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Grimmett C, Corbett T, Bradbury K, Morton K, May CR, Pinto BM, Foster C. Maintaining long-term physical activity after cancer: a conceptual framework to inform intervention development. J Cancer Surviv 2023:10.1007/s11764-023-01434-w. [PMID: 37578616 DOI: 10.1007/s11764-023-01434-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 07/20/2023] [Indexed: 08/15/2023]
Abstract
PURPOSE This paper describes a conceptual framework of maintenance of physical activity (PA) and its application to future intervention design. METHODS Evidence from systematic literature reviews and in-depth (N = 27) qualitative interviews with individuals with cancer were used to develop a conceptual framework of long-term physical activity behaviour. Determinants of long-term PA were listed and linked with domains of the Theoretical Domains Framework which in turn were linked to associated behaviour change techniques (BCTs) and finally to proposed mechanisms of action (MoA). RESULTS The conceptual framework is presented within the context of non-modifiable contextual factors (such as demographic and material resources) and in the presence of learnt and adapted behavioural determinants of skills, competence and autonomous motivation that must be established as part of the initiation of physical activity behaviour. An inventory of 8 determinants of engagement in long-term PA after cancer was developed. Clusters of BCTs are presented along with proposed MoA which can be tested using mediation analysis in future trials. CONCLUSION Understanding the processes of PA maintenance after cancer and presentation of implementable and testable intervention components and mechanisms of action to promote continued PA can inform future intervention development. IMPLICATIONS FOR CANCER SURVIVORS This resource can act as a starting point for selection of intervention components for those developing future interventions. This will facilitate effective support of individuals affected by cancer to maintain PA for the long term.
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Affiliation(s)
- Chloe Grimmett
- Centre for Psychosocial Research in Cancer: CentRIC+, School of Health Sciences, University of Southampton, Southampton, UK.
| | - Teresa Corbett
- Faculty of Sport, Health and Social Sciences, Solent University, Southampton, UK
| | | | - Kate Morton
- Centre for Psychosocial Research in Cancer: CentRIC+, School of Health Sciences, University of Southampton, Southampton, UK
| | - Carl R May
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Claire Foster
- Centre for Psychosocial Research in Cancer: CentRIC+, School of Health Sciences, University of Southampton, Southampton, UK
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Perperidi M, Saliari D, Christakis C, Huybrechts I, Saloustros E, Theodorakis Y, Androutsos O. Identifying the effective behaviour change techniques in nutrition and physical activity interventions for the treatment of overweight/obesity in post-treatment breast cancer survivors: a systematic review. Cancer Causes Control 2023; 34:683-703. [PMID: 37149509 PMCID: PMC10267275 DOI: 10.1007/s10552-023-01707-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 04/19/2023] [Indexed: 05/08/2023]
Abstract
PURPOSE Updated evidence for the treatment of obesity in cancer survivors includes behavioural lifestyle interventions underpinning at least one theoretical framework. The aim of this systematic review was to assess the effectiveness of theory-based lifestyle interventions for the treatment of overweight/obesity in breast cancer survivors and to report effective behavioural change techniques (BCTs) and components used in these interventions. METHODS Four databases were searched for RCTs published between database inception and July 2022. The search strategy included MeSH terms and text words, using the PICO-framework to guide the eligibility criteria. The PRISMA guidelines were followed. Risk-of-bias, TIDier Checklist for interventions' content, and the extent of behaviour change theories and techniques application were assessed. To evaluate the effectiveness of interventions, trials were categorised as "very," "quite," or "non" promising according to their potential to reduce body weight, and BCTs promise ratios were calculated to assess the potential of BCTs within interventions to decrease body weight. RESULTS Eleven RCTs met the inclusion criteria. Seven trials were classified as "very", three as "quite" and one study was "non" promising. Studies' size, design, and intervention strategies varied greatly, but the weight-loss goal in all studies was ≥ 5% of the initial body weight through a 500-1000 kcal/day energy deficit and a gradually increased exercise goal of ≥ 30 min/day. Social Cognitive Theory was the most commonly used theory (n = 10). BCTs ranged from 10 to 23 in the interventions, but all trials included behaviour goal setting, self-monitoring, instructions on the behaviour, and credible source. The risk-of-bias was "moderate" in eight studies and "high" in three. CONCLUSION The present systematic review identified the components of theory-based nutrition and physical activity behaviour change interventions that may be beneficial for the treatment of overweight/obesity in breast cancer survivors. The strategies mentioned, in addition to reported behavioural models and BCTs, should be considered when developing weight-loss interventions for breast cancer survivors.
