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Promoting physical activity during and after curative cancer treatment: Assessment, experiences and effect of behaviour change support
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness.ORCID iD: 0000-0001-6332-6022
2021 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aims:The overall aim of this thesis was to increase knowledge about the promotion of physical activity (PA) in patients during and after curative cancer treatment. Methods: Study I investigated agreement between a 7-day diary and the SenseWear Armband mini (SWA) when assessing PA and sedentary time in 65 participants with breast cancer. Agreement was examined with Bland-Altman plots. Studies II-IV used data from an RCT, where participants about to start curative treatment for breast, prostate or colorectal cancer, were randomised to six months of high or low-to-moderate intensity exercise (supervised group-based resistance- and home-based endurance training), with or without self-regulatory behaviour change techniques (BCTs; e.g. goal-setting and action planning). In study II, participants randomised to the groups with self-regulatory BCTs answered a questionnaire (n=229) and took part in semi-structured interviews (n=18) after exercise programme completion. The interviews were analysed with thematic analysis. In Study III, all participants (n=577) randomised were included. Exercise adherence during the intervention was assessed with attendance records, training logs and heart rate monitors. Regression analyses were performed to determine the effect of self-regulatory BCTs on exercise adherence. In Study IV, participants (n=301) who provided data about their PA level at 12-month follow-up were included. Regression analyses were performed to determine the effect of self-regulatory BCTs on PA maintenance and potential baseline predictors. Results: There were mean differences and wide limits of agreement between the 7-day diary and the SWA when assessing PA and sedentary time. Participants described different incentives to exercise, which fostered feelings of autonomy, competence and relatedness and helped them find motivation to exercise during cancer treatment. Social support from coaches, feedback, self-registration of exercise and scheduled sessions at a public gym were useful for exercising. There was no effect of the self-regulatory BCTs on exercise adherence during the intervention; however, a positive effect was found on PA maintenance at 12-month follow-up. Baseline predictors of PA maintenance at 12-month follow-up were health-related quality of life, exercise motivation, expectations of exercise and being a former or current smoker/snus user. Conclusions: A 7-day diary and the SWA have limited agreement and cannot be used interchangeably in patients with breast cancer. Individual incentives and a positive and supportive environment are crucial to increase exercise motivation in patients undergoing curative cancer treatment, and can be promoted using specific support (i.e. social support, feedback, self-registration of exercise and scheduled exercise sessions). The addition of self-regulatory BCTs is not likely to improve exercise adherence in patients undergoing curative treatment for breast, prostate or colorectal cancer and participating in structured, well-controlled exercise interventions, but may improve long-term PA maintenance in this population. Patients with low health-related quality of life, low exercise motivation, high expectations of exercise or with a history of tobacco use at the start of their cancer treatment may be those most in need of such support to maintain PA.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2021. , p. 108
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1727
Keywords [en]
Adherence, Behavioural medicine, Exercise, Incentives, Maintenance, Oncology
National Category
Health Sciences
Research subject
Caring Sciences
Identifiers
URN: urn:nbn:se:uu:diva-437677ISBN: 978-91-513-1160-9 (print)OAI: oai:DiVA.org:uu-437677DiVA, id: diva2:1537810
Public defence
2021-05-06, Sal IX, Universitetshuset, Biskopsgatan 3, Uppsala, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2021-04-14 Created: 2021-03-17 Last updated: 2021-04-23
List of papers
1. Comparison between logbook-reported and objectively-assessed physical activity and sedentary time in breast cancer patients: an agreement study
Open this publication in new window or tab >>Comparison between logbook-reported and objectively-assessed physical activity and sedentary time in breast cancer patients: an agreement study
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2017 (English)In: BMC Sports Science, Medicine and Rehabilitation, E-ISSN 2052-1847 , Vol. 9, article id 8Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Increasing physical activity (PA) and decreasing sedentary time (ST) have important health effects among breast cancer patients, a growing population group. PA and sedentary behaviors are complex multi-dimensional behaviors and are challenging to monitor accurately. To date few studies have compared self-reports and objective measurement in assessing PA and ST in women undergoing breast cancer treatments. The aim of the present study was to compare self-reports and objective measures for assessing daily time spent in moderate-intensity physical activity (MPA), vigorous-intensity physical activity (VPA) and ST in women undergoing breast cancer treatments.

