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Background Moderate to vigorous physical activity (MVPA) interventions improve patient-reported outcomes (PROs) of physical and psychological health among breast cancer survivors (BCS); however, the effects of specific intervention components on PROs are unknown. Purpose To use the Multiphase Optimization Strategy (MOST) to examine overall effects of the Fit2Thrive MVPA promotion intervention on PROs in BCS and explore whether there are intervention component-specific effects on PROs. Methods Physically inactive BCS [ n = 269; M age = 52.5 (SD = 9.9)] received a core intervention (Fitbit + Fit2Thrive smartphone app) and were randomly assigned to one of 32 conditions in a full factorial experiment of five components ("on" vs. "off"): (i) support calls, (ii) deluxe app, (iii) text messages, (iv) online gym, and (v) buddy. Patient-Reported Outcomes Measurement Information System (PROMIS) questionnaires assessed anxiety, depression, fatigue, physical functioning, sleep disturbance and sleep-related impairment at baseline, post-intervention (12-week), and 24-week follow-up. Main effects for all components at each time point were examined using an intention to treat mixed-effects model. Results All PROMIS measures except sleep disturbance significantly improved (p 's <.008 for all) from baseline to 12-weeks. Effects were maintained at 24-weeks. The "on" level of each component did not result in significantly greater improvements on any PROMIS measure compared to the "off" level. Conclusions Participation in Fit2Thrive was associated with improved PROs in BCS, but improvements did not differ for "on" vs. "off" levels for any component tested. The low-resource Fit2Thrive core intervention is a potential strategy to improve PROs among BCS. Future studies should test the core in an RCT and examine various intervention component effects in BCS with clinically elevated PROs. [ABSTRACT FROM AUTHOR]

Background: Disease-free survival (DFS) and overall survival (OS) associations with anthropometric measures of obesity and changes in these exposures remain unknown among endometrial cancer survivors.Methods: Endometrial cancer survivors diagnosed between 2002 and 2006 completed direct anthropometric measurements and self-reported lifetime weight history during in-person interviews approximately 4 months after diagnosis (peridiagnosis) and approximately 3 years after diagnosis (follow-up). Participants were followed-up until death or March 20, 2019. Cox proportional regression was used to estimate multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for body mass index (BMI), weight, waist circumference, and waist-hip ratio with DFS and OS. Statistical tests were 2-sided.Results: A total of 540 and 425 cancer survivors were assessed peridiagnosis and follow-up, respectively. During the median 14.2 years of follow-up (range = 0.3-16.5 years), 132 participants had a recurrence and/or died (DFS), with 111 deaths overall (OS). Reduced DFS was noted with greater recalled weight 1 year before diagnosis (HR = 1.88, 95% CI = 1.15 to 3.07), BMI 1 year before diagnosis (HR = 1.88, 95% CI = 1.09 to 3.22), and measured peridiagnosis BMI (HR = 2.04, 95% CI = 1.18 to 3.53). Measured peridiagnosis waist circumference of at least 88 cm was associated with decreased DFS (HR = 1.94, 95% CI = 1.24 to 3.03) and OS (HR = 1.90, 95% CI = 1.16 to 3.13). A twofold decrease in DFS and OS was associated with a BMI of at least 5% or weight change from 1 year before diagnosis to peridiagnosis. No associations were observed for the assessment during follow-up.Conclusions: One-year before- and peridiagnosis anthropometric measures of obesity were associated with reduced survival among endometrial cancer survivors. Anthropometric changes from 1 year before to peridiagnosis may provide an important indication of future survival in this population. [ABSTRACT FROM AUTHOR]

Increased moderate and vigorous physical activity (MVPA) is associated with better health outcomes in breast cancer survivors; yet, most are insufficiently active. Smartphone applications (apps) to promote MVPA have high scalability potential, but few evidence-based apps exist. The purpose is to describe the testing and usability of Fit2Thrive, a MVPA promotion app for breast cancer survivors. A user-centered, iterative design process was utilized on three independent groups of participants. Two groups of breast cancer survivors (group 1 n = 8; group 2: n = 14) performed app usability field testing by interacting with the app for ≥3 days in a free-living environment. App refinements occurred following each field test. The Post-Study System Usability Questionnaire (PSSUQ) and the User Version Mobile Application Rating Scale (uMARS) assessed app usability and quality on a 7- and 5-point scale, respectively, and women provided qualitative written feedback. A third group (n = 15) rated potential app notification content. Quantitative data were analyzed using descriptive statistics. Qualitative data were analyzed using a directed content analysis. The PSSUQ app usability score (M 1 = 3.8; SD = 1.4 vs. M 2 = 3.2; SD = 1.1; lower scores are better) and uMARS app quality score (M 1 = 3.4; SD = 1.3 vs. M 2 = 3.4; SD = 0.6; higher scores are better) appeared to improve in Field Test 2. Group 1 participants identified app "clunkiness," whereas group 2 participants identified issues with error messaging/functionality. Group 3 "liked" 53% of the self-monitoring, 71% of the entry reminder, 60% of the motivational, and 70% of the goal accomplishment notifications. Breast cancer survivors indicated that the Fit2Thrive app was acceptable and participants were able to use the app. Future work will test the efficacy of this app to increase MVPA. [ABSTRACT FROM AUTHOR]

