Psychosocial correlates of physical activity in cancer survivors: a systematic review and meta-analysis.

BACKGROUND: Physical activity (PA) is a non-pharmacological approach to optimize health benefits in cancer survivors and is recommended as part of care. However, most cancer survivors fail to meet PA recommendations. The current systematic review and meta-analysis aimed to identify psychosocial correlates of free-living PA in cancer survivors. METHODS: Three electronic databases were searched (PubMed, PsycINFO, and SportDiscus). Meta-analyses were conducted for psychosocial correlates tested ≥ 3 times. RESULTS: Sixty-four articles were included. Eighty-eight different free-living PA correlates were identified. Meta-analyses (n = 32 studies) tested 23 PA correlates, of which 16 were significant (p < 0.05). Larger effect sizes (0.30 < ES > 0.45) were found for exercise self-efficacy, perceived behavioral control, intention, lower perceived barriers for exercise, enjoyment, perceived PA benefits, and attitudes. Small-to-moderate effects (0.18 < ES < 0.22) were found for subjective norms, physical functioning, quality of life, depression, and mental health. These findings were generally in line with narrative results. CONCLUSIONS: This systematic review highlights important psychosocial correlates of free-living PA that can be targeted in future PA promotion interventions for cancer survivors. Constructs mainly from SCT and TPB were the most studied and appear to be associated with free-living PA in this population. However, we cannot currently assert which frameworks might be more effective. Further studies of better methodological quality, per correlate and theory, exploring longer-term associations and across different types of cancer, are needed. IMPLICATIONS FOR CANCER SURVIVORS: Having higher exercise self-efficacy, perceived behavioral control, intention, enjoyment and perceived PA benefits, more positive attitudes towards PA, and lower perceived barriers for exercise, can help increase PA in cancer survivors.

Home-based exercise interventions' impact on breast cancer survivors' functional performance: a systematic review.

INTRODUCTION: Home-based exercise (HBE) programs can be a feasible strategy to enhance functional performance and promote physical activity (PA) in breast cancer survivors. A deeper analysis of the effects of HBE interventions, structured by HBE program type and treatment phase, is needed. This systematic review aimed to synthesize the evidence on HBE interventions' impact on breast cancer survivors' functional performance, PA levels, and program adherence rates, according to HBE intervention type and treatment phase. METHODS: A comprehensive search of peer-reviewed articles reporting HBE interventions' effects on the outcomes of interest was performed in Pubmed, Google Scholar, EBSCO, Web of Science, Science Direct, and B-ON until January 15th, 2024. Data were synthesized according to Denton's domains to classify HBE interventions (prescription: structured vs. unstructured; Delivery method: supervised vs. facilitated vs. unsupervised) and treatment phase. Methodological quality appraisal was performed using the Effective Public Health Practice Project tool. RESULTS: Twenty-six studies were included. Most studies conducted structured/facilitated interventions and reported positive effects on functional performance (particularly aerobic capacity), increases in PA levels, and high adherence rates (> 70%) during and post-treatment. CONCLUSION: HBE interventions may be feasible to improve functional performance and promote physical activity among breast cancer survivors. Further studies are needed to confirm which HBE intervention type is more appropriate for each treatment phase. More evidence applying HBE interventions with different designs is required to allow the drawing of more solid conclusions. Studies exploring the effects of HBE interventions on the pre-treatment phase are needed.

Promoting physical activity through supervised vs motivational behavior change interventions in breast cancer survivors on aromatase inhibitors (PAC-WOMAN): protocol for a 3-arm pragmatic randomized controlled trial.

