Alternative Healthy Eating Index-2010 and Incident Non-Communicable Diseases: Findings from a 15-Year Follow Up of Women from the 1973-78 Cohort of the Australian Longitudinal Study on Women's Health.

Non-communicable diseases (NCDs) and multimorbidity (≥two chronic conditions), are increasing globally. Diet is a risk factor for some NCDs. We aimed to investigate the association between diet quality (DQ) and incident NCDs. Participants were from the Australian Longitudinal Study on Women's Health 1973-78 cohort with no NCD and completed dietary data at survey 3 (2003, aged 25-30 years) who responded to at least one survey between survey 4 (2006) and survey 8 (2018). DQ was measured by the Alternative Healthy Eating Index-2010 (AHEI-2010). Outcomes included coronary heart disease (CHD), hypertension (HT), asthma, cancer (excluding skin cancer), diabetes mellitus (DM), depression and/or anxiety, multimorbidity, and all-cause mortality. Repeated cross-sectional multivariate logistic regressions were performed to investigate the association between baseline DQ and NCDs over 15 years. The AHEI-2010 mean (±sd) for participants (n = 8017) was 51.6 ± 11.0 (range: 19-91). There was an inverse association between AHEI-2010 and incident asthma at survey 4 (ORQ5-Q1: 0.75, 95% CI: 0.57, 0.99). Baseline DQ did not predict the occurrence of any NCDs or multimorbidity between the ages of 25-45 years. Further well-planned, large prospective studies conducted in young women are needed to explore dietary risk factors before the establishment of NCDs.

The Barriers and Facilitators of Sport and Physical Activity Participation for Aboriginal Children in Rural New South Wales, Australia: A Photovoice Project.

Participating in physical activity is beneficial for health. Whilst Aboriginal children possess high levels of physical activity, this declines rapidly by early adolescence. Low physical activity participation is a behavioral risk factor for chronic disease, which is present at much higher rates in Australian Aboriginal communities compared to non-Aboriginal communities. Through photos and 'yarning', the Australian Aboriginal cultural form of conversation, this photovoice study explored the barriers and facilitators of sport and physical activity participation perceived by Aboriginal children (n = 17) in New South Wales rural communities in Australia for the first time and extended the limited research undertaken nationally. Seven key themes emerged from thematic analysis. Four themes described physical activity barriers, which largely exist at the community and interpersonal level of children's social and cultural context: the physical environment, high costs related to sport and transport, and reliance on parents, along with individual risk factors such as unhealthy eating. Three themes identified physical activity facilitators that exist at the personal, interpersonal, and institutional level: enjoyment from being active, supportive social and family connections, and schools. Findings highlight the need for ongoing maintenance of community facilities to enable physical activity opportunities and ensure safety. Children held strong aspirations for improved and accessible facilities. The strength of friendships and the family unit should be utilized in co-designed and Aboriginal community-led campaigns.

Diet Quality and Incident Non-Communicable Disease in the 1946-1951 Cohort of the Australian Longitudinal Study on Women's Health.

Diet quality indices (DQIs) can be useful predictors of diet-disease relationships, including non-communicable disease (NCD) multimorbidity. We aimed to investigate whether overall diet quality (DQ) predicted NCD, multimorbidity, and all-cause mortality. Women from the 1945-51 cohort of the Australia Longitudinal Study on Women's Health (ALSWH) were included if they: responded to S3 in 2001 and at least one survey between 2004 (S4) and 2016 (S8), and had no NCD history and complete dietary data at S3. DQ was summarized by the Healthy Eating Index for Australian Adults-2013 (HEIFA-2013), Mediterranean Diet Score (MDS), and Alternative Healthy Eating Index-2010 (AHEI-2010). Outcomes included each NCD (diabetes mellitus (DM), coronary heart disease (CHD), hypertension (HT), asthma, cancer (except skin cancer), depression and/or anxiety) independently, multimorbidity, and all-cause mortality. Repeated multivariate logistic regressions were used to test associations between DQIs and NCD outcomes across the 15 years of follow-up. The mean (±sd) of DQIs of participants (n = 5350) were 57.15 ± 8.16 (HEIFA-2013); 4.35 ± 1.75 (MDS), and 56.01 ± 10.32 (AHEI-2010). Multivariate regressions indicated that women reporting the highest quintile of AHEI-2010 had lower odds of DM (42-56% (S5-S8)), HT (26% (S8)), asthma (35-37% (S7, S8)), and multimorbidity (30-35% (S7, S8)). The highest quintile of HEIFA-2013 and MDS had lower odds of HT (26-35% (S7, S8); 24-27% (S6-S8), respectively) and depression and/or anxiety (30% (S6): 30-34% (S7, S8)). Our findings support evidence that DQ is an important predictor of some NCDs and a target for prevention in middle-aged women.

