A new paradigm for examining the correlates of aerobic, strength, and combined exercise: an application to gynecologic cancer survivors

Determinants of physical activity during cancer treatment: a longitudinal exploration of psycho-cognitive variables and physician counseling

Individuals with cancer are recommended to engage in regular physical activity (PA) even during cancer therapy. The aim of this study was to explore how patient-reported physician PA counseling influences their PA intention and behavior in addition to psycho-cognitive determinants derived from the theory of planned behavior (TPB). A longitudinal study during cancer treatment was conducted among N = 115 patients with breast, prostate, or colorectal cancer (Mage = 58.0, SD = 11.5; 55.7% female). The median time since diagnosis was 2 months, and 19.1% were diagnosed with metastases. Participants provided information on PA counseling by their physicians and on psycho-cognitive variables of the TPB at three measurement points. Additionally, they wore accelerometers for seven days at baseline and three months later. Nearly half of participants (48%) reported basic PA counseling and 30% reported in-depth PA counseling. Patients in poorer health and with lower education reported significantly less in-depth counseling. In addition to patient self-efficacy in performing PA, only in-depth physician PA counseling, but not basic physician counseling, predicted intention for PA four weeks later. Patients' PA three months after baseline was predicted by patients' PA at baseline and their intention for PA. Overall, the PA level at baseline was identified as the most important predictor of PA three months later. Nevertheless, physicians seem to have the ability to increase their cancer patients' intention for PA by in-depth counseling.

Exploration of helpful elements contributing to engage in physical activity in patients with cancer

PURPOSE

Although there are many reported benefits of physical activity for patients with cancer (e.g., improving quality of life), many patients with cancer do not meet the recommendations of physical activity guidelines. The amount of physical activity declines after diagnosis of cancer. This study aimed to clarify the elements that contribute engagement in regular moderate-or-higher-level intensity of physical activity (MHPA), based on the Health Action Process Approach (HAPA), among patients with cancer.

METHODS

Two web surveys were conducted among cancer outpatients, asking them to respond to a questionnaire. Participants provided information regarding their demographics, physical activity, purpose, advantages, disadvantages, barriers, triggers, and need for support for regular MHPA.

RESULTS

Categories were obtained for purposes, advantages, disadvantages, barriers, triggers, and support needs for regular MHPA. For example, the support they considered necessary to regularly engage in MHPA were developed 9 categories, such as Improving the environment, Support for the implementation of PA (interpersonal), and Reducing the burden. Women and younger patients provided more statements about reducing their burden; younger patients also mentioned on improving the environment more among those who did not engage in MHPA. Additionally, patients with cancer who provided statements about interpersonal support reported higher barriers to physical activity.

CONCLUSIONS

These findings will contribute to the development of a scale to measure the components of the HAPA on physical activity in patients with cancer. In addition, it will help develop a support system that promotes engagement in regular MHPA.

Changes in physical activity and associations with quality of life among a global sample of cancer survivors during the COVID-19 pandemic

PURPOSE

Meeting physical activity (PA) guidelines (i.e., ≥ 150 min/week of aerobic PA and/or 2 days/week of resistance training) is beneficial for maintaining cancer survivors' well-being. The impact of the COVID-19 pandemic on PA participation in cancer survivors and its association on quality of life (QoL) remains unknown. The purpose of this study was to compare PA levels prior to and during the COVID-19 pandemic, and examine the association between changes in PA and QoL in cancer survivors.

METHODS

A global sample of cancer survivors participated in a cross-sectional, online survey. Participants self-reported their PA participation before and during the pandemic using the Godin Leisure Time Exercise Questionnaire and QoL with the Functional Assessment of Cancer Therapy (FACT) scales. Paired t-tests compared PA before and during the pandemic. Analysis of covariance examined differences in QoL between PA categories: non-exercisers, inactive adopters, complete and partial relapsers, single and combined guideline maintainers.

