Item-level psychometrics of a brief self-reported memory problem screening measure in breast cancer survivors.

Background: We previously developed and psychometrically validated a self-reported memory problem (SRMP) measure using principal component analysis. In the present study, we applied item response theory (IRT) analysis to further examined the construct validity and determine item-level psychometric properties for the SRMP.Methods: The sample included 530 female breast cancer survivors (61% non-Hispanic White, mean age = 57 years) who were recruited from community-based organizations and large health care systems. We examined the construct validity, item-level psychometric properties, and differential item functioning (DIF) of the SRMP using confirmatory factor analysis (CFA), IRT and logistic regression analysis models.Results: The CFA confirmed a one-factor structure for the SRMP (comparative fit index [CFI] = 0.996, root-mean-square-error-approximation [RMSEA] = 0.059). As expected, SRMP scores correlated significantly with pain, mood, and fatigue; but not spiritual health locus of control (SPR). DIF analysis showed no measurement differences based on race/ethnicity and age groups.Conclusion: The CFA and DIF analysis supported the construct validity of the SRMP and its use in an ethnically diverse breast cancer population. These findings provide further evidence of the generalizability for the SRMP, and support its utilization as a psychometrically valid and reliable screening measure of cancer and treatment-related memory difficulties.

The effects of exercise on insulin, glucose, IGF-axis and CRP in cancer survivors: Meta-analysis and meta-regression of randomised controlled trials.

BACKGROUND: The purpose of this study was to investigate the relationship between physical activity and biological mediators of cancer recurrence and survival. METHODS: We conducted a comprehensive literature search of PubMed, ScienceDirect and Web of Science for randomised controlled trials examining the association between physical activity and C-reactive protein (CRP), glucose, insulin, insulin resistance and insulin growth factor-one (IGF-1) up to December 2017. Standardised mean difference (SMD) scores were calculated, and meta-regression was performed. RESULTS: The meta-analysis indicated that survivors randomised to physical activity conditions experienced greater improvements in Insulin (SMD = -0.59; 95% CI, -1.05 to -0.14), CRP (SMD = -0.52; 95% CI, -0.87 to -0.17), insulin resistance (SMD = -0.20; 95% CI, -0.41 to -0.003) and glucose (SMD = -0.19; 95% CI, -0.35 to -0.02) than survivors randomised to control conditions. The meta-regression showed that study duration was positively, albeit marginally related (p = .056) to change in CRP levels among survivors in the physical activity conditions. Furthermore, higher baseline insulin levels in the physical activity conditions were associated with improving insulin levels throughout the intervention (p = .007). CONCLUSIONS: Promoting physical activity throughout the survivorship continuum is an effective intervention strategy for improving levels of insulin, glucose control, insulin resistance and CRP among cancer survivors.

Spiritual health locus of control and life satisfaction among African American breast cancer survivors.

Purpose: To examine the relationships between spiritual health locus of control (SHLOC) and satisfaction with life in African American (AA) breast cancer survivors (BCS).Methods: A total of 118 AABCS completed a mailed survey. Logistic regression models were used to examine relationships among variables of interest.Results: Annual income and SHLOC were significantly associated with life satisfaction. In unadjusted analyses, high overall SHLOC increased the odds (odds ratio [OR] = 2.8) of being satisfied with life. The adjusted relationships between SHLOC and life satisfaction differed by income level. Among survivors with lower incomes, high spiritual life/faith and God's grace subscale scores increased the odds of life satisfaction, when compared to those with higher incomes.Conclusions: Our data indicated that high overall SHLOC was significantly related to higher odds of life satisfaction. Further, SHLOC may serve as a resource to bolster life satisfaction, especially in low-income AA BCS.

Patient recommendations for reducing long-lasting economic burden after breast cancer.