BACKGROUND: Aromatase inhibitors (AI) are frequently used to treat hormone-receptor-positive breast cancer, but they have multiple adverse effects (e.g., osteoporosis, arthralgia), resulting in premature therapy discontinuation/switch. Physical activity (PA) can attenuate these negative effects and improve quality of life (QoL). However, most cancer survivors fail to perform/sustain adequate PA levels, especially in the long-term. Theory-based interventions, using evidence-based behavior change techniques, aimed at promoting long-term behavior change in breast cancer survivors are effective, but remain scarce and fail to promote self-regulatory skills and better-quality motivations associated with sustained PA adoption. This paper describes the design of the PAC-WOMAN trial, which will test the long-term effectiveness and cost-effectiveness of two state of the art, group-based interventions encouraging sustained changes in PA, sedentary behavior, and QoL. Additional aims include examining the impact of both interventions on secondary outcomes (e.g., body composition, physical function), and key moderators/mediators of short and long-term changes in primary outcomes. METHODS: A 3-arm pragmatic randomized controlled trial, involving a 4-month intervention and a 12-month follow-up, will be implemented, in a real exercise setting, to compare: 1) brief PA counseling/motivational intervention; 2) structured exercise program vs. waiting-list control group. Study recruitment goal is 122 hormone-receptor-positive breast cancer survivors (stage I-III), on AI therapy (post-primary treatment completion) ≥ 1 month, ECOG 0-1. Outcome measures will be obtained at baseline, 4 months (i.e., post-intervention), 10 and 16 months. Process evaluation, analyzing implementation determinants, will also be conducted. DISCUSSION: PAC-WOMAN is expected to have a relevant impact on participants PA and QoL and provide insights for the improvement of interventions designed to promote sustained adherence to active lifestyle behaviors, facilitating its translation to community settings. TRIAL REGISTRATION: April 20, 2023 - NCT05860621. April 21, 2023 - https://doi.org/10.17605/OSF.IO/ZAQ9N April 27, 2023 - UMIN000050945.

Theory-based physical activity and/or nutrition behavior change interventions for cancer survivors: a systematic review.

PURPOSE: Theory-based interventions aimed at promoting health behavior change in cancer survivors seem to be effective but remain scarce. More information on intervention features is also needed. This review aimed to synthesize the evidence from randomized controlled trials evaluating the efficacy of theory-based interventions (and its features) on physical activity (PA) and/or diet behaviors in cancer survivors. METHODS: A systematic search in three databases (PubMed, PsycInfo, and Web of Science) identified studies that (i) targeted adult cancer survivors and (ii) included theory-based randomized controlled trials designed to influence PA, diet, or weight management. A qualitative synthesis of interventions' effectiveness, extensiveness of theory use, and applied intervention techniques was conducted. RESULTS: Twenty-six studies were included. Socio-Cognitive Theory was the most used theory, showing promising results in PA-only trials and mixed findings in multiple-behavior interventions. Mixed findings were observed for interventions based on the Theory of Planned Behavior and Transtheoretical Model. Limited findings were found in diet-only interventions. A large variability in the extensiveness of theory use, and in intervention techniques was found. Further research is required to understand how and why these interventions offer promise for improving behavior. CONCLUSIONS: Theory-based interventions seem to improve PA and diet behaviors in cancer survivors. Further studies, including thorough intervention descriptions, are needed to confirm these findings and identify the optimal features and content of lifestyle theory-based interventions for cancer survivors. IMPLICATIONS FOR CANCER SURVIVORS: This systematic review can contribute to the development of more effective interventions to promote long-term adherence to healthy lifestyle behaviors.

Exercise training in the management of overweight and obesity in adults: Synthesis of the evidence and recommendations from the European Association for the Study of Obesity Physical Activity Working Group.

There is a need for updated practice recommendations on exercise in the management of overweight and obesity in adults. We summarize the evidence provided by a series of seven systematic literature reviews performed by a group of experts from across Europe. The following recommendations with highest strength (Grade A) were derived. For loss in body weight, total fat, visceral fat, intra-hepatic fat, and for improvement in blood pressure, an exercise training program based on aerobic exercise at moderate intensity is preferentially advised. Expected weight loss is however on average not more than 2 to 3 kg. For preservation of lean mass during weight loss, an exercise training program based on resistance training at moderate-to-high intensity is advised. For improvement in insulin sensitivity and for increasing cardiorespiratory fitness, any type of exercise training (aerobic, resistance, and combined aerobic or resistance) or high-intensity interval training (after thorough assessment of cardiovascular risk and under supervision) can be advised. For increasing muscular fitness, an exercise training program based preferentially on resistance training alone or combined with aerobic training is advised. Other recommendations deal with the beneficial effects of exercise training programs on energy intake and appetite control, bariatric surgery outcomes, and quality of life and psychological outcomes in management of overweight and obesity.

