The Effectiveness of an Online Learning Strategy on Changing Physical Activity Counseling Practice in Nurses.

BACKGROUND: Nurses may be well poised for providing physical activity guidance and support to patients. PURPOSE: The purposes of this study were to examine the effectiveness of a concise, evidence based online learning modules strategy (OLMS) for improving nurses' physical activity counselling. METHODS: 68 nurses were randomly assigned to either an OLMS group or control group. The OLMS group completed a series of six online learning modules aimed at improving physical activity counselling practice. RESULTS: The OLMS group, compared to the control group, showed a trend for improvement in Physical Activity Counselling Practice (p = .063) after controlling for baseline values, and significant improvement in (a) Self-efficacy for Physical Activity Counselling (p = .001), (b) Knowledge of Physical Activity Guidelines, (p = .031), and (c) Perceived Benefits of Physical Activity Counselling (p = .014) over the course of the intervention. No significant change was found for Barriers for Providing Physical Activity Counselling (p > .05). CONCLUSIONS: The OLMS tested may be an effective means for improving self-efficacy, knowledge, and perceived benefits of physical activity counselling, suggesting the utility of online learning strategies for improving nurses' physical activity counselling practice. Given barriers to providing physical activity counselling were not affected by the intervention, future interventions and policy change could target these barriers specifically in order to give nurses more tools and time for reaching patients and addressing physical activity counselling in practice.

Health beliefs and engagement in moderate-to-vigorous-intensity physical activity among cancer survivors: a cross-sectional study.

PURPOSE: Moderate-to-vigorous-intensity physical activity (PA) can alleviate many adverse side effects and symptoms caused by cancer treatments; yet, most cancer survivors are insufficiently active. Evidence shows that theory-based PA behavior change interventions are more effective than non-theory-based interventions; thus, it is necessary to ascertain modifiable theoretical factors associated with moderate-to-vigorous-intensity PA among cancer survivors. Drawing on the health belief model (HBM), the associations between moderate-to-vigorous-intensity PA and (1) perceived susceptibility to cancer recurrence and health problems, (2) perceived severity of cancer recurrence and health problems, (3) perceived benefits of PA for reducing risk of cancer recurrence and health problems, (4) perceived barriers to PA, and (5) PA barrier self-efficacy among cancer survivors were examined. METHODS: A total of 123 adult cancer survivors (Mage = 50.1 ± 15.5 years; 82.9% female) completed an online self-report survey assessing sociodemographic and medical characteristics, moderate-to-vigorous-intensity PA, and the HBM constructs. Data were analyzed descriptively and using hierarchical linear regression analysis. RESULTS: After adjusting for age, sex, body mass index, time since cancer diagnosis, and treatments received, the HBM constructs collectively explained 29% of the variance in moderate-to-vigorous-intensity PA. Perceived benefits of PA (ß = .20, 95% CI [1.81, 11.67], p = .007) and PA barrier self-efficacy (ß = .42, 95% CI [0.26, 0.53], p < .001) were significantly associated with moderate-to-vigorous-intensity PA. CONCLUSION: Raising awareness of the benefits of PA for reducing risk of cancer recurrence and health problems and strengthening self-efficacy to overcome PA barriers may help to promote cancer survivors' attainment of moderate-to-vigorous-intensity PA guidelines.

Investigating physical activity knowledge and beliefs as correlates of behaviour in the general population: a cross-sectional study.

This study examines knowledge of physical activity (PA) guidelines for cancer prevention and beliefs of the role of PA in preventing cancer as correlates of moderate-to-vigorous intensity PA (MVPA) behaviour among adults. Measures assessing socio-demographic characteristics, knowledge of PA guidelines, and PA beliefs and behaviour were completed online by 654 adults (Mage = 36.92 ± 14.61 years) with no history of cancer. Data were analyzed descriptively and using unadjusted and adjusted logistic regression analysis. Approximately half the sample was aware of PA guidelines for cancer prevention (49.24%) and believed that PA was extremely effective in reducing the risk of developing cancer (48.93%). Knowledge of PA guidelines for cancer prevention was associated with a greater likelihood of being active (unadjusted odds ratio [OR]: 1.66, 95% confidence interval [95% CI]: 1.18-2.34; p <.01; adjusted OR: 2.05, 95% CI: 1.36-3.11; p <.001). Beliefs regarding the effectiveness of PA in preventing cancer was not associated with a greater likelihood of being active. There is a lack of awareness of current PA guidelines for cancer prevention. Experimental studies are needed to further explore if increasing adults' knowledge of PA guidelines for cancer prevention can enhance PA levels.