Incorporating peer and professional social support features into remotely delivered, technology-supported physical activity interventions may increase their effectiveness. However, very little is known about survivors' preferences for potential social features. This study explored breast cancer survivors' preferences for both traditional (e.g., coaching calls and peer support) and innovative (i.e., message boards and competitions) social support features within remotely delivered, technology-supported physical activity interventions. Survivors [ N = 96; M age = 55.8 (SD = 10.2)] self-reported demographic and disease characteristics and physical activity. A subset (n = 28) completed semistructured phone interviews. Transcribed interviews were evaluated using a thematic content analysis approach and consensus review. Following interviews, the full sample self-reported preferences for social features for remotely delivered physical activity interventions via online questionnaires. Questionnaire data were analyzed using descriptive statistics. Four themes emerged from interview data: (a) technology increases social connectedness; (b) interest in professional involvement/support; (c) connecting with similar survivors; and (d) apprehension regarding competitive social features. Quantitative data indicated that most survivors were interested in social features including a coach (77.1 per cent), team (66.7 per cent), and exercise buddy (57.3 per cent). Survivors endorsed sharing their activity data with their team (80.0 per cent) and buddy (76.6 per cent), but opinions were mixed regarding a progress board ranking their activity in relation to other participants' progress. Survivors were interested in using a message board to share strategies to increase activity (74.5 per cent) and motivational comments (73.4 per cent). Social features are of overall interest to breast cancer survivors, yet preferences for specific social support features varied. Engaging survivors in developing and implementing remotely delivered, technology-supported social features may enhance their effectiveness. [ABSTRACT FROM AUTHOR]

Background Adverse upper limb musculoskeletal effects occur after surgical procedures and radiotherapy for breast cancer and can interfere with activities of daily living. Objective The objective of this study was to examine the effects of a 16-week exercise intervention on shoulder function in women who are overweight or obese and have breast cancer. Design This study was a randomized controlled trial. Setting The study was performed at the Division of Biokinesiology and Physical Therapy at the University of Southern California. Participants One hundred women with breast cancer were randomly allocated to exercise or usual-care groups. The mean (SD) age of the women was 53.5 (10.4) years, 55% were Hispanic white, and their mean (SD) body mass index was 33.5 (5.5) kg/m2. Intervention The 16-week exercise intervention consisted of supervised, progressive, moderate to vigorous aerobic and resistance exercise 3 times per week. Measurements Shoulder active range of motion, isometric muscular strength, and patient-reported outcome measures (including Disabilities of the Arm, Shoulder, and Hand and the Penn Shoulder Scale) were assessed at baseline, after the intervention, and at the 3-month follow-up (exercise group only). Differences in mean changes for outcomes were evaluated using mixed-model repeated-measures analysis. Results Compared with the usual-care group, the exercise group experienced significant increases in shoulder active range of motion (the mean between-group differences and 95% confidence intervals (CIs) were as follows: shoulder flexion = 36.6° [95% CI = 55.2–20.7°], external rotation at 0° = 23.4° [95% CI = 31.1–12.5°], and external rotation at 90° = 34.3° [95% CI = 45.9–26.2°]), improved upper extremity isometric strength, and improved Disabilities of the Arm, Shoulder, and Hand and Penn Shoulder Scale scores. Limitations Limitations include a lack of masking of assessors after the intervention, an attention control group, and statistical robustness (shoulder function was a secondary end point). Conclusions A 16-week exercise intervention effectively improved shoulder function following breast cancer treatment in women who were overweight or obese, who were ethnically diverse, and who had breast cancer. [ABSTRACT FROM AUTHOR]