METHODS: Baseline data from 65 women with breast cancer scheduled to undergo adjuvant treatment was included. Daily time spent in MPA, VPA and ST was assessed by a study-specific logbook and the SenseWear Armband mini (SWA). The level of agreement between the two measurement methods was then determined by performing Bland-Altman plots with limits of agreements, and calculating Spearman's rank correlation coefficients.

RESULTS: The mean difference between the logbook and SWA with limits of agreement was 14 (±102) minutes for MPA, 1 (±21) minute for VPA and -196 (±408) minutes for ST, respectively. The logbook reported an average of 34 and 50% higher values than the SWA for MPA and VPA, as well as an average of 27% lower values for ST (P < 0.05). The Spearman's rank correlation coefficients showed that the differences between the methods increased as the average amount of time spent in PA and ST increased (P < 0.01).

CONCLUSIONS: The results imply that the two measurement methods have limited agreement and cannot be used interchangeably.

Keywords
Activity monitor, Breast neoplasms, Exercise, Measurement accuracy, Sedentary lifestyle
National Category
Physiotherapy
Identifiers
urn:nbn:se:uu:diva-319631 (URN)10.1186/s13102-017-0072-2 (DOI)000397925300001 ()28373907 (PubMedID)
Funder
Swedish Cancer Society, 15 0841Swedish Research Council, 521-2013-2734
Available from: 2017-04-06 Created: 2017-04-06 Last updated: 2021-03-17Bibliographically approved
2. "Finding my own motivation" - A Mixed Methods Study of Exercise and Behaviour Change Support During Oncological Treatment
Open this publication in new window or tab >>"Finding my own motivation" - A Mixed Methods Study of Exercise and Behaviour Change Support During Oncological Treatment
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2019 (English)In: International Journal of Behavioral Medicine, ISSN 1070-5503, E-ISSN 1532-7558, Vol. 26, no 5, p. 499-511Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Exercising during oncological treatment is beneficial but challenging for persons with cancer and may require strategies to increase motivation. Behaviour change support, including specific behaviour change techniques (BCTs), have been used to facilitate exercise in persons undergoing oncological treatment, but more detailed knowledge from an individual perspective is needed to inform clinical practice. The aims were to explore the motivational experiences of exercise combined with behaviour change support, and to describe how specific BCTs were valued among persons exercising during oncological treatment. METHODS: A mixed-methods study was conducted using semi-structured interviews (n = 18) and a questionnaire (n = 229). Participants with breast, colorectal or prostate cancer who completed or dropped out of a six-month exercise programme during oncological treatment were included. The interviews were analysed with thematic analysis and the questionnaire with descriptive statistics (median and interquartile range). RESULTS: The participants underwent a motivational process through the exercise programme. By experiencing 'Health gains and mastery', 'Learning', 'Affinity', 'Commitment', and 'Managing challenges', they found incentives that fostered feelings of autonomy, competence and relatedness, leading to an increased motivation to exercise. Social support from coaches, structuring the physical environment with scheduled sessions, self-monitoring with resistance training log, and feedback based on heart rate monitor and fitness tests were the most valued BCTs. CONCLUSIONS: The results indicate the importance of finding incentives and creating an environment that fosters autonomy, competence and relatedness to motivate persons to exercise during oncological treatment. Some BCTs appear particularly useful and may be used by health professionals to increase patients' motivation to exercise.

