Exercise beliefs of breast cancer survivors before and after participation in a randomized controlled trial

The purpose of this study was to examine the exercise beliefs of breast cancer survivors before and after participation in a randomized trial. Prior to randomization, 52 breast cancer survivors completed exercise belief measures based on the theory of planned behavior. After the trial, participants assigned to the exercise group (n = 24) completed the belief measures again. Results show that there was significant variability in the expected benefits of exercise prerandomization, ranging from 40% for a reduced risk of breast cancer recurrence to 94% for an improved energy level. Moreover, attitudes toward exercise and perceptions of control were higher in the exercise group after the exercise program. The findings are discussed in terms of the veracity of the exercise beliefs held by breast cancer survivors as well as the aspects of the program that may have contributed to the positive changes in exercise beliefs.     

Social cognitive determinants of hospital-based exercise in cancer patients following high-dose chemotherapy and bone marrow transplantation

Preliminary evidence indicates that physical exercise may be an effective strategy for the rehabilitation of cancer patients following bone marrow transplantation (BMT), but the determinants of such exercise are not known. In this study, we used a prospective design to evaluate the theory of planned behavior (Ajzen, 1991) as a social cognitive framework for understanding exercise motivation and behavior in 37 BMT patients. On admittance to the hospital, participants completed a baseline questionnaire that assessed the theory of planned behavior and then monitored the frequency and duration of self-initiated cycle ergometer exercise during their hospitalization. Hierarchical regression analyses demonstrated that intention and perceived behavioral control explained 36% of the variance in exercise behavior when the analyses were restricted to nonthrombocytopenic patients (n = 28). Moreover, attitude and perceived behavioral control explained 68% of the variance in exercise intentions. We concluded that the theory of planned behavior provided an excellent understanding of exercise intentions in this population and context and that its ability to predict exercise behavior could be improved substantially by taking into account significant medical complications. Kerry S. Courneya’s research program is supported by the National Cancer Institute of Canada (NCIC) with funds from the Canadian Cancer Society (CCS) and the CCS/NCIC Sociobehavioral Cancer Research Network.     

Where Perception and Reality Differ: Dropping Out Is Not the Same as Failure

The present study examined whether exercise adherers and dropouts differ in their perceptions of success and, in turn, whether their social cognitions and behavior correspondingly differ. Using a prospective, observational design, exercise class participants were followed over 12 weeks of attendance. Social-cognitive measures were assessed at both early and late program while attendance was tracked for each half of the program. Multivariate analyses of variance (MANOVAs) using a 2 (Success/Failure) × 2 (Adherer/Dropout) factorial design revealed significant interactions for self-efficacy, affect, causal attributions, as well as rate of perceived exertion. Multiple main effects for perceived success and adherence were also found. The results suggest that “successful” dropouts possess social-cognitive characteristics that may enable them to resume their exercise participation at some later date. These findings provide evidence that the examination of perceived success allows for valuable insight into the differences among and between exercise adherers and dropouts, which may have implications regarding long-term exercise participation.     

Predicting adherence to eye patching in children with amblyopia: An application of protection motivation theory

Objectives: This study reports an application of protection motivation theory (PMT) to the prediction of parental adherence to eye patching recommendations for children with amblyopia over a 2‐month period. The study also considered the role of past behaviour in PMT. Design and methods: A total of 151 parents of children with amblyopia who were attending follow‐up appointments for orthoptic treatment participated. They completed questionnaires based on PMT to assess their beliefs about amblyopia and eye patching. Of the parents, 105 were contacted again at 2‐month follow‐up to obtain a measure of adherence to the recommended treatment for their child. Results: PMT was found to be predictive of adherence intentions and behaviour at 2‐month follow‐up. Regression analyses revealed perceived vulnerability, response efficacy and self‐efficacy to be significant predictors of protection motivation, whereas perceived vulnerability and response costs were significant predictors of adherence behaviour. Past adherence behaviour was found to have a direct effect on future adherence behaviour over and above the influence of PMT. Conclusions: The results are discussed in relation to the sufficiency of PMTas a model of adherence behaviour. The practical implications for attempts to increase adherence to eye patching among children with amblyopia are outlined.     

Multimodal Guided Self-Help Exercise Program to Prevent Speech,Swallowing, and Shoulder Problems Among Head and Neck Cancer Patients: A Feasibility Study

Background

During a 6-week course of (chemo)radiation many head and neck cancer patients have to endure radiotherapy-induced toxicity, negatively affecting patients’ quality of life. Pretreatment counseling combined with self-help exercises could be provided to inform patients and possibly prevent them from having speech, swallowing, and shoulder problems during and after treatment.

Objective

Our goal was to investigate the feasibility of a multimodal guided self-help exercise program entitled Head Matters during (chemo)radiation in head and neck cancer patients.

