Correlates of meeting the combined and independent aerobic and strength exercise guidelines in hematologic cancer survivors.

BACKGROUND: Most previous research on the correlates of physical activity has examined the aerobic or strength exercise guidelines separately. Such an approach does not allow an examination of the correlates of meeting the combined guidelines versus a single guideline, or one guideline versus the other. Here, we report the prevalence and correlates of meeting the combined and independent exercise guidelines in hematologic cancer survivors (HCS). METHODS: In a population-based, cross-sectional survey of 606 HCS from Alberta, Canada using a mailed questionnaire, we obtained separate assessments of aerobic and strength exercise behaviors, as well as separate assessments for motivations, regulations, and reflective processes using the multi-process action control framework (M-PAC). RESULTS: Overall, 22% of HCS met the combined exercise guideline, 22% met aerobic-only, 10% met strength-only, and 46% met neither exercise guideline. HCS were more likely to meet the combined guideline over the aerobic-only guideline if they had no children living at home, and over both the aerobic and strength-only guidelines if they had completed university. As hypothesized, those meeting the combined guideline also had a more favorable strength-specific M-PAC profile (i.e., motivations, regulations, and reflective processes) than those meeting the aerobic-only guideline, and a more favorable aerobic-specific M-PAC profile than those meeting the strength-only guideline. Interestingly and unexpectedly, HCS meeting the combined guidelines also reported significantly greater aerobic-specific perceived control, planning, and obligation/regret than those meeting the aerobic-only guideline, and greater strength-specific perceived control, planning, and obligation/regret than those meeting the strength-only guideline. CONCLUSIONS: Few HCS are meeting the combined exercise guidelines. M-PAC based variables are strong correlates of meeting the combined guidelines compared to aerobic or strength only guidelines. Strategies to help HCS meet the combined guidelines may need to promote more favorable behavioral regulations and reflective processes for both types of exercise rather than just the type of exercise in which HCS are deficient.

Feasibility and preliminary efficacy of an exercise telephone counseling intervention for hematologic cancer survivors: a phase II randomized controlled trial.

BACKGROUND: Supervised exercise interventions produce the largest improvements in patient-reported outcomes in cancer survivors but their scalability has been questioned. Telephone counseling has been proposed as a more feasible alternative but its impact on exercise behavior and health outcomes have been modest. Basing telephone counseling exercise (TCE) interventions on the theoretical advances described in the multi-process action control framework (M-PAC) may improve these outcomes. PURPOSE: To assess the feasibility and preliminary efficacy of a M-PAC-based TCE intervention for increasing aerobic exercise behavior in hematologic cancer survivors (HCS). METHODS: We recruited 51 HCS who were randomized to either a weekly TCE group (n = 26) or a self-directed exercise (SDE) group (n = 25). Participants completed online measures of self-reported aerobic exercise behavior, quality of life (QoL), fatigue, and program satisfaction at baseline and post-intervention (12 weeks). RESULTS: Adherence to the TCE intervention was 93% and retention was 100%. Participants receiving TCE increased their weekly aerobic exercise by 218 min compared to 93 min in the SDE group [mean-adjusted between-group difference (MBGDadj) = 139, 95%CI = 65 to 213, p < .001, effect size (d) = 2.19]. Clinically meaningful QoL improvements favored the TCE group for mental health (MBGDadj = 3.7, 95%CI = - 0.4 to 7.9, p = .08, d = 0.42) and mental health component (MBGDadj = 3.6, 95%CI = - 0.8 to 8.1, p = .10, d = 0.35) subscales. CONCLUSIONS: The 12-week TCE intervention substantially increased exercise behavior and may have meaningfully improved QoL in HCS. IMPLICATIONS FOR CANCER SURVIVORS: Though more definitive trials are needed, remote TCE interventions based on the M-PAC may improve exercise behavior and QoL in HCS and perhaps other cancer survivor groups. TRIAL REGISTRATION NUMBER: Clinical Trials ID: NCT03052777.

Understanding strength exercise intentions and behavior in hematologic cancer survivors: an analysis of the intention-behavior gap.

BACKGROUND: Strength exercise improves many health outcomes in cancer survivors but the prevalence and correlates of strength exercise have not been well-described. Moreover, no study has examined the critical intention-behavior gap for exercise in cancer survivors. PURPOSE: The aims of this study are to quantify the intention-behavior gap for strength exercise in hematologic cancer survivors (HCS) and examine correlates of both intention formation and translation using the multi-process action control framework (M-PAC). METHODS: A random sample of 2100 HCS in Alberta, Canada, were mailed a survey assessing strength exercise behavior, the M-PAC, and demographic/medical variables. Separate logistic regressions were used to analyze the relationships between the correlates and intention formation and translation. RESULTS: Surveys were completed by 606 HCS with 58 % (n = 353) intending to do strength exercise. HCS who were not retired (OR = 1.56, p = 0.001), were highly educated (OR = 1.32, p = 0.001), and had a favorable attitude (OR = 1.56, p < 0.001), descriptive norm (OR = 1.38, p = 0.006), injunctive norm (OR = 1.45, p = 0.004), and perceived control (OR = 1.38, p < 0.001), were more likely to form an exercise intention. Of those with an exercise intention, 51 % (n = 181) reported regular strength exercise. HCS with a detailed plan (OR = 1.86, p < 0.001), favorable attitude (OR = 1.68, p = 0.001), sense of obligation (OR = 1.38, p = 0.010), and self-regulated their affinity for competing activities (OR = 1.35, p = 0.012), were more likely to translate their intention into behavior. CONCLUSION: Just over half of HCS intended to do strength exercise and only half of intenders translated that intention into behavior. IMPLICATIONS FOR CANCER SURVIVORS: Interventions targeting both intention formation and translation may provide the best approach for increasing strength exercise in HCS.

