scholarly journals Effect of self-regulatory behaviour change techniques and predictors of physical activity maintenance in cancer survivors: a 12-month follow-up of the Phys-Can RCT

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Anne-Sophie Mazzoni ◽  
Hannah L. Brooke ◽  
Sveinung Berntsen ◽  
Karin Nordin ◽  
Ingrid Demmelmaier

Abstract Background Current knowledge about the promotion of long-term physical activity (PA) maintenance in cancer survivors is limited. The aims of this study were to 1) determine the effect of self-regulatory BCTs on long-term PA maintenance, and 2) identify predictors of long-term PA maintenance in cancer survivors 12 months after participating in a six-month exercise intervention during cancer treatment. Methods In a multicentre study with a 2 × 2 factorial design, the Phys-Can RCT, 577 participants with curable breast, colorectal or prostate cancer and starting their cancer treatment, were randomized to high intensity exercise with or without self-regulatory behaviour change techniques (BCTs; e.g. goal-setting and self-monitoring) or low-to-moderate intensity exercise with or without self-regulatory BCTs. Participants’ level of PA was assessed at the end of the exercise intervention and 12 months later (i.e. 12-month follow-up), using a PA monitor and a PA diary. Participants were categorized as either maintainers (change in minutes/week of aerobic PA ≥ 0 and/or change in number of sessions/week of resistance training ≥0) or non-maintainers. Data on potential predictors were collected at baseline and at the end of the exercise intervention. Multiple logistic regression analyses were performed to answer both research questions. Results A total of 301 participants (52%) completed the data assessments. A main effect of BCTs on PA maintenance was found (OR = 1.80, 95%CI [1.05–3.08]) at 12-month follow-up. Participants reporting higher health-related quality-of-life (HRQoL) (OR = 1.03, 95%CI [1.00–1.06] and higher exercise motivation (OR = 1.02, 95%CI [1.00–1.04]) at baseline were more likely to maintain PA levels at 12-month follow-up. Participants with higher exercise expectations (OR = 0.88, 95%CI [0.78–0.99]) and a history of tobacco use at baseline (OR = 0.43, 95%CI [0.21–0.86]) were less likely to maintain PA levels at 12-month follow-up. Finally, participants with greater BMI increases over the course of the exercise intervention (OR = 0.63, 95%CI [0.44–0.90]) were less likely to maintain their PA levels at 12-month follow-up. Conclusions Self-regulatory BCTs improved PA maintenance at 12-month follow-up and can be recommended to cancer survivors for long-term PA maintenance. Such support should be considered especially for patients with low HRQoL, low exercise motivation, high exercise expectations or with a history of tobacco use at the start of their cancer treatment, as well as for those gaining weight during their treatment. However, more experimental studies are needed to investigate the efficacy of individual or combinations of BCTs in broader clinical populations. Trial registration NCT02473003 (10/10/2014).

2020 ◽  
Author(s):  
Lillemor Amanda Nyberg ◽  
Carl Johan Sundberg ◽  
Per Wändell ◽  
Jan Kowalski ◽  
Mai-Lis Hellenius

Abstract Background: Low physical performance is a predictor of morbidity and mortality. This study looks at long-term effects of an exercise intervention on maximal step-up height (MSH) in individuals with low physical function. Furthermore, we studied correlates to changes in MSH. Methods: Female patients (n=101), mean(SD) age of 52(11) years, were recruited for a 3-month group exercise intervention including 2-3 sessions/week of mixed aerobic fitness and strength training. MSH, weight, body mass index (BMI), waist circumference, maximal oxygen consumption (VO₂-max), self-reported health (SF-36) and physical activity (PA) were measured at baseline (T0), after 3 months (T1) and after 14-30(mean 22) months (T2). Relationships between changes in MSH (cm) and age, baseline MSH, time to follow-up, changes in anthropometric measurements, VO₂-max, SF-36 and PA were studied with regression analyses. Results: MSH, significantly, increased from T0 to T1, 27.2(5.7) to 29.0(5.5) cm and decreased to 25.2(5.5) cm at T2. Time to follow-up (B=-0.42, p<0.001) and change in BMI (B=-0.29, p=0.012) correlated significantly to changes in MSH. Waist circumference, VO₂-max, PF and exercise/physical activity levels were significantly improved at T2, while BMI did not change. In a univariate logistic regression model, maintenance of MSH correlated to the extent of mixed training (OR 3.33, 95% CI 1.25-8.89). In a multivariate logistic regression model adjusted for important factors the correlation was not significant. However, MSH was significantly higher in individuals participating in 2-3 session per week compared to one session. Conclusions: A 3-month group exercise intervention increased MSH, improved fitness, decreased risk in female patients with elevated cardio-metabolic risk. After an average of 22 months MSH was reduced while positive effects remained for waist circumference, VO₂-max, physical function and physical activity. However, regular group exercise 2-3 times per week with mixed aerobic fitness and strength training was associated with maintenance of MSH in a subgroup of patients. We suggest that such an intervention including regular support from healthcare professionals is a successful approach for maintaining improved leg-muscle strength among primary care patients.