Background: Exercise demonstrates a dose-response effect on many health outcomes; however, adhering to higher doses of exercise can be challenging, and the predictors of adherence may differ based on exercise volume.Purpose: To examine the predictors of adherence to two different volumes of aerobic exercise within the Breast Cancer and Exercise Trial in Alberta (BETA).Methods: In BETA, we randomized 400 inactive but healthy postmenopausal women to either a moderate volume (150 min/week) or a high volume (300 min/week) of aerobic exercise for 1 year. We collected data on several predictors of exercise adherence at baseline and used linear and mixed-effect models to determine predictors of exercise adherence to exercise volume and overall.Results: Adherence was higher in the moderate-volume group (84.5%) compared with the high-volume group (75.2%; p < .001). There were no statistically significant interactions between predictors of exercise adherence and exercise volume. Overall, we found that exercise adherence was predicted by randomization group, body mass index (BMI), employment status, and physical health. Adherence was 8.6% lower in the high-volume versus moderate-volume group, 6.7% lower for women working full time versus not, 0.8% lower per BMI increase of 1 kg/m2, and 0.5% higher per unit of physical health.Conclusions: Adherence to high-volume aerobic exercise was more challenging than for moderate-volume aerobic exercise, but the predictors of adherence were similar. Moreover, few factors were major predictors of exercise adherence in this setting suggesting that well-controlled efficacy trials that produce high adherence rates may reduce the influence of individual characteristics on exercise adherence.Trial Registration: NCT1435005. [ABSTRACT FROM AUTHOR]

Background: Exercise is beneficial for prostate cancer survivors. Therefore, understanding the mechanisms of physical activity (PA) behavior change is imperative.Purpose: The ENGAGE study was an exercise intervention for prostate cancer survivors, which improved vigorous physical activity (VPA) at postintervention and follow-up. The purpose of this study was to assess (a) whether the intervention improved social cognitive determinants of behavior and (b) the extent to which social cognitive determinants mediated the effect of the exercise intervention on VPA.Methods: Overall, 147 men consented to be involved in the study (intervention = 54, usual care = 93). Data from baseline, postintervention (12 weeks) and follow-up (6 months) were used in this analysis. Social cognitive determinants were measured using appropriate measures. VPA was measured using an adapted version of the Leisure-Time Exercise Questionnaire.Results: Compared with the control condition, men in the intervention condition had higher task self-efficacy postintervention (+16.23; 95% confidence interval [CI] +9.19 to +23.31; effect size [d] = 0.85, p < .001) and at follow-up (+12.58; 95% CI = +4.45 to +20.71, d = 0.50, p = .002). Task self-efficacy partially mediated the effect of the exercise intervention on VPA (indirect effect: B = 19.90; 95% CI 1.56 to 38.25, p = .033).Conclusion: The intervention improved the belief among prostate cancer survivors that they could perform challenging exercises for longer periods of time, which partially explained the positive effect of the intervention on VPA.Australia and New Zealand Clinical Trials Registration: ACTRN12610000609055. [ABSTRACT FROM AUTHOR]

Background: Ethnic minority groups including Asians in Canada have different knowledge and perceptions of heart disease and breast cancer compared with the ethnic majority group. Aim: Examine relationships between perceptions of heart disease and breast cancer, and lifestyle behaviors for Canadian women with British and with South Asian ancestry. Methods: Women with South Asian (n = 170) and with British (n = 373) ancestry (Mage = 33.01, SD = 12.86) reported leisure time physical activity, intended fruit and vegetable consumption, disease perceptions (ability to reduce risk, control over getting the diseases, and influence of family history), and demographic information. Mann–Whitney tests and multiple hierarchical linear regressions were used to examine the relationships between lifestyle behaviors and disease perceptions, with ancestry explored as a possible moderator. Results: Participants with South Asian ancestry believed they had greater ability to reduce their risk and have control over getting breast cancer than participants with British ancestry. Family history influences on getting either disease was perceived as higher for women with British ancestry. Age was positively related to all three perceptions in both diseases. Intended fruit and vegetable consumption was positively related to perceptions of ability to reduce risk and control of both diseases, but was stronger for women with South Asian ancestry regarding perceptions of breast cancer. Leisure time physical activity was positively related to perceptions of control over getting heart disease for women with British ancestry. Conclusions: Women’s disease perceptions can vary by ancestry and lifestyle behaviors. Accurate representation of diseases is essential in promoting effective preventative behaviors. [ABSTRACT FROM AUTHOR]