RESULTS

PA participation of cancer survivors (N = 488) significantly decreased during the pandemic (p's < .001). Cancer survivors were classified as non-exercisers (37.7%), inactive adopters (6.6%), complete (13.1%) and partial (6.1%) relapsers, and single (23.8%) or combined (12.7%) guideline maintainers. Partial relapsers had significantly lower QoL and fatigue than inactive adopters, and combined guideline maintainers (p's < .05) that were clinically meaningful.

CONCLUSION

PA decreased during the pandemic which has negative implications for QoL and fatigue in cancer survivors.

IMPLICATIONS FOR CANCER SURVIVORS

PA is critical for maintaining QoL during the pandemic; therefore, behavioral strategies are needed to help cancer survivors adopt and maintain PA.

Correlates of Physical Activity Participation among Individuals Diagnosed with Cancer: An Application of the Multi-Process Action Control Framework

BACKGROUND

The purpose of this study was to test Multi-Process Action Control (M-PAC) processes as correlates of physical activity (PA) intention formation and translation (i.e., action control) in individuals diagnosed with cancer.

METHODS

This study was a cross-sectional survey, completed from July to November of 2020 during the COVID-19 pandemic. PA and M-PAC processes were self-reported using the Godin Leisure-Time Exercise Questionnaire and questionnaires for reflective (instrumental/affective attitudes, perceived opportunity/capability), regulatory (e.g., goal-setting, planning), and reflexive processes (habit, identity). Separate hierarchical multinomial logistic regression models determined correlates of intention formation and action control.

RESULTS

Participants (n = 347; M_age= 48.2 ± 15.6) were primarily diagnosed with breast cancer (27.4%) and at a localized stage (85.0%). Most participants intended to perform PA (70.9%), yet only 50.4% met guidelines. Affective judgements (p < 0.001) and perceived capability (p < 0.01) were significantly associated with intention formation. Preliminary models indicated employment, affective judgements, perceived capability, and self-regulation to be significant (ps < 0.05) correlates of action control, but in the final model, only surgical treatment (p = 0.02) and PA identity (p < 0.001) were significantly associated with action control.

CONCLUSION

Reflective processes were associated with PA intention formation, while reflexive processes were associated with PA action control. Behavior change efforts for individuals diagnosed with cancer should extend beyond social-cognitive approaches to include regulatory and reflexive processes of PA behavior (i.e., PA identity).

Feasibility and acceptability of home-based strength training in endometrial cancer survivors

PURPOSE

Physical activity is important for healthy cancer survivorship, yet many endometrial cancer survivors do not participate in recommended muscle-strengthening activity. The purpose of this study was to determine the feasibility of home-based muscle strengthening activity in endometrial cancer survivors.

METHODS

Forty post-treatment endometrial cancer survivors were enrolled in a randomized trial, of twice-weekly home-based strength exercise versus wait-list control. The intervention included educational materials, exercise equipment (dumbbells, resistance bands), and support/feedback via video coaching sessions. Participants completed the exercises twice per week for 10 weeks, with a 5-week follow-up period. Feasibility was measured by program adherence, as well as safety of and satisfaction with the study.

RESULTS

On average, participants were 60.9 years old (SD = 8.7), had a BMI of 39.9 kg/m2 (SD = 15.2), and were 2.9 years (SD = 1.2) since diagnosis. The majority (83%) had stage I disease at diagnosis. Seventy-five percent adhered to the exercise prescription of twice/week, with 85% of participants missing fewer than 3 of the workouts. Forty percent of participants continued workouts during the 5-week follow-up. Participants were highly satisfied with intervention. No injuries or adverse everts occurred.

CONCLUSION

This home-based program was feasible in endometrial cancer survivors. While adherence was measured, future research should focus on long-term maintenance of exercise and should explore progressions and modifications of exercises at a distance for various abilities.

IMPLICATIONS FOR CANCER SURVIVORS

Muscle strengthening activities are recommended for all cancer survivors. This study shows that a home-based muscle strengthening exercise is feasible in endometrial cancer survivors.