2019 ◽  
Vol 16 (9) ◽  
pp. 785-791
Author(s):  
Heather J. Leach ◽  
Katie B. Potter ◽  
Mary C. Hidde

Background: To maintain increases in physical activity (PA), interventions that implement group dynamics principles and strategies with the intent of enhancing group cohesion may be advantageous. This study examined group cohesion and PA following a group dynamics-based PA intervention among breast cancer survivors. Methods: The study was designed as a pilot randomized controlled trial comparing an 8-week group dynamics-based intervention with an individually supervised intervention. Group cohesion was measured by the Physical Activity Group Environment Questionnaire, and PA was measured at baseline, post-intervention, and 3-month follow-up using a self-report questionnaire and pedometer. Results: Group cohesion levels were high following the intervention and positively associated with PA at 3-month follow-up (ranger = .182–.555). At 3-month follow-up, 91.7% of participants in the group-dynamics-based intervention (n = 12) were classified as moderately active or greater, compared with 54.5% in the individually supervised intervention (n = 11). Conclusions: These results suggest that, for breast cancer survivors, peer support and fostering group cohesion as part of an exercise program may help to support PA following the completion of a structured intervention. A larger trial with longer follow-up is needed to establish comparative efficacy for a group-dynamics-based exercise intervention to enhance long-term PA adherence in breast cancer survivors.


Author(s):  
Lillemor A. Nyberg ◽  
Carl Johan Sundberg ◽  
Per Wändell ◽  
Jan Kowalski ◽  
Mai-Lis Hellénius

Abstract Background Low physical performance is a predictor of morbidity and mortality. This study looks at long-term effects of an exercise intervention on maximal step-up height (MSH) in individuals with low physical function. Factors associated with changes in MSH was studied. Methods Female patients (n = 101), mean (SD) age of 52 (11) years, were recruited for a 3-month group exercise intervention including 2–3 sessions/week of mixed aerobic fitness and strength training. MSH, weight, body mass index (BMI), waist circumference, maximal oxygen consumption (VO2-max), self-reported health (SF-36) and physical activity (PA) were measured at baseline (T0), after 3 months (T1) and after 14–30 (mean 22) months (T2). Relationships between changes in MSH (cm) and age, baseline MSH, time to follow-up, changes in anthropometric measurements, VO2-max, SF-36 and PA were studied with regression analyses. Results MSH, significantly, increased from T0 to T1, 27.2 (5.7) to 29.0 (5.5) cm and decreased to 25.2 (5.5) cm at T2. Time to follow-up (B = − 0.42, p < 0.001) and change in BMI (B = − 0.29, p = 0.012) correlated significantly to changes in MSH. Waist circumference, VO2-max, PF and exercise/physical activity levels were significantly improved at T2, while BMI did not change. In a univariate logistic regression model, maintenance of MSH correlated to the extent of mixed training (OR 3.33, 95% CI 1.25–8.89). In a multivariate logistic regression model adjusted for important factors the correlation was not significant. However, MSH was significantly higher in individuals participating in 2–3 session per week compared to one session. Conclusions A 3-month group exercise intervention increased MSH, improved fitness, decreased risk in female patients with elevated cardio-metabolic risk. After an average of 22 months MSH was reduced while positive effects remained for waist circumference, VO2-max, physical function and physical activity. However, regular group exercise 2–3 times per week with mixed aerobic fitness and strength training was associated with maintenance of MSH in a subgroup of patients. We suggest that such an intervention including regular support from healthcare professionals is a successful approach for maintaining improved leg-muscle strength among primary care patients. Trial registration ISRCTN21220201 September 18, 2019, retrospectively registered.