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Affiliation(s)
- Maria Perperidi
- Laboratory of Clinical Nutrition and Dietetics, Department of Nutrition and Dietetics, School of Physical Education, Sport Science and Dietetics, University of Thessaly, 1C Argonafton, 42132, Trikala, Thessaly, Greece
| | - Dimitra Saliari
- Laboratory of Clinical Nutrition and Dietetics, Department of Nutrition and Dietetics, School of Physical Education, Sport Science and Dietetics, University of Thessaly, 1C Argonafton, 42132, Trikala, Thessaly, Greece
| | - Christos Christakis
- Laboratory of Clinical Nutrition and Dietetics, Department of Nutrition and Dietetics, School of Physical Education, Sport Science and Dietetics, University of Thessaly, 1C Argonafton, 42132, Trikala, Thessaly, Greece
| | - Inge Huybrechts
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Emmanouil Saloustros
- Department of Oncology, Medical School, University Hospital of Larissa, Larissa, Greece
| | - Yannis Theodorakis
- Department of Physical Education and Sport Science, School of Physical Education, Sport Science and Dietetics, University of Thessaly, Trikala, Thessaly, Greece
| | - Odysseas Androutsos
- Laboratory of Clinical Nutrition and Dietetics, Department of Nutrition and Dietetics, School of Physical Education, Sport Science and Dietetics, University of Thessaly, 1C Argonafton, 42132, Trikala, Thessaly, Greece.
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Salisbury CE, Hyde MK, Cooper ET, Stennett RC, Gomersall SR, Skinner TL. Physical activity behaviour change in people living with and beyond cancer following an exercise intervention: a systematic review. J Cancer Surviv 2023; 17:569-594. [PMID: 37074621 PMCID: PMC10209249 DOI: 10.1007/s11764-023-01377-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/31/2023] [Indexed: 04/20/2023]
Abstract
PURPOSE Exercise interventions can increase physical activity and wellbeing of people living with/beyond cancer. However, little is known about maintenance of physical activity in this population ≥ 6 months post-exercise intervention, when theoretical evidence suggests behaviour maintenance occurs. Study aims are to (i) systematically review maintenance of physical activity ≥ 6-month post-exercise intervention, and (ii) investigate the influence of behaviour change techniques (BCTs) on physical activity maintenance in people living with/beyond cancer. METHODS CINAHL, CENTRAL, EMBASE and PubMed databases were searched for randomised controlled trials up to August 2021. Trials including adults diagnosed with cancer that assessed physical activity ≥ 6 months post-exercise intervention were included. RESULTS Of 142 articles assessed, 21 reporting on 18 trials involving 3538 participants were eligible. Five (21%) reported significantly higher physical activity ≥ 6 months post-exercise intervention versus a control/comparison group. Total number of BCTs (M = 8, range 2-13) did not influence intervention effectiveness. The BCTs Social support, Goal setting (behaviour), and Action planning, alongside supervised exercise, were important, but not sufficient, components for long-term physical activity maintenance. CONCLUSIONS Evidence for long-term physical activity maintenance post-exercise intervention for people living with/beyond cancer is limited and inconclusive. Further research is required to ensure the physical activity and health benefits of exercise interventions do not quickly become obsolete. IMPLICATIONS FOR CANCER SURVIVORS Implementation of the BCTs Social support, Goal setting (behaviour), and Action planning, alongside supervised exercise, may enhance physical activity maintenance and subsequent health outcomes in people living with/beyond cancer.