Improvements in strength and agility measures of functional fitness following a telehealth-delivered home-based exercise intervention in endometrial cancer survivors

PURPOSE

Endometrial cancer is strongly linked to obesity and inactivity; however, increased physical activity has important benefits even in the absence of weight loss. Resistance (strength) training can deliver these benefits; yet few women participate in resistance exercise. The purpose of this study was to describe both physiological and functional changes following a home-based strength training intervention.

METHODS

Forty post-treatment endometrial cancer survivors within 5 years of diagnosis were enrolled in a pilot randomized trial, comparing twice-weekly home-based strength exercise to wait list control. Participants conducted the exercises twice per week for 10 supervised weeks with 5 weeks of follow-up. Measures included DXA-measured lean mass, functional fitness assessments, blood biomarkers, and quality of life outcomes.

RESULTS

On average, participants were 60.9 years old (SD = 8.7) with BMI of 39.9 kg/m2 (SD = 15.2). At baseline, participants had 51.2% (SD = 6.0) body fat, which was not different between groups. Improvements were seen in the 30-s chair sit to stand (d = .99), the 30-s arm curl (d = .91), and the 8-ft up-and-go test (d = .63). No changes were measured for HbA1c or C-reactive protein. No changes were observed for flexibility (chair sit and reach, back scratch tests), 6-min walk test, maximum handgrip test, anxiety, depression, fatigue, or self-efficacy for exercise.

CONCLUSIONS

Home-based muscle-strengthening exercise led to favorable and clinically relevant improvements in 3 of 7 physical function assessments. Physical function, body composition, blood biomarkers, and patient-reported outcomes were feasible to measure. These fitness improvements were observed over a relatively short time frame of 10 weeks.

Correlates of Aerobic and Strength Exercise in Korean Cancer Patients: Data From the 2014-2016 Korea National Health and Nutrition Examination Survey

BACKGROUND

Understanding the prevalence and correlates of exercise in Korean cancer patients is important to improve their health-related fitness and quality of life.

OBJECTIVE

The aim of this study was to examine the prevalence and correlates of aerobic and strength exercise in Korean cancer patients.

METHODS

Overall, 640 cancer patients from the Korea National Health and Nutrition Examination Survey 2014-2016 were categorized as meeting the exercise guidelines as follows: (a) neither, (b) strength only, (c) aerobic only, or (d) combined. Correlates included demographic, medical, health-related fitness, and quality of life variables. Univariate and stepwise multinomial logistic regression were used for statistical analyses.

RESULTS

Over 70% of Korean cancer patients did not meet either exercise guideline. Higher education was associated with being more likely to meet the combined (odds ratio [OR], 4.69; P < .001), aerobic-only (OR, 3.58; P < .001), and strength-only (OR, 1.87; P = .042) guidelines. Higher hand-grip strength (per 10 kg) was associated with being more likely to meet the combined (OR, 1.78; P = .003) and strength-only (OR, 1.73; P < .001) guidelines. Older age (per 10 years) was associated with being less likely to meet the combined (OR, 0.69; P = .009) and aerobic-only (OR, 0.59; P < .001) guidelines and more likely to meet the strength-only guideline (OR, 1.46; P = .004).

CONCLUSIONS

Exercise levels are very low among Korean cancer patients and are correlated with age, education, and physical strength.

IMPLICATIONS FOR PRACTICE

Oncology nurses in Korea should consider promoting exercise to cancer patients, especially older, less educated, and physically weaker patients.

Rural-urban differences in meeting physical activity recommendations and health status in cancer survivors in central Pennsylvania

PURPOSE

This study explored rural-urban differences in meeting physical activity (PA) recommendations and health status in cancer survivors in central Pennsylvania and associations between PA and health status.

METHODS

Cancer survivors (N = 2463) were identified through a state cancer registry and mailed questionnaires assessing PA and health status. Rural-urban residence was based on county of residence at diagnosis. Participants self-reported frequency and duration of leisure-time PA and were classified as meeting: (1) aerobic recommendations (≥ 150 min/week), (2) muscle-strengthening recommendations (≥ 2 times/week), (3) both aerobic and muscle-strengthening recommendations, or (4) neither recommendation. Logistic regression models examined associations between rural-urban residence and meeting PA recommendations and associations between PA and health status, adjusting for age, cancer type, gender, and income.