A 15-year follow-up study on long-term adherence to health behaviour recommendations in women diagnosed with breast cancer.

BACKGROUND: Whilst a cancer diagnosis may prompt health behaviour change, there is limited evidence regarding whether such changes are maintained in the long-term. We aimed to investigate the impact of cancer diagnosis on health behaviour changes over the long-term survivorship period among breast cancer survivors (BCSs). METHODS: The sample comprised 153 BCSs and 4778 cancer-free women, aged 49-55 years in 2001 (our baseline), from the 1946-1951 birth cohort of the Australian Longitudinal Study on Women's Health. Health behaviours (physical activity, smoking, alcohol, diet and Body Mass Index), recommended by the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR), were assessed in five survivorship periods: ≤ 3 years, 3 to ≤ 6 years, 6 to ≤ 9 years, 9 to ≤ 12 years, and 12 to 15 years since diagnosis. A validated semi-quantitative Food Frequency Questionnaire was used for dietary assessment. Pre-diagnosis (baseline) health behaviours of BCSs and cancer-free women were compared (using Generalized Linear Models (GLM)). Multilevel (mixed effect) models were used for longitudinal data in BCSs. RESULTS: There was no significant difference in health behaviours between BCSs (prior to diagnosis) and cancer-free women. Following diagnosis, BCSs were significantly more physically active (≥ 600 MET min/week; 50.8% to 63.3%; p = 0.02) and consumed more fruit (≥ 2 serves/day; 57.4% to 66.4%; p = 0.01) in the recent survivorship period, but were less likely to be classified in the healthy weight range (p < 0.01). The proportion of non-drinkers and non-smokers slightly increased over the survivorship period. Whole-vegetable intake did not significantly change; however, the intake of non-starchy vegetables significantly increased from pre-diagnosis (LS mean = 89.1 g/day) to post-diagnosis, 6 to ≤ 9 years (LS mean = 137.1 g/day), and 9 to ≤ 12 years (LS mean = 120.8 g/day). There were no significant changes in the total intake of fibre, carotenoids, calcium, fat, saturated fat, vitamin C, or vitamin E observed, except for increased total energy intake (p = 0.012). CONCLUSION: Before diagnosis, BCSs had similar adherence to health behaviours compared to cancer-free women. Initial positive changes to health behaviours were observed post BC diagnosis, except healthy body weight, but maintenance of such changes over the long-term was poor. BCSs may benefit from additional advice and support to make healthy lifestyle choices throughout survivorship.

Multiple health behaviors before and after a cancer diagnosis among women: A repeated cross-sectional analysis over 15 years.