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Affiliation(s)
- Chloe E Salisbury
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, Australia.
| | - Melissa K Hyde
- School of Psychology, The University of Queensland, Brisbane, QLD, Australia
| | - Ella T Cooper
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Rebecca C Stennett
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Sjaan R Gomersall
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Tina L Skinner
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, Australia
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Qiu L, Ye M, Tong Y, Jin Y. Promoting physical activity among cancer survivors: an umbrella review of systematic reviews. Support Care Cancer 2023; 31:301. [PMID: 37097500 PMCID: PMC10129958 DOI: 10.1007/s00520-023-07760-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 04/16/2023] [Indexed: 04/26/2023]
Abstract
PURPOSE Exercise is the core element of rehabilitation for cancer patients. However, most of the patients' exercise levels failed to meet the indicators recommended by the guidelines or even decreased. Therefore, this umbrella review aims to provide an overview of review articles addressing the evidence of interventions to promote physical activity behavior change and increase physical activity among cancer patients. METHODS We searched nine databases from inception to 12 May 2022 to obtain systematic reviews and meta-analyses of interventions to promote physical activity among cancer patients. The AMSTAR-2 was used for the quality assessment. RESULTS Twenty-six individual systematic reviews including 13 studies performed meta-analyses. A total of 16 studies' designs were all in randomized controlled trial. Most reviews included studies that were mainly delivered in home settings. The most frequent and mean duration of the interventions was 12 weeks. Interventions mainly included electronic, wearable health technology-based, behavior change techniques (BCTs), and theory-based strategies. CONCLUSIONS Electronic, wearable health technology-based, BCTs, and theory-based interventions were effective and feasible in promoting physical activity in cancer survivors. Clinical practitioners should take corresponding intervention measures according to the characteristics of patients in different groups. IMPLICATIONS FOR CANCER SURVIVORS Future research may benefit cancer survivors by more comprehensively applying electronic, wearable health technology-based, BCTs, and theory-based interventions.
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Affiliation(s)
- Lin Qiu
- Department of Nursing, 7Th Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Maodie Ye
- Department of Nursing, 7Th Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yang Tong
- Department of Nail-Breast Hernia Surgery, 7Th Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yongmei Jin
- Department of Nursing, 7Th Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China.
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Polo KM, Fleischer A, Campbell C. Supporting Physical Activity in Adults Living With and Beyond Cancer (2018-2022). Am J Occup Ther 2023; 77:7710393330. [PMID: 37815619 DOI: 10.5014/ajot.2023.77s10033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/11/2023] Open
Abstract
Systematic review briefs provide a summary of the findings from systematic reviews evaluated in conjunction with the American Occupational Therapy Association's Evidence-Based Practice Program. Each systematic review brief summarizes the evidence on a theme related to a systematic review topic. This systematic review brief presents findings from the systematic review on the effectiveness of interventions addressing physical activity in adults living with and beyond cancer.
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Affiliation(s)
- Katie M Polo
- Katie M. Polo, DHS, OTR, CLT-LANA, is Associate Professor, School of Occupational Therapy, University of Indianapolis
| | - Anne Fleischer
- Anne Fleischer, PhD, MPH, OT/L, CLT-LANA, is Associate Professor, Occupational Therapy Program, Department of Rehabilitation, Exercise and Nutrition Sciences, University of Cincinnati
| | - Claudine Campbell
- Claudine Campbell, OTD, OTR/L, CLT, is Lead Occupational Therapist, Memorial Sloan Kettering Cancer Center
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Ee C, Cave A, Vaddiparthi V, Naidoo D, Boyages J. Factors associated with weight gain after breast cancer: Results from a community-based survey of Australian women. Breast 2023:S0960-9776(23)00012-7. [PMID: 36710237 DOI: 10.1016/j.breast.2023.01.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 01/27/2023] Open
Abstract
PURPOSE Weight gain after breast cancer is common. The aim of this study was to determine factors associated with weight gain after breast cancer in Australian women. METHODS A cross-sectional online survey was conducted between November 2017 and January 2018. Women living in Australia who self-identified as having breast cancer or ductal carcinoma in-situ were eligible. We created stepwise linear and logistic regression models to evaluate predictors for absolute and clinically significant (≥5%) weight gain respectively. RESULTS Data from 276 women were analysed. Most were Caucasian and 92% had been diagnosed with Stage 0-III breast cancer. Absolute weight gain was associated with hot flushes, being in the menopausal transition at diagnosis, being less physically active than at diagnosis, lower eating self-efficacy when watching television or using a computer, and higher self-efficacy when anxious or nervous (F-ratio = 3.26, R2-adjusted = 0.16, p < .001). Clinically significant weight gain was associated with tamoxifen use (OR 2.7), being less physically active than at diagnosis (OR 3.1), and lower eating self-efficacy when watching television or using a computer (OR 0.82) (Chi-square 64.94, df = 16, p < .001). Weight gain was not associated with chemotherapy, radiotherapy, aromatase inhibitor use, number of lymph nodes removed, or body mass index at diagnosis. CONCLUSIONS Interventions to prevent weight gain after breast cancer, particularly aiming to maintain physical activity, should be targeted at women receiving tamoxifen. The role of eating self-efficacy, especially attentive eating, in managing weight after breast cancer should be explored.