RESULTS

Nearly 600 (N = 591, 24.0%) cancer survivors returned completed questionnaires (rural 9.5%, urban 90.5%). Half (50.0%) of rural cancer survivors reported no leisure-time PA compared to 35.2% of urban cancer survivors (p = 0.020), and urban cancer survivors were 2.6 times more likely to meet aerobic PA recommendations (95% CI 1.1-6.4). Odds of reporting good physical and mental health were 2.3 times higher among survivors who reported meeting aerobic recommendations compared to those who did not meet PA recommendations (95% CI 1.1-4.5), adjusting for rurality and covariates.

CONCLUSIONS

Results demonstrate persistent rural-urban differences in meeting PA recommendations in cancer survivors and its association with self-reported health.

IMPLICATIONS FOR CANCER SURVIVORS

Findings underscore the need for interventions to increase PA in rural cancer survivors in an effort to improve health status and reduce cancer health disparities.

Determinants of adherence to physical cancer rehabilitation guidelines among cancer patients and cancer centers: a cross-sectional observational study

PURPOSE

To tailor implementation strategies that maximize adherence to physical cancer rehabilitation (PCR) guidelines, greater knowledge concerning determinants of adherence to those guidelines is needed. To this end, we assessed the determinants of adherence to PCR guidelines in the patient and cancer center.

METHODS

We investigated adherence variation of PCR guideline-based indicators regarding [1] screening with the Distress Thermometer (DT), [2] information provision concerning physical activity (PA) and physical cancer rehabilitation programs (PCRPs), [3] advice to take part in PA and PCRPs, [4] referral to PCRPs, [5] participation in PCRPs, and [6] PA uptake (PAU) in nine cancer centers. Furthermore, we assessed patient and cancer center characteristics as possible determinants of adherence. Regression analyses were used to determine associations between guideline adherence and patient and cancer center characteristics. In these analyses, we assumed the patient (level 1) nested within the cancer center (level 2).

RESULTS

Nine hundred and ninety-nine patients diagnosed with cancer between January 2014 and June 2015 were included. Of the 999 patients included in the study, 468 (47%) received screening with the DT and 427 (44%) received information provision concerning PA and PCRPs. Subsequently, 550 (56%) patients were advised to take part in PA and PCRPs, which resulted in 174 (18%) official referrals. Ultimately, 280 (29%) patients participated in PCRPs, and 446 (45%) started PAU. Screening with the DT was significantly associated with information provision concerning PA and PCRPs (OR 1.99, 95% CI 1.47-2.71), advice to take part in PA and PCRPs (OR 1.79, 95% CI 1.31-2.45), referral to PCRPs (OR 1.81, 95% CI 1.18-2.78), participation in PCRPs (OR 2.04, 95% CI 1.43-2.91), and PAU (OR 1.69, 95% CI 1.25-2.29). Younger age, male gender, breast cancer as the tumor type, ≥2 cancer treatments, post-cancer treatment weight gain/loss, employment, and fatigue were determinants of guideline adherence. Less variation in scores of the indicators between the different cancer centers was found. This variation between centers was too low to detect any association between center characteristics with the indicators.

CONCLUSIONS

The implementation of PCR guidelines is in need of improvement. We found determinants at the patient level associated with guideline-based PCR care.

IMPLICATIONS FOR CANCER SURVIVORS

Implementation strategies that deal with the determinants of adherence to PCR guidelines might improve the implementation of PCR guidelines and the quality of life of cancer survivors.

Original Research: Arthritis-Related Functional Limitations and Inadequate Physical Activity Among Female Adult Cancer Survivors

BACKGROUND

The American Cancer Society (ACS) Guidelines on Nutrition and Physical Activity for Cancer Prevention recommend an adequate level of physical activity for cancer prevention and survivorship. Many adults have been diagnosed with arthritis, with a significantly higher rate in women. People with arthritis tend to be less physically active than those without arthritis, and are less likely to engage in moderate or vigorous activity. The proportion of adults meeting ACS physical activity guidelines is especially low among those with arthritis.