BACKGROUND: Cancer diagnosis may be a cue for health behavior change. Previous research that assessed the impact of a cancer diagnosis on multiple health behavior (MHB) change is limited by small sample size, cross-sectional study design, and a focus on individual rather than multiple behaviors. This study investigated the impact of a cancer diagnosis on compliance with MHB recommendations. METHODS: Data from Australian Longitudinal Study on Women's Health (ALSWH) were utilized. Compliance with MHB was assessed by cancer survivorship period; 0-3 years pre-diagnosis, 0-3 years postdiagnosis, 4-12 years postdiagnosis, and compared to controls. A MHB score based on the WCRF/AICR guidelines was calculated for six behaviors (physical activity, smoking, alcohol, BMI, fruit, and vegetable intake); scores ranged from 0 to 6, with a higher score indicating higher compliance. Generalized estimating equation (GEE) was used for statistical analysis. RESULTS: Participants comprised 7585 women from the 2001 ALSWH survey, of whom 2285 developed cancer during 15 years of follow-up. Compared to controls, the mean MHB score was slightly lower (Mean Difference (MD) = -0.015, P > .05) in survivors pre-diagnosis, after adjusting for confounders; however, the compliance score increased during postdiagnosis, with the mean difference score being significantly higher in recent survivors (0-3 years post diagnosis; MD = 0.055, P < .01). Likewise, within cancer survivors, the mean compliance score significantly increased 0-3 years postdiagnosis (MD = 0.07, P < .05) compared to pre-diagnosis, but this significant improvement was not maintained over the longer term (MD = 0.037, P > .05). CONCLUSION: In this sample, survivors had higher MHB score than controls. A cancer diagnosis may provide a teachable moment for health behavior change in the period immediately following diagnosis, but this effect was not sustained during longer-term survivorship.

Moderators of Exercise Effects on Cancer-related Fatigue: A Meta-analysis of Individual Patient Data.

PURPOSE: Fatigue is a common and potentially disabling symptom in patients with cancer. It can often be effectively reduced by exercise. Yet, effects of exercise interventions might differ across subgroups. We conducted a meta-analysis using individual patient data of randomized controlled trials (RCT) to investigate moderators of exercise intervention effects on cancer-related fatigue. METHODS: We used individual patient data from 31 exercise RCT worldwide, representing 4366 patients, of whom 3846 had complete fatigue data. We performed a one-step individual patient data meta-analysis, using linear mixed-effect models to analyze the effects of exercise interventions on fatigue (z score) and to identify demographic, clinical, intervention- and exercise-related moderators. Models were adjusted for baseline fatigue and included a random intercept on study level to account for clustering of patients within studies. We identified potential moderators by testing their interaction with group allocation, using a likelihood ratio test. RESULTS: Exercise interventions had statistically significant beneficial effects on fatigue (ß = -0.17; 95% confidence interval [CI], -0.22 to -0.12). There was no evidence of moderation by demographic or clinical characteristics. Supervised exercise interventions had significantly larger effects on fatigue than unsupervised exercise interventions (ßdifference = -0.18; 95% CI -0.28 to -0.08). Supervised interventions with a duration ≤12 wk showed larger effects on fatigue (ß = -0.29; 95% CI, -0.39 to -0.20) than supervised interventions with a longer duration. CONCLUSIONS: In this individual patient data meta-analysis, we found statistically significant beneficial effects of exercise interventions on fatigue, irrespective of demographic and clinical characteristics. These findings support a role for exercise, preferably supervised exercise interventions, in clinical practice. Reasons for differential effects in duration require further exploration.

Adherence to multiple health behaviours in cancer survivors: a systematic review and meta-analysis.

PURPOSE: Multiple health behaviours (not smoking, minimal alcohol consumption, and maintaining a healthy weight by having a healthy diet and regular physical activity) improve quality of life and longevity of cancer survivors. Despite international guidelines, there are no existing reviews that synthesise cancer survivors' adherence to healthy lifestyle recommendations. METHOD: Five databases (Embase, MEDLINE, PsycINFO, Web of Science, and Google Scholar) were searched for relevant articles published from 2007 until January 2018. Studies reporting adult cancer survivors' adherence to at least two lifestyle behaviours (body mass index, physical activity, smoking, fruit and vegetable intake, fiber intake, red meat intake, caloric intake, sodium intake, and alcohol consumption) based on the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) recommendations were included in the review. The pooled prevalence of adherence to single and multiple behaviours was calculated using a random-effects model. Subgroup analysis (mean years of survival and publication year) was undertaken. RESULTS: A total of 3322 articles were identified. Of these, 51 studies matched the inclusion criteria, presenting data from 2,620,586 adult cancer survivors. Adherence to single behaviours, which was estimated from studies that assessed at least two health behaviours, was highest for not smoking (PE 87%; 95% CI, 85%, 88%) and low or no alcohol intake (PE 83%; 95% CI, 81%, 86%), and lowest for fiber intake (PE 31%; 95% CI, 21%, 40%). Adherence to multiple healthy behaviours (13 studies), ranged from 7 to 40% (pooled estimate (PE) 23%; 95% CI, 17%, 30%). Recent survivors (< 5-year survival time) had relatively better adherence to multiple behaviours (PE 31%; 95% CI, 27%, 35%) than long-term (> 5 years) survivors (PE 25%; 95% CI, 14%, 36%). Adherence to multiple behaviours improved over time since 2007. CONCLUSION: Adherence to physical activity, dietary, and multiple lifestyle behaviours recommendations was low amongst cancer survivors. Recent cancer survivors were relatively more adherent to WCRF/AICR recommendations compared to long-term survivors. IMPLICATIONS FOR CANCER SURVIVORS: Health promotion programs help support healthy lifestyle behaviours of cancer survivors. PROSPERO registration number: CRD42018091663.

