Factors predicting long-term physical activity of breast cancer survivors. 5-year-follow-up of the BREX exercise intervention study

BACKGROUND

The benefits of exercise training are well documented among breast cancer (BC) survivors. Patients decrease their physical activity during treatment, and many fail to regain their previous exercise levels. There is therefore a need to define factors supporting long-term physical activity behavior in this patient group, to target supporting interventions aimed at preventing the decline in physical activity (PA).

AIM

The aim of this study was to determine physical and psychosocial factors explaining long-term physical activity after the adjuvant treatments in BC survivors.

METHODS

Four-hundred forty-six BC survivors followed for 5-years within a randomized exercise trial participated. Factors explaining (1) physical activity after the adjuvant treatments and (2) changes in physical activity in long-term were analyzed using linear regression models and general estimating equation models. Pretreatment leisure-time physical activity (LTPA), demographic, and treatment factors, physical fitness, and quality of life (Qol) at baseline were independent factors.

RESULTS

Exercise levels increased during the first year, and thereafter remained mostly stable. Higher LTPA, higher fitness level, better Qol and older age at baseline were associated with higher physical activity level after adjuvant treatments (p < .001) in multivariate analysis. Higher levels of fatigue (p < .008) and better emotional functioning (p = .017) at baseline were the main factors associated with increased physical activity during the follow-up.

CONCLUSION

Previous exercise habits and Qol after adjuvant chemo-, and radiotherapy were the strongest determinants of long-term physical activity levels in breast cancer survivors. Patients with better emotional functioning increased their exercise activity most as did those patients with higher fatigue levels at baseline. Patients suffering from fatigue after adjuvant treatment managed to increase their exercise levels, in contrast to patients with low emotional functioning, and may benefit from physical exercise interventions. Emotionally deprived patients may benefit from psychosocial support to regain their previous exercise levels.

Psychosocial Determinants of Lifestyle Change after a Cancer Diagnosis: A Systematic Review of the Literature

Simple Summary

Although cancer survivors may experience health benefits from favorable lifestyle changes, many cancer survivors do not adhere to lifestyle recommendations or make favorable lifestyle changes after cancer diagnosis. This systematic review of the literature aimed to provide an overview of the scientific literature on sociodemographic, psychological and social determinants that may facilitate or hamper lifestyle change after the diagnosis cancer. It provides a structured overview of the large variety of determinants of changes in different lifestyle behaviors (physical activity, diet, smoking, alcohol, sun protection, and multiple lifestyle behaviors) derived from the 123 included papers (71 quantitative and 52 qualitative). Findings demonstrate the important role of oncology healthcare professionals in promoting healthy lifestyle changes in cancer survivors and inform researchers and healthcare professionals about the methods and strategies they can use to promote healthy lifestyle changes in cancer survivors.

Abstract

The aim of this study is to provide a systematic overview of the scientific literature on sociodemographic, psychological and social determinants that may facilitate or hamper lifestyle change after the diagnosis cancer. Four databases (PubMed, PsychINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Web of Science) were searched for relevant papers up to October 2021. Of the 9586 references yielded by the literature search, 123 papers were included: 71 quantitative and 52 qualitative papers. Findings showed a large variety of determinants influencing lifestyle change after cancer diagnosis, with differences between lifestyle behaviors (physical activity, diet, smoking, alcohol, sun protection, and multiple lifestyle behaviors) and findings from quantitative vs. qualitative studies. Findings demonstrate the important role of oncology healthcare professionals in promoting healthy lifestyle changes in cancer survivors. In addition, findings inform researchers involved in the development of health promotion programs about the methods and strategies they can use to promote healthy lifestyle changes in cancer survivors. Favorable lifestyle changes are expected to have beneficial effects on cancer risk and overall health in cancer survivors.

