What adverse effects are attributed to different exercise interventions?
Search methods:
We used standard methodological procedures expected by Cochrane. We updated our 2013 Cochrane systematic review by updating the searches of the following electronic databases: Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, Embase, AMED, CINAHL, PsycLIT/PsycINFO, SportDiscus and PEDro up to May 2018. We also searched the grey literature, trial registries, wrote to leading experts in the field and searched reference lists of included studies and other related recent systematic reviews.
Selection criteria:
We included only randomised controlled trials (RCTs) that compared an exercise intervention with usual care or 'waiting list' control in sedentary people over the age of 18 with a homogenous primary cancer diagnosis.
Data collection and analysis:
In the update, review authors independently screened all titles and abstracts to identify studies that might meet the inclusion criteria, or that could not be safely excluded without assessment of the full text (e.g. when no abstract is available). We extracted data from all eligible papers with at least two members of the author team working independently (RT, LS and RG). We coded BCTs according to the CALO-RE taxonomy. Risk of bias was assessed using the Cochrane's tool for assessing risk of bias. When possible, and if appropriate, we performed a fixed-effect meta-analysis of study outcomes. If statistical heterogeneity was noted, a meta-analysis was performed using a random-effects model. For continuous outcomes (e.g. cardiorespiratory fitness), we extracted the final value, the standard deviation (SD) of the outcome of interest and the number of participants assessed at follow-up in each treatment arm, to estimate the standardised mean difference (SMD) between treatment arms. SMD was used, as investigators used heterogeneous methods to assess individual outcomes. If a meta-analysis was not possible or was not appropriate, we narratively synthesised studies. The quality of the evidence was assessed using the GRADE approach with the GRADE profiler.
Main results:
We included 23 studies in this review, involving a total of 1372 participants (an addition of 10 studies, 724 participants from the original review); 227 full texts were screened in the update and 377 full texts were screened in the original review leaving 35 publications from a total of 23 unique studies included in the review. We planned to include all cancers, but only studies involving breast, prostate, colorectal and lung cancer met the inclusion criteria. Thirteen studies incorporated a target level of exercise that could meet current recommendations for moderate-intensity aerobic exercise (i.e.150 minutes per week); or resistance exercise (i.e. strength training exercises at least two days per week).Adherence to exercise interventions, which is crucial for understanding treatment dose, is still reported inconsistently. Eight studies reported intervention adherence of 75% or greater to an exercise prescription that met current guidelines. These studies all included a component of supervision: in our analysis of BCTs we designated these studies as 'Tier 1 trials'. Six studies reported intervention adherence of 75% or greater to an aerobic exercise goal that was less than the current guideline recommendations: in our analysis of BCTs we designated these studies as 'Tier 2 trials.' A hierarchy of BCTs was developed for Tier 1 and Tier 2 trials, with programme goal setting, setting of graded tasks and instruction of how to perform behaviour being amongst the most frequent BCTs. Despite the uncertainty surrounding adherence in some of the included studies, interventions resulted in improvements in aerobic exercise tolerance at eight to 12 weeks (SMD 0.54, 95% CI 0.37 to 0.70; 604 participants, 10 studies; low-quality evidence) versus usual care. At six months, aerobic exercise tolerance was also improved (SMD 0.56, 95% CI 0.39 to 0.72; 591 participants; 7 studies; low-quality evidence).
Authors' conclusions:
Since the last version of this review, none of the new relevant studies have provided additional information to change the conclusions. We have found some improved understanding of how to encourage previously inactive cancer survivors to achieve international physical activity guidelines. Goal setting, setting of graded tasks and instruction of how to perform behaviour, feature in interventions that meet recommendations targets and report adherence of 75% or more. However, long-term follow-up data are still limited, and the majority of studies are in white women with breast cancer. There are still a considerable number of published studies with numerous and varied issues related to high risk of bias and poor reporting standards. Additionally, the meta-analyses were often graded as consisting of low- to very low-certainty evidence. A very small number of serious adverse effects were reported amongst the studies, providing reassurance exercise is safe for this population.
Objective:
To encourage increased participation in physical activity among Americans of all ages by issuing a public health recommendation on the types and amounts of physical activity needed for health promotion and disease prevention.
Participants:
A planning committee of five scientists was established by the Centers for Disease Control and Prevention and the American College of Sports Medicine to organize a workshop. This committee selected 15 other workshop discussants on the basis of their research expertise in issues related to the health implications of physical activity. Several relevant professional or scientific organizations and federal agencies also were represented.
Evidence:
The panel of experts reviewed the pertinent physiological, epidemiologic, and clinical evidence, including primary research articles and recent review articles.
Consensus process:
Major issues related to physical activity and health were outlined, and selected members of the expert panel drafted sections of the paper from this outline. A draft manuscript was prepared by the planning committee and circulated to the full panel in advance of the 2-day workshop. During the workshop, each section of the manuscript was reviewed by the expert panel. Primary attention was given to achieving group consensus concerning the recommended types and amounts of physical activity. A concise "public health message" was developed to express the recommendations of the panel. During the ensuing months, the consensus statement was further reviewed and revised and was formally endorsed by both the Centers for Disease Control and Prevention and the American College of Sports Medicine.