Compliance with Multiple Health Behaviour Recommendations: A Cross-Sectional Comparison between Female Cancer Survivors and Those with no Cancer History.

Lifestyle behaviours have an important role in preventing cancer, reducing treatment side effects, and improving survival and quality of life for cancer survivors. This study investigated adherence to multiple lifestyle behaviours among women with and without a cancer history. From the Australian Longitudinal Study on Women's Health (ALSWH) surveys, 2407 cancer survivors and 3896 controls (cancer free population) were identified. Based on the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) recommendations, adherence to six health behaviours (smoking, physical activity, fruit and vegetable intake, alcohol consumption, sugary drink intake, and Body Mass Index [BMI]) were assessed. Overall adherence was low, and there were no differences between survivors and controls on adherence to any of the six individual health behaviours. However, both recent and long-term cancer survivors were more likely than controls to adhere to multiple health behaviours (p < 0.05). When participants with melanoma or non-melanoma skin cancer were excluded, adherence was less likely (but not significant) in the cancer group than controls. Higher education (p < 0.01), being married (p < 0.01), and lower comorbidity of chronic illnesses (p < 0.01) were significantly associated with adherence to multiple lifestyle behaviours. Overall, the findings suggest that a cancer diagnosis may result in increased compliance with multiple health behaviour guidelines.

Targeting Exercise Interventions to Patients With Cancer in Need: An Individual Patient Data Meta-Analysis.

Background: Exercise effects in cancer patients often appear modest, possibly because interventions rarely target patients most in need. This study investigated the moderator effects of baseline values on the exercise outcomes of fatigue, aerobic fitness, muscle strength, quality of life (QoL), and self-reported physical function (PF) in cancer patients during and post-treatment. Methods: Individual patient data from 34 randomized exercise trials (n = 4519) were pooled. Linear mixed-effect models were used to study moderator effects of baseline values on exercise intervention outcomes and to determine whether these moderator effects differed by intervention timing (during vs post-treatment). All statistical tests were two-sided. Results: Moderator effects of baseline fatigue and PF were consistent across intervention timing, with greater effects in patients with worse fatigue (Pinteraction = .05) and worse PF (Pinteraction = .003). Moderator effects of baseline aerobic fitness, muscle strength, and QoL differed by intervention timing. During treatment, effects on aerobic fitness were greater for patients with better baseline aerobic fitness (Pinteraction = .002). Post-treatment, effects on upper (Pinteraction < .001) and lower (Pinteraction = .01) body muscle strength and QoL (Pinteraction < .001) were greater in patients with worse baseline values. Conclusion: Although exercise should be encouraged for most cancer patients during and post-treatments, targeting specific subgroups may be especially beneficial and cost effective. For fatigue and PF, interventions during and post-treatment should target patients with high fatigue and low PF. During treatment, patients experience benefit for muscle strength and QoL regardless of baseline values; however, only patients with low baseline values benefit post-treatment. For aerobic fitness, patients with low baseline values do not appear to benefit from exercise during treatment.

