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Correlates of resistance training in post-treatment breast cancer survivors
Abstract
To explore demographic, health, social-cognitive and behavioural correlates of resistance training among post-treatment breast cancer survivors.
A sample of 330 post-treatment breast cancer survivors recruited from across Australia completed a mailed questionnaire. A multivariate logistical regression model was used to test associations between independent variables and meeting the resistance training guidelines.
Less than a quarter of the participants were meeting the resistance training guidelines of at least two sessions of resistance training per week. Higher task self-efficacy for resistance training (p < 0.01) and greater goal-setting behaviour (p < 0.05) were identified as significant predictors of meeting the resistance training guidelines, with a one unit increase in task self-efficacy and goal setting, increasing the odds of meeting the resistance training guidelines by a factor of approximately 1.2 (odds ratio (OR) task self-efficacy = 1.23, 95 % confidence interval (CI) = 1.05-1.43; goal-setting OR = 1.20, 95 % CI = 1.04-1.38). No other variables significantly predicted meeting the resistance training guidelines in the multivariate analysis.
Strategies targeting task self-efficacy and goal-setting behaviours are likely to be important intervention components in resistance training interventions for breast cancer survivors.
The findings of this study will be useful for informing the development of evidence-based interventions aiming to promote resistance training among this group.
... The first study to estimate the prevalence of strength exercise found that only 26 % of colorectal cancer survivors were meeting the guideline [7]. Similar estimates were reported for breast cancer survivors (24 %) [8] and a mixed sample of breast, prostate, and colorectal cancer survivors (23 %) [9]. Moreover, the few studies that have examined the correlates of strength exercise in cancer survivors have reported that survivors who were younger, highly educated, healthier, nonsmokers, and not obese were more likely to do strength exercise [7][8][9]. ...
... Similar estimates were reported for breast cancer survivors (24 %) [8] and a mixed sample of breast, prostate, and colorectal cancer survivors (23 %) [9]. Moreover, the few studies that have examined the correlates of strength exercise in cancer survivors have reported that survivors who were younger, highly educated, healthier, nonsmokers, and not obese were more likely to do strength exercise [7][8][9]. Survivors were especially more likely to do strength exercise if they were also more motivated, had Electronic supplementary material The online version of this article (doi:10.1007/s11764-016-0540-9) contains supplementary material, which is available to authorized users. strong exercise self-efficacy, and developed a detailed plan for their exercise [8,9]. ...
... Survivors were especially more likely to do strength exercise if they were also more motivated, had Electronic supplementary material The online version of this article (doi:10.1007/s11764-016-0540-9) contains supplementary material, which is available to authorized users. strong exercise self-efficacy, and developed a detailed plan for their exercise [8,9]. ...
Background:
Strength exercise improves many health outcomes in cancer survivors but the prevalence and correlates of strength exercise have not been well-described. Moreover, no study has examined the critical intention-behavior gap for exercise in cancer survivors.
Purpose:
The aims of this study are to quantify the intention-behavior gap for strength exercise in hematologic cancer survivors (HCS) and examine correlates of both intention formation and translation using the multi-process action control framework (M-PAC).
Methods:
A random sample of 2100 HCS in Alberta, Canada, were mailed a survey assessing strength exercise behavior, the M-PAC, and demographic/medical variables. Separate logistic regressions were used to analyze the relationships between the correlates and intention formation and translation.
Results:
Surveys were completed by 606 HCS with 58 % (n = 353) intending to do strength exercise. HCS who were not retired (OR = 1.56, p = 0.001), were highly educated (OR = 1.32, p = 0.001), and had a favorable attitude (OR = 1.56, p < 0.001), descriptive norm (OR = 1.38, p = 0.006), injunctive norm (OR = 1.45, p = 0.004), and perceived control (OR = 1.38, p < 0.001), were more likely to form an exercise intention. Of those with an exercise intention, 51 % (n = 181) reported regular strength exercise. HCS with a detailed plan (OR = 1.86, p < 0.001), favorable attitude (OR = 1.68, p = 0.001), sense of obligation (OR = 1.38, p = 0.010), and self-regulated their affinity for competing activities (OR = 1.35, p = 0.012), were more likely to translate their intention into behavior.
Conclusion:
Just over half of HCS intended to do strength exercise and only half of intenders translated that intention into behavior.
Implications for cancer survivors:
Interventions targeting both intention formation and translation may provide the best approach for increasing strength exercise in HCS.
... Based on this evidence, and similar to other exercise guidelines, the American College of Sports Medicine [4] recommends that cancer survivors should perform both aerobic and strength exercise. Despite this recommendation, evidence suggests that few cancer survivors engage in aerobic (25-35 %) [11,12] or strength (20-25 %) exercise [13,14] and even fewer meet both exercise guidelines (10-20 %) [11,15]. Similar to research in other populations, previous studies in cancer survivors have separately examined the correlates of aerobic [16] and strength exercise [13,14]. ...
... Despite this recommendation, evidence suggests that few cancer survivors engage in aerobic (25-35 %) [11,12] or strength (20-25 %) exercise [13,14] and even fewer meet both exercise guidelines (10-20 %) [11,15]. Similar to research in other populations, previous studies in cancer survivors have separately examined the correlates of aerobic [16] and strength exercise [13,14]. While informative, this approach does not provide a comprehensive understanding of the correlates of the various exercise guidelines. ...
... Similarly, Forbes et al. [27] reported that breast, prostate, and colorectal cancer survivors who were younger, more educated, higher income, in better health, had fewer comorbidities, and a healthy body weight were more likely to meet the strength exercise guidelines. Conversely, Short et al. [14] reported no associations between these variables and meeting strength exercise guidelines in breast cancer survivors; however, the sample had volunteered for a randomized controlled trial designed to increase exercise levels. The inconsistency in these results may be due to the different cancer survivor groups studied (e.g., age, gender, treatment, and time since diagnosis) but they also may be due to the different approach to categorizing exercise guidelines and analyzing the data. ...
Purpose:
Almost all exercise guidelines recommend both aerobic and strength exercise, however, few studies have simultaneously examined the correlates of meeting both exercise guidelines. Here, we propose a new paradigm that calls on researchers to examine not only the correlates of meeting the various exercise guidelines versus no guideline but also the correlates of meeting the combined guidelines versus one guideline and meeting one guideline versus the other guideline.
Methods:
A random sample of 621 gynecologic cancer survivors located in Alberta, Canada, completed a mailed questionnaire.
Results:
A multivariate multinomial logistic regression analysis indicated that (a) meeting only the aerobic exercise guideline compared to neither guideline was associated with younger age, social drinking, healthy weight, better general health, and no comorbidities; (b) meeting only the strength exercise guideline compared to neither guideline was associated with social drinking and being healthy weight; (c) meeting the combined exercise guideline compared to neither guideline was associated with social drinking, being healthy weight, and better general health; (d) meeting the aerobic guideline only compared to the strength guideline only was associated with younger age and better general health; and (e) few correlates distinguished between meeting the combined guidelines compared to a single guideline.
Conclusions:
Demographic and health variables are associated with meeting the various exercise guidelines versus no guideline but they are not associated with meeting the combined exercise guidelines versus a single guideline or meeting one guideline versus the other guideline. Application of this new paradigm to cancer survivors is encouraged.
... In addition, the study found that colorectal cancer survivors were more likely to meet the guidelines if they were male, married, in better health, and not obese. Short et al. (2014) reported on the strength exercise behavior of 330 breast cancer survivors and found that less than 25% were meeting the strength exercise guidelines. Breast cancer survivors who had higher outcome expectan-cies, task self-efficacy, barrier self-efficacy, behavioral capability, social support, and goal setting were more likely to be meeting the strength exercise guidelines. ...
... Based on the studies by Speed-Andrews et al. (2013) and Short et al. (2014), the authors hypothesized that the majority of survivors in Nova Scotia would not be meeting the strength exercise guidelines. Based on the evidence of benefit, the authors hypothesized that prostate cancer survivors would have the highest rate of strength exercise participation, followed by breast and colorectal cancer survivors. ...
... The authors are only aware of two studies that have assessed the prevalence of strength exercise among cancer survivors. Speed-Andrews et al. (2013) found that 26% of colorectal cancer survivors in Alberta were meeting strength exercise guidelines, whereas Short et al. (2014) found that 24% of breast cancer survivors in Australia were meeting guidelines. The data suggest a remarkable consistency of about 25% of cancer survivors meeting the strength exercise guidelines with very little variation across cancer sites or geographic region. ...
To identify and compare the prevalence and correlates of strength exercise among breast, prostate, and colorectal cancer survivors.
.
Cross-sectional, descriptive survey.
.
Nova Scotia, Canada.
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741 breast, prostate, and colorectal cancer survivors.
.
A stratified sample of 2,063 breast, prostate, and colorectal cancer survivors diagnosed from 2003-2011 were identified and mailed a questionnaire. Descriptive, chi-square, and logistic regression analyses were used to determine any correlations among the main research variables.
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Strength exercise behavior; medical, demographic, and motivational correlates using the Theory of Planned Behavior.
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Of 741 respondents, 23% were meeting the strength exercise guidelines of two or more days per week. Cancer survivors were more likely to meet guidelines if they were younger, more educated, had a higher income, better perceived general health, fewer than two comorbidities, and a healthy body weight. In addition, those meeting guidelines had significantly more favorable affective attitude, instrumental attitude, injunctive norm, perceived behavioral control, planning, and intention. The correlates of strength exercise did not differ by cancer site.