BACKGROUND: In the United States, patients who have breast cancer experience significant economic burden compared with those who have other types of cancers. Cancer-related economic burden is exacerbated by adverse treatment effects. Strategies to resolve the economic burden caused by breast cancer and its adverse treatment effects have stemmed from the perspectives of health care providers, oncology navigators, and other subject-matter experts. For the current study, patient-driven recommendations were elicited to reduce economic burden after 1) breast cancer and 2) breast cancer-related lymphedema, which is a common, persistent adverse effect of breast cancer. METHODS: Qualitative interviews were conducted with 40 long-term breast cancer survivors who were residents of Pennsylvania or New Jersey in 2015 and were enrolled in a 6-month observational study. Purposive sampling ensured equal representation by age, socioeconomic position, and lymphedema diagnosis. Semistructured interviews addressed economic challenges, supports used, and patient recommendations for reducing financial challenges. Interviews were coded, and representative quotes from the patient recommendations were analyzed and reported to illustrate key findings. RESULTS: Of 40 interviewees (mean age, 64 years; mean time since diagnosis, 12 years), 27 offered recommendations to reduce the economic burden caused by cancer and its adverse treatment effects. Nine recommendations emerged across 4 major themes: expanding affordable insurance and insurance-covered items, especially for lymphedema treatment (among the 60% who reported lymphedema); supportive domestic help; financial assistance from diagnosis through treatment; and employment-preserving policies. CONCLUSIONS: The current study yielded 9 actionable, patient-driven recommendations-changes to insurance, supportive services, financial assistance, and protective policies-to reduce breast cancer-related economic burden. These recommendations should be tested through policy and programmatic interventions.

Survivorship issues in older breast cancer survivors.

PURPOSE: Almost half of breast cancer survivors are aged ≥ 65 years and the proportion is likely to increase due to the aging of the population. The objectives of this article were to review studies of health outcomes among older breast cancer survivors ≥ 65 years to identify gaps in the published literature and offer suggestions for future research. METHODS: The present review is based upon bibliographic searches in PubMed and CINAHL and relevant search terms. Articles published in English from January 1, 1970 through October 1, 2018 were identified using the following MeSH search terms and Boolean algebra commands. RESULTS: This review has revealed that older breast cancer survivors cope with health issues related to cancer treatment and the aging process, including comorbidities, osteoporosis, symptoms, physical functioning, cognitive functioning, nutrition, and physical activity. CONCLUSIONS: Additional research is needed to examine therapeutic interventions to address the health conditions older breast cancer survivors are coping with. Particular focus of further research should be on the nutritional status and physical activity levels of older breast cancer survivors. Individualized nutrition plans and tailored physical activity programs for older survivors are needed that meet people where they are and that form habits.

An exploratory decision tree analysis to predict physical activity compliance rates in breast cancer survivors.

Background: The study of physical activity in cancer survivors has been limited to one cause, one effect relationships. In this exploratory study, we used recursive partitioning to examine multiple correlates that influence physical activity compliance rates in cancer survivors. Methods: African American breast cancer survivors (N = 267, Mean age = 54 years) participated in an online survey that examined correlates of physical activity. Recursive partitioning (RP) was used to examine complex and nonlinear associations between sociodemographic, medical, cancer-related, theoretical, and quality of life indicators. Results: Recursive partitioning revealed five distinct groups. Compliance with physical activity guidelines was highest (82% met guidelines) among survivors who reported higher mean action planning scores (P < 0.001) and lower mean barriers to physical activity (P = 0.035). Compliance with physical activity guidelines was lowest (9% met guidelines) among survivors who reported lower mean action and coping (P = 0.002) planning scores. Similarly, lower mean action planning scores and poor advanced lower functioning (P = 0.034), even in the context of higher coping planning scores, resulted in low physical activity compliance rates (13% met guidelines). Subsequent analyses revealed that body mass index (P = 0.019) and number of comorbidities (P = 0.003) were lowest in those with the highest compliance rates. Conclusion: Our findings support the notion that multiple factors determine physical activity compliance rates in African American breast cancer survivors. Interventions that encourage action and coping planning and reduce barriers in the context of addressing function limitations may increase physical activity compliance rates.

Correlates of dysfunctional career thoughts in breast cancer survivors from the Bahamas.