Methods

Head and neck cancer patients treated with primary (chemo)radiation or after surgery were asked to perform Head Matters at home. This prophylactic exercise program, offered in three different formats, aims to reduce the risk of developing speech, swallowing, shoulder problems, and a stiff neck. Weekly coaching was provided by a speech and swallowing therapist. Patients filled out a diary to keep track of their exercise activity. To gain insight into possible barriers and facilitators to exercise adherence, reports of weekly coaching sessions were analyzed by 2 coders independently.

Results

Of 41 eligible patients, 34 patients were willing to participate (83% uptake). Of participating patients, 21 patients completed the program (64% adherence rate). The majority of participants (58%) had a moderate to high level of exercise performance. Exercise performance level was not significantly associated with age (P=.50), gender (P=.42), tumor subsite (P=1.00) or tumor stage (P=.20), treatment modality (P=.72), or Head Matters format (Web-based or paper) (P=1.00). Based on patients’ diaries and weekly coaching sessions, patients’ perceived barriers to exercise were a decreased physical condition, treatment-related barriers, emotional problems, lack of motivation, social barriers, and technical problems. Patients’ perceived facilitators included an increased physical condition, feeling motivated, and social and technical facilitators.

Conclusions

Head Matters, a multimodal guided self-help exercise program is feasible for head and neck cancer patients undergoing (chemo)radiation. Several barriers (decreased physical condition, treatment-related barriers) and facilitators (increased physical condition, feeling motivated) were identified providing directions for future studies. The next step is conducting a study investigating the (cost-)effectiveness of Head Matters on speech, swallowing, shoulder function, and quality of life.     

Cognitive mediators of the social influence-exercise adherence relationship: A test of the theory of planned behavior

The purpose of this study was to examine cognitive constructs from the theory of planned behavior (i.e., attitude, perceived behavioral control, and intention) as potential mediators of the relationship between selected social influence constructs (i.e., subjective norm, social support, and cohesion) and adherence to structured exercise classes. Sixty-two participants completed self-administered questionnaires during the fourth week (social influence constructs) and eighth week (cognitive constructs) of a 12-week exercise program. Exercise adherence was monitored during weeks 9 through 12 using perceived intensity and attendance. Pearson correlations indicated that social support correlated with perceived behavioral control, whereas cohesion correlated with attitude. Path analysis supported two distinct paths from social influence to exercise adherence: (a) social support perceived behavioral control intention excersise adherence, and (b) cohesion attitude intention exercise adherence. Discussion focuses on the theoretical importance of these findings, conceptual and measurement issues regarding subjective norm, and suggestions for future research.     

Pilot Randomized Controlled Trial of LEAP: A Selective Preventive Intervention to Reduce Adolescents’ Perceived Burdensomeness

This research draws upon the interpersonal-psychological theory of suicide in the development of the LEAP intervention, a web-based selective preventive suicide intervention targeting cognitions of perceived burdensomeness toward others. The pilot randomized controlled trial consisted of 80 adolescents (68.8% female, 65.8% Hispanic) 13–19 of age years who were randomly assigned to either the LEAP intervention or a psychoeducational control condition. Participants completed baseline, posttreatment, and 6-week follow-up assessments. All participants reported high levels of satisfaction with the program. Findings on outcome variables differed across intent-to-treat analyses and treatment completer analyses. Intent-to-treat analysis yielded no significant between-condition differences in perceived burdensomeness at posttreatment or follow-up. Treatment completer analyses revealed significant between-condition differences on outcome variables such that participants who completed the LEAP intervention showed significantly lower perceived burdensomeness scores at postintervention and significantly lower perceived burdensomeness, thwarted belongingness, and depressive symptom scores at follow-up as compared to participants in the control condition. No significant differences in suicidal ideation were found between conditions. These findings support the promise of the LEAP intervention as a brief, web-based selective preventive intervention for reducing perceived burdensomeness among adolescents who complete the intervention. This study provides evidence that perceived burdensomeness can be modified via a psychosocial intervention. Future research is needed to identify ways to enhance adolescent engagement with and completion of the intervention.     

Self-regulation predictors of medication adherence among ethnically different pediatric patients with renal transplants.

OBJECTIVE: To predict medication adherence among ethnically different pediatric patients with renal transplants between the ages of 6 and 20 years old, using self-regulation variables including motivation, perceived control and responsibility, and perceived support. METHODS: Twenty-six African American children and 42 Caucasian children were verbally administered the Self-Regulation of Medication Adherence Battery to assess their (1) motivation to be medication adherent, (2) perceived control of and responsibility for medication adherence, and (3) perceived support of medication adherence from their primary caregiver. Four measures were used to assess medication adherence: self-ratings, nephrologists' ratings, cyclosporine levels, and pill count/refill histories. RESULTS: For the African American patients, regression analyses revealed that responses to motivation and perceived control questions that focused on self-efficacy were unique predictors of medication adherence as rated by their primary nephrologist. For the Caucasian patients, one motivation question regarding how often they forget to take their medication predicted their self-reported adherence. CONCLUSIONS: Facilitating their beliefs that they can regularly take their medications may help promote medication adherence among African American children with renal transplants, whereas for Caucasian children, providing cues and reminders to take their medications may help. We discuss implications of the results for multimodal assessment of medication adherence and for ethnic group-specific medication adherence research and interventions.     