.
The prevalence of strength exercise is low among breast, prostate, and colorectal cancer survivors in Nova Scotia and the correlates are consistent across those survivor groups.
.
Nurses should take an active role in promoting strength exercise among cancer survivors using the Theory of Planned Behavior, particularly among those survivors at higher risk of not performing strength exercise.
.
... In virtually all RT research, capabilities, in the form of psychological capabilities, have shown positive associations along the b path with behavior [42][43][44][45], which again follows our prior support of the ab path for capabilities. Indeed, each study that assessed the effects of psychological capabilities on behavior had positive associations [24,26,27]. ...
... Many observational RT studies that have examined motivation constructs such as self-efficacy [50,51], perceived behavioral control [52,53], outcome expectations [50,54], and intention [45,50,52] have shown positive associations with behavior. Our results from intervention studies further support these findings as each study that examined motivation showed positive associations with behavior. ...
Resistance training (RT) has been identified as an important lifestyle activity for health. While systematic reviews have examined behavior change techniques (BCTs) used in interventions and potential correlates of RT behavior, the connection between BCTs and changes in putative mediators and RT participation have yet to be linked. The purpose of this review was to examine RT intervention effects, as coded by BCT clusters, on behavior change via capability, opportunity, and motivation as putative mediators of that change.
Literature searches were concluded in January of 2023, using three databases. Eligible studies included a comparison group, assessed RT as an outcome, included BCTs, assessed potential mediators, and were in English. The initial search yielded 1050 hits, which was reduced to 5 to independent RT interventions. Screening of previous reviews yielded three additional papers for a total of 8 papers. Each paper was assessed for the associations between intervention effects (as BCT clusters) on mechanisms of action (a path), effects of mechanisms of action on behavior (b path), and indirect (ab path) and direct (c path) effects of BCT clusters.
There was support that interventions had significant effects on capability and opportunity with inconclusive effects on motivation (a path). Both capabilities and motivation had associations with RT behavior (b path). The examined studies showed that changes in capabilities have the strongest support as a mediator with some support for motivation as a mediator (ab path). Studies that used more BCT clusters seemed to have a more positive effect on behavior, yet there were no trends to suggest any one crucial BCT cluster (c path).
Current evidence suggests that capabilities and motivation are important to target in RT interventions. Future interventions would be well suited to utilize behavior change techniques that address these mediators.
... This is reflected in public health guidelines which recommend training for all major muscle groups. Of the studies that included major muscle groups, most used this component to inform whether participants were meeting the guidelines, overall frequency of training, or to categorize stage of change (Branscum & Fairchild, 2019;Cardinal & Kosma, 2004;Cardinal, Keis & Ferrand, 2005;Castellanos, Daprano, Blevins & Crecelius, 2020;Dean, Farrell, Kelley, Jane Taylor & Rhodes, 2006;Kathrins & Turbow, 2010;Loustalot, Carlson, Kruger, Buchner, Fulton et al., 2013;Ratz, Lippke, Muellmann et al., 2020;Short, James, Vandelanotte et al., 2014). In eight studies, participants followed programs that included all major muscle groups (Arikawa, O'Dougherty, Schmitz et al., 2011;Bopp et al., 2004;Dalager et al., 2015;Fetherman, Hakim & Sanko, 2011;Jette, Rooks, Lachman et al., 1998;Millen & Bray, 2009;Ott, Lindsey, Waltman et al., 2004;Sylvester et al., 2016). ...
... Of the studies that included a reference to repetitions, only one of them used this variable to calculate volume (Kathrins & Turbow, 2010). Rather, repetitions were referenced in the context of the training program (Arikawa et al., 2011;Fetherman et al., 2011;Jette et al., 1998;Millen & Bray, 2009;Ott et al., 2004) or to informed frequency, stage of change or whether a participant was achieving the guidelines (Cardinal & Kosma, 2004;Cardinal et al., 2005;Dean et al., 2006;Kathrins & Turbow, 2010;Short et al., 2014;Wilson & Bopp, 2021;Patterson, Umstattd Meyer & Beville, 2015). ...
... In the current analysis, three subtypes of self-efficacy (task, coping, and scheduling) were evaluated. Further, as well as examining correlates of total activity, this analysis also examined correlates of resistance training, which are less heavily researched in the literature [47]. The sample also included people from regional and remote geographic areas who are often not well represented in breast cancer research, with the proportion of participants residing outside of major cities (36%) being representative of the Australian population [48]. ...
Purpose
The purpose of this analysis was to explore associations between exercise behaviour among breast cancer survivors and three behavioural constructs from distinct theories: self-efficacy from social cognitive theory, motivation from self-determination theory, and habits from habit theory.
Methods
Breast cancer survivors (n = 204) completed a cross-sectional survey that collected demographic and disease characteristics, exercise levels, and self-efficacy, motivation, and habits. Multivariable linear regression models were used to identify constructs associated with total activity and resistance training.
Results
Participants were a mean (SD) age of 57.3 (10.8) years and most were diagnosed with early-stage disease (72%) and engaged in sufficient levels of total activity (94%), though only 45% completed ≥ 2 resistance training sessions/week. Identified motivation (ꞵ[95% CI] = 7.6 [3.9–11.3]) and habits (ꞵ[95% CI] = 4.4 [1.4–7.4]) were significantly associated with total activity (as were body mass index and disease stage), whilst identified motivation (ꞵ[95% CI] = 0.6 [0.3–0.9]) and coping self-efficacy (ꞵ[95% CI] = 0.02 [< 0.01–0.03]) were significantly associated with resistance training. The models explained 27% and 16% of variance in total activity and resistance training behaviour, respectively.
Conclusion
Results suggest that incorporating strategies that support identified motivation, habits, and coping self-efficacy in future interventions could promote increased exercise behaviour among breast cancer populations. Future longitudinal research should examine associations with exercise in a more representative, population-based sample.
... Resistance exercise (RE) has a positive effect on improving upper and lower body strength, body composition, physical function, and quality of life in FBCSs [6,7], suggesting that regular participation in RE should be recommended as a key strategy for cancer recovery and risk reduction in FBCSs. However, most cancer survivors do not participate in RE [8]. In addition, questions remain about whether RE has a positive effect on immune and inflammatory cells. ...
Questions remain about whether resistance exercise has a positive effect on immune and inflammatory cells. The purpose of this study was to evaluate the effect of 12 weeks of high-intensity circuit resistance exercise (HCRE) on inflammation and immune cells, and physical fitness, of female breast cancer survivors (FBCSs). Thirty FBCSs were randomly assigned to the HCRE (n = 15) and control (n = 15) groups. HRCE was administered for 50 min a day, 2–3 times a week, for 12 weeks. The control group only performed activities of daily living during the study period. Baseline and post-intervention measures included body composition, muscular strength, muscular endurance, flexibility, reaction time, balance, inflammation, and immune cell measurements. The results showed that HCRE improved body mass index, body fat, muscle mass, grip strength, back muscle strength, sit-up, whole-body reaction, standing on one leg with eyes closed, Y-balance test, and NKCA in FBCSs. The improvement of physical strength and immune cells of FBCSs was achieved using the 12-week HRCE program. Future studies must analyze various exercise intensities and types, and should be conducted on other cancer survivors. In addition, strategies should be developed to allow FBCSs to participate in resistance training.
... According to surveillance data from the Centers for Disease Control and Prevention, approximately 20% of US adults are meeting both aerobic and resistance physical activity guidelines [4]. Among cancer survivors, 9-20% meet both aerobic and resistance physical activity guidelines [19,[21][22][23][24][25][26], with 22-44% only meeting aerobic guidelines [24,25] and about 10-34% only meeting resistance guidelines [24,25,27,28]. Evidence suggests that physical activity counseling from a health care provider improves physical activity behaviors, both among cancer survivors [29][30][31] and the general population [31]. ...
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.
... Social-cognitive variables accounted for the largest portion of variance (20.5%) in meeting PA guidelines. This is consistent with literature suggesting that social-cognitive variables, specifically intentions, attitudes, planning, and PBC, are predictive of performing PA across guidelines [8,11,13,35,36]. Compared with KCS meeting neither guideline, those meeting aerobic-only, ST-only, and combined guidelines were each more likely to have greater PA intentions and planning. ...
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.
... 39 45 54 61 64 Two studies reported a positive association between family support and participating in RT, with small effects, 54 56 while one study 39 reported a similar positive relationship in the first 3 months of RT participation but no relationship at 6 months. In one study, there was a small positive association between friend support and participating in RT, 56 while one study showed no association. 54 Six qualitative studies found that peer support was a key factor for participating in RT, and one quantitative study 39 showed no association. ...
Objective:
Regular participation in resistance training (RT) is critical to health and recommended in most international physical activity guidelines. Few people, however, participate in RT. The purpose of this review was to assess the demographic, behavioural, intrapersonal, interpersonal and environmental factors associated with participating in RT.
Data sources:
Eligible studies were from English peer-reviewed published articles that examined correlates or determinants of RT in adult samples. Searches were performed from August 2015 to April 2016 in six databases.