Purpose: The purpose of this research was to examine the correlates of dysfunctional career thoughts (DCTs) in a sample of breast cancers survivors. Sample and design: A total of 195 breast cancer survivors from the Bahamas completed a cross-sectional survey. Methods: The Career Thoughts Inventory (CTI) and standard medical and demographic items were administered. Analysis of Variance and logistic regression models were used to examine associations. Findings: Total CTI scores differed by age group, marital status, surgical remedy, and employment prior to diagnosis. The odds of DCT were higher among younger (Odds Ratio [OR] = 4.4), married (OR = 2.4), who were unemployed prior to diagnosis (OR = 3.5). Conclusion: Dysfunctional career thoughts appear to be common in certain breast cancer survivors. Further research is needed to determine whether similar associations are observed in other samples. Implications for Providers: Providers should discuss DCTs after treatment.

Do Cancer-Related Fatigue and Physical Activity Vary by Age for Black Women With a History of Breast Cancer?

INTRODUCTION: Cancer-related fatigue (CRF) is the most uncomfortable symptom among women with a history of breast cancer. Black women are more likely than women of other racial/ethnic groups to have CRF risk factors, such as physical inactivity and obesity, yet CRF studies have not focused on black women. We conducted a cross-sectional analysis to assess CRF and physical activity among black women survivors of breast cancer. METHOD: In May and July of 2012, 267 members (mean age, 54 y) of the Sisters Network, Inc, completed an online survey of sociodemographic characteristics, medical characteristics, and physical activity, and a fatigue instrument (the Functional Assessment of Chronic Illness Therapy [FACIT]). Multiple linear regression assessed fatigue and physical activity compliance (ie, 150 minutes of moderate to vigorous physical activity per week). RESULTS: Participants had an average FACIT score of 32.3, Fatigue was greater (P < .001) among the 56% of women not meeting physical activity guidelines. In multivariable analysis, correlates of fatigue showed that physical activity compliance (ß = 3.20, P < .001) and older age group (50-59 y: ß = 3.98, P = .001; ≥60 y,: ß = 3.76, P = .003) were associated with less fatigue. The interaction between age and fatigue was also significant: mean differences in fatigue by physical activity level were obvious only among women younger than 50 years. (P < .001). CONCLUSION: Physical activity compliance was associated with a lower level of fatigue. However, the effect of physical activity on fatigue may differ by age. Interventions aimed at curbing CRF in black women should consider age-appropriate strategies that can be integrated into existing lifestyles.

The health action process approach applied to African American breast cancer survivors.

BACKGROUND: The health action process approach (HAPA) is a relevant model for understanding physical activity (PA), yet it has not been examined in cancer survivors or minorities. In this study, we assessed the HAPA in African American breast cancer survivors using covariance modeling. METHODS: A total of 304 African American breast cancer survivors (mean age = 54 years) participated in a Web-based survey assessing demographic and medical characteristics as well as constructs of the HAPA. A two-step covariance modeling approach was used to assess the structural relationships among the constructs. RESULTS: The hypothesized measurement model fit the data; however, general severity was not significantly associated with the remaining constructs. General severity was removed, and the fit did not change significantly. The final adjusted model provided a reasonable fit to the data and accounted for significant variance in intentions (49%) and PA (42%). Action (ß = 0.1, p < 0.01) and coping (ß = 0.3, p < 0.01) planning mediated the relationship between intentions and behavior. CONCLUSIONS: The HAPA appears to be a relevant model for understanding PA in African American breast cancer survivors. However, more work is needed to determine whether these relationships can be replicated in other breast cancer survivors. Copyright © 2015 John Wiley & Sons, Ltd.

Impact of Booster Breaks and Computer Prompts on Physical Activity and Sedentary Behavior Among Desk-Based Workers: A Cluster-Randomized Controlled Trial.