Process redesign of a surgical pathway improves access to cataract surgery for Aboriginal and Torres Strait Islander people in South East Queensland.

The Institute for Urban Indigenous Health (IUIH) aimed to improve access to cataract surgery in urban South East Queensland (SEQ) for Indigenous Australians, without compromising clinical visual outcomes. The Penchansky and Levesque concept of access as the 'fit' between the patient's needs and the ability of the system to meet those needs was used to inform the redesign of the mainstream cataract surgical pathway. The IUIH staff and community stakeholders mapped the traditional external cataract surgical pathway and then innovatively redesigned it to reduce the number of patients being removed by the system at key transition points. The integration of eye health within the primary health care (PHC) clinic has improved the continuity and coordination of care along the surgical pathway, and ensured the sustainability of collaborative partnerships with key external organisations. Audit data demonstrated a significant increase in utilisation of cataract surgical services after the process redesign. Previous studies have found that PHC models involving integration, coordination and continuity of care enhance patient health outcomes; however, the IUIH surgical model extends this to tertiary care. There is scope to apply this model to other surgical pathways and communities who experience access inequity.

Maintenance of Lifestyle Changes at 12-month Follow-up in a Nutrition and Physical Activity Trial for Cancer Survivors.

OBJECTIVES: In this paper, we report maintenance of behavior change in a nutrition and physical activity intervention for cancer survivors at 12-months follow-up. METHODS: The ENRICH (Exercise and Nutrition Routine Improving Cancer Health) program was an 8-week face-to-face program for cancer survivors and caregivers, focused on healthy eating, healthy weight, resistance training, and a walking program. Randomized controlled trial participants completed a survey and 7-days of pedometry at baseline, 8-weeks, and 20-weeks. Intervention participants completed 12-month measures. Maintenance was assessed by examining change between 20-weeks and 12-months for cancer survivors. RESULTS: Sixty cancer survivors in the intervention group completed baseline data collection, and 29 (48%) completed 12-month assessments. Initial improvements in step counts, weight, and body mass index were maintained from 20-weeks to 12-months. Vegetable consumption declined significantly (difference -30g/day; p = .04). Moderate-to-vigorous physical activity increased significantly (difference 55 minutes/week; p = .05). CONCLUSIONS: Physical activity and weight improvements were maintained over 12-months indicating the potential for a multiple health behavior intervention to help cancer survivors sustain improvements to lifestyle behaviors. Additional support is warranted to assist cancer survivors to make and maintain dietary changes.

Effects and moderators of exercise on quality of life and physical function in patients with cancer: An individual patient data meta-analysis of 34 RCTs.

This individual patient data meta-analysis aimed to evaluate the effects of exercise on quality of life (QoL) and physical function (PF) in patients with cancer, and to identify moderator effects of demographic (age, sex, marital status, education), clinical (body mass index, cancer type, presence of metastasis), intervention-related (intervention timing, delivery mode and duration, and type of control group), and exercise-related (exercise frequency, intensity, type, time) characteristics. Relevant published and unpublished studies were identified in September 2012 via PubMed, EMBASE, PsycINFO, and CINAHL, reference checking and personal communications. Principle investigators of all 69 eligible trials were requested to share IPD from their study. IPD from 34 randomised controlled trials (n=4519 patients) that evaluated the effects of exercise compared to a usual care, wait-list or attention control group on QoL and PF in adult patients with cancer were retrieved and pooled. Linear mixed-effect models were used to evaluate the effects of the exercise on post-intervention outcome values (z-score) adjusting for baseline values. Moderator effects were studies by testing interactions. Exercise significantly improved QoL (ß=0.15, 95%CI=0.10;0.20) and PF (ß=0.18, 95%CI=0.13;0.23). The effects were not moderated by demographic, clinical or exercise characteristics. Effects on QoL (ßdifference_in_effect=0.13, 95%CI=0.03;0.22) and PF (ßdifference_in_effect=0.10, 95%CI=0.01;0.20) were significantly larger for supervised than unsupervised interventions. In conclusion, exercise, and particularly supervised exercise, effectively improves QoL and PF in patients with cancer with different demographic and clinical characteristics during and following treatment. Although effect sizes are small, there is consistent empirical evidence to support implementation of exercise as part of cancer care.