Nutrients ◽  
2021 ◽  
Vol 13 (12) ◽  
pp. 4460
Author(s):  
Cindy L. Carmack ◽  
Nathan H. Parker ◽  
Wendy Demark-Wahnefried ◽  
Laura Shely ◽  
George Baum ◽  
...  

Spouses offer a primary source of support and may provide critical assistance for behavior change. A diet-exercise intervention previously found efficacious in improving cancer survivors’ lifestyle behaviors was adapted to utilize a couples-based approach. The aims were to test the feasibility of this couples-based (CB) intervention and compare its efficacy to the same program delivered to the survivor-only (SO). Twenty-two survivor-spouse couples completed baseline assessments and were randomized to the CB or SO interventions. The study surpassed feasibility benchmarks; 91% of survivors and 86% of spouses completed a 6-month follow-up. Survivors and spouses attended 94% and 91% of sessions, respectively. The SO survivors showed significant improvements on the 30-s chair stand and arm curl tests, weight, and fruit and vegetable (F and V) consumption. The CB survivors showed significant improvements on the 6-min walk and 2-min step tests, body weight, and fat and F and V consumption. Improvement in the 30-s chair stand and arm curl tests was significantly better for SO survivors. The SO spouses showed no significant changes in outcome measures, but the CB spouses showed significant improvements in moderate-to-strenuous physical activity, weight, and fat and F and V consumption. Weight loss was significantly greater in CB spouses compared to SO spouses. Findings demonstrate feasibility, warranting further investigation of CB approaches to promote lifestyle change among cancer survivors and spouses.


Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 70-70
Author(s):  
Jeffrey R. Andolina ◽  
Kimberley Dilley

Abstract Abstract 70 Background: Cardiac toxicity secondary to anthracyclines is a significant problem in childhood cancer survivors, and the Children's Oncology Group (COG) has developed a recommended screening protocol for echocardiograms based on age at diagnosis, cumulative anthracycline dose, and chest radiation. The objective of this study was to assess the yield of screening and risk factors for cardiac toxicity in long-term survivors. Methods: A retrospective medical record review was performed for all patients seen in a single institution long-term survivor clinic from 2000 through 2007. Patients eligible for analysis included any patient previously treated with anthracyclines and/or chest radiation; patients with prior cardiac disease were excluded. Results: 370 patients were eligible for analysis; 206 (56%) patients were male, 236 (64%) were white, and 197 (53%) were ≤5 years of age at diagnosis. The most common diagnoses included acute lymphoblastic anemia in 152 (41%) patients and Wilms' tumor in 44 (12%). 360 (97%) patients received anthracyclines, and the median dose received was 190 mg/m2. Fifty (14%) patients received radiation to the chest only while an additional 64 (17%) patients received total body irradiation. Overall, 308/370 (83%) patients had received at least one screening echocardiogram with a mean time from diagnosis to latest follow-up of 9.3 years. Younger patients at diagnosis were more likely to be screened during follow-up (p=0.007). All other measured factors were similar between those screened and not screened, including diagnosis, sex, BMI, anthracycline dose, and having received radiation. Of all patients receiving a screening echocardiogram, 24/308 (8%) patients had an abnormal echocardiogram defined as shortening fraction (SF) <28%. By the end of the study period, 9 patients had been placed on cardiac medications for the treatment of cardiac dysfunction identified through screening. Anthracycline dose was associated with a future abnormal echocardiogram; odds ratio (OR) of ever having SF<28% was 9.2 (95% CI: 3.1–27.6) for anthracycline dose ≥250 mg/m2. For all patients who had received an echocardiogram and received an anthracycline dose ≥250 mg/m2, 20/122 (16%) had a SF<28%; for patients who received an anthracycline dose <250 mg/m2, only 4/185 (2%) had a SF<28% (p<0.001). Further, only 1 patient who received a dose <175 mg/m2 had a SF<28%. Age, sex, chest radiation, type of anthracycline, history of relapse, and history of stem cell transplant were not associated with an abnormal echocardiogram in univariate analyses. Body mass index (BMI) was calculated from available weight and height data at latest follow-up visit. BMI category was significantly associated with having an abnormal echocardiogram, as currently underweight patients (BMI <5th%) were more likely to have a SF<28% than their heavier counterparts (p=0.001). For currently underweight patients, 4/12 (33%) had an abnormal echocardiogram with a SF<28%; for all patients in a non-underweight category, only 15/216 (7%) had a SF<28%. This result was significant with an OR of 6.7 (95% CI: 1.8–24.8). Conclusions: We found anthracycline toxicity to be dependent on dose although not on age, with a significantly increased risk with doses ≥250 mg/m2. We also describe a novel association between underweight status and anthracycline-induced cardiac toxicity. Eighty-three percent of patients at our institution are being screened by echocardiography. Our data support the current screening recommendations of the Children's Oncology Group (COG), as 24 patients were identified with decreased cardiac function. Echocardiography is a relatively inexpensive tool to identify patients with late-onset cardiac toxicity and may positively impact the medical care for the growing population of childhood cancer survivors. Disclosures: No relevant conflicts of interest to declare.