INTRODUCTION: The 15-minute work break provides an opportunity to promote health, yet few studies have examined this part of the workday. We studied physical activity and sedentary behavior among office workers and compared the results of the Booster Break program with those of a second intervention and a control group to determine whether the Booster Break program improved physical and behavioral health outcomes. METHODS: We conducted a 3-arm, cluster-randomized controlled trial at 4 worksites in Texas from 2010 through 2013 to compare a group-based, structured Booster Break program to an individual-based computer-prompt intervention and a usual-break control group; we analyzed physiologic, behavioral, and employee measures such as work social support, quality of life, and perceived stress. We also identified consistent and inconsistent attendees of the Booster Break sessions. RESULTS: We obtained data from 175 participants (mean age, 43 y; 67% racial/ethnic minority). Compared with the other groups, the consistent Booster Break attendees had greater weekly pedometer counts (P < .001), significant decreases in sedentary behavior and self-reported leisure-time physical activity (P < .001), and a significant increase in triglyceride concentrations (P = .02) (levels remained within the normal range). Usual-break participants significantly increased their body mass index, whereas Booster Break participants maintained body mass index status during the 6 months. Overall, Booster Break participants were 6.8 and 4.3 times more likely to have decreases in BMI and weekend sedentary time, respectively, than usual-break participants. CONCLUSION: Findings varied among the 3 study groups; however, results indicate the potential for consistent attendees of the Booster Break intervention to achieve significant, positive changes related to physical activity, sedentary behavior, and body mass index.

Associations between time spent sitting and cancer-related biomarkers in postmenopausal women: an exploration of effect modifiers.

PURPOSE: Despite evidence that prolonged periods of sitting may influence biological mediators of cancer development, few studies have considered these relationships in a cancer-specific context. METHODS: This cross-sectional study included 755 postmenopausal women enrolled in an ancillary study of the Women's Health Initiative. Plasma levels of Insulin-like growth factor-I (IGF-I), IGF-binding protein-3, leptin, insulin, C-peptide, C-reactive protein (CRP), and Interleukin (IL)-6 were measured. The time spent sitting per day was categorized as quartiles (Qs). The relationships between sedentary time and biomarkers were modified by race, physical activity, and exogenous estrogen use. RESULTS: IGF-I levels among African American (AA) women were higher than those of white women across the Qs of sedentary time. Likewise, IL-6 levels in AA women were higher than those in white women at Q3 and Q4 of sedentary time. IGFBP-3 levels were higher and insulin levels were lower across the Qs of sedentary time among women meeting guidelines for physical activity than women who were not. Additionally, CRP levels were higher among estrogen users than nonusers at Q1, Q2, and Q4 of sedentary time. CONCLUSIONS: These results suggest that relationship between time spent sitting and cancer-related biomarkers may not be simply linear, but differ in the context of effect modifiers.

Booster Breaks in the workplace: participants' perspectives on health-promoting work breaks.

Increasing sedentary work has been associated with greater cardiovascular and metabolic risk, as well as premature mortality. Interrupting the sedentary workday with health-promoting work breaks can counter these negative health effects. To examine the potential sustainability of work-break programs, we assessed the acceptance of these breaks among participants in a Booster Break program. We analyzed qualitative responses from 35 participants across five worksites where one 15-min physical activity break was taken each workday. Two worksites completed a 1-year intervention and three worksites completed a 6-month intervention. Responses to two open-ended questions about the acceptance and feasibility of Booster Breaks were obtained from a survey administered after the intervention. Three themes for benefits and two themes for barriers were identified. The benefit themes were (i) reduced stress and promoted enjoyment, (ii) increased health awareness and facilitated behavior change, and (iii) enhanced workplace social interaction. The barrier themes were the need for (iv) greater variety in Booster Break routines and (v) greater management support. This study provides empirical support for the acceptance and feasibility of Booster Breaks during the workday. Emphasizing the benefits and minimizing the barriers are strategies that can be used to implement Booster Breaks in other workplaces.

Associations among physical activity, body mass index, and health-related quality of life by race/ethnicity in a diverse sample of breast cancer survivors.