Background: Exercise generally improves quality of life (QoL) and psychosocial functioning in adult populations but few randomized trials have examined dose-response effects.Purpose: The purpose of the present study was to report the QoL and psychosocial outcomes from the Breast Cancer and Exercise Trial in Alberta (BETA).Methods: Healthy but inactive postmenopausal women at risk for breast cancer were randomized to a year-long aerobic exercise intervention consisting of either 150 min/week (moderate volume group, n = 200) or 300 min/week (high volume group, n = 200). QoL was assessed at baseline and 1 year using the short form-36 health survey. Sleep quality, depression, anxiety, stress, self-esteem, and happiness were also assessed. Participant preference for group assignment (i.e., exercise volume) was assessed at baseline and tested as a moderator.Results: There were no statistically significant dose-response effects of aerobic exercise on any QoL, sleep quality, or psychosocial outcome. Participant preference for group assignment did not moderate any QoL, sleep quality, or psychosocial responses. Marital status was a significant moderator (p for interaction = 0.01) and obesity showed a trend towards being a moderator (p for interaction = 0.08) of the dose-response effects of aerobic exercise on global sleep quality such that unmarried and obese women improved sleep quality with the higher volume of aerobic exercise.Conclusions: A higher volume of aerobic exercise, approximately double the minimum public health guideline, did not provide additional QoL or psychosocial benefits compared to the minimum public health guideline in inactive postmenopausal women, even for women who preferred the higher volume of exercise at baseline.Trial Registration: Trial Registration clinicaltrials.gov identifier: NCT1435005. [ABSTRACT FROM AUTHOR]

Background: Most breast cancer survivors do not meet physical activity recommendations. Understanding mediators of physical activity behavior change can improve interventions designed to increase physical activity in this at-risk population.Purpose: Study aims were to determine the 3-month Better Exercise Adherence after Treatment for Cancer (BEAT Cancer) behavior change intervention effects on social cognitive theory constructs and the mediating role of any changes on the increase in accelerometer-measured physical activity previously reported.Methods: Post-treatment breast cancer survivors (N = 222) were randomized to BEAT Cancer or usual care. Assessments occurred at baseline, 3 months (M3), and 6 months (M6). Adjusted linear mixed model analysis of variance determined intervention effects on walking self-efficacy, outcome expectations, goal setting, and perceived barrier interference at M3. Path analysis determined mediation of intervention effects on physical activity at M6 by changes in social cognitive constructs during the intervention (i.e., baseline to M3).Results: BEAT Cancer significantly improved self-efficacy, goals, negative outcome expectations, and barriers. Total path analysis model explained 24 % of the variance in M6 physical activity. There were significant paths from randomized intervention group to self-efficacy (β = 0.15, p < .05) and barriers (β = -0.22, p < .01). Barriers demonstrated a borderline significant association with M6 physical activity (β = -0.24, p = .05). No statistically significant indirect effects were found.Conclusions: Although BEAT Cancer significantly improved social cognitive constructs, no significant indirect effects on physical activity improvements 3 months post-intervention were observed (NCT00929617). [ABSTRACT FROM AUTHOR]

Background This research examined differences in perceptions of heart disease compared with breast cancer and if the differences are reflected in media presentations of the diseases. Relationships of differences in perceptions to demographic groups, heart disease risk factors and health behaviors were examined. Methods Study 1 was a quantitative content analysis of articles and advertisements related to heart disease or breast cancer. Results There were greater perceptions of susceptibility, preventability and controllability of heart disease and lower perceptions regarding seriousness, fearfulness and extent to which family history determines disease development of heart disease compared with breast cancer. Five times more pieces related to breast cancer were found compared with heart disease. Study 2 was a survey of 1524 women. More articles and advertisements about breast cancer than heart disease were found, and survey participants reported seeing significantly more breast cancer than heart disease media. Younger women had greater perceived susceptibility of breast cancer relative to heart disease while the content analysis revealed that the heart disease pieces were more likely to feature women older than 40 years of age. Conclusions This research is an important step in the development of theories regarding causal effects of media on health perceptions and behaviors. [ABSTRACT FROM AUTHOR]

Background: Exercise is beneficial for breast cancer patients during chemotherapy, but their motivation to perform different types and doses of exercise is unknown.Purpose: The purpose of this study was to examine the anticipated and experienced motivation of breast cancer patients before and after three different exercise programs during chemotherapy.Methods: Breast cancer patients initiating chemotherapy (N = 301) were randomized to a standard dose of 25-30 min of aerobic exercise, a higher dose of 50-60 min of aerobic exercise, or a combined dose of 50-60 min of aerobic and resistance exercise. Patient preference and motivational outcomes from the theory of planned behavior (i.e., perceived benefit, enjoyment, support, difficulty, and motivation) were assessed before and after the interventions.Results: At pre-randomization, breast cancer patients were significantly (p < 0.001) more likely to prefer the combined program (80.1 %); however, after the interventions there was a significant (p < 0.001) increase in the number of patients preferring the high volume program and having no preference. At pre-randomization, breast cancer patients anticipated more favorable motivational outcomes for the combined program and less favorable motivational outcomes for the high volume program (all p < 0.001). After the interventions, the motivational outcomes experienced exceeded the anticipated motivational outcomes significantly more in the high volume group than the standard or combined groups.Conclusions: Anticipated motivational outcomes for different types and doses of exercise during chemotherapy varied considerably at pre-randomization, but the motivational outcomes experienced after the three interventions were similar. Clinicians can recommend any of the three exercise interventions to breast cancer patients knowing that positive motivational outcomes will result. Clinicaltrials.gov identifier: NCT00249015 . [ABSTRACT FROM AUTHOR]