Effect of exercise training before and after bariatric surgery: A systematic review and meta-analysis.

We aimed to assess the effectiveness of exercise training programs in adults with severe obesity undergoing bariatric surgery. A systematic search of controlled trials published up to October 2019 that assigned participants to either a preoperative or postoperative exercise training group or a nonexercise group was performed. Meta-analyses were conducted using random-effects models. Twenty-two training programs were assessed (18 performed after bariatric surgery). The effect of preoperative exercise training on postsurgery outcomes was reported in only one study. Compared with the control condition without exercise, postoperative exercise training led to higher weight loss (N = 14, mean difference [95% CI] = -1.8 [-3.2; -0.4] kg, P = 0.01), fat loss (N = 9, P = 0.01), increase in VO2 max (N = 8, P < 0.0001), and increase in muscle strength (N = 9, P < 0.0001). No significant effect was found on lean body mass (N = 11). Preliminary evidence suggests a beneficial effect of postoperative exercise training on bone mineral density (N = 3, P < 0.001) and weight maintenance after the end of the intervention (N = 2, P < 0.001) but no significant effect on quality of life (N = 2), habitual physical activity (N = 2), or cardiometabolic outcomes (N < 4). In conclusion, exercise training performed after bariatric surgery improves physical fitness and leads to a small additional weight and fat loss and may prevent bone loss and weight regain after bariatric surgery.

A Motivational Pathway Linking Physical Activity to Body-Related Eating Cues.

OBJECTIVE: To explore the motivational transfer between physical activity (PA) and body-related eating cues, through self-determined motivations to exercise (SDM Ex) and regulate eating (SDM Eat). DESIGN: Cross-sectional. SETTING: Participants completed an online inventory on PA and eating behaviors and motivations in 2017-2018. PARTICIPANTS: A convenience sample of 300 adults (71% women; 34.4 ± 10.7 years; 23.2 ± 3.4 kg/m2), recruited through Facebook and cooperating Portuguese gyms. VARIABLES MEASURED: Moderate-to-vigorous physical activity (independent), SDM Ex and SDM Eat (mediators), and body-related eating cues (dependent) variables assessed through validated self-reported measures. ANALYSIS: Structural equation modeling and serial mediation procedures were used to test the hypothetical model. RESULTS: Physical activity was positively associated with SDM Ex, which was, in turn, associated with SDM Eat, which in turn positively predicted reliance on hunger/satiety cues and (more strongly) body-food choice congruence. The path through exercise and eating motivations was the leading mediating path in the PA and body-food choice congruence association. CONCLUSIONS AND IMPLICATIONS: This study lends support to the motivational transfer hypothesis between SDM Ex and SDM Eat in normal-weight adults, suggesting that more physically active individuals present higher SDM Ex and SDM Eat, and therefore, greater attentiveness to body-related eating cues and necessities. Encouraging PA might also improve individuals' eating self-regulation, especially if self-determined motivations are targeted in future interventions.

The Effects of the Type of Exercise and Physical Activity on Eating Behavior and Body Composition in Overweight and Obese Subjects.

The aim of this study was to examine whether a type of exercise favors better compliance with a prescribed diet, higher eating-related motivation, healthier diet composition or greater changes in body composition in overweight and obese subjects. One hundred and sixty-two (males n = 79), aged 18-50 years, were randomized into four intervention groups during 24 weeks: strength, endurance, combined strength + endurance and guideline-based physical activity; all in combination with a 25-30% caloric restriction diet. A food frequency questionnaire and a "3-day food and drink record" were applied pre- and post-intervention. Diet and exercise-related motivation levels were evaluated with a questionnaire developed for this study. Body composition was assessed by DXA and habitual physical activity was measured by accelerometry. Body weight, body mass index (BMI) and body fat percentage decreased and lean body mass increased after the intervention, without differences by groups. No interactions were observed between intervention groups and time; all showing a decreased in energy intake (p < 0.001). Carbohydrate and protein intakes increased, and fat intake decreased from pre- to post-intervention without significant interactions with intervention groups, BMI category or gender (p < 0.001). Diet-related motivation showed a tendency to increase from pre- to post-intervention (70.0 ± 0.5 vs 71.0 ± 0.6, p = 0.053), without significant interactions with intervention groups, BMI or gender. Regarding motivation for exercise, gender x time interactions were observed (F(1,146) = 7.452, p = 0.007): Women increased their motivation after the intervention (pre: 17.6 ± 0.3, post: 18.2 ± 0.3), while men maintained it. These findings suggest that there are no substantial effects of exercise type on energy intake, macronutrient selection or body composition changes. After a six-month weight loss program, individuals did not reduce their motivation related to diet or exercise, especially women. Individuals who initiate a long-term exercise program do not increase their energy intake in a compensatory fashion, if diet advices are included.