Results:
We identified 51 independent data sets, from nine countries, primarily of moderate to high quality, and 23 factors related to participating in RT. Education, perceived health status, quality of life, affective judgements, self-efficacy, intention, self-regulation behaviours, subjective norm and programme leadership were associated with RT.
Conclusion:
Low education levels and poor health status were associated with low participation rates in RT. Intrapersonal factors including affective judgements, self-efficacy, and self-regulation behaviours, and interpersonal factors including subjective norms and programme leadership may be important for promoting RT behaviours. Full text available at: http://hdl.handle.net/1828/15384
... The 1-RM bench press test is safe among breast cancer survivors. 7,8,22,24,25 Study participants completed a maximal isometric handgrip strength test at baseline using a Jamar dynamomter. a The trained exercise physiologist provided instruction and demonstration on how to use the dynamometer. ...
... It may be that when behaviour change is more challenging, receiving a greater number of modules spread out over time is better (or at least more optimal when provided alongside weekly action plans). Self-efficacy and behavioural capability for resistance-training are generally low among breast cancer survivors [53], and addressing these determinants may require on-going support and encouragement, more so than aerobic activity. Further research is needed to clarify these findings. ...
PurposeThe purpose of the study is to investigate the impact of differing delivery schedules of computer-tailored physical activity modules on engagement and physical activity behaviour change in a web-based intervention targeting breast cancer survivors. Methods
Insufficiently active breast cancer survivors (n = 492) were randomly assigned to receive one of the following intervention schedules over 12 weeks: a three-module intervention delivered monthly, a three-module intervention delivered weekly or a single module intervention. Engagement with the website (number of logins, time on site, modules viewed, action plans completed) was measured using tracking software. Other outcomes (website acceptability, physical activity behaviour) were assessed using online surveys. Physical activity outcomes were analysed using regression models for both study completers and when applying intention-to-treat (using multiple imputation). ResultsCompleters allocated to the monthly module group rated the intervention higher (b = 2.2 95 % CI = 0.02–4.53) on acceptability and had higher levels of resistance-training (IRR = 1.88, 95 % CI = 1.16–3.04) than those in the single module group. When accounting for missing data, these differences were no longer significant. The completion of at least two action plans was higher among those allocated to the monthly module group compared to those in the weekly module group (53 vs 40 %, p = 0.02); though the completion of at least two modules was higher in the weekly module group compared to the monthly module group (60 vs 46 %; p = 0.01). There were no other significant between group differences observed. Conclusion
This study provides preliminary evidence that web-based computer-tailored interventions can be used to increase physical activity among breast cancer survivors. Further, there were some outcome differences based on how the tailored modules were delivered, with the most favourable outcomes observed in the monthly delivery group. Implications for Cancer SurvivorsThis study will be useful for informing the design of future web-based interventions targeting breast cancer survivors.
... self-efficacy). Considering the influence selfefficacy has on the way people think, act, and behave based on theory [47] and empirical evidence in the exercise domain, [48][49][50][51] this finding reiterates the importance of properly training instructors. It suggests that it is necessary to have instructors who are knowledgeable about both exercise and breast cancer. ...
Purpose:
The adverse side effects of current treatments for breast cancer highlight the need for rehabilitative programmes. Group-based exercise programmes have been found to be effective in reducing symptoms and treatment side effects and improving physical and psychological health in cancer survivors. To assist programme administrators and instructors in the ongoing design and delivery of optimal group-based exercise programmes, we conducted a longitudinal qualitative study to explore breast cancer survivors' perceptions of the instructor and the climate the instructor created within the context of a group-based exercise programme, and how this contributes to women's motivational experiences.
Method:
Seven women participating in an eight-week group-based exercise programme were interviewed at the start and end of the programme. Data were analysed using thematic analysis.
Results:
The instructor's attributes (energy, enthusiasm, approachability, knowledge, experience) and her focus on promoting self-improvement, personal progress, skill development and task mastery contributed to participants' positive experiences, which served to enhance their motivation to remain involved in the programme.
Conclusions:
Instructors play an essential role in creating a supportive climate and fostering positive experiences in group-based exercise programmes for breast cancer survivors. Hiring caring and knowledgeable instructors who are able to create a supportive climate may enhance breast cancer survivors' experiences in group-based exercise programmes and promote sustained participation. Implications for Rehabilitation Promoting self-improvement, personal progress, skill development and task mastery can enhance breast cancer survivors' adherence to group-based exercise programmes, which can help mitigate the effects of cancer and its treatment. In addition to training leaders to run safe and effective programmes, hiring instructors who have high energy, and who are enthusiastic, approachable, knowledgeable and experienced can promote breast cancer survivors' adherence to group-based exercise programmes. Training in breast cancer management is required to allow instructors to understand the complexities of this disease and develop tailored exercise programmes. Future research needs to identify training techniques that can effectively promote exercise instructors' competence in working with breast cancer survivors.
... It may be that when behaviour change is more challenging, receiving a greater number of modules spread out over time is better (or at least more optimal when provided alongside weekly action plans). Self-efficacy and behavioural capability for resistance-training are generally low among breast cancer survivors [53], and addressing these determinants may require on-going support and encouragement, more so than aerobic activity. Further research is needed to clarify these findings. ...
Background
Physical activity (PA) is a non-pharmacological approach to optimize health benefits in cancer survivors and is recommended as part of care. However, most cancer survivors fail to meet PA recommendations. The current systematic review and meta-analysis aimed to identify psychosocial correlates of free-living PA in cancer survivors.
Methods
Three electronic databases were searched (PubMed, PsycINFO, and SportDiscus). Meta-analyses were conducted for psychosocial correlates tested ≥ 3 times.
Results
Sixty-four articles were included. Eighty-eight different free-living PA correlates were identified. Meta-analyses (n = 32 studies) tested 23 PA correlates, of which 16 were significant (p < 0.05). Larger effect sizes (0.30 < ES > 0.45) were found for exercise self-efficacy, perceived behavioral control, intention, lower perceived barriers for exercise, enjoyment, perceived PA benefits, and attitudes. Small-to-moderate effects (0.18 < ES < 0.22) were found for subjective norms, physical functioning, quality of life, depression, and mental health. These findings were generally in line with narrative results.
Conclusions
This systematic review highlights important psychosocial correlates of free-living PA that can be targeted in future PA promotion interventions for cancer survivors. Constructs mainly from SCT and TPB were the most studied and appear to be associated with free-living PA in this population. However, we cannot currently assert which frameworks might be more effective. Further studies of better methodological quality, per correlate and theory, exploring longer-term associations and across different types of cancer, are needed.
Implications for Cancer Survivors
Having higher exercise self-efficacy, perceived behavioral control, intention, enjoyment and perceived PA benefits, more positive attitudes towards PA, and lower perceived barriers for exercise, can help increase PA in cancer survivors.
Regular physical activity (PA) can address many of the negative side effects experienced by individuals following cancer treatment and support the optimization of physical and psychosocial well-being. However, many survivors of cancer are not sufficiently active to achieve these health benefits. The purpose of this study was to describe the development of a physical activity behavior change (PABC) intervention, MedEx IMPACT (IMprove Physical Activity after Cancer Treatment), which aims to increase cancer survivors’ PA levels. A review of the literature and focus groups with survivors of cancer were conducted in order to generate recommendations to inform the intervention development process. This process was guided and informed by: (1) the Medical Research Council’s (MRC) framework for the development, evaluation, and implementation of complex interventions, (2) the Behaviour Change Wheel (BCW), and (3) the Theoretical Domains Framework (TDF). Recommendations for strategies to support habitual PA and adherence to community-based exercise programs, generated by survivors of cancer who participated in 7 focus groups (n = 41), were synthesized with 13 statements of findings that were generated from 10 studies included within the review of the literature. Detailed mapping exercises are presented which outline the link between these sources, the MRC framework, the BCW and TDF, and the intervention content. MedEx IMPACT is the first PABC intervention for survivors of cancer to be developed through the application of the MRC framework, BCW, and TDF. The next phase in this research is to test the acceptability and effectiveness of MedEx IMPACT.
Presents an integrative theoretical framework to explain and to predict psychological changes achieved by different modes of treatment. This theory states that psychological procedures, whatever their form, alter the level and strength of self-efficacy. It is hypothesized that expectations of personal efficacy determine whether coping behavior will be initiated, how much effort will be expended, and how long it will be sustained in the face of obstacles and aversive experiences. Persistence in activities that are subjectively threatening but in fact relatively safe produces, through experiences of mastery, further enhancement of self-efficacy and corresponding reductions in defensive behavior. In the proposed model, expectations of personal efficacy are derived from 4 principal sources of information: performance accomplishments, vicarious experience, verbal persuasion, and physiological states. Factors influencing the cognitive processing of efficacy information arise from enactive, vicarious, exhortative, and emotive sources. The differential power of diverse therapeutic procedures is analyzed in terms of the postulated cognitive mechanism of operation. Findings are reported from microanalyses of enactive, vicarious, and emotive modes of treatment that support the hypothesized relationship between perceived self-efficacy and behavioral changes. (21/2 p ref)
The purpose of this study was to assess the safety and efficacy of progressive resistance training (PRT) in breast cancer. Randomized controlled trials (RCTs) published to November 2013 that reported on the effects of PRT (>6 weeks) on breast cancer-related lymphedema (BCRL) (incidence/exacerbation, arm volume, and symptom severity), physical functioning (upper and lower body muscular strength), and health-related quality of life (HRQoL) in breast cancer patients were included. Of 446 citations retrieved, 15 RCTs in 1,652 patients were included and yielded five studies on BCRL incidence/exacerbation (N = 647), four studies on arm volume (N = 384) and BCRL symptom severity (N = 479), 11 studies on upper body muscular strength (N = 1,252), nine studies on lower body muscular strength (N = 1,079), and seven studies on HRQoL (N = 823). PRT reduced the risk of BCRL versus control conditions [OR = 0.53 (95 % CI 0.31–0.90); I
2 = 0 %] and did not worsen arm volume or symptom severity (both SMD = −0.07). PRT significantly improved upper [SMD = 0.57 (95 % CI 0.37–0.76); I
2 = 58.4 %] and lower body muscular strength [SMD = 0.48 (95 % CI 0.30–0.67); I
2 = 46.7 %] but not HRQoL [SMD = 0.17 (95 % CI −0.03 to 0.38); I
2
= 47.0 %]. The effect of PRT on HRQoL became significant in our sensitivity analysis when two studies conducted during adjuvant chemotherapy [SMD = 0.30 (95 % CI 0.04–0.55), I
2 = 37.0 %] were excluded. These data indicate that PRT improves physical functioning and reduces the risk of BCRL. Clinical practice guidelines should be updated to inform clinicians on the benefits of PRT in this cohort.