Applying Social Cognitive Theory in Predicting Physical Activity Among Chinese Adolescents: A Cross-Sectional Study With Multigroup Structural Equation Model

This cross-sectional study aimed to assess the applicability of social cognitive determinants among the Chinese adolescents and examine whether the predictability of the social cognitive theory (SCT) model on physical activity (PA) differs across gender (boys and girls) and urbanization (urban and suburban). A total of 3,000 Chinese adolescents ranging between the ages of 12-15 years were randomly selected to complete a set of questionnaires. Structural equation modeling (SEM) was applied to investigate the relationships between social cognitive variables and PA in the urbanization and gender subgroups. The overall model explained 38.9% of the variance in PA. Fit indices indicated that the structural model of SCT was good: root mean square error of approximation (RMSEA) = 0.047, (root mean square residual) RMR = 0.028, goodness of fit index (GFI) = 0.974, adjusted goodness of fit index (AGFI) = 0.960, Tucker-Lewis coefficient (TLI) = 0.971, and comparative fit index (CFI) = 0.978. Regarding the subgroup analysis, social support (critical ratios [CRs] = 2.118; p < 0.001) had a more substantial impact on the PA of adolescents in suburban areas than that in urban areas, whereas self-regulation (CRs = -2.896, p < 0.001) had a more substantial impact on the PA of adolescents in urban areas than in suburban areas. The results indicate that the SCT model predicts the PA of Chinese adolescents substantially. An SCT model could apply over a range of subgroups to predict the PA behavior and should be considered comprehensively when designing interventions. These findings would benefit PA among the Chinese adolescents, especially across genders and urbanization.

Theoretical Explanation of Upper Limb Functional Exercise and Its Maintenance in Postoperative Patients With Breast Cancer

Background: Upper limb functional exercise (ULFE) has a positive effect on promoting the rehabilitation of upper limb function. However, little is known, about what drives postoperative patients to engage in and even maintain the advised exercises. This study integrated the health action process approach (HAPA) and the theory of planned behavior theory (TPB) to investigate the psychosocial determinants on the initiation and maintenance of ULFE in breast cancer patients. In addition, this study also tests key hypotheses relating to reasoned and implicit pathways to ULFE and its maintenance among postoperative patients with breast cancer. Methods: Purposive sampling was used to recruit patients from two breast cancer wards in a provincial hospital in Jiangsu, China. Patients (N = 430) completed self-reported questionnaire about constructs from integrated theories concerning ULFE at an initial time point (T1): task self-efficacy, positive outcome expectations, negative outcome expectations, risk perception, attitude behavior, subjective norm, perceived behavioral control, behavioral intention, and ULFE-in hospital (ULFE-IH). Three months later (T2), patients self-reported: maintenance self-efficacy, action planning, coping planning, recovery self-efficacy, and ULFE-maintenance (ULFE-M). Results: The model has a good fit (GoF = 0.48). For behavioral intention of ULFE, subjective norm (β = 0.35) and perceived behavioral control (β = 0.61) were positively directly related to behavioral intention. Regarding the initiation of ULFE, perceived behavioral control (β = 0.47) and behavioral intention (β = 0.42) had a direct positive relation to ULFE-IH. In the maintenance of ULFE, action planning (β = 0.30), coping planning (β = 0.21), maintenance self-efficacy (β = 0.32), and recovery self-efficacy (β = 0.09) all had significant positive relation on ULFE-M. In addition, maintenance self-efficacy had a significant positive association on action planning (β = 0.80), coping planning (β = 0.74), and recovery self-efficacy (β = 0.67). Coping planning was significantly predicted by behavioral intention (β = 0.07). Additionally, behavioral intention is a mediator of subjective norm (β = 0.14) and perceived behavioral control (β = 0.25) to ULFE-IH. Action planning, coping planning, and recovery self-efficacy are mediators of maintaining self-efficacy to ULFE-M (β = 0.46). Conclusions: This study presents the first attempt to integrate the health behavior model in ULFE in postoperative patients with breast cancer. The study has shown that the HAPA-TPB integrated model has good applicability and effectiveness to explain and predict ULFE initiation and maintenance. Future work can be considered to develop appropriate intervention strategies based on this integrated behavioral theory.