Family history of cancer as a cue to action for physical activity behaviour and beliefs.

Objective: Examine if family history of cancer serves as a cue to action prompting adults to assess their personal risk of cancer, consider the consequences, and engage in physical activity (PA) if they believe it will reduce their risk.Design: Cross-sectional survey of adults with and without a close relative with cancer.Main Outcome Measures: Health Belief Model (HBM) constructs of perceived cancer vulnerability, perceived cancer severity, response effectiveness of PA, self-efficacy for PA, and barriers to PA, and moderate-to-vigorous intensity PA (MVPA).Results: Perceived barriers and self-efficacy correlated with MVPA in both groups (p < .05), and perceived vulnerability and response effectiveness correlated with MVPA in participants with a close relative with cancer (p < .05). In multiple regression analyses, HBM constructs accounted for 18.5% and 8.3% of the variability in MVPA among participants with and without a close relative with cancer, respectively. Participants with a close relative with cancer had greater perceived vulnerability to cancer compared to participants without a close relative with cancer (p < .001).Conclusion: Adults with and without a close relative with cancer may be differentially influenced by HBM constructs, and as a result may respond differently to PA interventions and public health messaging.

Evaluation of Online Learning Modules for Improving Physical Activity Counseling Skills, Practices, and Knowledge of Oncology Nurses.

PURPOSE/OBJECTIVES: To examine the effectiveness of online learning modules for improving physical activity counseling practices among oncology nurses. 
. DESIGN: Randomized, controlled trial.
. SETTING: Online.
. SAMPLE: 54 oncology nurses.
. METHODS: Oncology nurses were randomly assigned to the learning modules group or control group. The learning modules group completed six online learning modules and quizzes focused on physical activity for cancer survivors, general physical activity principles, and motivational interviewing.
. MAIN RESEARCH VARIABLES: Percentage of cancer survivors counseled, self-efficacy for physical activity counseling, knowledge of physical activity, and perceived barriers and benefits of physical activity counseling.
. FINDINGS: Analyses of covariance revealed no significant difference between the learning modules and control groups in the percentage of cancer survivors that oncology nurses counseled. Significant differences were found in self-efficacy for physical activity counseling and perceived barriers to physical activity counseling at postintervention. 
. CONCLUSIONS: The online learning intervention tested in this study improved some parameters of physical activity counseling but did not increase the percentage of cancer survivors that oncology nurses counseled. Additional pilot work is needed to refine the intervention.
. IMPLICATIONS FOR NURSING: This study suggests the potential utility of an evidence-based online learning strategy for oncology nurses that includes information on physical activity and its benefits in cancer survivorship. The findings offer a framework on how to implement physical activity counseling skills in oncology nursing practice.

HealtheSteps™ Study Protocol: a pragmatic randomized controlled trial promoting active living and healthy lifestyles in at-risk Canadian adults delivered in primary care and community-based clinics.