This critical review assesses whether evaluation studies can answer three key questions about behaviour change interventions: 'Do they work? How well do they work? How do they work?' Reviews of intervention evaluations are examined, particularly those addressing decreasing unprotected sexual intercourse and smoking. Selection of outcome measures and calculation of effect sizes are discussed. The article also considers the extent to which evaluation reports specify (i) discrete intervention techniques and (ii) psychological mechanisms that account for observed behavioural change. It is concluded that intervention descriptions are often not specific about the techniques employed and that there is no clear correspondence between theoretical inspiration and adoption of particular change techniques. The review calls for experimental testing of specific theory-based techniques, separately and in combination.
Several physical activity interventions have been effective in improving the health outcomes of breast cancer survivors. However, few interventions have provided detailed descriptions regarding how such interventions work. To develop evidence-based practice in this field, detailed descriptions of intervention development and delivery is needed. This paper aims to (1) describe the theory-and evidence-based development of the Move More for Life program, a physical activity program for breast cancer survivors; and (2) serve as an exemplar for theory-based applied research.
The program-planning model outlined by Kreuter and colleagues was used to develop the computer-tailored intervention.
The tailoring guide developed by Kreuter and colleagues served as a useful program planning tool in terms of integrating theory and evidence-based best practice into intervention strategies. Overall, participants rated the intervention positively, with the majority reporting that the tailored materials caught their attention, were personally relevant to them, and were useful for helping them to change their behaviour. However, there was considerable room for improvement.
The Move More for Life program is an example of a theory-based, low-cost and potentially sustainable strategy to physical activity promotion and may stand as an exemplar for Social Cognitive Theory-based applied research. By providing a detailed description of the development of the Move More for Life program, a critical evaluation of the working mechanisms of the intervention is possible, and will guide researchers in the replication or adaption and re-application of the specified techniques. This has potential implications for researchers examining physical activity promotion among cancer survivors and for researchers exploring distance-based physical activity promotion techniques among other populations.Trial registrations: Australian New Zealand Clinical Trials Registry (ANZCTR) identifier: ACTRN12611001061921.
Objective: Researchers have yet to establish how interventions to increase physical activity influence specific self-efficacy beliefs. The current study sought to quantify the effect of interventions to increase physical activity among healthy adults on exercise task (EXSE) and barrier self-efficacy (BSE) via meta-analysis. Intervention characteristics associated with self-efficacy and physical activity changes were also identified. Methods: A systematic database search and manual searches through reference lists of related publications were conducted for articles on randomized, controlled physical activity interventions. Published intervention studies reporting changes in physical activity behavior and either EXSE or BSE in healthy adults were eligible for inclusion. Results: Of the 1,080 studies identified, 20 were included in the meta-analyses. Interventions had a significant effect of g = 0.208, 95% confidence interval (CI) [0.027, 0.388], p < .05, on EXSE; g = 0.128, 95% CI [0.05, 0.20], p < .05 on BSE; and g = 0.335 95% CI [0.196, 0.475], p < .001, on physical activity. Moderator analyses indicated shorter interventions that did not include structured exercise sessions effectively increased EXSE and physical activity, whereas long interventions improved BSE. Interventions that did not provide support increased BSE and physical activity levels. Further, interventions that did not require the use of daily exercise logs improved EXSE and physical activity behavior. Conclusion: Interventions designed to increase physical activity differentially influenced EXSE and BSE. EXSE appeared to play a more significant role during exercise adoption, whereas BSE was involved in the maintenance of exercise behavior. Recommendations are offered for the design of future interventions.
Health outcome trials have provided strong evidence that participating in regular physical activity can improve the quality of life and health of post-treatment breast cancer survivors. Focus is now needed on how to promote changes in physical activity behaviour among this group.
This systematic review examines the efficacy of behavioural interventions for promoting physical activity among post-treatment breast cancer survivors.
Behavioural intervention studies published up until July 2012 were identified through a systematic search of two databases: MEDLINE and CINAHL, and by searching reference lists of relevant publications and scanning citation libraries of project staff.
Eight out of the ten identified studies reported positive intervention effects on aerobic physical activity behaviour, ranging from during the intervention period to 6 months post-intervention. Only two studies reported intervention effect sizes. The identification of factors related to efficacy was not possible because of the limited number and heterogeneity of studies included, as well as the lack of effect sizes reported. Nonetheless, an examination of the eight studies that did yield significant intervention effects suggests that 12-week interventions employing behaviour change techniques (e.g., self-monitoring and goal setting) derived from a variety of theories and delivered in a variety of settings (i.e., one-on-one, group or home) can be effective at changing the aerobic physical activity behaviour of breast cancer survivors in the mid- to long terms.
Behavioural interventions do hold promise for effectively changing physical activity behaviour among breast cancer survivors. However, future research is needed to address the lack of studies exploring long-term intervention effects, mediators of intervention effects and interventions promoting resistance-training activity, and to address issues impacting on validity, such as the limited use of objective physical activity measures and the use of convenience samples.
Identifying effective ways of assisting breast cancer survivors to adopt and maintain physical activity is important for enhancing the well-being and health outcomes of this group.
This study examined the validity and reliability of decisional balance scales for exercise (i.e., pros and cons) in a large longitudinal population-based randomized sample of Canadian adults ages 18 to 65 years (N = 703). Assessments were taken over 3 time points with 6-month intervals between testing. Content, factorial, concurrent, and construct validity along with internal consistency and test-retest reliability were established for the decisional balance scales. The developed measures have utility for researchers and practitioners who test and apply the exercise decisional balance constructs of the Transtheoretical Model.
Tailored health communication research represents a very promising line of inquiry that has the potential to produce major impacts on lifestyle behaviors. This study defines tailoring and discusses how tailored interventions operate, including comparing/ contrasting different tailoring channels. Next, the authors review the literature on tailored interventions to change lifestyle behaviors, with a focus on smoking cessation, dietary change, and physical activity, as well as interventions that address multiple lifestyle behaviors. Finally, future directions for tailoring research are discussed. To date, a large literature has amassed showing the promise of tailored programs delivered via print, Internet, local computer/kiosk, telephone, and interpersonal channels. Numerous studies demonstrate that these programs are capable of significant impacts on smoking cessation, dietary change, physical activity, and multiple behavior change. It is concluded that the potential of tailoring will be more fully realized as (a) the field builds a more cumulative science of tailoring and (b) greater dissemination of efficacious tailored programs takes place.
Background
Compared to females, males experience a range of health inequities including higher rates of diabetes and cardiovascular disease. Although sitting time is emerging as a distinct risk factor for chronic disease, research on the association of sitting time and chronic disease in middle-aged Australian males is limited.
Methods
A sample of 63,048 males aged 45-64 years was drawn from the baseline dataset of the 45 and Up Study – a longitudinal cohort study on healthy ageing with 267,153 participants from across New South Wales, Australia’s most populous state. Baseline data on self-reported chronic disease (heart disease, cancer, diabetes, high blood pressure, combined chronic diseases), sitting time, physical activity (Active Australia Survey), and a range of covariates were used for cross-sectional analyses. Crude (OR), partially and fully adjusted odds ratios (AOR) and 95% confidence intervals (CI) were calculated using binary logistic regression.
Results
Compared to those sitting <4 hours/day, participants reporting 4 to <6, 6 to <8, and ≥8 hours were significantly more likely to report ever having any chronic disease (AOR 1.06, 95% CI 1.00 – 1.12, p = 0.050; AOR 1.10, 95% CI 1.03 – 1.16, p = 0.003; AOR 1.09, 95% CI 1.03 – 1.15, p = 0.002, respectively). Participants who reported 6 to <8 hours and ≥8 hours of sitting were also significantly more likely to report ever having diabetes than those reporting <4 hours/day (AOR 1.15, 95% CI 1.03 – 1.28, p = 0.016; AOR 1.21, 95% CI 1.09 – 1.33, p <0.001, respectively).