Exercise adherence in breast cancer patients: A cross-sectional questionnaire survey

To describe social support, self-efficacy, and exercise adherence and to measure the correlations among these factors in postoperative breast cancer patients in Southwest China.Social support, self-efficacy, and exercise adherence are interacting factors that contribute to physical and mental health and quality of life. Little is known about the status of these factors in Southwest China, and little research has explored the relationships among them.Using a stratified sampling method, we selected patients who underwent modified radical mastectomy in 20 secondary and tertiary comprehensive hospitals in Southwest China. A descriptive cross-sectional study was conducted. Questionnaires were given to 632 breast cancer patients who met the inclusion and exclusion criteria (from August 2018 to February 2019). The questionnaire included the following 4 sections: general information, perceived social support scale, strategies used by people to promote health, and postoperative functional exercise adherence scale. Structural equation modeling was used to evaluate the hypothesized relationships among social support, self-efficacy, and exercise adherence.The level of social support of postoperative patients with breast cancer in Southwest China was high (63.43 ± 9.25); however, levels of self-efficacy (95.00 ± 18.81) and exercise adherence (49.07 ± 10.57) were moderate. Higher social support correlated with higher exercise adherence (r = 0.526, P < .01). Higher self-efficacy was also correlated with higher exercise adherence (r = 0.427, P < .01). In-home support, out-of-home support, and self-efficacy had direct positive effects on exercise adherence (β = 0.37, P < .01; β = 0.23, P < .01; and β = 0.32, P < .01, respectively); in-home support indirectly affected exercise adherence through self-efficacy (β = 0.58, P < .01).Social support and self-efficacy correlated highly with exercise adherence. It is recommended that attention be paid to the development of self-efficacy and social support during postoperative rehabilitation to improve the exercise adherence of postoperative breast cancer patients.

Disentangling Efficacy and Expectations: A Prospective, Cross-lagged Panel Study of Cancer Survivors' Physical Activity

Background

Despite demonstrated utility of Bandura's social cognitive theory for increasing physical activity among cancer survivors, the validity of the originally hypothesized relationships among self-efficacy, outcome expectations, and physical activity behavior continues to be debated.

Purpose

To explore the temporal ordering of outcome expectations and self-efficacy as they relate to moderate-to-vigorous physical activity behavior.

Methods

Longitudinal data from cancer survivors (N = 1,009) recently completing treatment were used to fit six cross-lagged panel models, including one parent model, one model representing originally hypothesized variable relationships, and four alternative models. All models contained covariates and used full information maximum likelihood and weighted least squares mean and variance adjusted estimation. Tests of equal fit between the parent model and alternative models were conducted.

Results

The model depicting Bandura's originally hypothesized relationships showed no statistically significant relationship between outcome expectations and physical activity (p = .18), and was a worse fit to the data, compared with the parent model [Χ2 (1) = 5.92, p = .01]. An alternative model showed evidence of a reciprocal relationship between self-efficacy and outcome expectations, and was statistically equivalent to the parent model [Χ2(1) = 2.01, p = .16].

Conclusions

This study provides evidence against Bandura's theoretical assertions that (a) self-efficacy causes outcome expectations and not vice versa, and (b) outcome expectation has a direct effect on physical activity. Replication within population subgroups and for other health behaviors will determine whether the social cognitive theory needs modification. Future trials should test whether differential construct ordering results in clinically meaningful differences in physical activity behavior change.