Conclusion:
Every US adult should accumulate 30 minutes or more of moderate-intensity physical activity on most, preferably all, days of the week.
Objective.
—To encourage increased participation in physical activity among Americans of all ages by issuing a public health recommendation on the types and amounts of physical activity needed for health promotion and disease prevention.
We applied the model of the stages and processes of change to exercise adoption and maintenance. This model has shown promise in advancing theory and treatment of the addictions and other negative health behaviors, but there have been few systematic attempts to apply the model to positive health behaviors, such as exercise adoption. Questionnaires dealing with the stages and processes of exercise change were developed and administered to a sample of 1,172 participants in a worksite health promotion project. The sample was split randomly into halves for (a) initial model development and testing and (b) confirmatory measurement model testing. Additional model confirmation was obtained by examining the hierarchical structure of the processes of change and by conducting Stage × Process analyses. Results suggest that the underlying constructs derived from smoking cessation and other addictive behaviors can be generalized to exercise behavior. Understanding the stages and processes of exercise behavior change may yield important information for enhancing exercise adoption, adherence, and relapse prevention at both individual and public health levels.
Key words: stages of change, processes of change, exercise adoption and maintenance
Purpose: Despite the recognition of fatigue as a common and distressing symptom during cancer treatment, there are few evidence-based interventions available to manage such fatigue. The purpose of this multi-institutional pilot study was to explore the effects of a home-based moderate walking exercise intervention on fatigue, physical functioning, emotional distress, and quality of life (QOL) during breast cancer treatment.
Description of study: Fifty-two women were recruited from five university hospital outpatient departments for this pilot study with an experimental design. Subjects were randomly assigned to the walking program or to usual care during adjuvant chemotherapy or radiation therapy for breast cancer. Symptoms, physical functioning, and QOL were measured at baseline, midtreatment, and at the end of treatment.
Results: Women who exercised at least 90 minutes per week on 3 or more days reported significantly less fatigue and emotional distress as well as higher functional ability and QOL than women who were less active during treatment.
Clinical implications: A home-based walking exercise program is a potentially effective, low-cost, and safe intervention to manage fatigue and to improve QOL during adjuvant chemotherapy or radiation therapy for breast cancer. This health-promoting self-care activity needs further testing in large randomized clinical trials.
OBJECTIVE--To encourage increased participation in physical activity among Americans of all ages by issuing a public health recommendation on the types and amounts of physical activity needed for health promotion and disease prevention. PARTICIPANTS--A planning committee of five scientists was established by the Centers for Disease Control and Prevention and the American College of Sports Medicine to organize a workshop. This committee selected 15 other workshop discussants on the basis of their research expertise in issues related to the health implications of physical activity. Several relevant professional or scientific organizations and federal agencies also were represented. EVIDENCE--The panel of experts reviewed the pertinent physiological, epidemiologic, and clinical evidence, including primary research articles and recent review articles. CONSENSUS PROCESS--Major issues related to physical activity and health were outlined, and selected members of the expert panel drafted sections of the paper from this outline. A draft manuscript was prepared by the planning committee and circulated to the full panel in advance of the 2-day workshop. During the workshop, each section of the manuscript was reviewed by the expert panel. Primary attention was given to achieving group consensus concerning the recommended types and amounts of physical activity. A concise \"public health message was developed to express the recommendations of the panel. During the ensuing months, the consensus statement was further reviewed and revised and was formally endorsed by both the Centers for Disease Control and Prevention and the American College of Sports Medicine. CONCLUSION--Every US adult should accumulate 30 minutes or more of moderate-intensity physical activity on most, preferably all, days of the weekType: CONSENSUS DEVELOPMENT CONFERENCEType: JOURNAL ARTICLEType: REVIEWLanguage: Eng
Motivational and cognitive processes of behavior change with respect to the area of exercise adoption were investigated. A total of 778 men and women, recruited from four worksites, answered a 40-item questionnaire consisting of statements based on constructs from the transtheoretical model of behavior change. Principal-components analysis identified two factors—one a 6-item component representing avoidance of exercise (Cons), the other a 10-item component representing positive perceptions of exercise (Pros). Analysis of variance showed that the Pros, Cons, and a Decisional Balance measure (Pros minus Cons) were significantly associated with stage of exercise adoption. Results are consistent with applications of the model to smoking cessation and other areas of behavior change. Distinctions between exercise adoption and behaviors such as smoking cessation, weight loss, and alcoholism are discussed.