Background: Physical activity improves health in prostate cancer survivors; however, participation rates are low. Purpose: This study aims to determine the effects of an implementation intention intervention on physical activity and quality of life in prostate cancer survivors. Methods: Prostate cancer survivors ( N = 423) were randomly assigned to a standard physical activity recommendation, a self-administered implementation intention, or a telephone-assisted implementation intention. Physical activity and quality of life were assessed at baseline, 1, and 3 months. Results: Analyses of covariance using multiple imputation showed that physical activity at 1 month increased by 86 min/week in the standard physical activity recommendation group compared with 168 min/week in the self-administered implementation intention group ( P = 0.023) and 105 min/week in the telephone-assisted implementation intention group ( P = 0.35). Conclusions: A self-administered implementation intention intervention resulted in a meaningful short-term increase in physical activity. Supplementation with additional intervention strategies and more frequent intervention may improve longer-term exercise. (ClinicalTrials.gov number NCT01410656). [ABSTRACT FROM AUTHOR]

Background: Cancer survivors often seek information about how lifestyle factors, such as physical activity, may influence their prognosis. We systematically reviewed studies that examined relationships between physical activity and mortality (cancer-specific and all-cause) and/or cancer biomarkers.Methods: We identified 45 articles published from January 1950 to August 2011 through MEDLINE database searches that were related to physical activity, cancer survival, and biomarkers potentially relevant to cancer survival. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement to guide this review. Study characteristics, mortality outcomes, and biomarker-relevant and subgroup results were abstracted for each article that met the inclusion criteria (ie, research articles that included participants with a cancer diagnosis, mortality outcomes, and an assessment of physical activity).Results: There was consistent evidence from 27 observational studies that physical activity is associated with reduced all-cause, breast cancer-specific, and colon cancer-specific mortality. There is currently insufficient evidence regarding the association between physical activity and mortality for survivors of other cancers. Randomized controlled trials of exercise that included biomarker endpoints suggest that exercise may result in beneficial changes in the circulating level of insulin, insulin-related pathways, inflammation, and, possibly, immunity; however, the evidence is still preliminary.Conclusions: Future research directions identified include the need for more observational studies on additional types of cancer with larger sample sizes; the need to examine whether the association between physical activity and mortality varies by tumor, clinical, or risk factor characteristics; and the need for research on the biological mechanisms involved in the association between physical activity and survival after a cancer diagnosis. Future randomized controlled trials of exercise with biomarker and cancer-specific disease endpoints, such as recurrence, new primary cancers, and cancer-specific mortality in cancer survivors, are warranted. [ABSTRACT FROM AUTHOR]

The transtheoretical model's (TTM's) ability to predict physical activity stage transitions that incorporates all social-cognitive constructs from the original model has not been conducted among adults with diabetes. The purpose of this study was to test the capacity of the TTM for predicting physical activity stage transitions among adults (≥18 years of age) with type 1 ( N = 517) or type 2 ( N = 1,157) diabetes over 6 months. Participants were identified by a random-digit dialing telephone protocol through the Alberta Diabetes Registry. Assessments of TTM's stage of physical activity behavior change, self-efficacy, pros and cons, cognitive Processes of Change, and behavioral Processes of Change at baseline (time 1) and 6 months (time 2) were assessed by questionnaire. Over this time period, participants were categorized as having regressed (moved back at least one stage), remained (no stage change), or progressed (moved forward at least one stage). Baseline TTM constructs were analyzed for their ability to predict transition over 6 months. Moderate support for the TTM constructs in predicting physical activity stage transitions was found. Self-efficacy, pros, and behavioral Processes of Change hold relatively strong predictive power for stage progression over 6 months, with very few differences found between the types 1 and 2 diabetes groups. The capacity of the model in predicting stage transition is partially supported. When promoting physical activity among adults with diabetes, targeting self-efficacy, pros, and cognitive Processes of Change may favorably support stage transition in the pre-action stages, while strategies to enhance the behavioral Processes of Change may be appropriate for the Action and Maintenance stages. [ABSTRACT FROM AUTHOR]