Demographic, clinical, psychosocial, and environmental correlates of objectively assessed physical activity among breast cancer survivors.

PURPOSE: The aim of this study was to identify demographic, clinical, psychosocial, and environmental correlates of objectively assessed physical activity among breast cancer survivors. METHODS: Baseline data were utilized from 574 female breast cancer survivors who participated in three different intervention studies: Resistance and Endurance exercise After ChemoTherapy (REACT), Exercise and Nutrition Routine Improving Cancer Health (ENRICH), and Move More for Life (MM4L). Participants were eligible if they were aged ≥18 years and had completed primary cancer treatment. Physical activity was objectively assessed by accelerometers or pedometers. Participants completed self-reported questionnaires on demographic, psychosocial, and environmental factors. Information regarding clinical factors was obtained from medical records or patient self-report. Multivariable linear regression analyses were applied on the pooled dataset to identify factors that were significantly correlated with physical activity. In addition, the explained variance of the model was calculated. RESULTS: The multivariable regression model revealed that older age, (ß = -0.01, 95 %CI = -0.02; -0.003), higher body mass index (ß = -0.05, 95 %CI = -0.06; -0.03), lower self-efficacy (ß = 0.2, 95 %CI = 0.08; 0.2), and less social support (ß = 0.1, 95 %CI = 0.05; 0.2) were significantly correlated with lower physical activity. This model explained 15 % of the variance in physical activity. CONCLUSION: Age, body mass index, self-efficacy, and social support were significantly correlated with objectively assessed physical activity in breast cancer survivors. It may therefore be recommended that physical activity intervention studies in these women target those who are older, and have a higher body mass index, and should operationalize behavior change strategies designed to enhance self-efficacy and social support. TRIAL REGISTRATION: The REACT study is registered at the Netherlands Trial Register [NTR2153]. The ENRICH study is registered at Australian New Zealand Clinical Trials Register [ANZCTRN12609001086257]. And the MM4L study is registered at Australian New Zealand Clinical Trials Register [ACTRN12611001061921].

A systematic review and meta-analysis of social cognitive theory-based physical activity and/or nutrition behavior change interventions for cancer survivors.

PURPOSE: Little is known about how to improve and create sustainable lifestyle behaviors of cancer survivors. Interventions based on social cognitive theory (SCT) have shown promise. This review examined the effect of SCT-based physical activity and nutrition interventions that target cancer survivors and identified factors associated with their efficacy. METHODS: A systematic search of seven databases identified randomized controlled trials that (i) targeted adult cancer survivors (any point from diagnosis); (ii) reported a primary outcome of physical activity, diet, or weight management; and (iii) included an SCT-based intervention targeting physical activity or diet. Qualitative synthesis and meta-analysis were conducted. Theoretical constructs and intervention characteristics were examined to identify factors associated with intervention efficacy. RESULTS: Eighteen studies (reported in 33 publications) met review inclusion criteria. Meta-analysis (n = 12) revealed a significant intervention effect for physical activity (standardized mean difference (SMD) = 0.33; P < 0.01). Most studies (six out of eight) that targeted dietary change reported significant improvements in at least one aspect of diet quality. No SCT constructs were associated with intervention effects. There were no consistent trends relating to intervention delivery method or whether the intervention targeted single or multiple behaviors. CONCLUSIONS: SCT-based interventions demonstrate promise in improving physical activity and diet behavior in cancer survivors, using a range of intervention delivery modes. Further work is required to understand how and why these interventions offer promise for improving behavior. IMPLICATIONS FOR CANCER SURVIVORS: SCT-based interventions targeting diet or physical activity are safe and result in meaningful changes to diet and physical activity behavior that can result in health improvements.

Main outcomes of the Move More for Life Trial: a randomised controlled trial examining the effects of tailored-print and targeted-print materials for promoting physical activity among post-treatment breast cancer survivors.