BACKGROUND: Physical inactivity is one of the leading causes of chronic disease in Canadian adults. With less than 50% of Canadian adults reaching the recommended amount of daily physical activity, there is an urgent need for effective programs targeting this risk factor. HealtheSteps™ is a healthy lifestyle prescription program, developed from an extensive research base to address risk factors for chronic disease such as physical inactivity, sedentary behaviour and poor eating habits. HealtheSteps™ participants are provided with in-person lifestyle coaching and access to eHealth technologies delivered in community-based primary care clinics and health care organizations. METHOD/DESIGN: To determine the effectiveness of Healthesteps™, we will conduct a 6-month pragmatic randomized controlled trial with integrated process and economic evaluations of HealtheSteps™ in 5 clinic settings in Southwestern Ontario. 110 participants will be individually randomized (1:1; stratified by site) to either the intervention (HealtheSteps™ program) or comparator (Wait-list control). There are 3 phases of the HealtheSteps™ program, lasting 6 months each. The active phase consists of bi-monthly in-person coaching with access to a full suite of eHealth technology supports. During the maintenance phase I, the in-person coaching will be removed, but participants will still have access to the full suite of eHealth technology supports. In the final stage, maintenance phase II, access to the full suite of eHealth technology supports is removed and participants only have access to publicly available resources and tools. DISCUSSION: This trial aims to determine the effectiveness of the program in increasing physical activity levels and improving other health behaviours and indicators, the acceptability of the HealtheSteps™ program, and the direct cost for each person participating in the program as well as the costs associated with delivering the program at the different community sites. These results will inform future optimization and scaling up of the program into additional community-based primary care sites. TRIAL REGISTRATION: NCT02413385 (Clinicaltrials.gov). Date Registered: April 6, 2015.

Newly diagnosed lung cancer patients' preferences for and beliefs about physical activity prior to chemotherapy.

Physical activity has been found to have a number of benefits for lung cancer patients yet very little information is available concerning physical activity beliefs and preferences for this population. The purpose of the study was to explore physical activity programming and counseling preferences and beliefs about physical activity in newly diagnosed lung cancer patients scheduled to receive chemotherapy. A total of 43 new diagnosed lung cancer patients completed a researcher-administered survey prior to commencing chemotherapy. Results indicated that only 7 participants (17%) reported meeting public health recommendations for physical activity yet the majority of participants (n = 28) indicated interest or possible interest in physical activity counseling. Many participants also indicated interest or possible interest in an exercise program (n = 29) for lung cancer survivors, preferring it to start during chemotherapy (n = 20), for it to be home based (n = 21), and moderate in intensity (n = 22). The most common behavioral belief (advantage) of physical activity was to build/maintain strength (n = 26) and the most common control belief (barrier) was fatigue (n = 11). These data suggest that physical activity counseling and programming may be well received by newly diagnosed lung cancer patients. Information about physical activity and programming preferences and beliefs from this study may be useful for the design of optimal physical activity interventions for lung cancer patients.

Lifestyle Counseling Practices of Oncology Nurses in the United States and Canada.

BACKGROUND: Oncology nurses are well poised to provide lifestyle behavior counseling to cancer survivors. However, very little is known about the current lifestyle behavior counseling practices of oncology nurses. OBJECTIVES: The primary purpose of this study was to examine lifestyle behavior counseling practices of oncology nurses. The secondary purpose was to examine differences in lifestyle behavior counseling based on nurses' health behaviors, additional training received, and country of residence. METHODS: Oncology nurses (N = 314) were primarily recruited through emails from oncology nursing email lists. Participants completed an online survey. FINDINGS: Overall, oncology nurses reported providing lifestyle counseling to most cancer survivors when appropriate. The majority of oncology nurses said they were receptive to receiving additional training about lifestyle counseling. Participants who had received additional training and who lived in the United States were more likely to provide counseling to cancer survivors. Concerning their own health behaviors, no meaningful differences were found regarding lifestyle behavior counseling practices, which contrasts with findings from previous research. Strengthening oncology nurses' lifestyle behavior counseling knowledge and skills may offer opportunities to enhance survivors' optimal health and quality of life and to reduce their risk of recurrence.

The Teachable Moment After Cancer Diagnosis: Perceptions From Oncology Nurses.