Key words: exercise, decisional balance, health behavior, transtheoretical model, behavioral adoption
Assessment of habitual physical activity in epidemiologic and health education studies has been difficult. A seven-day physical activity recall interview was developed and administered in a community health survey, a randomized clinical trial, and two worksite health promotion programs during 1979-1982. These studies were conducted in several populations in California, Texas, Pennsylvania, and New Jersey. Energy expenditure estimates from the physical activity recall conformed to expected age- and sex-specific values in the cross-sectional community survey. Estimates of energy expenditure were also congruent with other questions on physical activity and job classification. In a randomized, one-year exercise trial, the physical activity recall detected increases in energy expenditure in the treated group and was positively associated with miles run during training (p less than 0.05). Changes in energy expenditure were associated with changes in maximal oxygen uptake (VO2max (r = 0.33, p less than 0.05) and body fatness (r = -0.50, p less than 0.01) at six months, and in high density lipoprotein-cholesterol (r = 0.31, p less than 0.05) and triglyceride (r = -0.41, p less than 0.01) at one year. The physical activity recall detected significant (p less than 0.01) increases in energy expenditure in treatment groups in two worksite health promotion projects. These data suggest that the physical activity recall provides useful estimates of habitual physical activity for research in epidemiologic and health education studies.
An integrative model of change was applied to the study of 872 Ss (mean age 40 yrs) who were changing their smoking habits on their own. Ss represented the following 5 stages of change: precontemplation, contemplation, action, maintenance, and relapse. 10 processes of change were expected to receive differential emphases during particular stages of change. Results indicate that Ss (a) used the fewest processes of change during precontemplation; (b) emphasized consciousness raising during the contemplation stage; (c) emphasized self-reevaluation in both contemplation and action stages; (d) emphasized self-liberation, a helping relationship, and reinforcement management during the action stage; and (e) used counterconditioning and stimulus control the most in both action and maintenance stages. Relapsers responded as a combination of contemplaters and people in action would. Results are discussed in terms of developing a model of self-change of smoking and enhancing a more integrative general model of change. (14 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
In this study, we examined correlates of adherence and contamination in a randomized controlled trial (RCT) of exercise in cancer survivors using the theory of planned behavior and the Five Factor Model of personality (FFM). We randomly assigned cancer survivors in group psychotherapy classes to either a waiting-list control group (n = 45) or a home-based, moderate intensity exercise program (n = 51). At baseline, participants completed measures of the theory of planned behavior, the FFM, past exercise, physical fitness, medical variables, and demographics. We then monitored exercise over a 10-week period by weekly self-reports. Hierarchical multiple regression analyses indicated that the independent predictors of overall RCT exercise across both conditions were past exercise (beta = .36, p < .001), assignment to experimental condition (beta = .34, p < .001), sex (beta = .30, p < .001), and intention (beta = .14, p < .10). For exercise adherence in the exercise condition, the independent predictors were sex (beta = .38, p < .01), extraversion (beta = .30, p < .05), normative beliefs (beta = -.27, p < .05), and perceived behavioral control (beta = .23, p < .10). Finally, the independent predictors of exercise contamination in the control condition were past exercise (beta = .70, p < .001), sex (beta = .20, p < .05), and intention (beta = .17, p < .10). We conclude that the correlates of exercise adherence and contamination differ in kind as well as in degree. Explanations for these findings and practical implications for conducting exercise RCTs in this population are offered.
Physical exercise has been shown to enhance quality of life (QOL) in cancer survivors using pretest-posttest designs and compared to usual care (i.e. no intervention). In the present study, we conducted a randomized controlled trial to determine if exercise could improve QOL in cancer survivors beyond the known benefits of group psychotherapy (GP). We matched 22 GP classes (N=108) on content and then randomly assigned 11 (n=48) to GP alone and 11 (n=60) to GP plus home-based, moderate-intensity exercise (GP+EX). Participants completed a physical fitness test and QOL measures (e.g. Functional Assessment of Cancer Therapy scales) at the beginning and end of GP classes (about 10 weeks). We had excellent recruitment (81%), retention (89%), and adherence (84%) rates and a modest contamination (22%) rate. Using intention-to-treat repeated measures analyses of variance, we found significant Time by Condition interactions for functional well-being, fatigue, and sum of skinfolds. We also found borderline significant interactions for physical well-being, satisfaction with life, and flexibility. All interactions favored the GP+EX condition. We conclude that a home-based, moderate intensity exercise program may im-prove QOL in cancer survivors beyond the benefits of GP, particularly in relation to physical and functional well-being.
Declines in physical functioning (PF) among elderly cancer patients threaten quality of life and the ability to maintain independence. Adherence to healthy lifestyle behaviors may prevent functional decline.
Project Leading the Way in Exercise and Diet (LEAD), an intervention development study of the Pepper Older Americans Independence Center, aimed to determine whether breast and prostate cancer survivors (age 65+ years) assigned to a 6-month home-based diet and exercise intervention experienced improvements in PF when compared with an attention control arm receiving general health information. An accrual target was set at 420, and PF (Short Form-36 subscale), physical activity (Community Healthy Activities Models Program for Seniors), and diet quality (index from 3-day recalls) were assessed at baseline and at 6 and 12 months (6 months after intervention).
This developmental project did not achieve its accrual target (N = 182); however, PF change scores were in the direction and of the magnitude projected. Baseline to 6-month change scores in the intervention versus the control arms were as follows: PF, +3.1 v -0.5 (P = .23); physical activity energy expenditure, +111 kcal/wk v -400 kcal/wk (P = .13); and diet quality index, +2.2 v -2.9 (P = .003), respectively. Differences between arms diminished during the postintervention period.