OBJECTIVE

We wanted to explore the extent to which arthritis-related functional limitations are predictive of inadequate physical activity in female adult cancer survivors after accounting for other known predictors.

METHODS

Data included in the analyses were from a sample of 729 adult women diagnosed with cancer who participated in the U.S. National Health and Nutrition Examination Survey between 2011 and 2016. Inadequate physical activity was defined as not meeting ACS physical activity guidelines. Bivariate and multivariate logistic regression analyses were conducted to identify correlates of inadequate physical activity.

RESULTS

Being age 65 years or older, having no more than a high school education, being overweight or obese, being clinically depressed, and having arthritis-related functional limitations were found to be significant correlates of inadequate physical activity in the study population.

CONCLUSIONS

Our results indicate that, in addition to previously identified predictors of inadequate physical activity in cancer survivors, having arthritis-related functional limitations is a significant predictor of inadequate physical activity in female adult cancer survivors. Assessment and management of arthritis-related functional limitations by health care providers are needed to facilitate successful adherence to physical activity guidelines.

Exploring Parents' Message Receipt and Message Enactment of the World's First Integrated Movement Behaviour Guidelines for Children and Youth

The Canadian 24-Hour Movement Guidelines for Children and Youth are novel in how they integrate the guideline recommendations for the full continuum of movement behaviours, from sleep to vigorous physical activity. Research suggests that the integrated guidelines strategy is perceived favourably, and this study is the first to compare this strategy to traditional segregated guidelines on its effectiveness to disseminate health information. Specifically, this study explored (1) the influence of the integrated guidelines strategy on parents' message receipt and message enactment to support their child meet the guidelines, and (2) the relationship between message receipt and message enactment in a youth movement behaviour context. In this prospective randomized experiment, parents (n= 162) were randomized to read integrated, segregated, or control guidelines and complete pre, post, and 2-week follow-up surveys. Repeated-measures ANOVAs revealed significantly higher message enactment outcomes among participants in the integrated guidelines group (p< .05). Message receipt and enactment outcomes were significantly correlated (r> .171, p< .05). These findings highlight that parents' initial receipt of a message is important for subsequent behaviour change in a youth movement behaviour context. Furthermore, the integrated guidelines strategy may have an advantage in promoting guideline update and should continue to be explored.

Clinical factors associated with adherence to aerobic and resistance physical activity guidelines among cancer prevention patients and survivors

Physical activity (PA) is a known behavior to reduce cancer risk and improve cancer survivorship, yet adherence to PA guidelines is poor among the general population and cancer survivors. The purpose of this study was to determine the extent to which patients referred for exercise consultation within a clinical cancer prevention setting were meeting aerobic and resistance physical activity (PA) guidelines and to identify factors associated with guideline adherence. Between 2013 and 2015, cancer prevention patients and cancer survivors were interviewed by an exercise physiologist within an Integrative Health Program at The University of Texas MD Anderson Cancer Prevention Center. PA adherence was defined as at least 150-minutes of moderate-intensity or 75-minutes of vigorous-intensity PA per week, along with resistance training at least 2 days per week. Logistic regression was used to determine factors associated with meeting or not meeting PA guidelines for aerobic exercise, resistance exercise, and aerobic and resistance exercise combined. Among 1,024 cancer prevention patients and survivors, 9% of patients adhered to guideline-based PA. Adherence to aerobic and resistance guidelines were 20% and 12%, respectively. Overweight or obesity was associated with not meeting guideline-based PA in both cancer prevention patients and cancer survivors. Among breast cancer survivors, combination treatment with surgery, radiation, and chemotherapy ('multimodal therapy') was robustly associated with not meeting aerobic guidelines (OR 2.20, 95% CI: 1.17 to 4.16). BMI and breast cancer treatment history are key determinants of PA behavior among cancer prevention patients and survivors. Poor adherence to PA guidelines is a key issue for cancer prevention patients and survivors, particularly obese patients and women who receive multimodal therapy for breast cancer. Identifying and connecting patients at highest risk of poor PA adherence with exercise programs is needed to improve PA, a key modifiable cancer risk factor.