Keywords
Behaviour change techniques, Cancer, Incentives, Physical activity, Qualitative research, Self-determination theory
National Category
Cancer and Oncology Physiotherapy
Identifiers
urn:nbn:se:uu:diva-392500 (URN)10.1007/s12529-019-09809-z (DOI)000489300800006 ()31441015 (PubMedID)
Funder
Swedish Cancer Society, 15 0841Swedish Research Council, 521-2013-2734
Available from: 2019-09-05 Created: 2019-09-05 Last updated: 2021-03-17Bibliographically approved
3. Exercise Adherence and Effect of Self-Regulatory Behavior Change Techniques in Patients Undergoing Curative Cancer Treatment: Secondary Analysis from the Phys-Can Randomized Controlled Trial
Open this publication in new window or tab >>Exercise Adherence and Effect of Self-Regulatory Behavior Change Techniques in Patients Undergoing Curative Cancer Treatment: Secondary Analysis from the Phys-Can Randomized Controlled Trial
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2020 (English)In: Integrative Cancer Therapies, ISSN 1534-7354, E-ISSN 1552-695X, Vol. 19, article id 1534735420946834Article in journal (Refereed) Published
Abstract [en]

Introduction: Adherence to exercise interventions in patients with cancer is often poorly described. Further, it is unclear if self-regulatory behavior change techniques (BCTs) can improve exercise adherence in cancer populations. We aimed to (1) describe exercise adherence in terms of frequency, intensity, time, type (FITT-principles) and dropouts, and (2) determine the effect of specific self-regulatory BCTs on exercise adherence in patients participating in an exercise intervention during curative cancer treatment. Methods: This study was a secondary analysis using data from a Swedish multicentre RCT. In a 2x2 factorial design, 577 participants recently diagnosed with curable breast, colorectal or prostate cancer were randomized to 6 months of high (HI) or low-to-moderate intensity (LMI) exercise,withorwithoutself-regulatory BCTs (e.g., goal-setting and self-monitoring). The exercise program included supervised group-based resistance training and home-based endurance training. Exercise adherence (performed training/prescribed training) was assessed using attendance records, training logs and heart rate monitors, and is presented descriptively. Linear regression and logistic regression were used to assess the effect of self-regulatory BCTs on each FITT-principle and dropout rates, according to intention-to-treat. Results: For resistance training (groupswithvswithoutself-regulatory BCTs), participants attended on average 52% vs 53% of prescribed sessions, performed 79% vs 76% of prescribed intensity, and 80% vs 77% of prescribed time. They adhered to exercise type in 71% vs 68% of attended sessions. For endurance training (groupswithvswithoutself-regulatory BCTs), participants performed on average 47% vs 51% of prescribed sessions, 57% vs 62% of prescribed intensity, and 71% vs 72% of prescribed time. They adhered to exercise type in 79% vs 78% of performed sessions. Dropout rates (groupswithvswithoutself-regulatory BCTs) were 29% vs 28%. The regression analysis revealed no effect of the self-regulatory BCTs on exercise adherence. Conclusion: An exercise adherence rate >= 50% for each FITT-principle and dropout rates at similar to 30% can be expected among patients taking part in long-term exercise interventions, combining resistance and endurance training during curative cancer treatment. Our results indicate that self-regulatory BCTs do not improve exercise adherence in interventions that provide evidence-based support to all participants (e.g., supervised group sessions).

Keywords
adherence, adjuvant treatment, behavioral intervention, behavior change support, exercise prescription, oncology, physical activity
National Category
Sport and Fitness Sciences Physiotherapy
Identifiers
urn:nbn:se:uu:diva-423149 (URN)10.1177/1534735420946834 (DOI)000570671500001 ()32909467 (PubMedID)
Funder
Swedish Cancer Society, CAN 2012/621Swedish Cancer Society, CAN 2012/631Swedish Cancer Society, CAN 2015/414Swedish Research Council, K2014-99X
Available from: 2020-10-28 Created: 2020-10-28 Last updated: 2021-03-17Bibliographically approved
4. Effect of self-regulatory behaviour change techniques and predictors of physical activity maintenance in cancer survivors: a 12-month follow-up of the Phys-Can RCT
Open this publication in new window or tab >>Effect of self-regulatory behaviour change techniques and predictors of physical activity maintenance in cancer survivors: a 12-month follow-up of the Phys-Can RCT
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(English)Manuscript (preprint) (Other academic)
Keywords
Behaviour change, Behavioural support, Cancer, Determinants, Exercise, Maintenance, Self-regulation
National Category
Health Sciences
Research subject
Caring Sciences
Identifiers
urn:nbn:se:uu:diva-437676 (URN)
Available from: 2021-03-13 Created: 2021-03-13 Last updated: 2022-06-20

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