BACKGROUND: Health-related quality of life (HRQOL), body mass index (BMI), and physical activity (PA) levels have all been associated with prognosis following breast cancer and may explain partially the higher mortality for breast cancer in certain racial/ethnic subgroups. In this study, associations between PA, BMI, and HRQOL by race were examined in a sample of breast cancer survivors. METHODS: Measures of PA, BMI, and HRQOL as well as demographic and medical characteristics of women (N = 3013, 13% nonwhite) who participated in the Women's Healthy Eating and Living Study were assessed at baseline. Analysis of covariance was used to examine the relationship between PA and obesity with HRQOL outcomes. Statistical tests were 2-sided. RESULTS: African American women were less likely to meet guidelines for PA and more likely to be obese than women from other ethnic groups (P < .05). In adjusted models, women who met guidelines for PA reported significantly higher physical health composite (point differences ranged from 10.5 to 21.2 points, all P < .05) and vitality (point differences ranged from 9.9 to 16.5 points, all P < .05) scores than those who did not, regardless of race/ethnicity. Associations between obesity and HRQOL were mixed with fewer associations for Asian American and African American women and stronger associations for whites. CONCLUSIONS: Breast cancer survivors from racially and ethnically diverse populations have lower levels of PA and higher rates of obesity that are generally associated with poorer HRQOL. Culturally sensitive PA and weight loss interventions may improve these lifestyle characteristics and result in improved HRQOL.

A randomized parallel-group dietary study for stages II-IV ovarian cancer survivors.

OBJECTIVE: Few studies have examined the dietary habits of ovarian cancer survivors. Therefore, we conducted a study to assess the feasibility and impact of two dietary interventions for ovarian cancer survivors. METHODS: In this randomized, parallel-group study, 51 women (mean age, 53 years) diagnosed with stages II-IV ovarian cancer were recruited and randomly assigned to a low fat, high fiber (LFHF) diet or a modified National Cancer Institute diet supplemented with a soy-based beverage and encapsulated fruit and vegetable juice concentrates (FVJCs). Changes in clinical measures, serum carotenoid and tocopherol levels, dietary intake, anthropometry, and health-related quality of life (HRQOL) were assessed with paired t-tests. RESULTS: The recruitment rate was 25%, and the retention rate was 75% at 6 months. At baseline, 28% and 45% of women met guidelines for intake of fiber and of fruits and vegetables, respectively. After 6 months, total serum carotenoid levels and α- and ß-carotene concentrations were significantly increased in both groups (P<0.01); however, ß-carotene concentrations were increased more in the FVJC group. Serum ß-cryptoxanthin levels, fiber intake (+5.2g/day), and daily servings of juice (+0.9 servings/day) and vegetables (+1.3 servings/day) were all significantly increased in the LFHF group (all P<0.05). Serum levels of albumin, lutein and zeaxanthin, retinol, and retinyl palmitate were significantly increased in the FVJC group (all P<0.05). No changes in cancer antigen-125, anthropometry, or HRQOL were observed. CONCLUSION: Overall, this study supports the feasibility of designing dietary interventions for stages II-IV ovarian cancer survivors and provides preliminary evidence that a low fat high fiber diet and a diet supplemented with encapsulated FVJC may increase phytonutrients in ovarian cancer survivors.

Feasibility, reliability, and validity of the Pediatric Quality of Life Inventory ™ generic core scales, cancer module, and multidimensional fatigue scale in long-term adult survivors of pediatric cancer.