Demographic, medical, social-cognitive, and environmental correlates of meeting independent and combined physical activity guidelines in kidney cancer survivors

PURPOSE

Guidelines for cancer survivors recommend both aerobic physical activity (PA) and strength training (ST). Few kidney cancer survivors (KCS) are meeting single-activity or combined guidelines; therefore, examining factors influencing PA participation is warranted. The purpose of this study is to examine demographic, medical, social-cognitive, and environmental correlates of meeting independent (i.e., aerobic-only, strength training (ST)-only) and combined guidelines (i.e., aerobic and ST) in KCS.

METHODS

KCS (N = 651) completed self-reported measures of PA and demographic, medical, social-cognitive, and perceived environmental factors. Built environment was assessed using the geographic information systems (GIS). Multinomial logistic regressions were conducted to determine the correlates of meeting the combined versus independent guidelines.

RESULTS

Compared with meeting neither guideline, meeting aerobic-only guidelines was associated with higher intentions (p < .01) and planning (p < .01); meeting ST-only guidelines was associated with higher intentions (p = .02) and planning (p < .01), lower perceived behavioral control (PBC) (p = .03), healthy weight (p = .01), and older age (p < .01); and meeting the combined guidelines were associated with higher intentions (p < .01), planning (p = .02), higher instrumental attitudes (p < .01), higher education (p = .04), better health (p < .01), and localized cancer (p = .05). Additionally, compared with neither guideline, meeting aerobic-only (p < .01) and combined (p < .01) guidelines was significantly associated with access to workout attire. Compared with neither guideline, meeting aerobic-only guidelines was associated with proximity to retail (p = .02).

CONCLUSION

PA participation correlates may vary based on the modality of interest. Interventions may differ depending on the modality promoted and whether KCS are already meeting single-modality guidelines.

Worse or even better than expected? Outcome expectancies and behavioral experiences in the context of physical activity among cancer patients

Expectancies of cancer patients regarding their physical activity before they took part in a behavior change intervention were compared with their experiences during the intervention period. A total of 66 cancer patients completed either a randomly assigned 4-week physical activity or a stress-management counseling intervention. On average, participants had positive expectancies toward physical activity. Outcome expectancies predicted outcomes (e.g. physical activity) at a 10-week follow-up. Outcome realization (discrepancy between expectancies and experiences) further increased explained variance in self-efficacy and physical activity enjoyment. In conclusion, not only initial outcome expectancies but also their realizations seem to be important for subsequent behavior and cognitions.

To rest or not to rest-Health care professionals' attitude toward recommending physical activity to their cancer patients

OBJECTIVE

While in the past cancer patients were advised to rest, recent research revealed various beneficial effects of physical activity, including increased treatment tolerability during cancer treatment and prolonged survival, which has led to a paradigm shift in relevant guidelines. This study examined if this paradigm shift from rest to activity has been consolidated in health care professionals' (HCP') attitude. It was investigated if the two dimensions of attitude (rest and activity) are endorsed empirically within the theory of planned behavior (TPB). Differences between physicians and nurses were examined.

METHODS

Five hundred forty seven physicians and 398 nurses treating breast, prostate, or colorectal cancer patients completed a cross-sectional questionnaire. To assess attitude toward physical activity during cancer treatment, we developed a 15-item scale, which included original statements of HCP. TPB variables were assessed.

RESULTS

A factor analysis revealed the proposed distinction of attitude into two dimensions. The activity-paradigm was stronger represented in HCP' attitude compared with rest-paradigm (M_{activity-paradigm}  = 4.1 versus M_{rest-paradigm}  = 2.7, p < 0.001). Additionally, the activity-paradigm had higher exploratory power in explaining intention to recommend physical activity in cancer patients. However, the rest-paradigm was able to explain intention to recommend physical activity over and above activity-paradigm (ΔR²  = 0.05). Nurses had higher scores on the rest-paradigm than physicians.