PURPOSE/OBJECTIVES: To determine oncology nurses' perspectives of the receptiveness of survivors to receiving health behavior guidance, with secondary purposes to (a) explore other elements of oncology nurses' perceptions of the teachable moment and (b) examine differences in outcomes between American and Canadian nurses
. DESIGN: Cross-sectional survey.
 SETTING: In- and outpatient oncology nursing departments in the United States and Canada. SAMPLE: 310 members of the Canadian Association of Nurses in Oncology (CANO/ACIO) and the Oncology Nursing Society (ONS) who currently care for patients
. METHODS: Oncology nurses recruited through emails distributed through the CANO/ACIO and ONS Listservs completed online investigator-developed surveys. MAIN RESEARCH VARIABLES: Measures related to oncology nurses' perceptions of survivors' receptiveness to health behavior change counseling and the teachable moment (i.e., general receptiveness, perceived benefits, guidance and referral seeking, long- and short-term effectiveness, best time, and best resources). FINDINGS: Oncology nurses reported that survivors were receptive to receiving guidance on health behaviors, particularly during teachable moments after diagnosis and during treatment. They also perceived that a fairly low percentage of survivors asked for guidance about health behavior change; relatively few made improvements to their health behaviors.
 CONCLUSIONS: Survivors are reported to be interested in receiving guidance concerning health behavior change during key teachable moments. Oncology nurses may need to initiate conversations with survivors, offer education regarding the benefits of positive health behavior change, and provide ongoing support throughout the cancer trajectory. IMPLICATIONS FOR NURSING: Oncology nurses may use findings from the current study to guide their health behavior change counseling with survivors
.

Breast and Colon Cancer Survivors' Expectations About Physical Activity for Improving Survival.

PURPOSE/OBJECTIVES: To compare physical activity outcome expectations related to cancer survival with traditional physical activity outcome expectations in breast and colon cancer survivors
. DESIGN: Cross-sectional survey
. SETTING: Canada and the United States. SAMPLE: 146 participants
. METHODS: Self-reported survey instruments and height and weight measurement. The online survey was completed once by each participant
. MAIN RESEARCH VARIABLES: Godin Leisure-Time Exercise Questionnaire, Multidimensional Outcome Expectations for Exercise Scale (MOEES), and an item assessing physical activity outcome expectations related to cancer survival. FINDINGS: Paired sample t tests indicated that the mean score for the physical subscale of the MOEES was significantly higher than the mean score on the physical activity outcome expectations related to cancer survival variable (p < 0.001). Multiple regression analyses indicated that physical activity outcome expectations related to cancer survival explained 4.8% of the variance in physical activity (p = 0.011)
. CONCLUSIONS: Findings from the current study suggest that, among breast and colon cancer survivors, outcome expectations related to cancer survival may influence physical activity levels and may not be as realized as traditional outcome expectations
. IMPLICATIONS FOR NURSING: Oncology nurses should familiarize themselves with the guidelines and benefits of physical activity for survivors so they can provide guidance and support to patients.

Effect of an exercise training intervention with resistance bands on blood cell counts during chemotherapy for lung cancer: a pilot randomized controlled trial.

PURPOSE: Chemotherapy for lung cancer can have a detrimental effect on white blood cell (WBC) and red blood cell (RBC) counts. Physical exercise may have a role in improving WBCs and RBCs, although few studies have examined cancer patients receiving adjuvant therapies. The purpose of this pilot trial was to examine the effects of an exercise intervention utilizing resistance bands on WBCs and RBCs in lung cancer patients receiving curative intent chemotherapy. METHODS: A sample of lung cancer patients scheduled for curative intent chemotherapy was randomly assigned to the exercise intervention (EX) condition or usual care (UC) condition. The EX condition participated in a three times weekly exercise program using resistance bands for the duration of chemotherapy. RESULTS: A total of 14 lung cancer patients completed the trial. EX condition participants completed 79% of planned exercise sessions. The EX condition was able to maintain WBCs over the course of the intervention compared to declines in the UC condition (p = .008; d = 1.68). There were no significant differences in change scores in RBCs. CONCLUSIONS: Exercise with resistance bands may help attenuate declines in WBCs in lung cancer patients receiving curative intent chemotherapy. Larger trials are warranted to validate these findings. Ultimately these findings could be informative for the development of supportive care strategies for lung cancer patients receiving chemotherapy. TRIAL REGISTRATION: Clinical Trials Registration #: NCT01130714.

Does the perception that God controls health outcomes matter for health behaviors?

The purpose of this study was to examine the associations between God Locus of Health Control, health behaviors, and beliefs utilizing a cross-sectional online survey (N = 549). Results indicated that God Locus of Health Control was correlated with alcohol use, physical activity, perceived risk of chronic disease, and beliefs that poor health behaviors contribute to chronic disease (all p values < .05). Multiple regression analyses including covariates and other locus of control variables revealed that God Locus of Health Control was only an independent correlate of the belief that physical inactivity contributed to chronic disease. Insights from this study may be important for future faith-based health behavior change interventions.