2019 ◽  
Author(s):  
Lillemor Amanda Nyberg ◽  
Carl Johan Sundberg ◽  
Per Wändell ◽  
Jan Kowalski ◽  
Mai-Lis Hellenius

Abstract Background: Low physical performance is a predictor of morbidity and mortality. This study looks at long-term effects of an exercise intervention on maximal step-up height (MSH) in individuals with low physical function. Furthermore, we studied correlates to changes in MSH. Methods: Female patients (n = 101), mean (SD) age of 52 (11) years, were recruited for a 3-month group exercise intervention including 2-3 sessions/week of mixed aerobic fitness and strength training. MSH, weight, body mass index (BMI), waist circumference, maximal oxygen consumption (VO 2 -max), self-reported health (SF-36) and physical activity (PA) were measured at baseline (T0), after 3 months (T1) and after 14-30 (mean 22) months (T2). Relationships between changes in MSH (cm) and age, baseline MSH, time to follow-up, changes in anthropometric measurements, VO 2 -max, SF-36 and PA were studied with regression analyses. Results: MSH, significantly, increased from T0 to T1, 27.2 (5.7) to 29.0 (5.5) cm and decreased to 25.2 (5.5) cm at T2. Time to follow-up (B = -0.42, p < 0.001) and change in BMI (B = -0.29, p = 0.012) correlated significantly to changes in MSH. Waist circumference, VO 2 -max, PF and exercise/physical activity levels were significantly improved at T2, while BMI did not change. In a univariate logistic regression model, maintenance of MSH correlated to the extent of mixed training (OR 3.33, 95% CI 1.25-8.89). In a multivariate logistic regression model adjusted for important factors the correlation was not significant. However, MSH was significantly higher in individuals participating in 2-3 session per week compared to one session. Conclusions: A 3-month group exercise intervention increased MSH, improved fitness, decreased risk in female patients with elevated cardio-metabolic risk. After an average of 22 months MSH was reduced while positive effects remained for waist circumference, VO 2 -max, physical function and physical activity. However, regular group exercise 2-3 times per week with mixed aerobic fitness and strength training was associated with maintenance of MSH in a subgroup of patients. We suggest that such an intervention including regular support from healthcare professionals is a successful approach for maintaining improved leg-muscle strength among primary care patients.


Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Michael Fang ◽  
Natalie R Daya ◽  
Morgan Grams ◽  
Elizabeth Selvin

Background: Prolonged television watching is associated with numerous health problems. However, its long-term impact and its joint effect with other risk factors on the development of diabetes remains unclear. Methods: We conducted a prospective cohort analysis of television watching and incident diabetes using data from the Atherosclerosis Risk in Communities (ARIC) Study. We used Cox regression models and considered television watching independently and jointly with physical activity, weight status, and family history of diabetes. At baseline (1987-1989), participants self-reported frequency of television watching, leisure-time physical activity, and parental history of diabetes. Body mass index was calculated from measured weight and height and converted into weight status categories. Incident diabetes was defined as having a fasting glucose >126 mg/dL or non-fasting glucose >200 mg/dL, or self-report of a diagnosis of diabetes or diabetes medication with follow-up to 2017. Results: There were 13,127 participants without diabetes at baseline (mean age, 54, 23% black, 56% female). During 21 years of follow-up, there were 4,280 incident cases of diabetes. Compared to those who watched low levels of television, those who watched medium and high levels were more likely to develop diabetes (HRs 1.13 and 1.51, Figure ). Other risk factors combined with television watching jointly increased the risk of incident diabetes. That is, even within categories of physical activity, weight status, and family history, television watching was an independent risk factor for diabetes. Conclusion: Currently, there is substantial debate regarding the health effects of screen-time. Our study suggests prolonged television watching confers substantial long-term risk for diabetes, even in the setting of other major risk factors. Decreasing exposure to television and other screens may be an important target for diabetes prevention.


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