CONCLUSIONS

The activity-paradigm has already been consolidated in HCP' minds. However, the rest-paradigm is still present in the daily routine of oncology physicians and nurses. Addressing concerns and insecurities related to supporting cancer patients in maintaining or building up a physically active lifestyle is a very important educational task.

Modality-specific exercise guidelines and quality of life in kidney cancer survivors: A cross-sectional study

OBJECTIVES

Few exercise oncology trials have compared aerobic with strength exercise or compared combined exercise (ie, aerobic and strength training) with aerobic only or strength only. It is unknown what single or combined exercise modality is optimal for quality of life (QoL) in cancer survivors. The purpose of this study is to estimate the prevalence of meeting the combined and independent aerobic and strength exercise guidelines in kidney cancer survivors (KCS) and determine any associations with QoL.

METHODS

One thousand nine hundred eighty-five KCS were identified through a provincial registry in Canada and mailed a survey including exercise and QoL scales.

RESULTS

Completed surveys were received from 703 KCS. Only 10.1% of KCS reported meeting the combined exercise guidelines. Analyses of covariance indicated that, for most QoL outcomes (eg, Functional Assessment of Cancer Therapy-General and Functional Assessment of Cancer Therapy-Fatigue), meeting the combined exercise guideline was superior to meeting either single modality guideline that, in turn, were superior to meeting neither guideline. For the primary outcome of the Trial Outcome Index-Fatigue, meeting the combined exercise guideline was superior to meeting (a) neither guideline (P < 0.001), (b) the strength-only guideline (P = 0.021), and (c) the aerobic-only guideline (P = 0.051). In turn, the aerobic and strength exercise only guidelines were superior to meeting neither guideline (P < 0.001 for aerobic; P = 0.045 for strength) but were not different from each other (P = 0.50).

CONCLUSIONS

Meeting the combined exercise guideline has favorable associations with QoL in KCS, however, very few KCS are meeting the combined guideline.

Are healthcare professionals being left in the lurch? The role of structural barriers and information resources to promote physical activity to cancer patients

PURPOSE

Although many cancer patients benefit from physical activity (PA), healthcare professionals (HCP) still do not promote it routinely. Including different groups of HCP, this study aimed to examine how structural barriers are perceived as impeding by HCP for promoting PA to cancer patients, how the perceptions of structural barriers are associated with promoting PA, and how HCP react to information resources.

METHODS

A total of 287 physicians in outpatient care, 242 physicians in inpatient care, and 388 oncology nurses completed our questionnaire (paper-pencil or online). Participants assessed nine different structural barriers (on a 4-point Likert Scale) and reported their PA promotion frequency. Further, they could request three different kinds of information resources about PA in oncological settings.

RESULTS

Across professional groups, more than 70% of HCP indicated that they promoted PA to their cancer patients often or routinely. Oncology nurses indicated that they were more impeded in promoting PA by six structural barriers than physicians (all p < .01). "Not enough time per patient" and "lack of an expert contact person" were associated with a reduced PA promotion in two professional groups (all p < .05). Information resources were requested by 69.5% of the participants: mostly physicians working in outpatient care and especially by those perceiving structural barriers.

CONCLUSIONS

Although a big proportion of HCP reported that they frequently promoted PA, our findings suggest that HCP still perceive structural barriers. The perception and influence of structural barriers differed between professional groups, pointing to the importance of profession specific guidance.

Integrating Physical Activity Into Clinical Cancer Care

Physical activity is an important target for improving health and well-being among cancer survivors. Cancer clinicians are uniquely positioned to promote physical activity among survivors through follow-up visits for treatment planning and surveillance. Providers should prioritize assessment of guideline-concordant physical activity and facilitate achievement of physical activity guidelines through exercise prescription, goal setting, addressing barriers, and capitalizing on support systems.

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.

Electronic supplementary material

The online version of this article (doi:10.1186/s12966-017-0498-7) contains supplementary material, which is available to authorized users.