These findings suggest that home-based diet and exercise interventions hold promise in improving lifestyle behaviors among older cancer survivors, changes that trend toward improved PF. Future studies should incorporate larger sample sizes and interventions that sustain long-term effects and also take into account secular trends; these efforts will require adequate planning and resources to overcome the numerous barriers to intervening in this difficult to reach yet vulnerable population.
Physical activity (PA) interventions diminish some of the physical and psychosocial sequelae of breast cancer diagnosis and treatment. To increase intervention efficacy and portability, it is necessary to determine the factors mediating intervention effects on physical and psychosocial outcomes. This study presents mediator analyses from a randomized controlled trial of a home-based PA intervention (focused primarily on brisk walking) for breast cancer survivors. Eighty-six survivors were randomized to PA or contact control groups (mean age = 53.42 years, SD = 9.08 and 52.86 years, SD = 10.38 respectively; mean time since diagnosis < 2 years). The PA intervention was based on the transtheoretical model (TTM). Kraemer's approach was used to test hypothesized mediators. TTM variables did not mediate intervention effects on PA. Data indicate that increases in moderate-intensity PA and improved fitness may mediate intervention effects on vigor (β = .21; p = .01) and fatigue (β = .24; p = .05) and suggest the value of future research on these potential mediators.
This paper proposes an extension of generalized linear models to the analysis of longitudinal data. We introduce a class of
estimating equations that give consistent estimates of the regression parameters and of their variance under mild assumptions
about the time dependence. The estimating equations are derived without specifying the joint distribution of a subject's observations
yet they reduce to the score equations for niultivariate Gaussian outcomes. Asymptotic theory is presented for the general
class of estimators. Specific cases in which we assume independence, m-dependence and exchangeable correlation structures from each subject are discussed. Efficiency of the pioposecl estimators
in two simple situations is considered. The approach is closely related to quasi-likelihood.
Examined exercise-adherence rates and their predictors across 21 randomized controlled trials involving older adults (age ≥55 yrs). On average, Ss completed 78% of their prescribed exercise regimens. Predictive factors were cognitive-motivational (attitudes, self-efficacy), health-behavioral, physical, psychological or program-related. Adherence tended to be greater in training programs emphasizing strength and flexibility (87%) than in aerobic-exercise training programs (75%). The best adherers were individuals who were fitter at baseline, had a history of a physically active lifestyle, were nonsmokers, and had higher exercise self-efficacy. Different variables predicted adherence: (1) at different time points in a trial, (2) to different types of exercise, and (3) to different aspects of the exercise prescription (i.e., frequency, intensity, and duration). The findings suggest that older adults might be more adherent to exercise prescriptions than younger adults. The need for more theory-based research is emphasized. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Exercise has important health benefits, but a large proportion of the population is physically inactive. We examined the prevalence of stages of readiness to exercise and their relationship to self-efficacy and to the costs and benefits of exercising in samples of 1093 employees in and around Providence, Rhode Island, and 801 employees in Adelaide, Australia. In both samples, 40.6% of respondents had not yet begun to take action (not thinking about starting to exercise or thinking about it but not doing it), while 59.4% were at some phase of action (exercising some, starting to exercise regularly, exercising regularly). Scores on self-efficacy items and cost-and-benefit items significantly differentiated employees at extreme stages. In contrast with those who exercised regularly, employees who had not yet begun to exercise had little confidence in their ability to exercise and saw exercising as having nearly as many costs as it had benefits. There is the potential to enhance the impact of exercise interventions by targeting them so as to address factors related to these different stages of readiness to exercise.
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.
Purpose:
To present an overview of exercise interventions in cancer patients during and after treatment and evaluate dose-training response considering type, frequency, volume, and intensity of training along with expected physiological outcomes.
Methods:
The review is divided into studies that incorporated cardiovascular training, combination of cardiovascular, resistance, and flexibility training, and resistance training alone during and after cancer management. Criteria for inclusion were based on studies sourced from electronic and nonelectronic databases and that incorporated preintervention and postintervention assessment with statistical analysis of data.
Results:
Twenty-six published studies were summarized. The majority of the studies demonstrate physiological and psychological benefits. However, most of these studies suffer limitations because they are not randomized controlled trials and/or use small sample sizes. Predominantly, studies have been conducted with breast cancer patients using cardiovascular training rather than resistance exercise as the exercise modality. Recent evidence supports use of resistance exercise or "anabolic exercise" during cancer management as an exercise mode to counteract side effects of the disease and treatment.
Conclusion:
Evidence underlines the preliminary positive physiological and psychological benefits from exercise when undertaken during or after traditional cancer treatment. As such, other cancer groups, in addition to those with breast cancer, should also be included in clinical trials to address more specifically dose-response training for this population. Contemporary resistance training designs that provide strong anabolic effects for muscle and bone may have an impact on counteracting some of the side effects of cancer management assisting patients to improve physical function and quality of life.