Explaining the Aerobic Exercise Intention-behavior Gap in Cancer Survivors.

OBJECTIVES: We sought to quantify the aerobic exercise intention-behavior gap in hematologic cancer survivors (HCS), and examine the correlates of intention formation and translation using the multi-process action control framework. METHODS: HCS (N = 606) completed a survey reporting their aerobic exercise motivation and behavior. The correlates of intention formation and translation were analyzed using separate logistic regressions. RESULTS: Overall, 71% (N = 428/606) of HCS intended to do aerobic exercise, 44% (N = 267/606) met aerobic exercise guidelines, and 60% of intenders (N = 256/428) translated their intention into aerobic exercise. Attitude (OR = 1.9), perceived control (OR = 1.5), younger age (OR = 2.0), and higher education (OR = 2.1) explained intention formation (all ps ≤ .001). A sense of obligation/regret (OR = 2.8), self-regulation over alternative activities (OR = 1.6), attitude (OR = 2.0), perceived control (OR = 1.7), planning (OR = 1.7), being female (OR = 2.0), and younger (OR = 3.0) explained intention translation (all ps < .005). CONCLUSIONS: Forming an intention is insufficient for many HCS to meet aerobic exercise guidelines. Interventions targeting the determinants of both intention formation and translation may be most effective in promoting aerobic exercise in cancer survivors.

Examining the role of acculturation in the leisure-time physical activity of South Asians living in Canada.

OBJECTIVES: The purpose of this study was to examine the leisure-time physical activity of South Asians living in Canada using a four-mode, bidimensional acculturation framework. DESIGN: Cross-sectional, descriptive study. METHODS: A random sample (N=204) of South Asian adults living in Calgary, Canada completed a telephone interview that assessed their leisure-time physical activity and acculturation. Interviews were conducted in either English or Punjabi, depending on participant preference. RESULTS: Cluster analysis identified four acculturation clusters: Low-Separated and High-Separated (with separation signifying different preference levels for maintaining one's heritage culture while distancing oneself from the mainstream culture); and Integrated-Heritage and Integrated-Mainstream (with integration indicating a preference for maintaining one's heritage culture and being involved in the mainstream culture-albeit with the former cluster emphasizing heritage more whereas the latter cluster emphasized the mainstream more). A MANOVA performed on light, moderate, and vigorous leisure-time physical activity using the four clusters was significant (p<.05). Moderate leisure-time physical activity was greater for the two separated clusters than the two integrated clusters (p<.05), with the Separated-Low cluster being greater than both the Integrated-Mainstream (p<.05) and the Integrated-Heritage (p<.01) clusters. Vigorous leisure-time physical activity was greater for the two integrated clusters than the two separated clusters (p<.01), with the Integrated-Mainstream cluster being greater than both the Separated-Low (p<.05) and Separated-High (p<.01) clusters. CONCLUSIONS: An integrative, four-mode bidimensional approach should be employed when developing messages and designing programs to promote and encourage leisure-time physical activity in South Asian communities.

Gender-Associated Perceptions of Barriers and Motivators to Physical Activity Participation in South Asian Punjabis Living in Western Canada.

BACKGROUND: Gender is a sociocultural factor known to impact the physical activity (PA) behaviors of South Asians. The purpose of this research was to examine gender-associated perceptions of barriers and motivators for PA in a South Asian population living Canada. METHODS: A random sample (N = 204) of South Asian Punjabi adults (18yrs+) completed a computer assisted telephone interview concerning their perceptions to PA participation. Content analysis was used to identify relevant main themes and chi-square analysis was used to calculate gender differences. RESULTS: Results indicated that women more often reported a lack of time due to work and family (χ2 = 7.284, df = 1, P = .007) and a lack of motivation (χ2 = 4.982, df = 1, P = .026), yet men more often reported climate (χ2 = 7.045, df = 1, P = .008) as a barrier. Regarding motivators, men more often reported prevention and reduction of disease (χ2 = 4.451, df = 1, P = .034) and watching others perform (χ2 = 10.827, df = 1, P = .001); however, reducing weight gain (χ2 = 4.806, df = 1, P = .028) and looking like others (χ2 = 4.730, df = 1, P = .029) were reported more often by women. CONCLUSIONS: Gender-associated differences concerning PA are present in this population and must be considered in the design and implementation of effective interventions.