Exercise Behavior Change Interventions In Cancer Survivors

At present, few published studies have examined the effects of an exercise behavior change intervention in cancer survivors. Jones and colleagues37 examined the effects of two oncologist-centered interventions on self-reported exercise behavior in breast cancer survivors beginning treatment. During their initial treatment consultation, participants were randomized to receive either: (a) an oncologist's recommendation to exercise, (b) an oncologist's recommendation to exercise plus a referral to a Kinesiologist, and (c) usual care (i.e., no recommendation). Results of this study indicated that participants receiving an exercise recommendation reported more exercise than those receiving usual care. The authors noted, however, that the initial treatment consultation may not be the opportune time to recommend exercise given the amount of information dispensed during this time and the stress level of the cancer survivor. Nonetheless, this trial suggests that advocating exercise behavior via an oncologist's recommendation may be an easy and efficient form of promoting exercise in cancer survivors.

Recognizing the need for efficient and effective methods that have the capacity to positively affect exercise behaviors, Demark-Wahnefried and colleagues have recently published two design papers that outline and describe two ongoing randomized controlled trials designed to test whether various health behavior counseling methods affect exercise behavior and fruit and vegetable consumption in breast and prostate cancer survivors. Project LEAD (Project Leading the Way in Education Against Disease)38 is the first trial to test whether a 6-month personally tailored telephone-counseling program is effective in improving diet and exercise behaviors in early stage breast and prostate cancer survivors. Survivors are being randomized to an experimental or control group. The experimental group receives a mailed workbook and telephone counseling (tailored on stage of readiness) pertaining to overall diet and exercise behaviors. The control group receives a mailed workbook and telephone counseling in other health-related areas. The primary outcome of the study is physical function. Secondary outcomes include diet quality, exercise, body mass index, depression, quality of life (QoL), and perceived health.

FRESH START (a randomized trial of activity and diet among cancer survivors)39 is designed to evaluate the efficacy and effectiveness of personally tailored print materials in promoting lifestyle changes in breast and prostate cancer survivors. Survivors in the intervention group receive the FRESH START intervention program that consists of a series of workbooks, newsletters, and update cards that are tailored based upon information collected during a baseline interview. Survivors in the control group receive non-tailored, health-promotion print materials that promote exercise and a healthy diet. Primary endpoints are exercise behavior and dietary intake. Secondary endpoints include perceived health, QoL, depression, and weight status. These aforementioned studies will provide important information pertaining to the efficacy of distance medicine-based approaches in promoting exercise in cancer survivors.

At the University of Alberta, we have recently developed a 62-page exercise guidebook for breast cancer survivors (Exercise for health: An exercise guide for breast cancer survivors) based on the theoretical components of the TPB. The information in the exercise guidebook was formulated and written based on behavioral, normative, and control beliefs elicited from breast cancer survivors in previous research. The guidebook consists of 10 chapters and includes participant-centered activities designed to enhance attitude (i.e., instrumental and affective attitudes), subjective norm (i.e., injunctive and descriptive norms), PBC (i.e., self-efficacy and controllability), and implementation intentions (e.g., goal-setting, planning). These written activities are also designed to facilitate participant engagement in the information. The exercise guidebook also incorporated previous research examining exercise preferences of breast cancer survivors.2,32

By examining potentially feasible, practical, and novel forms of exercise promotion in the cancer population, cancer care professionals (e.g., oncologists, nurses, physiotherapists, dieticians) can become aware of these approaches of communicating and promoting exercise information and behavior as an effective tool for assisting in exercise adoption and maintenance and further enhancing QoL after treatment(s) for cancer. These interventions may also offer the researcher a viable opportunity to reach, target, and influence a large number of individuals that otherwise would not be able to participate in clinically-based programs.

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