Recruiting cancer patients for randomized trials investigating psychosocial interventions presents several unique challenges. This paper describes the challenges and yields for different recruitment methods used in Moving Forward, a randomized trial of a home-based moderate-intensity physical activity program for early-stage breast cancer survivors. Recruitment methods included letters sent to patients by their oncologists, direct referrals from oncologists, in-person recruitment in oncology clinics, referrals from nurses and medical assistants, passive recruitment, other mailings, and community outreach strategies. Of the 424 screenings completed, 86 (20.3%) participants were randomized. Physician letters yielded the greatest number of initial screenings (147; 34.7%) and participants randomized (28; 32.5%). In-person recruitment also proved to be a productive recruitment strategy; 14 (16.3%) of the participants were recruited via this strategy. Community outreach efforts did not provide as great a yield and were labor intensive. We discuss suggestions for recruitment of cancer patients in future trials.
We applied the model of the stages and processes of change to exercise adoption and maintenance. This model has shown promise in advancing theory and treatment of the addictions and other negative health behaviors, but there have been few systematic attempts to apply the model to positive health behaviors, such as exercise adoption. Questionnaires dealing with the stages and processes of exercise change were developed and administered to a sample of 1,172 participants in a worksite health promotion project. The sample was split randomly into halves for (a) initial model development and testing and (b) confirmatory measurement model testing. Additional model confirmation was obtained by examining the hierarchical structure of the processes of change and by conducting Stage x Process analyses. Results suggest that the underlying constructs derived from smoking cessation and other addictive behaviors can be generalized to exercise behavior. Understanding the stages and processes of exercise behavior change may yield important information for enhancing exercise adoption, adherence, and relapse prevention at both individual and public health levels.
This study examined the application of constructs concerning stage of readiness to change and self-efficacy to exercise. We developed two scales to measure stages of change for exercise behavior. Prevalence information on a sample of 1,063 government employees and 429 hospital employees was then obtained. Next, the ability of a questionnaire measuring exercise self-efficacy to differentiate employees according to stage of readiness to change was tested. Results from both stages-of-change scales revealed that 34-39% of employees were regularly participating in physical activity. Scores on efficacy items significantly differentiated employees at most stages. Results indicated employees who had not yet begun to exercise, in contrast with those who exercised regularly, had little confidence in their ability to exercise. Continued work at understanding the stages of exercise behavior and exercise self-efficacy could yield important information for enhancing exercise adoption and adherence.
Perceptions of personal efficacy have been consistently identified as being determinants of exercise adherence in asymptomatic, rehabilitative, younger, and older populations. The present study incorporated a randomized control design in an effort to examine the effects of an efficacy-based intervention in enhancing exercise adherence in a large sample (N = 114) of formerly sedentary middle-aged males and females.
Subjects randomly assigned to an exercise plus intervention group or an exercise plus attentional control group participated in a 5-month long walking program led by trained personnel. Exercise behavior (frequency, miles walked, duration) were assessed on a continuous basis and self-efficacy was measured at 1, 2, and 4 months.
Repeated measures multivariate analyses revealed a significant treatment effect with subjects in the intervention group exercising more frequently, for longer duration, and walking greater distances over the course of the program. Path analysis indicated that the effect of the treatment on adherence was direct rather than through self-efficacy as hypothesized. Self-efficacy was, however, a significant predictor of exercise behavior in the early and middle stages of the exercise program but not during the last month.
An intervention program designed to maximize information pertaining to participants' capabilities appears to have had a reasonable effect on reducing attrition in middle-aged males and females and self-efficacy was a significant predictor of exercise frequency over time. Further research efforts are required to tease out those cognitive factors that might underlie any effects of interventions in exercise adherence.
The stages of change model has shown promise in advancing knowledge about smoking behavior change and other negative addictive behaviors. The model was applied to the study of exercise, a healthy rather than unhealthy behavior. A stages of exercise behavior questionnaire was administered to a sample of 235 employees. Next, the ability of a second questionnaire measuring physical activity behavior to differentiate employees according to stage of exercise was tested. Results revealed that 51% of employees were participating in no physical activity (Precontemplation, Contemplatation) and 49% were participating in occasional or regular physical activity (Preparation, Action, Maintenance). Scores on physical activity behavior items significantly differentiated employees among the stages. This model developed on smoking and other behaviors can be generalized to exercise behavior. Understanding the stages of exercise behavior could yield important information for enhancing rates of participation in physical activity.
In theory-based interventions for behavior change, there is a need to examine the effects of interventions on the underlying theoretical constructs and the mediating role of such constructs. These two questions are addressed in the Physically Active for Life study, a randomized trial of physician-based exercise counseling for older adults. Three hundred fifty-five patients participated (intervention n = 181, control n = 174; mean age = 65.6 years). The underlying theories used were the Transtheoretical Model, Social Cognitive Theory and the constructs of decisional balance (benefits and barriers), self-efficacy, and behavioral and cognitive processes of change. Motivational readiness for physical activity and related constructs were assessed at baseline, 6 weeks, and 8 months. Linear or logistic mixed effects models were used to examine intervention effects on the constructs, and logistic mixed effects models were used for mediator analyses. At 6 weeks, the intervention had significant effects on decisional balance, self-efficacy, and behavioral processes, but these effects were not maintained at 8 months. At 6 weeks, only decisional balance and behavioral processes were identified as mediators of motivational readiness outcomes. Results suggest that interventions of greater intensity and duration may be needed for sustained changes in mediators and motivational readiness for physical activity among older adults.