Resources for physical activity in cancer centers in the United States.

Physical activity (PA) has many benefits for cancer survivors. However, the available PA resources for survivors at cancer centers throughout the United States are undocumented. The current study surveyed major cancer centers concerning the availability and types (e.g., facilities, programs, counseling, information resources) of PA resources available. Of supportive care services, PA resources were the least commonly reported. Significant correlations were found among availability of PA resources and other supportive care services. Although many cancer centers reported offering PA programming, formal and informal PA guidance and support seem to fall on oncology nurses and other clinicians. Oncology nurses should be reminded that they may be one of the only sources of PA guidance available to survivors at cancer centers.

Multicomponent intervention to reduce daily sedentary time: a randomised controlled trial.

OBJECTIVES: To test the efficacy of a multicomponent technology intervention for reducing daily sedentary time and improving cardiometabolic disease risk among sedentary, overweight university employees. DESIGN: Blinded, randomised controlled trial. SETTING: A large south-eastern university in the USA. PARTICIPANTS: 49 middle-aged, primarily female, sedentary and overweight adults working in sedentary jobs enrolled in the study. A total of 40 participants completed the study. INTERVENTIONS: Participants were randomised to either: (1) an intervention group (N=23; 47.6+9.9 years; 94.1% female; 33.2+4.5 kg/m(2)); (2) or wait-list control group (N=17; 42.6+8.9 years; 86.9% female; 31.7+4.9 kg/m(2)). The intervention group received a theory-based, internet-delivered programme, a portable pedal machine at work and a pedometer for 12 weeks. The wait-list control group maintained their behaviours for 12 weeks. OUTCOME MEASURES: Primary (sedentary and physical activity behaviour measured objectively through StepWatch) and secondary (heart rate, blood pressure, height, weight, waist circumference, per cent body fat, cardiorespiratory fitness, fasting lipids) outcomes were measured at baseline and postintervention (12 weeks). Exploratory outcomes including intervention compliance and process evaluation measures were also assessed postintervention. RESULTS: Compared to controls, the intervention group reduced daily sedentary time (mean change (95%CI): -58.7 min/day (-118.4 to 0.99; p<0.01)) after adjusting for baseline values and monitor wear time. Intervention participants logged on to the website 71.3% of all intervention days, used the pedal machine 37.7% of all working intervention days and pedalled an average of 31.1 min/day. CONCLUSIONS: These findings suggest that the intervention was engaging and resulted in reductions in daily sedentary time among full-time sedentary employees. These findings hold public health significance due to the growing number of sedentary jobs and the potential of these technologies in large-scale worksite programmes. TRIAL REGISTRATION: ClinicalTrials.gov #NCT01371084.

Stress reactivity, health behaviors, and compliance to medical care in breast cancer survivors.

PURPOSE/OBJECTIVES: To explore relationships among quality of life (QOL), stress reactivity, health behaviors, and compliance to medical care in breast cancer survivors. DESIGN: One-time descriptive laboratory study. SETTING: A visual motor laboratory at a rural university in the southeastern United States. SAMPLE: 25 breast cancer survivors. METHODS: Participants were subjected to the Trier Social Stress Test (TSST) in a laboratory setting and completed questionnaires at home prior to and after the laboratory session. main research variables: Changes in heart rate variability (HRV), salivary cortisol, and state anxiety from the State-Trait Anxiety Inventory (STAI) estimated stress reactivity. Health behaviors, QOL, and trait anxiety were determined by questionnaires. Compliance to medical care was determined from medical records. FINDINGS: Analyses of variance (ANOVAs) indicated that QOL scores were higher for participants with lower compared to higher stress reactivity (p < 0.05). In addition, ANOVAs revealed that participants high in compliance to medical care indicated a lower stress response as determined by HRV (p < 0.01) and the STAI (p < 0.05) compared to those low in compliance. No significant differences were noted in any of the health behaviors based on stress reactivity. CONCLUSIONS: The data suggest that breast cancer survivors who indicate the greatest stress reactivity tend to have the poorest compliance to medical care and lowest QOL. IMPLICATIONS FOR NURSING: Nurses may wish to provide additional support to breast cancer survivors who indicate high stress reactivity in the hopes of improving compliance to medical care and QOL. KNOWLEDGE TRANSLATION: The data suggest that supportive care strategies that reduce stress could potentially improve compliance to medical care in breast cancer survivors. In addition, strategies for managing stress may result in improvements in QOL. Health behaviors, according to the data, do not seem to be influenced by stress reactivity.