Conclusions
Our findings suggest that higher volumes of sitting time are significantly associated with diabetes and overall chronic disease, independent of physical activity and other potentially confounding factors. Prospective studies using valid and reliable measures into domain-specific sitting time in middle-aged males are required to understand and explain the direction of these relationships.
Tested the view that the number of arguments in a message could affect agreement with a communication by serving as a simple acceptance cue when personal involvement was low but could affect agreement by enhancing issue-relevant thinking when personal involvement was high. In addition to manipulating the personal relevance of the communication topic, both the number and the quality of the arguments in the message were varied. In a pilot study with 46 undergraduates, when the issue was of low relevance, Ss showed more agreement in response to a message containing 6 arguments (3 strong and 3 weak) than to messages containing either 3 strong or 3 weak arguments. Under high involvement, however, the 6-argument message did not increase agreement over the message containing only 3 strong arguments. In the full experiment, 168 undergraduates received either 3 or 9 arguments that were either all cogent or all specious under conditions of either high or low involvement. The manipulation of argument number had a greater impact under low than under high involvement, but the manipulation of argument quality had a greater impact under high than low involvement. Results indicate that increasing the number of arguments in a message could affect persuasion whether or not the actual content of the arguments was scrutinized. (53 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
To estimate the prevalence and correlates of meeting the public health strength exercise guidelines (≥2 days/week) in colorectal cancer (CRC) survivors.
A random sample of 600 CRC survivors in Alberta, Canada, completed a mailed questionnaire assessing medical, demographic, and behavioral variables and participation in strength exercise.
About a quarter (25.5%) of CRC survivors were meeting strength exercise guidelines. In multivariate analysis, meeting guidelines was associated with being male (p = .052), married (p = .079), a drinker (p = .006), in better health (p < .001), nonsmoking (p = .023), and nonobese (p = .010).
Interventions to increase strength exercise participation in CRC survivors are needed.
Background
Due to early detection and advances in treatment, the number of women surviving breast cancer is increasing. Whilst there are many positive aspects of improved survival, breast cancer survival is associated with many long-term health and psychosocial sequelae. Engaging in regular physical activity post-diagnosis can reduce this burden. Despite this evidence, the majority of breast cancer survivors do not engage in regular physical activity. The challenge is to provide breast cancer survivors with appealing and effective physical activity support in a sustainable and cost-effective way. This article describes the protocol for the Move More for Life Study, which aims to assess the relative efficacy of two promising theory-based, print interventions designed to promote regular physical activity amongst breast cancer survivors.
Method and design
Breast cancer survivors were recruited from across Australia. Participants will be randomised into one of three groups: (1) A tailored-print intervention group, (2) a targeted-print intervention group, or (3) a standard recommendation control group. Participants in the tailored-print intervention group will receive 3 tailored newsletters in the mail over a three month period. Participants in the targeted-print group will receive a previously developed physical activity guidebook designed specifically for breast cancer survivors immediately after baseline. Participants in the standard recommendation control will receive a brochure detailing the physical activity guidelines for Australian adults. All participants will be assessed at baseline, and at 4 and 10 months post-baseline. Intervention efficacy for changing the primary outcomes (mins/wk aerobic physical activity; sessions/exercises per week resistance physical activity) and secondary outcomes (steps per day, health-related quality life, compliance with physical activity guidelines, fatigue) will be assessed. Mediation and moderation analyses will also be conducted.
Discussion
Given the growing number of cancer survivors, distance-based behaviour change programs addressing physical activity have the potential to make a significant public health impact.
Trial registration
Australian New Zealand Clinical Trials Registry (ANZCTR) identifier: ACTRN12611001061921
There is convincing evidence that targeting self-efficacy is an effective means of increasing physical activity. However, evidence concerning which are the most effective techniques for changing self-efficacy and thereby physical activity is lacking. The present review aims to estimate the association between specific intervention techniques used in physical activity interventions and change obtained in both self-efficacy and physical activity behaviour. A systematic search yielded 27 physical activity intervention studies for 'healthy' adults that reported self-efficacy and physical activity data. A small, yet significant (P < 0.01) effect of the interventions was found on change in self-efficacy and physical activity (d = 0.16 and 0.21, respectively). When a technique was associated with a change in effect sizes for self-efficacy, it also tended to be associated with a change (r(s) = 0.690, P < 0.001) in effect size for physical activity. Moderator analyses found that 'action planning', 'provide instruction' and 'reinforcing effort towards behaviour' were associated with significantly higher levels of both self-efficacy and physical activity. 'Relapse prevention' and 'setting graded tasks' were associated with significantly lower self-efficacy and physical activity levels. This meta-analysis provides evidence for which psychological techniques are most effective for changing self-efficacy and physical activity.
An understanding of the determinants of physical activity through mediators of behaviour change is important in order to evaluate the efficacy of interventions. Prior reviews on this topic noted that few studies employed mediator analyses in experimental physical activity trials; the purpose of this review is to update these prior reviews in order to evaluate the state of our present understanding of interventions that include proposed mediators of behaviour change.
Literature was identified through electronic database (e.g., MEDLINE, psychINFO) searching. Studies were eligible if they described a published experimental or quasi-experimental trial examining the effect of an intervention on physical activity behaviour and mediator change in non-clinical adult populations. Quality of included studies was assessed and the analyses examined the symmetry between mediators and behaviour change.
Twenty seven unique trials passed the eligibility criteria and 22 were included in the analysis with scores of moderate or higher quality. Half of the studies reviewed failed to show an intervention effect on PA. The remaining studies showed evidence that the intervention affected changes in the proposed mediators, but tests of mediated effect were performed in only six of these 11 cases and demonstrated mixed outcomes. Differences by theory were not discernable at this time, but self-regulation constructs had the most evidence for mediation.
Published literature employing mediators of change analyses in experimental designs is still relatively elusive since the time of prior reviews; however, the general null findings of changes in mediating constructs from these interventions are a more timely concern. Changes in self-regulation constructs may have the most effect on changes in PA while self-efficacy and outcome expectation type constructs have negligible but limited findings. Innovation and increased fidelity of interventions is needed and should be a priority for future research.
The aim of this study was to explore the working mechanisms of a computer tailored physical activity intervention for older adults with environmental information compared to a basic tailored intervention without environmental information.
A clustered randomized controlled trial with two computer tailored interventions and a no-intervention control group was conducted among 1971 adults aged >/= 50. The two tailored interventions were developed using Intervention Mapping and consisted of three tailored letters delivered over a four-month period. The basic tailored intervention targeted psychosocial determinants alone, while the environmentally tailored intervention additionally targeted environmental determinants, by providing tailored environmental information. Study outcomes were collected with questionnaires at baseline, three and six months and comprised total physical activity (days/week), walking (min/week), cycling (min/week), sports (min/week), environmental perceptions and use and appreciation of the interventions.
Mediation analyses showed that changes in cycling, sports and total physical activity behaviour induced by the environmentally tailored intervention were mediated by changes in environmental perceptions. Changes in environmental perceptions did not mediate the effect of the basic tailored intervention on behaviour. Compared with the basic tailored intervention, the environmentally tailored intervention significantly improved cycling behaviour (tau = 30.2). Additionally, the tailored letters of the environmentally tailored intervention were better appreciated and used, although these differences did not mediate the intervention effect.
This study gave some first indications of the relevance of environmental perceptions as a determinant of changing physical activity behaviours and the potential effectiveness of providing environmental information as an intervention strategy aimed at enhancing physical activity behaviour among older adults.
PURPOSE
We developed and validated a brief, yet sensitive, 33-item general cancer quality-of-life (QL) measure for evaluating patients receiving cancer treatment, called the Functional Assessment of Cancer Therapy (FACT) scale.
METHODS AND RESULTS
The five-phase validation process involved 854 patients with cancer and 15 oncology specialists. The initial pool of 370 overlapping items for breast, lung, and colorectal cancer was generated by open-ended interview with patients experienced with the symptoms of cancer and oncology professionals. Using preselected criteria, items were reduced to a 38-item general version. Factor and scaling analyses of these 38 items on 545 patients with mixed cancer diagnoses resulted in the 28-item FACT-general (FACT-G, version 2). In addition to a total score, this version produces subscale scores for physical, functional, social, and emotional well-being, as well as satisfaction with the treatment relationship. Coefficients of reliability and validity were uniformly high. The scale's ability to discriminate patients on the basis of stage of disease, performance status rating (PSR), and hospitalization status supports its sensitivity. It has also demonstrated sensitivity to change over time. Finally, the validity of measuring separate areas, or dimensions, of QL was supported by the differential responsiveness of subscales when applied to groups known to differ along the dimensions of physical, functional, social, and emotional well-being.
CONCLUSION
The FACT-G meets or exceeds all requirements for use in oncology clinical trials, including ease of administration, brevity, reliability, validity, and responsiveness to clinical change. Selecting it for a clinical trial adds the capability to assess the relative weight of various aspects of QL from the patient's perspective.