Exercise improves health in lymphoma patients but the determinants of adherence in this population are unknown. The purpose of this study is to examine predictors of exercise adherence in lymphoma patients. In a randomized trial, 60 lymphoma patients were assigned to the exercise group and asked to attend three supervised exercise sessions per week for 12 weeks. Baseline data were collected on demographic, medical, fitness, psychosocial, and motivational variables. Adherence was assessed by objective attendance. Adherence was 77.8% and was significantly predicted by age ( β = 0.29; p = 0.016) and past exercise ( β = 0.27; p = 0.024); and borderline significantly predicted by previous treatments ( β = 0.22; p = 0.053), body mass index ( β = −0.21; p = 0.076), and smoking ( β = −0.19; p = 0.092). Poorer exercise adherence was experienced by lymphoma patients under age 40, insufficiently active at baseline, previously treated with radiation therapy, overweight or obese, and smokers. Findings may facilitate the development of targeted interventions to improve exercise adherence in this understudied patient population. [ABSTRACT FROM AUTHOR]

Although physical activity (PA) interventions have been effective for improving health outcomes in breast cancer survivors, little is known relative to their potential for translation into practice. This review was designed to provide a quantitative estimate of the reporting of both internal and external validity in recent studies of PA in breast cancer survivors (BCS). The Reach, Efficacy/Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework was utilized to assess the reporting of internal and external validity in 25 randomized controlled trials (RCTs) of PA and BCS published between 1998 and 2008. Each trial was evaluated relative to the degree it met criteria for each of the above dimensions. The majority of studies in this review reported dimensions reflecting internal validity. The overall level of detail relative to external validity of PA interventions was rarely reported, limiting the generalizability of study findings. As with many RCTs of health behavior change, detail relative to contextual elements of published PA interventions in BCS is limited. It is recommended that future physical activity interventions in BCS be designed to facilitate scalable and sustainable interventions for improving health outcomes in this population. [ABSTRACT FROM AUTHOR]

Background: Most of the population have positive intentions to engage in physical activity (PA) but fail to act; thus, the need to understand successful translation of intention into behavior is warranted in order to focus intervention efforts.Purpose: The objective of the study is to examine constructs of the transtheoretical model, theory of planned behavior, and protection motivation theory as predictors of physical activity intention-behavior profiles across 6 months in a Canadian workplace sample.Methods: Employees from three large organizations in the province of Alberta (n = 887) completed a baseline survey relating to their demographic and medical background, PA, and social-cognitive constructs. A total of 611 participants completed a second assessment 6 months later.Results: Participants were grouped by five profiles: nonintenders, unsuccessful adopters, successful adopters, unsuccessful maintainers, and successful maintainers. Perceived importance and concern for PA (cognitive processes, instrumental attitude, perceived severity) distinguished nonintenders from the other four profiles, self-management and self-regulation of the behavior (behavioral processes, self-efficacy) distinguished successful adopters from unsuccessful adopters, while control over constraints (cons, perceived control, self-efficacy) were the key discriminators of successful maintainers from unsuccessful maintainers.Conclusion: The results provide useful information for intervention campaigns and demonstrate a need to consider adoption and maintenance profiles. [ABSTRACT FROM AUTHOR]

Short term exercise interventions have been shown to be beneficial for breast cancer survivors soon after treatments but longer term adherence is needed. To examine the effects of a supervised exercise program on motivational variables in breast cancer survivors using Self-Determination Theory (SDT). Sixty breast cancer survivors were randomized in a cross-over design to either an immediate exercise group (IEG; n = 30) that exercised from baseline to week 12 or a delayed exercise group (DEG; n = 30) that exercised from week 12 to 24. SDT variables were assessed at baseline, 6, 12, 18 and 24 weeks using the Behavioral Regulation for Exercise Questionniare-2 and the Basic Psychological Needs Satisfaction Scale. Fifty-eight participants completed the follow-up assessments and achieved a 61.3% adherence rate. Analyses of variance revealed significant time by group interactions for almost all psychological needs and motivations that favored the exercise intervention time periods. For example, autonomy increased in the IEG from baseline to 12 weeks by 2.0 points compared to the DEG where scores decreased by 0.1 points (mean group difference = 2.0, p < 0.001). The cross-over results further supported the main findings. Supervised exercise soon after breast cancer treatments may help to develop a positive exercise motivational profile among breast cancer survivors that could portend longer term adherence. [ABSTRACT FROM AUTHOR]