Predictors of adherence to supervised and unsupervised exercise in the Alberta Physical Activity and Breast Cancer Prevention Trial.

BACKGROUND: Few studies have examined the predictors of adherence separately for supervised and unsupervised exercise or in postmenopausal women over an extended time period. Here, we report the predictors of exercise adherence in the Alberta Physical Activity and Breast Cancer Prevention (ALPHA) Trial. METHODS: The ALPHA trial randomized 160 postmenopausal women in Calgary and Edmonton, Canada to an exercise intervention that consisted of an average of 200 min/wk of supervised (123 minutes) and unsupervised (77 minutes) exercise over a 1-year period. Baseline data were collected on demographic, health-related fitness, quality of life, and motivational variables from the theory of planned behavior. RESULTS: Participants completed an average of 95% of their supervised exercise and 79% of their unsupervised exercise. In multivariate analyses, 8.1% (P=.001) of the variance was explained for supervised exercise by being from Edmonton (ß=0.22; P=.004) and older (ß=0.15; P=.050). For unsupervised exercise, 21.1% (P<.001) of the variance was explained by being from Calgary (ß=-0.39; P<.001), having a family history of breast cancer (ß=0.21; P=.003), and having higher vitality (ß=0.19; P=.011). CONCLUSIONS: Predictors of adherence may differ for supervised and unsupervised exercise, moreover, predicting adherence to supervised exercise may be particularly difficult in well-controlled efficacy trials.

Physical activity promotion among oncology nurses.

BACKGROUND: Oncology nurses may be influential for providing physical activity guidance to cancer patients. OBJECTIVE: The purposes of this study were to examine physical activity promotion practices of oncology nurses and to explore nurses' perceived benefits of physical activity for cancer patients and barriers to physical activity promotion. METHODS: Two thousand e-mails were sent by a data service company to a random selection of oncology nurses throughout the United States with a link to a Web-based survey. To be eligible, nurses had to be currently seeing patients. RESULTS: Completed surveys were received from 274 oncology nurses. Most participants inquired about physical activity on at least some office visits (74.9%) and gave physical activity recommendations to 65.7% and 66.9% of on-treatment and posttreatment patients. "Lack of time" and that "patients are not interested" were the most prominent barriers identified by nurses, whereas perceived benefits for patients were rated favorably, with the exception of "reducing risk of recurrence." Almost all perceived benefits and barriers were correlated with physical activity promotion, with the strongest correlates being "unsure what to recommend" and "unsure that physical activity is safe." CONCLUSIONS: Although most oncology nurses frequently inquire about patient physical activity, they may be less apt to provide recommendations. A number of barriers and perceived benefits may influence physical activity promotion, especially concerning what to recommend and patient safety. IMPLICATIONS FOR PRACTICE: Oncology nurses would benefit from education opportunities about the benefits of physical activity for survival outcomes and types of physical activity to recommend.

Exercise programming and counseling preferences of breast cancer survivors during or after radiation therapy.