Effects of exercise motivations on body image and eating habits/behaviours: A systematic review.

AIM: The quality of exercise motivations may undermine body image and eating habits/behaviours. This systematic review summarizes the state of the scientific evidence on the effects of exercise motivations on body image and eating habits/behaviours. METHODS: This review was registered on PROSPERO (CRD42019129904). Three electronic databases (PubMed, PsycINFO, SportDiscus) were searched using combinations of terms concerning: (a) the population of interest (adults, exercisers), (b) the independent variables (eg, exercise autonomous motivations) and (c) the outcomes of interest (eg, body image, eating habits). No study design restrictions were implemented. To be included, empirical studies had to be published up to June 2019, in English, in peer-reviewed journals/theses and analyse associations between exercise motivations and body image or eating habits/behaviours. Study quality was assessed using the EPHPP Quality Assessment Tool for Quantitative Studies. Two authors performed all steps. Outcome data were combined narratively. RESULTS: Of 168 records, 26 were included in this review: 22 analysing links between exercise motivations and body image and 11 exploring links between exercise motivations and eating habits/behaviours. Autonomous motivations (eg, for pleasure, health, wellbeing) and health-focused exercise were associated with positive body image and healthy eating habits/behaviours, whereas exercising for appearance-related and other controlled reasons was inversely related to both outcomes. CONCLUSIONS: Better-quality exercise motivations (ie, autonomous) seem to result in healthier body image and eating outcomes. Further research is still recommended to explore these associations in more depth. Nevertheless, these findings suggest that future interventions should promote individuals' autonomy, competence and relatedness to foster autonomous motivations.

Weight-Focused Physical Activity Is Associated with Poorer Eating Motivation Quality and Lower Intuitive Eating in Women.

BACKGROUND: Evidence suggests that physical activity may be related to improved eating regulation, helping people self-regulate their eating in a healthier way. Yet the positive associations between physical activity and eating-related behaviors appear to depend on the goals pursued by individuals when they engage in physical activity. OBJECTIVE: This study investigated differences in eating motivations (informed by Self-Determination Theory) and intuitive eating between women who did physical activity to lose weight (PA-Wt) vs for non-weight goals (PA-NWt), and explores whether eating motivations mediate associations between weight-focused physical activity and intuitive eating. DESIGN/PARTICIPANTS: A sample of 1,435 physically active women (40 to 50 years) participated in a nationally representative survey conducted in 2009 in New Zealand. Women were asked whether they did physical activity predominantly to lose weight and were dichotomized into PA-Wt and PA-NWt groups. MAIN OUTCOME MEASURES: Questions assessing eating in response to hunger and satiety cues (intuitive eating) and eating-related motivations were completed by participants. STATISTICAL ANALYSES: Analyses of covariance, t tests, correlations, and mediation analyses were conducted to test the study hypotheses. RESULTS: PA-Wt participants reported lower levels of intuitive eating than did PA-NWt (0.26

Perceived Environmental Supportiveness Scale: Portuguese Translation, Validation and Adaptation to the Physical Education Domain