From the reviews of the First Edition."An interesting, useful, and well-written book on logistic regression models . . . Hosmer and Lemeshow have used very little mathematics, have presented difficult concepts heuristically and through illustrative examples, and have included references."—Choice"Well written, clearly organized, and comprehensive . . . the authors carefully walk the reader through the estimation of interpretation of coefficients from a wide variety of logistic regression models . . . their careful explication of the quantitative re-expression of coefficients from these various models is excellent."—Contemporary Sociology"An extremely well-written book that will certainly prove an invaluable acquisition to the practicing statistician who finds other literature on analysis of discrete data hard to follow or heavily theoretical."—The StatisticianIn this revised and updated edition of their popular book, David Hosmer and Stanley Lemeshow continue to provide an amazingly accessible introduction to the logistic regression model while incorporating advances of the last decade, including a variety of software packages for the analysis of data sets. Hosmer and Lemeshow extend the discussion from biostatistics and epidemiology to cutting-edge applications in data mining and machine learning, guiding readers step-by-step through the use of modeling techniques for dichotomous data in diverse fields. Ample new topics and expanded discussions of existing material are accompanied by a wealth of real-world examples-with extensive data sets available over the Internet.
Purpose:
Current evidence suggests many health benefits from physical activity during and after cancer treatment. However, the optimal exercise program for cancer survivors has not yet been established. The purpose of this meta-analysis was to summarize evidence for the efficacy of resistance training (RT) interventions to improve muscle strength and body composition among adult cancer survivors. We also investigate potential dose-response relationships between intensity, duration, and frequency of RT and assessed outcomes.
Methods:
A systematic literature review of the Clinical Trial Register, Cochrane Trial Register, MEDLINE, and EMBASE literature databases was undertaken. Studies were included if they were randomized controlled trials (RCT) comparing RT with an exercise or nonexercise control group in cancer survivors during and after treatment. Thirteen articles from 11 RCT met our inclusion criteria. We performed a random-effects meta-analysis to determine weighted mean differences (WMD) with 95% confidence intervals using the Cochrane Review Manager 5.0.25. A random-effects metaregression model was performed to examine dose-response relationships between RT variables and assessed outcomes.
Results:
Quantitative evidence shows a large effect of RT on lower-limb and upper-limb muscle strength (WMD: +14.57 kg, P = 0.0005 and +6.90 kg, P < 0.00001, respectively) and moderate effects on lean body mass and percentage of body fat (WMD: +1.07 kg, P < 0.0001 and -2.08%, P = 0.003, respectively). A small positive effect of RT was noted on Functional Assessment of Cancer Therapy-Fatigue (P = 0.05). Upper-limb muscle strength and percentage of body fat improved to a greater extent when RT interventions were of low to moderate intensity (≤ 75% one-repetition maximum, P = 0.042).
Conclusions:
RT was shown to be associated with clinically important positive effects on muscular function and body composition in patients during treatment or in long-term follow-up.
Behavioral science theories have been used to develop physical activity interventions; however, little is known as to whether these interventions are effective due to changes in constructs related to these theories. Specifically, if the intervention is successful, does it work for the reasons hypothesized by the theory underlying it? The purpose of this study was to examine the importance of particular theoretical constructs among participants (n = 150) who had been randomly assigned to a physical activity intervention based on the Transtheoretical Model and Social Cognitive Theory (i.e., tailored group) or to a standard care group. Participants in the tailored group reported greater increases in behavioral processes and self-efficacy from baseline to 3 months than participants in the standard-care group. No between-group differences were found for cognitive processes and decisional balance. This study demonstrates that theory-based physical activity interventions may be effective through changes in particular theoretical constructs. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Background
Physical activity (PA) is associated with reduced morbidity and mortality in individuals with type 2 diabetes mellitus (T2DM); however, most T2DM adults are insufficiently active.
Purpose
To explore the effectiveness of two innovative/theoretically based behavioral-change strategies to increase PA and reduce hemoglobin A1c (A1c) in T2DM adults.
Methods
Participants (n = 287) were randomly assigned to a control group or an intervention group (i.e., print-based materials/pedometer group or print-based materials/pedometer plus telephone-counseling group). Changes in PA and A1c and other clinical measures were examined by Linear Mixed Model analyses over 18 months, along with moderating effects for gender and age.
Results
PA and A1c levels did not significantly change in intervention groups. Step counts significantly increased in the print-based materials and pedometer plus telephone counseling group, for women.
Conclusions
No significant effects were found for PA or A1c levels for T2DM adults. The multi-component strategy including telephone counseling may have potential for women. The trial was registered on ClinicalTrials.gov identifier: NCT00221234.
The purpose of the study was to test the Social Cognitive Theory (SCT; Bandura, 2004) for explaining physical activity (PA) in a large population sample of adults with type 1 or type 2 diabetes. Study objectives: (1) test the fit of the SCT structure in the total sample, and the diabetes sub-types; (2) determine the SCT structural invariance between the type 1 and type 2 groups; and (3) report explained variance and compare strength of association for the SCT constructs in predicting PA for both type 1 and type 2 groups. In all, 2,311 individuals with type 1 or type 2 diabetes were assessed on their self-efficacy, outcome expectancies, impediments, social support, goals, and physical activity at baseline and 1,717 (74.5%) completed these assessments again at 6 months. Multi-group Structural Equation Modeling was conducted. The findings provide evidence for the utility of the SCT in the diabetes samples. The SCT fits individuals with type 1 and type 2 diabetes except for SCT impediments, which appear to be obstructing goal-setting in individuals with type 2 diabetes only. Promotion of health behavior should target self-efficacy to set goals and change behavior. Outcome expectancies and social support are also important factors for setting goals and behavior performance. © 2008 The Authors. Journal compilation
Physical inactivity is an important contributor to non-communicable diseases in countries of high income, and increasingly so in those of low and middle income. Understanding why people are physically active or inactive contributes to evidence-based planning of public health interventions, because effective programmes will target factors known to cause inactivity. Research into correlates (factors associated with activity) or determinants (those with a causal relationship) has burgeoned in the past two decades, but has mostly focused on individual-level factors in high-income countries. It has shown that age, sex, health status, self-efficacy, and motivation are associated with physical activity. Ecological models take a broad view of health behaviour causation, with the social and physical environment included as contributors to physical inactivity, particularly those outside the health sector, such as urban planning, transportation systems, and parks and trails. New areas of determinants research have identified genetic factors contributing to the propensity to be physically active, and evolutionary factors and obesity that might predispose to inactivity, and have explored the longitudinal tracking of physical activity throughout life. An understanding of correlates and determinants, especially in countries of low and middle income, could reduce the eff ect of future epidemics of inactivity and contribute to effective global prevention of non-communicable diseases.
We conducted a randomized controlled trial to determine the effects of a home-based exercise intervention on change in quality of life (QOL) in recently resected colorectal cancer survivors, most of whom were receiving adjuvant therapy. Participants were randomly assigned in a 2 : 1 ratio to either an exercise (n = 69) or control (n = 33) group. The exercise group was asked to perform moderate intensity exercise 3–5 times per week for 20–30 min each time. The primary outcome was change in QOL as measured by the Functional Assessment of Cancer Therapy-Colorectal (FACT-C) scale. Adherence in the exercise group was good (75.8%) but contamination in the control group was problematic (51.6%). Intention-to-treat analysis revealed no significant differences between groups for change in the FACT-C (mean difference, −1.3; 95% CI, −7.8 to 5.1; P = 0.679). In an ‘on-treatment’ ancillary analysis, we compared participants who decreased versus increased their cardiovascular fitness over the course of the intervention. This analysis revealed significant differences in favour of the increased fitness group for the FACT-C (mean difference, 6.5; 95% CI, 0.4–12.6; P = 0.038). These data suggest that increased cardiovascular fitness is associated with improvements in QOL in colorectal cancer survivors but better controlled trials are needed.
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Cancer survivors are often highly motivated to seek information about food choices, physical activity, and dietary supplements to improve their treatment outcomes, quality of life, and overall survival. To address these concerns, the American Cancer Society (ACS) convened a group of experts in nutrition, physical activity, and cancer survivorship to evaluate the scientific evidence and best clinical practices related to optimal nutrition and physical activity after the diagnosis of cancer. This report summarizes their findings and is intended to present health care providers with the best possible information with which to help cancer survivors and their families make informed choices related to nutrition and physical activity. The report discusses nutrition and physical activity guidelines during the continuum of cancer care, briefly highlighting important issues during cancer treatment and for patients with advanced cancer, but focusing largely on the needs of the population of individuals who are disease free or who have stable disease following their recovery from treatment. It also discusses select nutrition and physical activity issues such as body weight, food choices, food safety, and dietary supplements; issues related to selected cancer sites; and common questions about diet, physical activity, and cancer survivorship. CA Cancer J Clin 2012.
BackgroundIt is well established that both aerobic physical activity (PA) and resistance training are essential in the treatment and management of type 2 diabetes (T2D), but few studies have examined the determinants of both modes of PA in the same sample.PurposeThe main objective was to investigate the utility of the Protection Motivation Theory (PMT) in predicting aerobic PA and resistance training in a population sample of T2D adults.MethodsA total of 244 individuals completed self-report PMT constructs of vulnerability, severity, fear, response efficacy, self-efficacy and intention, and a 3-month follow-up that assessed aerobic PA and resistance training.ResultsPMT explained 19% (p < .001) and 20% (p < .001) of the variance respectively for aerobic PA and resistance training behaviour. Significant associations were found between self-efficacy (β = 0.45, p < .001) and gender (β = 0.15, p < .05) for aerobic PA, and self-efficacy (β = 0.48, p < .001) and age (β = 0.17, p < .05) for resistance training. PMT accounted for 43% (p < .001) and 56% (p < .001) of the variance respectively for aerobic PA and resistance training intentions. For aerobic PA, response efficacy (β = 0.14, p < .05) and self-efficacy (β = 0.59, p < .001) were significantly associated with intention, while response efficacy (β = 0.23, p < .001), self-efficacy (β = 0.64, p < .001) and age (β = 0.10, p < .05) were significantly related with resistance training intention.ConclusionsNone of the unique constructs of the PMT (i.e., perceived vulnerability, severity and fear) were significant with either aerobic and resistance training intention. These results may guide the development of effective PA interventions in people with T2D.