BACKGROUND: Participation in physical activity can improve the health outcomes of breast cancer survivors. To impact public health, broad-reaching sustainable interventions that promote physical activity are needed. PURPOSE: To evaluate the efficacy of two distance-based interventions for promoting physical activity among breast cancer survivors compared with a standard recommendation control. METHODS: Breast cancer survivors who had finished 'active' cancer treatment were eligible to participate. Participants (n = 330) were randomly assigned to receive one of the following mail-delivered interventions: three computer-tailored newsletters, a previously developed breast cancer-specific physical activity booklet or a pamphlet detailing the public health recommendations for physical activity (control). Primary outcomes were self-reported moderate to vigorous aerobic activity and participant's self-reported resistance training activity at 4 months post-baseline. Secondary outcomes were pedometer step counts, whether or not participants were meeting the physical activity guidelines, time spent in sedentary behaviour, fatigue and health-related quality of life. RESULTS: Participants randomised into the tailored-print intervention group were three times more likely to commence resistance training and meet the resistance-training guidelines immediately after the intervention than participants allocated to the control group. There were no other significant intervention effects. CONCLUSION: Computer-tailored newsletters may be an effective strategy for enhancing resistance-based physical activity among breast cancer survivors. The null findings relating to other outcomes may be due to ceiling effects (in the case of aerobic activity, fatigue and health-related quality of life) or the sensitivity of the measure used (in the case of sitting time). These issues require further exploration.

Correlates of resistance training in post-treatment breast cancer survivors.

PURPOSE: To explore demographic, health, social-cognitive and behavioural correlates of resistance training among post-treatment breast cancer survivors. METHODS: A sample of 330 post-treatment breast cancer survivors recruited from across Australia completed a mailed questionnaire. A multivariate logistical regression model was used to test associations between independent variables and meeting the resistance training guidelines. RESULTS: Less than a quarter of the participants were meeting the resistance training guidelines of at least two sessions of resistance training per week. Higher task self-efficacy for resistance training (p < 0.01) and greater goal-setting behaviour (p < 0.05) were identified as significant predictors of meeting the resistance training guidelines, with a one unit increase in task self-efficacy and goal setting, increasing the odds of meeting the resistance training guidelines by a factor of approximately 1.2 (odds ratio (OR) task self-efficacy = 1.23, 95 % confidence interval (CI) = 1.05-1.43; goal-setting OR = 1.20, 95 % CI = 1.04-1.38). No other variables significantly predicted meeting the resistance training guidelines in the multivariate analysis. CONCLUSIONS: Strategies targeting task self-efficacy and goal-setting behaviours are likely to be important intervention components in resistance training interventions for breast cancer survivors. IMPLICATIONS FOR CANCER SURVIVORS: The findings of this study will be useful for informing the development of evidence-based interventions aiming to promote resistance training among this group.

Theory-and evidence-based development and process evaluation of the Move More for Life program: a tailored-print intervention designed to promote physical activity among post-treatment breast cancer survivors.

OBJECTIVE: Several physical activity interventions have been effective in improving the health outcomes of breast cancer survivors. However, few interventions have provided detailed descriptions regarding how such interventions work. To develop evidence-based practice in this field, detailed descriptions of intervention development and delivery is needed. This paper aims to (1) describe the theory-and evidence-based development of the Move More for Life program, a physical activity program for breast cancer survivors; and (2) serve as an exemplar for theory-based applied research. METHOD: The program-planning model outlined by Kreuter and colleagues was used to develop the computer-tailored intervention. RESULTS: The tailoring guide developed by Kreuter and colleagues served as a useful program planning tool in terms of integrating theory and evidence-based best practice into intervention strategies. Overall, participants rated the intervention positively, with the majority reporting that the tailored materials caught their attention, were personally relevant to them, and were useful for helping them to change their behaviour. However, there was considerable room for improvement. CONCLUSION: The Move More for Life program is an example of a theory-based, low-cost and potentially sustainable strategy to physical activity promotion and may stand as an exemplar for Social Cognitive Theory-based applied research. By providing a detailed description of the development of the Move More for Life program, a critical evaluation of the working mechanisms of the intervention is possible, and will guide researchers in the replication or adaption and re-application of the specified techniques. This has potential implications for researchers examining physical activity promotion among cancer survivors and for researchers exploring distance-based physical activity promotion techniques among other populations. TRIAL REGISTRATIONS: Australian New Zealand Clinical Trials Registry (ANZCTR) identifier: ACTRN12611001061921.