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Affiliation(s)
- Carolyn Ee
- NICM Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, Sydney, New South Wales, Australia; Translational Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, Sydney, New South Wales, Australia; LivingRoom, Chris O' Brien Lifehouse Cancer Centre, PO Box M33, Missenden Rd, Camperdown, Sydney, New South Wales, Australia; Caring Futures Institute, Flinders University, Bedford Park, Adelaide, South Australia, Australia.
| | - Adele Cave
- NICM Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, Sydney, New South Wales, Australia
| | - Vaishnavi Vaddiparthi
- NICM Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, Sydney, New South Wales, Australia
| | - Dhevaksha Naidoo
- NICM Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, Sydney, New South Wales, Australia
| | - John Boyages
- ICON Cancer Centre, Sydney Adventist Hospital, 185 Fox Valley Road, Wahroonga, Sydney, New South Wales, Australia; Faculty of Health and ANU College of Health & Medicine, Canberra, Australian Capital Territory, Australia
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Wang X, Sun J, Yin X, Zou C, Li H. Effects of behavioral change techniques on diet and physical activity in colorectal cancer patients: a systematic review and meta-analysis. Support Care Cancer 2022; 31:29. [PMID: 36515770 DOI: 10.1007/s00520-022-07511-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 12/01/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE To investigate the effect of behavior change technology on diet, exercise, and sedentary behaviors in colorectal cancer over the last decade. METHODS This study systematically searched six English databases (Cochrane Library, EMBASE, APA PsycInfo, SCOPUS, PubMed, Web of Science) and three Chinese databases (CNKI, WanFang, and SINOMEd), searched for eligible clinical trials published between January 1, 2012, and December 31, 2021. Each database follows the principle of PICOS and adopts the method of subject words combined with free words to conduct literature retrieval, such as "colorectal cancer" and "behavior change intervention." Meta-analysis was performed using RevMan 5.3 software. Continuous data using the same measurement tools were analyzed using weighted mean difference (MD). Otherwise, standard mean difference (SMD) was used for analysis. The confidence interval is 95%. There was no significant statistical heterogeneity between the studies (P > 0.1, I2 < 50%), and fixed-effects model was used. There was statistical heterogeneity (P ≤ 0.1), I2 ≥ 50%), and the random effects model was used for analysis. The Cochrane risk of bias tool was used to assess the risk of bias in the included studies. RESULTS In total, 15 good-quality randomized controlled trials were identified. Six studies focused on eating habits. Twelve studies focused on physical activity. We found that behavior change techniques had significant effects on colorectal cancer survivors' eating behaviors such as frequency of fruit and vegetable intake and mastery of dietary knowledge (P < 0.05). The meta-analysis showed that the amount of physical activity in the intervention group increased by 71.76 min/w (16.27 to 127.24, P = 0.01) at 3 months after treatment compared with the control group. The meta-analysis showed that the amount of physical activity in the intervention group increased by 113.97 min/w (48.34 to 179.59, P < 0.001) at 6 months after treatment compared with the control group. The results revealed significant difference in the overall effect of the behavior change technique on the amount of exercise. Behavior change techniques were not found to have significant effects on body weight and BMI in colorectal cancer survivors, but it had a significant effect on sedentary behavior (P < 0.05). CONCLUSIONS The effects of behavioral change technique intervention on diet and physical activity may be more clinically significant at 6 months. This is the first systematic review and meta-analysis to summarize the effectiveness of a behavioral change techniques health behavior intervention in patients with colorectal cancer.
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Affiliation(s)
- Xiao Wang
- First Hospital of Jilin University, Changchun, China
| | - Jiao Sun
- Jilin University, Changchun, China
| | - Xin Yin
- First Hospital of Jilin University, Changchun, China
| | - Congcong Zou
- First Hospital of Jilin University, Changchun, China
| | - Hongyan Li
- First Hospital of Jilin University, Changchun, China.