Cancer represents a major public health concern in Australia. Causes of cancer are multifactorial with lack of physical activity being considered one of the known risk factors, particularly for breast and colorectal cancers. Participating in exercise has also been associated with benefits during and following treatment for cancer, including improvements in psychosocial and physical outcomes, as well as better compliance with treatment regimens, reduced impact of disease symptoms and treatment-related side-effects, and survival benefits for particular cancers. The general exercise prescription for people undertaking or having completed cancer treatment is of low to moderate intensity, regular frequency (3–5 times/week) for at least 20 min per session, involving aerobic, resistance or mixed exercise types. Future work needs to push the boundaries of this exercise prescription, so that we can better understand what constitutes optimal, desirable and necessary frequency, duration, intensity and type, and how specific characteristics of the individual (e.g., age, cancer type, treatment, presence of specific symptoms) influence this prescription. What follows is a summary of the cancer and exercise literature, in particular the purpose of exercise following diagnosis of cancer, the potential benefits derived by cancer patients and survivors from participating in exercise programs, and exercise prescription guidelines and contraindications or considerations for exercise prescription with this special population. This report represents the position stand of the Australian Association of Exercise and Sport Science on exercise and cancer recovery and has the purpose of guiding exercise practitioners in their work with cancer patients.
The primary objective of this study was to investigate the utility of the two-component theory of planned behaviour (TPB) in understanding physical activity intentions and behaviour in rural and small town breast cancer survivors. The secondary objective was to elicit the most common behavioural, normative and control beliefs of rural and small town survivors regarding physical activity. Using a cross-sectional survey design, 524 rural and small town breast cancer survivors completed a mailed survey that assessed physical activity and TPB variables. Physical activity intention explained 12% of the variance in physical activity behaviour (p < 0.01) while the TPB constructs together explained 43% of the variance in physical activity intention (p < 0.01). Unique behavioural, normative and control beliefs were elicited from the sample. The two-component TPB framework appears to be a suitable model to initiate an understanding of physical activity determinants among rural and small town breast cancer survivors. These data can be used in the development and establishment of physical activity behaviour interventions and health promotion materials designed to facilitate physical activity behaviour among rural and small town breast cancer survivors.
Objective:
Physical activity determinants are subject to change when confronted with the diagnosis of 'cancer' and new cancer-related determinants appear. The aim of the present study is to compare the contribution of cancer-related determinants with more general ones in explaining physical activity 3 weeks to 6 months post-treatment.
Methods:
A theory-based and validated questionnaire was used to identify physical activity levels (total and domain-specific) and associated determinants among 464 breast cancer survivors (aged 18 to 65 years) 3 weeks to 6 months post-treatment.
Results:
Descriptive analyses showed higher scores for general determinants in comparison with cancer-related determinants. Nevertheless, regression analyses showed that both general and cancer-related determinants explained total and domain-specific physical activity. Self-efficacy, enjoyment, social support, lack of time and lack of company were important general determinants. The perception of returning to normal life, cancer-related barriers (fatigue, lack of energy and physical side effects) and self-efficacy in overcoming these barriers were important cancer-related determinants. Although results differed according to the women's working status and the physical activity domain, general self-efficacy explained most physical activity types in both groups.
Conclusion:
Comparable with the general population, enhancing breast cancer survivors' self-efficacy in being sufficiently physically active seems to be important in physical activity interventions post-treatment. However, interventions should be tailored to the experienced symptoms and working status of the women.
Physical activity (PA) participation has been shown to be helpful in improving physical and mental well-being among cancer survivors. The purpose of this chapter is to review the literature on the determinants of physical activity motivation and behavior among cancer survivors. Using theories of behavior change, researchers have sought to identify the correlates of motivation that predict the participation in regular physical activity in observational studies, while intervention studies have focused on manipulating those factors to support the initiation of physical activity. The majority of this work has been conducted with breast cancer survivors, and there is an interest in expanding this work to survivors of others cancers (e.g., prostate, lung, and colorectal cancer). Results suggest that constructs from the Theory of Planned Behavior (TPB), Transtheoretical Model (TTM), and Social Cognitive Theory (SCT) are associated with greater motivation for physical activity, and some of these constructs have been used in interventions to promote physical activity adoption. There is scope for understanding the determinants of physical activity adoption in various cancer survivor populations. Much more needs to done to identify the determinants of maintenance of physical activity.
Early detection and improved treatments for cancer have resulted in roughly 12 million survivors alive in the United States today. This growing population faces unique challenges from their disease and treatments, including risk for recurrent cancer, other chronic diseases, and persistent adverse effects on physical functioning and quality of life. Historically, clinicians advised cancer patients to rest and to avoid activity; however, emerging research on exercise has challenged this recommendation. To this end, a roundtable was convened by American College of Sports Medicine to distill the literature on the safety and efficacy of exercise training during and after adjuvant cancer therapy and to provide guidelines. The roundtable concluded that exercise training is safe during and after cancer treatments and results in improvements in physical functioning, quality of life, and cancer-related fatigue in several cancer survivor groups. Implications for disease outcomes and survival are still unknown. Nevertheless, the benefits to physical functioning and quality of life are sufficient for the recommendation that cancer survivors follow the 2008 Physical Activity Guidelines for Americans, with specific exercise programming adaptations based on disease and treatment-related adverse effects. The advice to "avoid inactivity," even in cancer patients with existing disease or undergoing difficult treatments, is likely helpful.
Theoretically, self-regulatory strategies (e.g., goal setting, self-monitoring) are an important influence of behavior change, but very little research has examined the relationship between self-regulation and physical activity (PA) behavior. Petosa's (1993) 43-item PA self-regulation scale (PASR-43) affords the opportunity for studying this construct in the context of PA; however the PASR-43 has not been tested for structural aspects of validity. Therefore, this study examines the structural validity of the PASR-43 in older adults.
The structural validity of the PASR-43 was tested in a large sample of older adults from North and South Carolina and Ohio (N = 460) using maximum likelihood estimation and confirmatory factor analysis in AMOS 5.0.
The original 6-factor model for the PASR-43 scale did not represent an acceptable fit to the data (chi2 = 4732.25, df = 845, P < .0001, RMSEA = 0.10, NNFI = 0.67, CFI = 0.71). Based on a post hoc specification search, iterative model modifications resulted in a 12-item PA self-regulation scale (PASR-12) that represented an excellent fit to the data (chi2 = 70.75, df = 39, P = .001, RMSEA = 0.04, NNFI = 0.98, CFI = 0.99).
The PASR-12 provides a concise and valid measure of PA self-regulation for use with older adults. Future studies should cross-validate the PASR-12 and examine invariance across time and between age, ethnic, gender, and geographical groups.
Although independent relationships between sitting behaviors (mainly television viewing) and health outcomes have been reported, few studies have examined the measurement properties of self-report sitting questions. This study assessed gender-specific test-retest reliability and validity of a questionnaire that assessed time spent sitting on weekdays and weekend days: 1) traveling to and from places, 2) at work, 3) watching television, 4) using a computer at home, and 5) for leisure, not including television.
Test-retest reliability of domain-specific sitting time (min x d(-1)) on weekdays and weekend days was assessed using data collected on two occasions (median = 11 d apart). Validity of domain-specific self-reported sitting time on weekdays and weekend days was assessed against log data and sedentary accelerometer data.
Complete repeat questionnaire and log data were obtained from 157 women (aged 51-59 yr) and 96 men (aged 45-63 yr). Reliability coefficients were high for weekday sitting time at work, watching television, and using a computer at home (r = 0.84-0.78) but lower for weekend days across all domains (r = 0.23-0.74). Validity coefficients were highest for weekday sitting time at work and using a computer at home (r = 0.69-0.74). With the exception of computer use and watching television for women, validity of the weekend-day sitting time items was low.
This study confirms the importance of measuring domain- and day-specific sitting time. The measurement properties of questions that assess structured domain-specific and weekday sitting time were acceptable and may be used in future studies that aim to elucidate associations between domain-specific sitting and health outcomes.
Increasing self-efficacy is an effective method to increase physical activity. Despite this, the evidence concerning the most effective techniques to increase self-efficacy in physical activity interventions has not been systematically reviewed. The aim of the present research is to systematically gather, and meta-analyse, intervention studies which aimed to increase self-efficacy for physical activity; to estimate the association between intervention techniques used, and change in self-efficacy achieved.
A systematic database search was conducted for papers reporting lifestyle or recreational physical activity interventions. Published intervention studies explicitly targeting self-efficacy in order to change physical activity behaviour in 'healthy' adults were eligible for inclusion.
