Social Representativeness and Intervention Adherence-A Systematic Review of Clinical Physical Activity Trials in Breast Cancer Patients.

Objectives: Representativeness in physical activity randomised controlled trials (RCT) in breast cancer patients is essential to analyses of feasibility and validity considering privileged- social groups. A step-by-step exclusion of less privileged groups through the trial process could reinforce health inequality. This study aimed at examining representativeness in breast cancer (BC) physical activity trials, investigate associations between socio-economic status (SES) and intervention adherence, and explore associations between representativeness and the relationship between SES and intervention adherence. Methods: Systematic, computerised searches were performed in PubMed, CINAHL, AMED, EMBASE and PsycINFO. Additional citation-based searches retrieved 37 articles. Distributions of education level, ethnicity, and marital status in study samples were compared to national populations data to estimate representativeness in less privileged groups. Results: A preponderance of studies favoured educated, married and white patients. Only six studies reported SES-adherence associations, hampering conclusions on this relationship and possible associations between representativeness and an SES-adherence relationship. Conclusion: Less educated, unmarried and non-white individuals may be underrepresented in BC physical activity RCTs, while SES-adherence associations in such trials are inconclusive. Unintentional social misrepresentations may indicate that disguised inequity warrants revived attention.

Do Breast Cancer Patients Manage to Participate in an Outdoor, Tailored, Physical Activity Program during Adjuvant Breast Cancer Treatment, Independent of Health and Socio-Demographic Characteristics?

Exercise could reduce the side-effects of adjuvant breast cancer treatment; however, socio-demographic, health, and intervention conditions may affect patients' adherence to interventions. This study aimed to examine adherence to a 12-month outdoor post-surgery exercise program among newly diagnosed breast cancer patients during adjuvant treatment, and to identify socio-demographic and health-related predictors. In total, 47 women with invasive breast cancer stage I-II or ductal/lobular carcinoma grade 3 were included pre-surgery and randomized two weeks post-surgery to exercise (2 × 60 min/week). Patient characteristics (body-mass index (BMI), socioeconomic status, comorbidity, physical activity, and maximal oxygen uptake (VO2max)) were recorded pre-surgery. Correlations between adherence and patient characteristics and statistics for between-group differences were performed. The mean age was 54.2 years, mean BMI 27.8 kg/m2, and 54.2% received chemotherapy. Completers had a mean adherence of 81%, independent of season. Withdrawals (23%) occurred after a mean of 6.5 weeks (0-24 weeks), they were suggestively older, had lower socioeconomic status and pre-surgery VO2max, and higher BMI. Household income was significantly lower among withdrawals. There were insignificant correlations between adherence and health conditions. High adherence is achievable in a Nordic outdoor physical exercise program in breast cancer patients during adjuvant treatment, including chemotherapy. Additional studies are needed to clarify follow-up needs in some groups.

Meaning Making for Psychological Adjustment and Quality of Life in Older Long-Term Breast Cancer Survivors.

Objectives: This study aims to explore in depth the meaning and meaning discrepancies among older Norwegian breast cancer survivors in light of the meaning making model by Park (2013). Design: We utilized a qualitative design collecting data using semi-structured interviews of 23 elderly breast cancer survivors 7-8 years after treatment. The interviews followed an interview guide structured along three main themes: "everyday life activities," "follow-up-care experiences" and "health status and QoL." Results: Several health problems were reported by the women in the aftermaths of the disease, such as sleeping problems, pain, and fatigue-including cognitive and emotional impairments. Meaning discrepancies were concentrated on six main themes: shifting perspectives and priorities, growing sense of autonomy, widening the limits of normality, dissociating oneself from the disease, embracing alternative health services, and feeling lucky. The women engaged in a wide range of coping techniques as efforts to change global meaning, and to develop a more positive view on the cancer experience. Common coping efforts across the six main themes were social comparison, denial, positive reappraisal, problem-focused coping, and revaluing ordinary events. Conclusion: Many cancer patients report on unmet needs for help with their meaning making, and the facilitation of meaning making processes is rarely included in the follow-up care of cancer survivors. The findings of the present study may help health care professionals provide care for women who have experienced breast cancer. The concrete knowledge of common coping efforts in the meaning making process may contribute to the development of future interventions and for gaining a deeper understanding for older survivors of breast cancer.