Abstract Aim: Grounded on Self-Determination Theory, this study aimed to translate, adapt and validate the Perceived Environmental Supportiveness Scale (PESS) in a sample of Portuguese physical education students. Methods: The global sample was comprised of 964 students (518 females), divided in two groups: the calibration (n = 469) and the validation one (n = 483), all of them enrolled in two Physical Education (PE) classes/week. Results: The analysis provided support for a one factor and 12 items model, which are in line with the values adopted in the methodology (χ² = 196.123, df = 54, p = <.001, SRMR = .035, NNFI = .943, CFI = .954, RMSEA = .074, 90% CI .063-.085). Results express that the models are invariant in all analysis (i.e., calibration vs. validation, male vs. female, and 3rd vs. secondary cycle; three and single factor models). Conclusion: The present study suggests that the PESS with one factor and 12 items has good psychometric properties and can be used to assess perceived need supportive motivational environments provided by PE teachers. Additionally, invariance analysis showed support for the use of the scale in both genders and in the 3rd and secondary cycles.

What is the effect of diet and/or exercise interventions on behavioural compensation in non-exercise physical activity and related energy expenditure of free-living adults? A systematic review.

Non-exercise physical activity (NEPA) and/or non-exercise activity thermogenesis (NEAT) reductions may occur from diet and/or exercise-induced negative energy balance interventions, resulting in less-than-expected weight loss. This systematic review describes the effects of prescribed diet and/or physical activity (PA)/exercise on NEPA and/or NEAT in adults. Studies were identified from PubMed, web-of-knowledge, Embase, SPORTDiscus, ERIC and PsycINFO searches up to 1 March 2017. Eligibility criteria included randomised controlled trials (RCT), randomised trials (RT) and non-randomised trials (NRT); objective measures of PA and energy expenditure; data on NEPA, NEAT and spontaneous PA; ≥10 healthy male/female aged>18 years; and ≥7 d length. The trial is registered at PROSPERO-2017-CRD42017052635. In all, thirty-six articles (RCT-10, RT-9, NRT-17) with a total of seventy intervention arms (diet, exercise, combined diet/exercise), with a total of 1561 participants, were included. Compensation was observed in twenty-six out of seventy intervention arms (fifteen studies out of thirty-six reporting declines in NEAT (eight), NEPA (four) or both (three)) representing 63, 27 and 23 % of diet-only, combined diet/exercise, and exercise-only intervention arms, respectively. Weight loss observed in participants who decreased NEAT was double the weight loss found in those who did not compensate, suggesting that the energy imbalance degree may lead to energy conservation. Although these findings do not support the hypothesis that prescribed diet and/or exercise results in decreased NEAT and NEPA in healthy adults, the underpowered trial design and the lack of state-of-the-art methods may limit these conclusions. Future studies should explore the impact of weight-loss magnitude, energetic restriction degree, exercise dose and participant characteristics on NEAT and/or NEPA.

Lack of interest in physical activity - individual and environmental attributes in adults across Europe: The SPOTLIGHT project.

A considerable proportion of European adults report little or no interest in physical activity. Identifying individual-level and environmental-level characteristics of these individuals can help designing effective interventions and policies to promote physical activity. This cross-sectional study additionally explored associations between level of interest and physical activity, after controlling for other individual and environmental variables. Measures of objective and perceived features of the physical environment of residence, self-reported physical activity and other lifestyle behaviors, barriers towards physical activity, general health, and demographics were obtained from 5205 European adults participating in the 2014 online SPOTLIGHT survey. t-Tests, chi-square tests, and generalized estimating equations with negative binomial log-link function were conducted. Adults not interested in physical activity reported a higher BMI and a lower self-rated health, were less educated, and to a smaller extent female and less frequently employed. They were more prone to have less healthy eating habits, and to perceive more barriers towards physical activity. Only minor differences were observed in environmental attributes: the non-interested were slightly more likely to live in neighborhoods objectively characterized as less aesthetic and containing more destinations, and perceived as less functional, safe, and aesthetic. Even after controlling for other individual and environmental factors, interest in physical activity remained a significant correlate of physical activity, supporting the importance of this association. This study is among the first to describe characteristics of individuals with reduced interest in physical activity, suggesting that (lack of) interest is a robust correlate of physical activity in several personal and environmental conditions.