The search strategy identified 27 unique physical activity intervention studies, with a total of 5,501 participants. A significant, yet small, relationship between the interventions and changes in self-efficacy was found (mean d=0.16, p<.001). Owing to significant heterogeneity, moderator analyses were conducted, examining the association of changes in self-efficacy with whether or not specific intervention techniques were used. Interventions that included feedback on past or others' performance produced the highest levels of self-efficacy found in this review. Vicarious experience was also associated with higher levels of self-efficacy. Persuasion, graded mastery, and barrier identification were associated with lower levels of self-efficacy.
This meta-analysis forms an evidence base for which psychological techniques are most effective in increasing self-efficacy for physical activity. The results are presented in terms of recommendations for those developing interventions and directions for future research.
This systematic review summarizes the research of previous studies that used resistance training in the post-treatment phase of cancer patients with a focus on methodological quality, training methods and physical outcome measures. We found twenty-four studies (10 RCTs, 4 controlled clinical trials and 10 uncontrolled trials) that met all inclusion criteria. The studies were of moderate methodological quality. The majority of studies involved breast cancer patients (54%), followed by prostate cancer patients (13%). Most studies used a combination of resistance and aerobic training, which was mostly supervised. Resistance training involved large muscle groups, with 1-3 sets of 8-12 repetitions. The duration of the resistance training programs varied from 3-24 weeks, with a training frequency of 1-5 sessions per week. The training intensity ranged from 25% to 85% of the one-repetition maximum. Overall, positive training effects were observed for cardiopulmonary and muscle function, with significant increases in peak oxygen uptake (range: 6-39%), and in the one-repetition maximum (range: 11-110%). In general, there were no effects of training on body composition, endocrine and immune function, and haematological variables. No adverse effects of the resistance training were reported. Based upon these results, we recommend to incorporate resistance training in cancer rehabilitation programmes.
To estimate the 5-year trajectory of physical activity among women with breast cancer, and to evaluate biopsychosocial variables (health status, physical symptoms, health-related quality of life (HRQL), depressive symptoms, and social support), measured soon after breast cancer diagnosis, as predictors of the 5-year trajectory.
Women diagnosed with Stage II or III regional breast cancer (n=227), surgically treated and awaiting the start of adjuvant therapy completed baseline assessments of medical, psychological, and behavioral functioning. Follow-up evaluations were conducted every 4 months during the first year and every 6 months during the subsequent 4 years (12 assessments total during the 5-year study). Mixed-effects modeling was utilized to estimate the baseline level of physical activity as well as rate of change over time. Measures of physical health status, HRQL, depressive symptoms, and social support were included as predictors of the physical activity trajectory.
A curvilinear pattern of change in physical activity was evident over the 5-year follow-up (p=0.002). Physical activity increased gradually during the first 18 months, then declined steadily over the subsequent 42 months. Poor physical health, depressive symptoms, and lower emotional HRQL were associated with less physical activity. Higher family support was associated with a slower decline in physical activity in the latter 42 months of the study.
Emotional HRQL following diagnosis with breast cancer appears to be important for sustaining physical activity in the first 1-2 years following diagnosis. Physical activity interventions among breast cancer survivors should address depressive symptoms early in the course of treatment.
While previous studies indicate a significant relationship between self-efficacy and physical activity, less research has focused on this relationship among patients with type 2 diabetes. The purpose of this investigation was to examine whether self-efficacy mediated the relationship between participation in a 1-month, print-based physical activity intervention and improvements in activity levels.
Participants (N = 85; mean age = 57; 73% Caucasian; 69% female) were recruited from a community diabetes center. The intervention was individually-tailored based on theoretical constructs, including self-efficacy.
After controlling for age, baseline activity, and baseline self-efficacy, the tailored intervention was associated with significant improvements in physical activity, 95% CI [23.01, 271.68] as well as self-efficacy, CI [0.02, 3.48]. There was an indirect effect of treatment on physical activity through self-efficacy, CI [0.77, 73.11], and the direct effect of treatment on physical activity was no longer significant, CI [-7.33, 253.40], after the influences of self-efficacy change were accounted for in the model.
Results supported a mediation effect, such that the treatment effect on physical activity was completely mediated by changes in self-efficacy. Although replication is needed, results support the theoretical rationale for targeting self-efficacy to promote physical activity among patients with type 2 diabetes.
While the physical and psychosocial benefits of participating in physical activity (PA) during and following breast cancer treatment are well understood, less is known about rates and uptake of PA following diagnosis. This paper explores the levels and patterns of PA among women recently diagnosed with breast cancer and the factors associated with change in activity levels.
Using a population-based recruitment approach, PA levels of 287 breast cancer patients were assessed at 6, 12 and 18 months post-diagnosis using the Behavioral Risk Factor Surveillance System, and then converted to MET (metabolic equivalent task)-hours/week. Regression analyses were used to explore the correlates associated with change between 6 and 18 months post-diagnosis.
Although more than 80% of women participated in PA at each testing phases, more than 50% were considered insufficiently active or sedentary according to national recommendations and less than one-third reported engagement in vigorous or strength activities. Mean change in total MET-hours/week between 6 and 18 months post-diagnosis was minor (mean=0.10, median=0.0), however individual changes were substantial (ranging from -100 to +174 MET-hours/week). Results are more encouraging for the lower threshold of 3+ MET-hours/week, which may be most relevant specifically for breast cancer outcomes.
Since the majority of women report insufficient levels of PA, there is a clear need for exercise interventions during and following breast cancer treatment. Few characteristics predict declines or improvements in PA levels, hence for optimal benefit, interventions should target the entire breast cancer population.
Data from a clinical study of 86 pancreatic cancer patients with involuntary, significant weight loss (cachexia) were used to explore the relationship between patient-reported outcomes (PROs) and survival. In all, 28 pancreatic cancer patients with cachexia were given gemcitabine (Gemzar) plus 3 mg/kg of infliximab (Remicade), 28 were given gemcitabine plus 5 mg/kg of infliximab, and 30 were given gemcitabine plus placebo in a double-blinded, phase II, multicenter trial. PRO endpoints included scores from the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), Functional Assessment of Anorexia/ Cachexia Therapy (FAACT), Brief Pain Inventory (BPI), and the Short-Form 36 general health survey (SF-36). Population mean scores at baseline indicated fatigue problems (FACIT-F), nutritional health issues (FAACT), and mild-to-moderate pain (BPI "worst pain" score). Baseline normalized SF-36 values for physical functioning, vitality, and mental health indicated substantial impairment. Baseline fatigue and physical-functioning scores predicted survival as well as, or better than, baseline Karnofsky Performance Status or hemoglobin level. A cut-point in the FACIT-F score (median < or = 30) strongly predicted mortality; patients with greater fatigue had a lower median overall survival than did those with less fatigue. These findings supported several features of an a priori clinical-benefit model. Patient-reported fatigue provided powerful prognostic information; tracking of this symptom may be useful for treatment planning and medical monitoring of advanced-stage pancreatic cancer patients with cachexia. These results must be confirmed by larger trials.
To review the theories that have been the basis for randomized controlled trials (RCTs) promoting health behavior change among adults diagnosed and treated for cancer.
Electronic databases and recent review papers.
Several theories have been used in intervention development: Transtheoretical Model, Motivational Interviewing, Social Learning and Social Cognitive Theory, Theory of Planned Behavior, and Cognitive Behavioral Theory. There is support for the efficacy of some of these interventions. However, there has been limited assessment of theory-based constructs and examination of the mediational role of theoretical constructs in intervention efficacy.
There is a need to apply theory in the development of interventions to assess the effects of the intervention on the constructs and to conduct mediational tests of these constructs.
The present article presents an integrative theoretical framework to explain and to predict psychological changes achieved by different modes of treatment. This theory states that psychological procedures, whatever their form, alter the level and strength of self-efficacy. It is hypothesized that expectations of per- sonal efficacy determine whether coping behavior will be initiated, how much effort will be expended, and how long it will be sustained in the face of ob- stacles and aversive experiences. Persistence in activities that are subjectively threatening but in fact relatively safe produces, through experiences of mastery, further enhancement of self-efficacy and corresponding reductions in defensive behavior. In the proposed model, expectations of personal efficacy are derived from four principal sources of information: performance accomplishments, vicarious experience, verbal persuasion, and physiological states. The more de- pendable the experiential sources, the greater are the changes in perceived self- efficacy. A number of factors are identified as influencing the cognitive processing of efficacy information arising from enactive, vicarious, exhortative, and emotive sources. The differential power of diverse therapeutic procedures is analyzed in terms of the postulated cognitive mechanism of operation. Findings are reported from microanalyses of enactive, vicarious, and emotive modes of treatment that support the hypothesized relationship between perceived self-efficacy and be- havioral changes. Possible directions for further research are discussed.
The purpose of this study was to develop measures of perceived social support specific to health-related eating and exercise behaviors. In Study I, specific supportive and nonsupportive behaviors were identified through interviews with 40 individuals making health-behavior changes. In Study II, items derived from the interviews were administered to 171 subjects. Support from family and friends was assessed separately for both diet and exercise habits. Meaningful factors were identified for each of the four scales, and some factors were similar for family and friend scales. Both test-retest and internal consistency reliabilities were acceptable, and six factors can be used as subscales. Social support scales were correlated with respective self-reported dietary and exercise habits, providing evidence of concurrent criterion-related validity. A measure of general social support was not related to the specific social support scales or to reported health habits. These scales are among the first measures of social support behaviors specific to dietary- and exercise-habit change.