Background. Anemia in patients with solid tumors is a common problem that is associated with impaired exercise capacity, increased fatigue, and lower quality of life (QoL). Erythropoiesis-stimulating agents (ESAs) have been shown to improve these outcomes; however, it is unknown if additional benefits can be achieved with aerobic exercise training. Methods. We conducted a single-center, prospective, randomized, controlled trial in 55 mild-to-moderately anemic patients with solid tumors. Patients were randomized to either darbepoetin alfa alone (DAL, n = 29) or darbepoetin alfa plus aerobic exercise training (DEX; n = 26). The DEX group performed aerobic exercise training three times per week at 60%-100% of baseline exercise capacity for 12 weeks. The primary endpoint was QoL assessed by the Functional Assessment of Cancer Therapy--Anemia scale. Secondary endpoints were fatigue, cardiorespiratory fitness (VO2peak), hemoglobin (Hb) response, and darbepoetin alfa dosing. Results. Intention-to-treat analyses indicated significant improvements in QoL and fatigue in both groups over time but there were no between-group differences. The DEX group had a significantly greater VO2peak than the DAL group (mean group difference, +3.0 ml/kg per minute; 95% confidence interval, 1.2- 4.7; p = .001) and there were borderline significant differences in favor of the DEX group for Hb response and darbepoetin alfa dosing. Conclusions. Aerobic exercise training did not improve QoL or fatigue beyond the established benefits of DAL but it did result in favorable improvements in exercise capacity and a more rapid Hb response with lower dosing requirements. Our results may be useful to clinicians despite the more recent restrictions on the indications for ESAs. [ABSTRACT FROM AUTHOR]

We previously reported that a physical activity (PA) behavior change intervention based on the theory of planned behavior (TPB) increased PA and quality of life in breast cancer survivors. To examine the effects of our interventions on TPB variables and to determine if PA at 12 weeks follow-up was mediated by TPB variables at 4 weeks. Breast cancer survivors ( N = 377) were randomly assigned to receive either a standard public health recommendation for PA (SR group), a step pedometer alone, or one of two TPB-based behavior change interventions consisting of print materials (alone or combined with a step pedometer). For the purpose of this study, we compared the two TPB-based intervention groups (INT group) to the SR group. Compared to the SR group, the INT group reported more favorable changes in instrumental attitude (mean difference = 0.13; 95% CI = −0.01 to 0.23; d = 0.19; p = 0.077), intention (mean difference = 0.33; 95% CI = 0.10 to 0.56; d = 0.33; p = 0.006), and planning (mean difference = 0.39; 95% CI = 0.04 to 0.73; d = 0.26; p = 0.027). Mediation analyses indicated that both planning and intention partially mediated the effects of the intervention on PA at 12 weeks. Our TPB-based behavior change intervention resulted in small improvements in the TPB constructs that partially mediated the effects of our intervention on PA behavior. Additional research with the TPB is warranted. [ABSTRACT FROM AUTHOR]

Exercise adherence is a challenge for breast cancer patients receiving chemotherapy but few studies have identified the key barriers. In this paper, we report the barriers to supervised exercise in breast cancer patients participating in a randomized controlled trial. Breast cancer patients initiating adjuvant chemotherapy ( N = 242) were randomly assigned to usual care ( n = 82) or supervised resistance ( n = 82) or aerobic ( n = 78) exercise. Participants randomized to the two exercise groups ( n = 160) were asked to provide a reason for each missed exercise session. The two exercise groups attended 70.2% (5,495/7,829) of their supervised exercise sessions and provided a reason for missing 89.5% (2,090/2,334) of their unattended sessions. The 2,090 reasons represented 36 different barriers. Feeling sick (12%), fatigue (11%), loss of interest (9%), vacation (7%), and nausea/vomiting (5%) accounted for the most missed exercise sessions. Disease/treatment-related barriers (19 of the 36 barriers) accounted for 53% (1,102/2,090) of all missed exercise sessions. Demographic and medical variables did not predict the types of exercise barriers reported. Barriers to supervised exercise in breast cancer patients receiving chemotherapy are varied but over half can be directly attributed to the disease and its treatments. Behavioral support programs need to focus on strategies to maintain exercise in the face of difficult treatment side effects. [ABSTRACT FROM AUTHOR]