A qualitative synthesis of trials promoting physical activity behaviour change among post-treatment breast cancer survivors.

BACKGROUND: Health outcome trials have provided strong evidence that participating in regular physical activity can improve the quality of life and health of post-treatment breast cancer survivors. Focus is now needed on how to promote changes in physical activity behaviour among this group. PURPOSE: This systematic review examines the efficacy of behavioural interventions for promoting physical activity among post-treatment breast cancer survivors. METHODS: Behavioural intervention studies published up until July 2012 were identified through a systematic search of two databases: MEDLINE and CINAHL, and by searching reference lists of relevant publications and scanning citation libraries of project staff. RESULTS: Eight out of the ten identified studies reported positive intervention effects on aerobic physical activity behaviour, ranging from during the intervention period to 6 months post-intervention. Only two studies reported intervention effect sizes. The identification of factors related to efficacy was not possible because of the limited number and heterogeneity of studies included, as well as the lack of effect sizes reported. Nonetheless, an examination of the eight studies that did yield significant intervention effects suggests that 12-week interventions employing behaviour change techniques (e.g., self-monitoring and goal setting) derived from a variety of theories and delivered in a variety of settings (i.e., one-on-one, group or home) can be effective at changing the aerobic physical activity behaviour of breast cancer survivors in the mid- to long terms. CONCLUSIONS: Behavioural interventions do hold promise for effectively changing physical activity behaviour among breast cancer survivors. However, future research is needed to address the lack of studies exploring long-term intervention effects, mediators of intervention effects and interventions promoting resistance-training activity, and to address issues impacting on validity, such as the limited use of objective physical activity measures and the use of convenience samples. IMPLICATIONS FOR CANCER SURVIVORS: Identifying effective ways of assisting breast cancer survivors to adopt and maintain physical activity is important for enhancing the well-being and health outcomes of this group.

Move more for life: the protocol for a randomised efficacy trial of a tailored-print physical activity intervention for post-treatment breast cancer survivors.

BACKGROUND: Due to early detection and advances in treatment, the number of women surviving breast cancer is increasing. Whilst there are many positive aspects of improved survival, breast cancer survival is associated with many long-term health and psychosocial sequelae. Engaging in regular physical activity post-diagnosis can reduce this burden. Despite this evidence, the majority of breast cancer survivors do not engage in regular physical activity. The challenge is to provide breast cancer survivors with appealing and effective physical activity support in a sustainable and cost-effective way. This article describes the protocol for the Move More for Life Study, which aims to assess the relative efficacy of two promising theory-based, print interventions designed to promote regular physical activity amongst breast cancer survivors. METHOD AND DESIGN: Breast cancer survivors were recruited from across Australia. Participants will be randomised into one of three groups: (1) A tailored-print intervention group, (2) a targeted-print intervention group, or (3) a standard recommendation control group. Participants in the tailored-print intervention group will receive 3 tailored newsletters in the mail over a three month period. Participants in the targeted-print group will receive a previously developed physical activity guidebook designed specifically for breast cancer survivors immediately after baseline. Participants in the standard recommendation control will receive a brochure detailing the physical activity guidelines for Australian adults. All participants will be assessed at baseline, and at 4 and 10 months post-baseline. Intervention efficacy for changing the primary outcomes (mins/wk aerobic physical activity; sessions/exercises per week resistance physical activity) and secondary outcomes (steps per day, health-related quality life, compliance with physical activity guidelines, fatigue) will be assessed. Mediation and moderation analyses will also be conducted. DISCUSSION: Given the growing number of cancer survivors, distance-based behaviour change programs addressing physical activity have the potential to make a significant public health impact. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR) identifier: ACTRN12611001061921.