This study examined predictors of exercise maintenance following completion of a physical activity intervention. Sedentary adults recruited through newspaper advertisements were randomly assigned to receive either (a) a motivation-matched intervention with feedback reports that were individually tailored (IT) to psychological variables from social cognitive theory and the Transtheoretical Model via computer expert system, or (b) a standard, print-based intervention (ST). The intervention phase of the study included mailed assessments and intervention materials at baseline, 1, 3, and 6 months. An assessment-only follow-up was conducted 6 months after the end of the intervention (Month 12). Participants were assessed for current physical activity participation, motivational readiness for physical activity, a number of psychological constructs posited to influence participation in physical activity (e.g., self-efficacy), and current affect. Significantly more participants in the IT condition met or exceeded exercise participation goals at the end of the intervention period and maintained this level of physical activity through the Month 12 follow-up compared to ST participants. Prospective analyses revealed significant differences in several psychological constructs both at program entry (baseline) and the end of the intervention period between individuals who maintained their physical activity participation through Month 12 and those who did not. Results suggest that the maintenance of physical activity following the end of an active intervention program may be influenced by attitudes and behaviors acquired along with increased participation in physical activity, as well as by preexisting characteristics that individuals bring into treatment.
Researchers examining theory-based, physical activity (PA) interventions postulate that interventions are effective by changing theoretical constructs hypothesized to mediate the relationship between the intervention and PA behavior. Research indicates that PA interventions are effective for increasing PA behavior. However, whether effective interventions are due to predicted changes in theoretical constructs remains poorly understood.
Studies that examined theoretical constructs (i.e., mediators) in PA interventions of adults or children, which used experimental designs and met other criteria for evaluating mediation, were collected via literature searches, personal searches of files, and personal communications. Only studies examining the direct effect of the intervention on the hypothesized mediator were considered relevant for this study.
Based on our criteria, the adult literature search yielded ten studies and the child literature search yielded two studies. The most common mediators examined included behavioral processes of change, cognitive processes of change, self-efficacy, decisional balance, social support, and enjoyment. Research indicates that behavioral processes are likely mediators. There was some support for the importance of self-efficacy as a mediator.
Few studies have used statistically recommended methods to examine mediators in PA intervention studies. Therefore, definitive conclusions about the importance of the mediators reviewed are not possible at this time. Additional PA mediator-intervention studies using recommended statistical methods are necessary to truly test if theory-based PA interventions are effective due to predicted changes in theoretical constructs.
The aims of this pilot study were the following: 1) to examine patterns of adherence to a brisk walking program in women receiving adjuvant chemotherapy or radiation therapy for newly diagnosed breast cancer using a prospective, randomized, controlled experimental design; 2) to examine the influence of disease symptoms and treatment side effects on exercise levels; and 3) to suggest methods that may improve future clinical trials of moderate-intensity exercise in similar populations.
Fifty-two patients with newly diagnosed breast cancer were randomly assigned to one of two treatment arms: usual care or usual care plus exercise. Those assigned to the exercise group received a standardized, self-administered, home-based brisk walking intervention in addition to usual care. Each day subjects completed self-report diary forms that elicited information about activity levels, and the occurrence of symptoms and side effects during cancer treatment.
Analyses of self-reported daily activity levels revealed a diffusion of treatment effect. Fifty percent of the usual-care group reported maintaining or increasing their physical activity to a moderate-intensity level, while 33% of the exercise group did not exercise at the prescribed levels. Analyses of self-reported disease symptoms and treatment side effects did not reveal clinically meaningful differences between the two groups.
The results of this study suggest that women who exercised regularly before receiving a breast cancer diagnosis attempted to maintain their exercise programs. Women who lead sedentary lifestyles may benefit from a structured exercise program that includes information and support related to exercise adherence strategies.
To determine the effects of exercise training on cardiopulmonary function and quality of life (QOL) in postmenopausal breast cancer survivors who had completed surgery, radiotherapy, and/or chemotherapy with or without current hormone therapy use.
Fifty-three postmenopausal breast cancer survivors were randomly assigned to an exercise (n = 25) or control (n = 28) group. The exercise group trained on cycle ergometers three times per week for 15 weeks at a power output that elicited the ventilatory equivalent for carbon dioxide. The control group did not train. The primary outcomes were changes in peak oxygen consumption and overall QOL from baseline to postintervention. Peak oxygen consumption was assessed by a graded exercise test using gas exchange analysis. Overall QOL was assessed by the Functional Assessment of Cancer Therapy-Breast scale.