The authors determined the validity and reliability of their Past Year Total Physical Activity Questionnaire (PYTPAQ), which assesses the frequency, duration, and intensity of occupational, household, and recreational activities performed over the past year. The PYTPAQ was completed twice at baseline, 9 weeks apart (on average), by 154 healthy Canadian men and women aged 35–65 years for assessment of reliability. The PYTPAQ was completed again 1 year later as a self-administered questionnaire. Four times during the year, participants wore an accelerometer for 7 days and completed 7-day physical activity logs. The authors assessed validity by comparing PYTPAQ summary values with 1-year averages of the physical activity logs and accelerometer data and with physical fitness and anthropometric data measured at baseline and 1 year. Spearman correlations for reliability (metabolic equivalent-hours/week) were 0.64 for total activity, 0.70 for occupational activity, 0.73 for recreational activity, and 0.65 for household activity. For total activity, the intraclass correlation coefficient for correlation between the PYTPAQ and the 7-day physical activity logs was 0.42 (95% confidence interval: 0.28, 0.54), and for the accelerometer data it was 0.18 (95% confidence interval: 0.03, 0.32). Spearman correlations between PYTPAQ hours/week of vigorous activity and maximal oxygen uptake were 0.37 and 0.32 at baseline and follow-up, respectively. In general, the PYTPAQ has acceptable reliability and validity for measurement of past-year physical activity that is comparable to that of similar questionnaires. [ABSTRACT FROM AUTHOR]

Background: The Colorectal Cancer and Home-Based Physical Exercise (CAN-HOPE) trial compared the effects of a 16-week home-based exercise program to usual care on quality of life in colorectal cancer survivors.Purpose: In this study, we report the weekly exercise barriers from the exercise group.Methods: Participants randomized to the exercise group (N = 69) were asked to report their exercise on a weekly basis by telephone. Those participants not achieving the minimum weekly exercise prescription (3 times per week of 30 min of moderate intensity exercise) were asked for a primary exercise barrier.Results: We obtained 1,073 (97.2%) weeks of adherence data out of a possible 1,104 (i.e., 69 × 16). Participants did not meet the minimum exercise prescription in 39.2% (421/1,073) of the weeks. We obtained an exercise barrier in 83.8% (353/421) of these cases. Overall, participants reported 37 different exercise barriers; the three most common were lack of time/too busy, nonspecific treatment side effects, and fatigue. The top 7 to 10 barriers accounted for 70% to 80% of all missed exercise weeks.Conclusions: These findings may have utility for promoting exercise in this population both inside and outside of clinical trials. [ABSTRACT FROM AUTHOR]

Background: Increased attention has focused on exercise as a quality of life intervention for breast cancer survivors during and after adjuvant therapy. Purpose: Our objective was to examine the effects of an oncologist's recommendation to exercise on self-reported exercise behavior in newly diagnosed breast cancer survivors attending their first adjuvant therapy consultation. Methods: Using a single-blind, 3-armed, randomized controlled trail, 450 breast cancer survivors were randomly assigned to receive an oncologist exercise recommendation only, an oncologist exercise recommendation plus referral to an exercise specialist, or usual care. The primary outcome was self-reported total exercise (in metabolic equivalent [MET] hours per week) at 5 weeks postconsultation. Results: The follow-up assessment rate was 73% (329 of 450). Intention-to-treat analysis based on participants with follow-up data indicated a significant difference in total exercise in favor of the recommendation-only group over the usual care group (mean difference, 3,4 MET hr per week; 95% confidence interval [CI], 0.7-6.1 MET hr per week: p = .011). There was no significant difference between the recommendation-plus-referral group and the usual care group (mean difference, 1.5 MET hr per week; 95% CI, -1.0 to 4.0 MET hr per week; p = .244). Ancillary "on-treatment" analyses showed that participants who recalled an exercise recommendation reported significantly more total exercise than participants who did not recall an exercise recommendation (mean difference, 4.1 MET hr per week; 95% CI, 1.9 -6.4 MET hr per week: p < .001). Conclusions: Our findings suggest that an oncologist recommendation may increase exercise behavior in newly diagnosed breast cancer survivors, particularly if it is recalled 1 week after the recommendation. [ABSTRACT FROM AUTHOR]

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 (β = .36, p < .001), assignment to experimental condition (β = .34, p < .001), sex (β = .30, p < .001), and intention (β = .14, p < .10). For exercise adherence in the exercise condition, the independent predictors were sex (β = .38, p < .01), extraversion (β = .30, p < .05), normative beliefs (β = -.27, p < .05), and perceived behavioral control (β = .23, p < .10). Finally, the independent predictors of exercise contamination in the control condition were past exercise (β = .70, p < .001), sex (β = .20, p < .05), and intention (β = .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. [ABSTRACT FROM AUTHOR]

Provides a framework called Physical Exercise Across the Cancer Experience (PEACE) for organizing research on physical exercise and cancer control. Overview of the framework; Cancer control outcomes; Applications of the framework.