BACKGROUND: Most health-related quality of life assessments are designed for either children or adults and have not been evaluated for adolescent and young adult survivors of pediatric cancer. The objective of this study was to examine the feasibility, reliability, and validity of the Pediatric Quality of Life Inventory (PedsQL ™ Generic Core Scales, Cancer Module, and Multidimensional Fatigue Scale in adult survivors of pediatric cancer. METHODS: Adult survivors (n = 64; Mean age 35 year old; >2 years after treatment) completed the PedsQL™ Generic Core Scales, Cancer Module, and Multidimensional Fatigue Scale. Feasibility was examined with floor and ceiling effects; and internal consistency was determined by Cronbach's coefficient alpha calculations. Inter-factor correlations were also assessed. RESULTS: Significant ceiling effects were observed for the scales of social function, nausea, procedural anxiety, treatment anxiety, and communication. Internal consistency for all subscales was within the recommended ranges (α ≥ 0.70). Moderate to strong correlations between most Cancer Module and Generic Core Scales (r = 0.25 to r = 0.76) and between the Multidimensional Fatigue Scale and Generic Core Scales (r = 0.37 to r = 0.73). CONCLUSIONS: The PedsQL™ Generic Core Scales, Cancer Module, and Multidimensional Fatigue Scale appear to be feasible for an older population of pediatric cancer survivors; however, some of the Cancer Module Scales (nausea, procedural/treatment anxiety, and communication) were deemed not relevant for long-term survivors. More information is needed to determine whether the issues addressed by these modules are meaningful to long-term adult survivors of pediatric cancers.

Are Physical Activity and Sedentary Behavior Associated With Cancer-Related Symptoms in Real Time?: A Daily Diary Study.

BACKGROUND: Few studies have examined the real-time and dynamic relationship between lifestyle behaviors and treatment-related symptoms. OBJECTIVE: The aim of this study was to examine the associations of daily physical activity and sedentary behavior with symptom burden, pain interference, and fatigue among patients who were undergoing active cancer treatment. METHODS: A total of 22 (mean age = 57 years; 73% women; 55% Black) cancer patients were recruited from a local hospital and reported a daily diary of physical activity, sedentary behavior, symptom burden, pain interference, and fatigue over 10 days. Adjusted mixed-effects models were used to examine all associations. RESULTS: Body mass index moderated the relationship between physical activity and symptom burden (γ = 0.06, P < .01) and physical activity and fatigue (γ = 0.09, P < .05). On days where physical activity was higher than average, symptom burden and fatigue scores were lower among patients who had lower body mass index values. Also, age moderated the relationship between sedentary behavior and symptom burden (γ = -0.04, P < .05); on days where patients sat more, symptom burden was lower among patients who were younger than the average age. CONCLUSIONS: Overall, these data indicate that treatment-related symptoms vary daily within cancer patients and that physical activity may alleviate treatment-related symptoms for leaner patients. Larger samples and objective assessments of physical activity and sedentary behavior are needed to validate our results. IMPLICATIONS FOR PRACTICE: Oncology nurses may be in the best position to promote physical activity during treatment as a strategy to manage symptom burden.

Was race a factor in the outcomes of the Women's Health Eating and Living Study?

BACKGROUND: The objective of this study was to determine whether women who were participating in the Women's Healthy Eating and Living (WHEL) Study exhibited similar dietary changes, second breast cancer events, and overall survival regardless of race/ethnicity. METHODS: For this secondary analysis, the authors used data from 3013 women who were self-identified as Asian American, African American, Hispanic, or white and who were assigned randomly to a dietary intervention or a comparison group. Changes in dietary intake over time by race/ethnicity and intervention status were examined using linear mixed-effects models. Cox proportional hazards models were used to examine the effects of the intervention on the occurrence of second breast cancer events and overall survival. Statistical tests were 2-sided. RESULTS: African Americans and Hispanics consumed significantly more calories from fat (+3.2%) and less fruit (-0.7 servings daily) than Asians and whites at baseline (all P < .01). Overall, intervention participants significantly improved their dietary pattern from baseline to the end of Year 1, reducing calories from fat by 4.9% and increasing intake of fiber (+6.6 grams daily), fruit (+1.1 servings daily), and vegetables (+1.6 servings daily; all P < .05). Despite improvements in the overall dietary pattern of these survivors, the intervention did not significantly influence second breast cancer events or overall survival. CONCLUSIONS: Overall, all racial groups significantly improved their dietary pattern over time, but the maintenance of these behaviors were lower among African-American women. More research and larger minority samples are needed to determine the specific factors that improve breast cancer-specific outcomes in diverse populations of survivors.

Influence of Spirituality, HIV Stigma and Education on HIV Knowledge in Rural African American Congregants in the Deep South: Additional Findings from Project FAITHH.