Fifty-two participants completed the trial. The exercise group completed 98.4% of the exercise sessions. Baseline values for peak oxygen consumption (P =.254) and overall QOL (P =.286) did not differ between groups. Peak oxygen consumption increased by 0.24 L/min in the exercise group, whereas it decreased by 0.05 L/min in the control group (mean difference, 0.29 L/min; 95% confidence interval [CI], 0.18 to 0.40; P <.001). Overall QOL increased by 9.1 points in the exercise group compared with 0.3 points in the control group (mean difference, 8.8 points; 95% CI, 3.6 to 14.0; P =.001). Pearson correlations indicated that change in peak oxygen consumption correlated with change in overall QOL (r = 0.45; P <.01).
Exercise training had beneficial effects on cardiopulmonary function and QOL in postmenopausal breast cancer survivors.
To examine predictors of adherence in a randomized controlled trial of resistance exercise training (RET) in prostate cancer survivors receiving androgen deprivation therapy.
A randomized controlled trial conducted at fitness centers in Ottawa and Edmonton, Canada. Prostate cancer survivors (n=155) completed measures of social cognitive variables, quality of life (QOL), behavior, and fitness before being randomized to either an exercise (n=82) or control (n=73) group. The exercise group was asked to perform supervised RET three times per week for 12 weeks.
The exercise group attended 28.2 of the 36 (78.3%) RET sessions. Univariate analyses revealed eight different significant (Ps <.05) predictors of exercise adherence including exercise stage of change, intention, age, QOL, fatigue, subjective norm, leg-press test, and perceived behavioral control. A multivariate analysis indicated that there were three independent predictors of adherence that explained 20.4% of the variance: exercise stage of change (beta=0.26; P=.013), age (beta=-0.22; P=.037), and intention (beta=0.19; P=.073).
Exercise adherence in the trial was very good but not optimal. Adherence was predicted by variables from many different categories including social cognitive, QOL, behavioral, fitness, and demographic. These findings may have important implications for maximizing adherence during clinical trials of exercise in prostate cancer survivors.
The purpose of this study was to examine predictors of exercise adherence (i.e. exercise in the intervention group) and exercise contamination (i.e. exercise in the control group) in a randomized controlled trial of home-based exercise in colorectal cancer survivors. At baseline, 102 participants completed measures of the theory of planned behavior, personality, past exercise, exercise stage of change, physical fitness, and medical/demographics and then were randomly assigned in a 2:1 ratio to an exercise (n=69) or control (n=33) group. Exercise was monitored weekly for 16 weeks using self-reports by telephone. Ninety-three (91%) participants completed the trial. Adherence was 76% in the exercise group and contamination was 52% in the control group. Hierarchical stepwise regression analyses indicated that baseline exercise stage of change (beta=0.35; p=0.001), employment status (beta=-0.28; p=0.010), treatment protocol (beta=-0.26; p=0.018), and perceived behavioral control (beta=0.20; p=0.055) explained 39.6% of the variance in exercise adherence. Intentions (beta=0.36; p=0.049) and baseline exercise stage of change (beta=0.30; p=0.095) explained 29.9% of the variance in exercise contamination. These findings may have implications for conducting clinical trials of exercise in colorectal cancer survivors and for promoting exercise to colorectal cancer survivors outside of clinical trials.
This pilot study examined whether exercise as an adjunctive rehabilitation therapy could benefit women who have early stage breast cancer and are currently receiving chemotherapy/radiotherapy. The study was designed as a randomised controlled trial (RCT). Physical functioning, fatigue and Quality of Life (QoL) outcomes were evaluated pre and post a 12-week intervention. The results showed that after 12 weeks the women who participated in the exercise programme (n = 12) displayed significantly higher levels of physical functioning and reported higher QoL scores than the controls (n = 10). Changes in fatigue and satisfaction with life favoured the intervention group but did not reach significance. These results are encouraging and suggest that a structured group exercise programme during adjuvant treatment is a safe, well tolerated and effective way of providing physical and psychological health benefits to women during treatment for early stage breast cancer. Since this was a pilot study the numbers did not allow appropriately powered analyses of some variables of interest and favoured relatively young and socio-economically advantaged women. Future studies need to address these issues and determine if these short-term benefits can be sustained.
The efficacy of a home-based physical activity (PA) intervention for early-stage breast cancer patients was evaluated in a randomized controlled trial.
Eighty-six sedentary women (mean age, 53.14 years; standard deviation, 9.70 years) who had completed treatment for stage 0 to II breast cancer were randomly assigned to a PA or contact control group. Participants in the PA group received 12 weeks of PA counseling (based on the Transtheoretical Model) delivered via telephone, as well as weekly exercise tip sheets. Assessments were conducted at baseline, after treatment (12 weeks), and 6 and 9 month after baseline follow-ups. The post-treatment outcomes are reported here.
Analyses showed that, after treatment, the PA group reported significantly more total minutes of PA, more minutes of moderate-intensity PA, and higher energy expenditure per week than controls. The PA group also out-performed controls on a field test of fitness. Changes in PA were not reflected in objective activity monitoring. The PA group was more likely than controls to progress in motivational readiness for PA and to meet PA guidelines. No significant group differences were found in body mass index and percent body fat. Post-treatment group comparisons revealed significant improvements in vigor and a reduction in fatigue in the PA group. There was a positive trend in intervention effects on overall mood and body esteem.