Physical activity in long-term breast cancer survivors - A mixed-methods approach.

OBJECTIVES: Traditional methods measuring physical activity (PA) may misrepresent breast cancer survivors (BCSs) and low-socioeconomic status (SES) groups. This study identifies PA-levels, routines and experiences among BCSs, in general and by SES, and explores whether a mixed-methods approach might unveil diversities of PA in BCS across SES. MATERIALS AND METHODS: 250 BCSs referred to postoperative radiation therapy in 2007-2008 participated in a longitudinal follow-up study examining health-related quality-of-life and late-effects. Subsample-data on SES and PA were collected by questionnaires (n = 52), activity-logs (n = 52) and interviews (n = 37). Parallel mixed analyses were conducted, in combination with sequential, full-sample analyses of questionnaires and contrasting case analyses of logs and interviews. RESULTS: Dependent on which measurement used, 23%, 35%, 54% and 63% of BCSs met PA guidelines. Questionnaire-data revealed no significant differences in PA levels between SES groups. Log-data showed more PA bouts in high-SES BCSs, but no difference in min/week across SES. Neighbourhood walking was preferred, while scheduled exercise was rare. Interview-data added that PA was medicating, normatively described and accompanied by unfulfilled ambitions, particularly in low-SES BCSs. Balancing duties and activities was demanding. PA constraints were similar across groups. Domestic PA was important in low-SES, while high-SES BCSs described more energy. CONCLUSION: Although PA levels among BCSs were similar across SES and equal to PA in the general population, SES differences became evident when measured by activity-logs and as stated in interviews. Future follow-up programs for BCSs could benefit from expanding the PA perspectives, thus better meet the needs of different SES groups.

Scaling Demands of Soccer According to Anthropometric and Physiological Sex Differences: A Fairer Comparison of Men's and Women's Soccer.

Spectators frequently harass female soccer players, and women's soccer is frequently compared negatively to men's soccer by writers who make the comparison without the backing of any data and without taking into account anthropometric and physiological differences between the sexes. This affects female soccer players' self-confidence negatively and contributes to an undeservedly negative image of women's soccer. In the present paper, we argue that most differences between men's and women's soccer can be explained by women having to adapt to rules and regulations that are suited for men and their physical attributes. Thus, games are much more demanding for women. Furthermore, we argue that if men had to play with a degree of adaptation similar to that which women do today, they would have to alter their style of play radically. As support for our argument, we scale game demands for male and female soccer players according to anthropometric and physiological differences in order to highlight the differences, and use these to predict what would be the most appropriate adaptations. Finally, we show that our predictions are largely supported by the scarce pool of comparable data across the sexes.

Are Differences in Physical Activity across Socioeconomic Groups Associated with Choice of Physical Activity Variables to Report?

Despite being challenged in recent years, the hypothesis that individuals of higher socioeconomic status (SES) are more physically active than their lower SES counterparts is generally considered a fact. Recent reviews, however, have suggested that differences across groups might be related to which physical activity (PA) domains have been investigated. In the present review, searches for relevant studies were performed in the MEDLINE, ISI Web of Knowledge and SPORTDiscus databases. Search terms included “socioeconomic”, “socio-economic”, “socio economic” and “social class” to meet all variations of the variable “socioeconomic status” in combination with the term “physical activity”. Studies were included when applying the dimensions of intensity, frequency, type/mode, and duration in measuring PA. Fifty-six studies were included and were subsequently split into four PA domains: transport PA (TPA), occupational PA (OPA), housing PA (HPA) and leisure time PA (LTPA). It turned out that the positive relationship held only for LTPA, whereas the relationship was non-existent or even opposite for all other domains. It is concluded that the assumed positive relationship between SES and PA is mainly a relationship between LTPA and SES. It is further suggested that the PA domain should always be considered when studying said relationships.