Translation and validation of the perceived locus of causality questionnaire (PLOCQ) in a sample of portuguese physical education students

AIM: This study main aim was to translate and validate one of the most used SDT-based instruments to assess motivation in PE classes, the Perceived Locus of Causality Questionnaire (PLOCQ), to the Portuguese context. METHOD: Sample was composed of 652 boys (M=15.4 years; SD=1.90) and 702 girls (M=15.47 years; SD=1.95), enrolled in physical education classes in several Portuguese schools. RESULTS: The analysis provided support for a five factors and 18 items model, after excluding two items (χ² = 491.473, df = 125, p = <.001, SRMR = .062, NNFI = .908, CFI = .924, RMSEA = .067, 90% CI .061-.073). Sample and gender invariance procedures were made to ensure proper psychometric validation. Results presented support for the model in both gender and calibration/validation samples. CONCLUSION: This study suggests that PLOCQ with five factors and 18 items has good psychometric proprieties and can be used to assess contextual motivation towards PE in the Portuguese context.(AU)

The association between physical activity and eating self-regulation in overweight and obese women.

OBJECTIVE: Successful weight management relies heavily on eating and exercise behaviors. However, little is known about the association between both on a psychosocial level. This study examined the relationship between exercise and eating regulation by exploring the mediating effects of negative body image investment and depressive mood, and their stability through time. METHODS: Analyses were conducted at two different moments (12 and 36 months), involving a sample of 221 overweight/obese women (age: 37.6 ± 7 years; BMI: 31.6 ± 4.1 kg/m(2)) that participated in a behavioral weight control intervention. Bivariate correlations and mediation analyses using Preacher & Hayes resampling procedures were conducted. RESULTS: At 12 months, negative body image investment was the only significant mediator of the exercise-eating relationship. This variable explained larger portions of the indirect effects of structured rather than lifestyle exercise on eating. At 36 months, negative investment and to a lesser extent depressive mood partially explained the exercise-eating association. CONCLUSIONS: Our findings suggest that, besides physiological effects of exercise, psychological mechanisms related to body image and mood also explain the role of physical activity as a 'gateway behavior' for improved eating regulation in overweight women. These effects appear to be stable and may help understand the key role of exercise in long-term weight management.

Exercise, physical activity, and self-determination theory: a systematic review.

BACKGROUND: Motivation is a critical factor in supporting sustained exercise, which in turn is associated with important health outcomes. Accordingly, research on exercise motivation from the perspective of self-determination theory (SDT) has grown considerably in recent years. Previous reviews have been mostly narrative and theoretical. Aiming at a more comprehensive review of empirical data, this article examines the empirical literature on the relations between key SDT-based constructs and exercise and physical activity behavioral outcomes. METHODS: This systematic review includes 66 empirical studies published up to June 2011, including experimental, cross-sectional, and prospective studies that have measured exercise causality orientations, autonomy/need support and need satisfaction, exercise motives (or goal contents), and exercise self-regulations and motivation. We also studied SDT-based interventions aimed at increasing exercise behavior. In all studies, actual or self-reported exercise/physical activity, including attendance, was analyzed as the dependent variable. Findings are summarized based on quantitative analysis of the evidence. RESULTS: The results show consistent support for a positive relation between more autonomous forms of motivation and exercise, with a trend towards identified regulation predicting initial/short-term adoption more strongly than intrinsic motivation, and intrinsic motivation being more predictive of long-term exercise adherence. The literature is also consistent in that competence satisfaction and more intrinsic motives positively predict exercise participation across a range of samples and settings. Mixed evidence was found concerning the role of other types of motives (e.g., health/fitness and body-related), and also the specific nature and consequences of introjected regulation. The majority of studies have employed descriptive (i.e., non-experimental) designs but similar results are found across cross-sectional, prospective, and experimental designs. CONCLUSION: Overall, the literature provides good evidence for the value of SDT in understanding exercise behavior, demonstrating the importance of autonomous (identified and intrinsic) regulations in fostering physical activity. Nevertheless, there remain some inconsistencies and mixed evidence with regard to the relations between specific SDT constructs and exercise. Particular limitations concerning the different associations explored in the literature are discussed in the context of refining the application of SDT to exercise and physical activity promotion, and integrating these with avenues for future research.