The intervention successfully increased PA and improved fitness and specific aspects of psychological well-being among early-stage breast cancer patients. The success of a home-based PA intervention has important implications for promoting recovery in this population.
To systematically review the methodologic quality of, and summarize the evidence from trials examining the effectiveness of physical exercise in improving the level of physical functioning and psychological well-being of cancer patients during and after medical treatment.
Thirty-four randomized clinical trials (RCTs) and controlled clinical trials were identified, reviewed for substantive results, and assessed for methodologic quality.
Four of 34 trials met all (seven of seven) methodologic criteria on the Delphi criteria list. Failure to conceal the sequencing of treatment allocation before patient recruitment, failure to blind the outcome assessor, and failure to employ an intention-to-treat analysis strategy were the most prevalent methodologic shortcomings. Various exercise modalities have been applied, differing in content, frequency, intensity, and duration. Positive results have been observed for a diverse set of outcomes, including physiologic measures, objective performance indicators, self-reported functioning and symptoms, psychological well-being, and overall health-related quality of life.
The trials reviewed were of moderate methodologic quality. Together they suggest that cancer patients may benefit from physical exercise both during and after treatment. However, the specific beneficial effects of physical exercise may vary as a function of the stage of disease, the nature of the medical treatment, and the current lifestyle of the patient. Future RCTs should use larger samples, use appropriate comparison groups to rule out the possibility of an attention-placebo effect, use a comparable set of outcome measures, pay greater attention to issues of motivation and adherence of patients participating in exercise programs, and examine the effect of exercise on cancer survival.
To evaluate a 12-week home-based walking intervention among breast cancer survivors and to quantify changes in physical activity (PA) behaviors, body weight, and body composition in response to the intervention.
Breast cancer survivors that were in the posttreatment period were randomized to intervention (n=23) or wait-list usual care (n=13). PA was assessed by self-report, and in a study subsample (n=23), by an accelerometer. Intention to treat principles were employed to estimate the intervention effect on PA behaviors, body weight, and body composition. Intervention adherence was calculated as the proportion of exercise sessions completed relative to the number of exercise sessions recommended, as reported each week on walking logs.
Thirty-four of 36 women randomized (94%) completed the study. Average intervention adherence over 12 weeks was 94%. Intervention participants reported a significantly greater increase in walking for exercise [+11.9 metabolic equivalent (MET)-h/week] over time than did usual care participants (+1.7 MET-h/week, p=0.01). Objective measures of activity also indicated that intervention participants increased their activity levels over time as compared to usual care participants [i.e., counts/min/day and steps/day (p< or =0.04)]. No significant changes in body weight or composition were observed.
We found that a 12-week home-based walking intervention was safe and effective for increasing short-term PA levels in breast cancer survivors. Future studies are needed to assess the ability of brief interventions to facilitate the maintenance of increased activity levels and to produce favorable quality of life and risk factor outcomes.
We describe adherence to a three group randomised controlled trial that involved aerobic exercise therapy (N=34) and exercise-placebo intervention (N=36) or usual care (N=38) in women treated for breast cancer. We also investigated relationships between routes of trial recruitment, socio-economic characteristics, health behaviours, cancer treatment regimen(s) and subsequent adherence to the interventions. Women who had completed breast cancer treatment 12-36 months previously were randomised to one of the groups. The intervention groups attended an exercise facility three times per week for eight weeks. A total of 77% of the aerobic exercise therapy and 88.9% of the exercise-placebo groups attended at least 70% of prescribed sessions. The percentage of women achieving 30min of aerobic exercise per session steadily increased during the intervention but many women were not able to achieve this goal. Routes of trial recruitment, socio-economic characteristics, health behaviours and cancer treatment regimen(s) were not related to intervention. Exercise therapy participants were able to comply with the progressive nature of the aerobic exercise intervention, although some women were not able to achieve 30min of aerobic exercise per session by intervention completion. Research is still required to tease out all the potential determinants of exercise in this population.
To review randomized controlled trials that offered exercise interventions for adults diagnosed and treated for cancer related to design, sample, type of intervention, and outcomes.
Several electronic databases were searched and recent review papers were scanned to identify relevant publications.
Exercise adoption seems clearly feasible for early stage cancer patients, particularly breast cancer patients. Data support positive effects for physical functioning, quality of life, and psychological well-being. Effects for patients with later-stage disease and other cancers are less clear. The impact of exercise adoption on biomarkers of disease status, immune functioning, and hormone levels should also be examined.
There are many opportunities for nurses to promote exercise in clinical care and in a research context.
Effectiveness of Behavioral Interventions to Modify Physical Activity Behaviors in General Populations and Cancer Patients and Survivors. Rockville, MD: U.S. Department of Health and Human Services
Effectiveness of Behavioral Interventions to Modify Physical Activity Behaviors in General
Populations and Cancer Patients and Survivors. Rockville, MD: U.S. Department of Health and Human
Services; 2004. Agency for Healthcare Research and Quality. (AHRQ Publ. No. 04-E027-2)
Fatigue and quality of life outcomes of exercise during cancer treatment
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