Effects of TPX2 gene on radiotherapy sensitization in breast cancer stem cells

The present study explored the link between the targeting protein for Xenopus kinesin-like protein 2 (TPX2) gene and breast tumor stem cells in order to screen novel radiosensitizers. Expression of TPX2 protein and gene in breast cancer cells was analyzed by western blot analysis and RT-PCR. Three kinds of broad-spectrum sensitizers were selected and their effects on radiotherapy were analyzed by immunohistochemistry in breast tumor stem cells. TPX2 gene and protein were expressed in breast tumor cells and increased gradually along with the expression of cancer cell differentiation; 25 mg/l lovastatin showed best radio-sensitizing effects on breast cancer cells. Furthermore, immunohistochemical results showed that the positive rate of breast cancer cells processed by 25 mg/l lovastatin were significantly decreased. In conclusion, TPX2 gene is closely related to the development of breast cancer stem cells. Moreover, the sensitizing effects of lovastatin on breast tumor stem cells are the result of its influence on the TPX2 gene.

Why are adult women physically active? A systematic review of prospective cohort studies to identify intrapersonal, social environmental and physical environmental determinants

OBJECTIVE

This study aims to systematically review available evidence from prospective cohort studies to identify intrapersonal, social environmental and physical environmental determinants of moderate-to-vigorous intensity physical activity (MVPA) among working-age women.

METHODS

Six databases were searched to identify all prospective cohort studies that reported on intrapersonal (e.g. self-efficacy and socioeconomic status [SES]), social (e.g. crime, area SES and social support) and/or physical (e.g. weather, work and recreation) environmental determinants of MVPA in working-age (mean 18-65 years) women. A qualitative synthesis including harvest plots was completed.

PROSPERO

CRD42014009750 RESULTS: Searching identified 17,387 potential articles; 97 were used in the analysis. The majority (n = 87 studies) reported on ≥1 intrapersonal determinant. Very few (n = 34) examined factors in the social or physical environments, and none looked at social policy. Positive and consistent influencers included higher self-efficacy (n = 18/23), self-rated health (n = 8/13) and intentions (n = 10/11) and perceived behavioural control (n = 5/7) to be physically active. Having children in the household was negatively related to MVPA (n = 9/15).

CONCLUSIONS

Physical activity intervention studies should consider a woman's level of self-efficacy and perceived behavioural control to be physically active. Additional studies are needed on the impact of children in the household, having a spouse/partner and using group goal setting. More evidence is needed to evaluate the impact of environmental factors.

Social cognitive theory and physical activity: a systematic review and meta-analysis

This review investigated three research questions (i) What is the utility of social cognitive theory (SCT) to explain physical activity (PA)?; (ii) Is the effectiveness of SCT moderated by sample or methodological characteristics? and (iii) What is the frequency of significant associations between the core SCT constructs and PA? Ten electronic databases were searched with no date or sample restrictions. Forty-four studies were retrieved containing 55 SCT models of PA. Methodological quality was assessed using a standardized tool. A random-effects meta-analysis revealed that SCT accounted for 31% of the variance in PA. However, methodological quality was mostly poor for these models. Methodological quality and sample age moderated the PA effect size, with increases in both associated with greater variance explained. Although self-efficacy and goals were consistently associated with PA, outcome expectations and socio-structural factors were not. This review determined that SCT is a useful framework to explain PA behaviour. Higher quality models explained more PA variance, but overall methodological quality was poor. As such, high-quality studies examining the utility of SCT to explain PA are warranted.

Effects of physical activity on the quality of life in taiwanese lung cancer patients receiving active treatment or off treatment

BACKGROUND

Lung cancer is the leading cause of cancer deaths in the world. Physical activity can enhance the quality of life (QOL) of cancer patients. However, the best timing according to cancer therapy to implement physical activities for lung cancer patients is not yet clear.

OBJECTIVE

The purpose of our study was to examine the relationship between physical activity and QOL in different cancer-treatment periods among lung cancer patients.

METHODS

This study used a cross-sectional design. Instruments included the Functional Assessment of Cancer Therapy-Lung Cancer and the Godin Leisure-Time Exercise Questionnaire.

RESULTS

In total, 185 patients participated in this study, and results showed that only 25% of participants achieved recommended physical-activity guidelines. Of all patients, 50.3% engaged in light physical activity, such as walking. During active-treatment periods, lung cancer patients who engaged in light or moderate activity had significantly higher scores for the overall QOL than did those who were completely sedentary. However, during off-treatment periods, there were no significant differences in the overall QOL with different activity levels.