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Tlusty GC, Alonso WW, Berger AM. Exercise Interventions During Hospitalization for Stem Cell Transplantation: An Integrative Review. West J Nurs Res 2022; 44:1167-1182. [PMID: 36154334 DOI: 10.1177/01939459221124433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Exercise interventions may influence adverse effects experienced during hospitalization for hematopoietic stem cell transplantation (HSCT). Adherence to exercise interventions is challenging. This review aimed to synthesize the literature to identify exercise interventions implemented during hospitalization for HSCT, including intervention characteristics, adherence, barriers and facilitators, and behavior change techniques using the behavior change technique taxonomy. A review of PubMed, CINAHL, PsycINFO, and Embase was completed. The sample included 19 studies. Exercise interventions demonstrated heterogeneity in prescription components, definitions, measures, and reporting of adherence. Barriers and facilitators of adherence to exercise were reported infrequently. Behavior change techniques most frequently used in studies reporting adherence rates of ≥75% included instruction on how to perform the behavior, graded tasks, and adding objects to the environment. The heterogeneity in definitions and measures of adherence limit forming conclusions to identify barriers and facilitators and determine which behavior change techniques increase adherence to exercise during HSCT.
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Affiliation(s)
- Gisele C Tlusty
- University of Nebraska Medical Center College of Nursing, Omaha, NE, USA
| | - Windy W Alonso
- University of Nebraska Medical Center College of Nursing, Omaha, NE, USA
| | - Ann M Berger
- University of Nebraska Medical Center College of Nursing, Omaha, NE, USA
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Ee C, Singleton AC, de Manincor M, Elder E, Davis N, Mitchell C, Dune T, MacMillan F, McBride K, Grant S. A Qualitative Study Exploring Feasibility and Acceptability of Acupuncture, Yoga, and Mindfulness Meditation for Managing Weight After Breast Cancer. Integr Cancer Ther 2022; 21:15347354221099540. [PMID: 35652533 PMCID: PMC9168877 DOI: 10.1177/15347354221099540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: Weight gain is common after breast cancer. Yoga, mindfulness meditation, and
acupuncture may assist with managing weight. However, evidence on
effectiveness is limited. This study assessed the feasibility and
acceptability of recruiting for and implementing a randomized controlled
trial (RCT) evaluating these interventions as adjuncts to lifestyle
interventions (diet and exercise) for weight management in women with breast
cancer. Methods: Qualitative study involving virtual focus groups or semi-structured
interviews. Participants were recruited via email invitation from a breast
cancer consumer organization and breast cancer center in Australia. Eligible
participants had received treatment for breast cancer, and were fluent in
English. A purposive sample of culturally and linguistically diverse (CALD)
participants was also recruited. Focus groups and interviews were
audio-recorded, transcribed verbatim and analyzed using thematic analysis
with the constant comparison method. Results: Emails were sent to 1415 women of which 37 provided data in 5 focus groups
and 1 semi-structured interview, including 1 focus group (n = 6) with only
women from CALD backgrounds. Yoga and mindfulness meditation were perceived
as feasible and acceptable for weight management, but acupuncture was seen
to be too invasive to be acceptable. A focus on wellness rather than weight
reduction, flexible program delivery, trusted advice, consideration of
participant burden and benefit, and peer-support were key factors perceived
to increase feasibility and acceptability. Conclusions: Yoga and mindfulness meditation are acceptable and useful adjuncts to
lifestyle interventions for weight management after breast cancer. This
research places end-users at the forefront of trial design, and will inform
future trials using these interventions for weight management and improving
health and wellbeing after breast cancer.
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Affiliation(s)
- Carolyn Ee
- Western Sydney University, Penrith, NSW, Australia
| | - Anna C Singleton
- Engagement and Co-Design Research Hub, Faculty of Medicine and Health, School of Health Sciences, University of Sydney, Westmead, NSW, Australia
| | | | | | - Nikki Davis
- Primary Care Collaborative Cancer Clinical Trials Group, Melbourne, VIC, Australia
| | | | - Tinashe Dune
- Western Sydney University, Penrith, NSW, Australia
| | | | - Kate McBride
- Western Sydney University, Penrith, NSW, Australia
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