PURPOSE/OBJECTIVES: To explore exercise programming and counseling preferences and exercise-related beliefs in breast cancer survivors during and after radiation therapy, and to compare differences based on treatment and insurance status. DESIGN: Cross-sectional survey. SETTING: Ambulatory cancer center in a rural community in eastern North Carolina. SAMPLE: 91 breast cancer survivors during or after radiation therapy. METHODS: The researchers administered the questionnaire to participants. MAIN RESEARCH VARIABLES: Exercise programming and counseling preferences and exercise beliefs moderated by treatment status (on-treatment, early, and late survivors) and insurance status (Medicaid, non-Medicaid). FINDINGS: Chi-square analyses indicated that fewer Medicaid users were physically active and reported health benefits as an advantage of exercise compared to non-Medicaid users (p < 0.05). In addition, more Medicaid users preferred exercise programming at their cancer center compared to non-Medicaid users (p < 0.05). More on-treatment and early survivors listed health benefits as advantages to exercise, but fewer indicated weight control as an advantage compared to late survivors (p < 0.05). Early survivors were more likely than on-treatment survivors to indicate that accessible facilities would make exercising easier for them (p < 0.05). CONCLUSIONS: Medicaid users are less active, less likely to identify health benefits as an advantage for exercising, and more likely to prefer cancer center-based exercise programming compared to non-Medicaid users. In addition, on-treatment and early survivors are more likely to list health benefits and less likely to indicate weight control as advantages of exercising compared to late survivors. IMPLICATIONS FOR NURSING: The low activity levels of Medicaid users may be best targeted by providing cancer center-based exercise programming. Exercise interventions may be most effective if tailored to the unique needs of treatment status.

Changes in insulin resistance indicators, IGFs, and adipokines in a year-long trial of aerobic exercise in postmenopausal women.

Physical activity is a known modifiable lifestyle means for reducing postmenopausal breast cancer risk, but the biologic mechanisms are not well understood. Metabolic factors may be involved. In this study, we aimed to determine the effects of exercise on insulin resistance (IR) indicators, IGF1, and adipokines in postmenopausal women. The Alberta Physical Activity and Breast Cancer Prevention Trial was a two-armed randomized controlled trial in postmenopausal, inactive, cancer-free women. A year-long aerobic exercise intervention of 225  min/week (n=160) was compared with a control group asked to maintain usual activity levels (n=160). Baseline, 6- and 12-month serum levels of insulin, glucose, IGF1, IGF-binding protein 3 (IGFBP3), adiponectin, and leptin were assayed, and after data collection, homeostasis model assessment of IR (HOMA-IR) scores were calculated. Intention-to-treat analyses were performed using linear mixed models. The treatment effect ratio (TER) of exercisers to controls was calculated. Data were available on 308 (96.3%) women at 6 months and 310 (96.9%) women at 12 months. Across the study period, statistically significant reductions in insulin (TER=0.87, 95% confidence interval (95% CI)=0.81-0.93), HOMA-IR (TER=0.86, 95% CI=0.80-0.93), and leptin (TER=0.82, 95% CI=0.78-0.87), and an increase in the adiponectin/leptin ratio (TER=1.21, 95% CI=1.13-1.28) were observed in the exercise group compared with the control group. No significant differences were observed for glucose, IGF1, IGFBP3, adiponectin or the IGF1/IGFBP3 ratio. Previously inactive postmenopausal women who engaged in a moderate-to-vigorous intensity exercise program experienced changes in insulin, HOMA-IR, leptin, and adiponectin/leptin that might decrease the risk for postmenopausal breast cancer.

A randomized controlled trial of continuous activity, short bouts, and a 10,000 step guideline in inactive adults.

OBJECTIVE: Although several studies have examined the effect of accumulated bouts on health outcomes, the impact of recommending short bouts on activity-related behavior in health promotion efforts has received minimal investigation. METHOD: During this 5-week study in 2007-2008, 43 university employees (8 male, 35 female) in the Southeastern United States were randomly assigned to a group recommended to achieve (a) 10,000 steps (10K), (b) 30-minutes (30 min) of continuous physical activity, or (c) 30-minutes of activity in bouts of at least 10 minutes (bouts). RESULTS AND CONCLUSIONS: Repeated measures ANOVA revealed that the 10K group showed the largest increase in step counts whereas the bouts group showed the smallest change over the intervention period, p=0.01. Condition differences were most pronounced on days in which participants met their activity recommendation. Accelerometer results revealed that the 10K (d=1.1) and 30 min groups (d=0.89) showed large increases in minutes of moderate to vigorous activity (MVPA), whereas the bouts group showed minimal change (d=0.11). Although activity recommendations did not differentially affect self-efficacy, participants from all conditions showed decreased self-efficacy across the intervention (p=0.02), highlighting the need to develop strategies to increase self-efficacy in activity promotion efforts.