CONCLUSIONS

The QOL may be improved by engaging in light or moderate physical activity during active-treatment periods among lung cancer patients.

IMPLICATIONS FOR PRACTICE

It is important for healthcare providers to consider promoting physical activity based on different cancer treatments to improve the QOL of Taiwanese lung cancer patients.

Exercise behaviors in breast cancer survivors in Taiwan

BACKGROUND

Although exercise is a recommended rehabilitation intervention for many breast cancer survivors, exercise activity after cancer treatment is rarely reported in this patient group in Taiwan.

OBJECTIVE

The objectives of this study were to analyze trends in exercise activity in breast cancer survivors in Taiwan.

INTERVENTIONS/METHODS

This prospective, longitudinal study with repeated-measures design used standardized instruments to measure trends in exercise activity but performed no treatments or interventions.

RESULTS

Of the 196 breast cancer survivors who participated in this study, 39% regularly engaged in light-to-moderate intensity exercise for approximately 15 minutes per day throughout the 6-month period of the study. Of these, 40% indicated that their exercise stage had increased, and only 13% indicated that their exercise stage had decreased. The most common exercise activities were walking, hiking, calisthenics, folk dancing, chi kung and tai chi. Although most women reported that exercise made them feel better both physically and emotionally, most said that they exercised mainly for health maintenance reasons.

CONCLUSIONS

Frequency, duration, and intensity of exercise significantly increased during the 6-month study but did not reach the recommended levels. Most women believed that physical activity enhanced their recovery from cancer treatment.

IMPLICATIONS FOR PRACTICE

When planning patient education interventions for breast cancer survivors, healthcare professionals should consider not only the role of exercise in breast cancer recovery, but also trends in exercise behavior among breast cancer survivors. The findings of this study contribute to the literature on exercise trends in breast cancer survivors.

Perceived benefits and barriers to exercise for recently treated patients with multiple myeloma: a qualitative study

BACKGROUND

Understanding the physical activity experiences of patients with multiple myeloma (MM) is essential to inform the development of evidence-based interventions and to quantify the benefits of physical activity. The aim of this study was to gain an in-depth understanding of the physical activity experiences and perceived benefits and barriers to physical activity for patients with MM.

METHODS

This was a qualitative study that used a grounded theory approach. Semi-structured interviews were conducted in Victoria, Australia by telephone from December 2011-February 2012 with patients who had been treated for MM within the preceding 2-12 months. Interviews were transcribed and analysed using the constant comparison coding method to reduce the data to themes. Gender differences and differences between treatment groups were explored.

RESULTS

Twenty-four interviews were completed. The sample comprised 13 females (54%), with a mean age of 62 years (SD = 8.8). Sixteen (67%) participants had received an autologous stem cell transplant (ASCT). All participants currently engaged in a range of light to moderate intensity physical activity; walking and gardening were the most common activities. Recovery from the symptoms of MM and side effects of therapy, psychological benefits, social factors and enjoyment were important benefits of physical activity. Barriers to physical activity predominately related to the symptoms of MM and side effects of therapy, including pain, fatigue, and fear of infection. Low self- motivation was also a barrier. Women participated in a more diverse range of physical activities than men and there were gender differences in preferred type of physical activity. Women were more likely to report psychological and social benefits; whereas men reported physical activity as a way to keep busy and self-motivation was a barrier. Patients treated with an ASCT more often reported affective benefits of participation in physical activity and fatigue as a barrier. Patients treated with other therapies (e.g., chemotherapy, radiotherapy) were more likely to report pain as a barrier.

CONCLUSIONS

Patients with MM experience debilitating effects of their condition and therapy, which influences their level and intensity of physical activity participation. Physical activity programs should be individualised; take into consideration gender differences and the impact of different types of therapy on physical activity; and focus on meeting the psychological, coping and recovery needs of patients.