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.

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.

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.

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.

The Alberta Physical Activity and Breast Cancer Prevention Trial: quality of life outcomes.

OBJECTIVE: Interventions for disease prevention should also be evaluated for quality of life (QoL) effects. Few exercise trials have examined QoL in the context of primary disease prevention. Here, we report the QoL outcomes from the Alberta Physical Activity and Breast Cancer Prevention (ALPHA) Trial. METHODS: The ALPHA trial was a randomized controlled trial in Calgary and Edmonton, Canada between May 2003 and July 2007 that compared an exercise intervention to a sedentary lifestyle among 320 sedentary, postmenopausal women. The exercise group was asked to perform moderate-to-vigorous intensity aerobic exercise 45 min/day, 5 days/week for 1 year. QoL was assessed by the short form-36 health survey. RESULTS: Compared to the control group, the exercise group maintained significantly better physical functioning (p<0.001), general health (p<0.001), vitality (p=0.002), and bodily pain (p=0.020) by 4-5 points which exceeds the 3.0 minimally important difference for these scales. Changes in body composition partially mediated the intervention effects. Antidepressant use and the presence of comorbidities moderated some intervention effects. CONCLUSIONS: A 1-year moderate-to-vigorous aerobic exercise program prevents declines in the physical aspects of QoL in postmenopausal women. Exercise may have a potentially important advantage for breast cancer prevention compared to other lifestyle or biomedical interventions.

Promotion of physical activity among oncologists in the United States.

Promotion of physical activity by health care providers has been found to positively influence the levels of physical activity in patients. The primary purpose of this study was to examine physical activity promotion practices of oncologists in the United States. Secondary purposes were to examine oncologists' perceptions of the benefits of physical activity for cancer survivors and barriers for promotion of physical activity. Of 702 medical and radiation oncologists in the United States invited to participate in the mailed survey, 199 oncologists responded to the survey (response rate, 30%). Approximately 64% of oncologists inquired about their patients' physical activity on some or most visits. Logistic regression indicated that oncologists who had been practicing > or =10 years (OR [odds ratio] = 2.52), were themselves physically active (OR = 1.99), or were medical oncologists (OR = 2.25) were the most likely to recommend physical activity to their patients. "Reducing the risk of recurrence" was rated lowest of all the potential benefits of physical activity for cancer patients. "Insufficient time" was rated the highest as a barrier to promotion of physical activity. Some oncologists are still not discussing physical activity with their patients. A number of barriers and perceptions of the benefits of physical activity may influence such discussions.

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.

Associations between exercise and quality of life in bladder cancer survivors: a population-based study.

BACKGROUND: Exercise has been shown to improve quality of life (QoL) in some cancer survivor groups, but it is unknown if the unique QoL issues faced by bladder cancer survivors are also amenable to an exercise intervention. This study provides the first data examining the association between exercise and QoL in bladder cancer survivors. METHODS: Bladder cancer survivors identified through a provincial cancer registry were mailed a survey that included the Godin Leisure Time Exercise Questionnaire, the Functional Assessment of Cancer Therapy-Bladder (FACT-Bl) scale, and the Fatigue Symptom Inventory. RESULTS: Of the 525 bladder cancer survivors (51% response rate) that completed the survey, 22.3% were meeting public health exercise guidelines in the past month, 16.0% were insufficiently active (i.e., some exercise but less than the guidelines), and 61.7% were completely sedentary. ANOVA indicated a general linear association between meeting guidelines and QoL, with those meeting guidelines reporting more favorable scores than completely sedentary survivors on the FACT-Bl (mean difference, 7.6; 95% confidence interval, 3.6-11.7; P < 0.001), the FACT (P = 0.001), the trial outcome index (P < 0.001), functional well-being (P < 0.001), additional concerns (P = 0.001), sexual functioning (P < 0.001), erectile function (P < 0.001), body image (P < 0.001), and various fatigue indicators (P < 0.05). Adjusting for key medical and demographic factors slightly attenuated the magnitude of the associations but did not alter the substantive conclusions. CONCLUSIONS: Exercise is positively associated with QoL in bladder cancer survivors, although few are meeting public health exercise guidelines. Studies testing the causal effects of exercise on QoL issues unique to this population are warranted.