HIV incidence has shifted racially and geographically in the United States and now represents higher proportions of African Americans living in the Rural South. Lower levels of HIV knowledge may be the culprit behind the increasing HIV rates observed in the Rural South. The purpose of this study was to investigate the individual and joint correlates of HIV knowledge in a sample of rural African Americans. Baseline data from a faith-based anti-stigma intervention (Project FAITHH, N= 210) was used to assess associations between sociodemographic characteristics, spirituality, stigma, and HIV knowledge scores. Associations were examined with recursive partitioning. Statistical significance was determined at P< 0.05 with a two-sided test. Recursive partitioning revealed five distinct groups based on the data. HIV knowledge scores were highest among participants who attended some college (P < 0.001) with lower levels of individual stigma (P < 0.001). HIV knowledge scores were lowest among less educated individuals (P < 0.001) who had lower levels of perceived community stigma (P = 0.002). Future interventions designed to improve HIV knowledge in rural African Americans should consider tailoring content to those who have the greatest deficits in HIV knowledge, which may be based on perceived community stigma and education levels.

Associations between leisure-time physical activity and health-related quality of life among adolescent and adult survivors of childhood cancers.

OBJECTIVE: Survivors of childhood cancer are at an increased risk for reduced quality of life (QOL), yet few studies have explored factors associated with improving health-related QOL (HRQOL) in this population. We thus explored the relationship between physical activity (PA) and HRQOL among survivors of childhood cancer. METHODS: A total of 215 survivors of childhood lymphoma, leukemia, and central nervous system cancers completed mailed surveys that elicited information regarding leisure-time PA (LTPA) measured in metabolic equivalents, HRQOL, and diagnostic and demographic factors. Correlations and adjusted regression models were used to explore the relationship between LTPA and HRQOL. RESULTS: In the total sample, modest, yet significant linear associations were observed between LTPA and overall HRQOL (beta=0.17, p<0.01), as well as each of the respective subscales (beta=0.11-0.23 and p's<0.05 to <0.001). Among adolescent survivors of childhood cancer, LTPA was significantly associated with overall HRQOL (beta=0.27), cancer worry (beta=0.36), cognitive function (beta=0.32), body appearance (beta=0.29), and social function (beta=0.27) (all p's<0.05). Among adult survivors of childhood cancer, LTPA was only significantly associated with physical function (beta=0.28, p<0.001). CONCLUSIONS: Significant associations exist between LTPA and HRQOL; however, the association was stronger and observed in more domains for adolescent survivors of childhood cancer. More research is needed to determine the antecedents and consequences of PA in this population.

Physical activity and quality of life--the complementary influence of self-efficacy for physical activity and mental health difficulties.

BACKGROUND: Studies proposed that the physical activity and quality of life (QoL) relationship may not be entirely direct but mediated through other variables; however, few studies have examined these relationships in diverse population's older adults. PURPOSE: This study aims to examine the roles of self-efficacy and mental health difficulties in the physical activity and QoL relationship and to determine if demographic characteristics alter these relationships. METHODS: One hundred ninety-six older adults completed measures of physical activity, self-efficacy, mental health difficulties, and QoL. Two-multilevel structural models were tested to determine the relationship between physical activity and QoL. RESULTS: Both structural models suggested that the relationship between physical activity and QoL is indirect, but the models were not significantly different. In model 1, we observed a positive linear relationship between physical activity and self-efficacy. In turn, self-efficacy was negatively associated with poor mental health difficulties and positively associated with QoL. Mental health difficulties were also negatively associated with QoL. In model 2, physical activity was positively associated with self-efficacy and negatively associated with mental health difficulties; in turn, self-efficacy was positively associated with QoL, whereas mental health difficulties were negatively associated with QoL. CONCLUSIONS: Overall, our findings suggest that self-efficacy and mental health have intermediary roles in the relationship between physical activity and QoL in a diverse sample of older adults. Prospective studies are needed to determine whether self-efficacy and mental health difficulties are complementary or one or the other accounts for more variance in the relationship between physical activity and QoL.