AIDS Clinical Trials Group Longitudinal Linked Randomized Trials (ALLRT): Rationale,Design, and Baseline Characteristics

Abstract

Purpose: This study assessed the utility of a placebo practice trial in determining adherence readiness among drug users. Method: Participants with histories of drug dependency completed a 2-week practice trial that mimicked HAART (Phase 1), followed by a 2-week observation of adherence to HAART (Phase 2) for those who began antiretroviral therapy during the study period. The primary measure of adherence was electronic monitoring. Results: There were 201 participants enrolled; 39% met criteria for current drug dependency. Mean adherence to the practice trial was 67%. Of the 184 Phase 1 completers, 83 (45%) initiated HAART prior to the end of the study. Mean adherence to HAART was 74%, including 33 patients (39%) with 90+% adherence. Adherence to the practice trial was correlated with antiretroviral adherence (r = .49, p < .001), and 90+% adherence to the practice trial was an accurate marker of the "adherence readiness" (ability to adhere 90+% on HAART) of 72% of the participants. In multivariate analyses, practice trial adherence was the best independent predictor of antiretroviral adherence, accounting for 19% of the explained variance; other predictors included adherence to recent clinic appointments, cognitive functioning, unstable housing, and adherence self-efficacy. Conclusion: These findings suggest that a brief placebo practice trial has the potential to provide clinicians and patients with an accurate screening tool for evaluating adherence readiness.     

Psychological effects and mediators of a group multi-component program for breast cancer survivors

This study evaluated the short-term impact of YWCA Encore, a mixed-modality group exercise and information support program for breast cancer patients situated in the community setting. Australian post-surgical breast cancer patients (N = 162) were assigned to either the 8-week Encore intervention or a Waitlist control. Intervention impact was assessed in terms of quality of life, cancer-specific distress, and social support. Changes in familiarity with exercise, self-efficacy and social support were tested as mediators of the intervention impact on quality of life. Overall adherence and satisfaction with the program were high. Significant enhancements at follow-up for quality of life and social support were evident for intervention compared with control participants. Familiarity with exercise and self-efficacy satisfied the requirements for mediation of quality of life. These findings provide evidence for psychosocial benefits of YWCA Encore multi-component program and support the use of such community-based programs for breast cancer survivors. The role of exercise familiarity and self-efficacy as probable mediators of the multi-component intervention is a critical finding and highlights the need for future investigations into the underlying mediating processes of similar interventions for cancer patients.     

The theory of planned behaviour as predictor of exercise: the moderating influence of beliefs and personality variables

In a test of the predictive utility of the theory of planned behaviour alone and in conjunction with a number of additional variables, 114 participants completed questionnaires measuring predictor variables and, three weeks later, reported exercise. The results of the present study provide partial support for the theory. Past behaviour was the most predictive variable. Subjective norm was not a significant predictor of intention to exercise. Attitude towards exercise was also not a predictor of exercise intention. Self-monitoring acted as a moderator of the attitude-intention relationship. Perceived behavioural control was not a significant predictor of exercise behaviour, while exercise intentions were only weak predictors. The results also suggested that perceived behavioural control and perceived barriers are not equivalent, and should be treated as separate variables that contribute independently to the predictive ability of the model. The implications of the findings are discussed.     

An exercise program for women who are caring for relatives with dementia

OBJECTIVE: This study describes factors related to retention and adherence to an exercise program for women caregivers. METHODS: One hundred sedentary women (average age = 62 years) caring for relatives with dementia were randomly assigned to an exercise program or an attention control (nutrition education) condition. Participants in the exercise condition received 12 months of home-based exercise counseling to achieve at least four exercise sessions per week, for at least 30 minutes per session. Adherence was tracked through monthly exercise logs, validated in a subsample by ambulatory heart rate and motion monitors. Participants also completed a psychosocial questionnaire battery at baseline and 12 months after randomization. RESULTS: Participants achieved a 12-month average exercise adherence rate of 74% (ie, three exercise sessions per week) with an average of 35 minutes per session. At 12 months, the exercise condition demonstrated increased knowledge of the benefits of exercise and increased motivational readiness for exercise compared with the nutrition education condition. Both groups significantly improved in perceived stress, burden, and depression from baseline to posttest. Women who were older, less depressed, and more anxious at baseline showed better program retention, and lower baseline depression was associated with better exercise adherence. CONCLUSIONS: This study demonstrates the feasibility and success of delivering home-based health promotion counseling for improving physical activity levels in a highly stressed and burdened population. Given the independent risk factors of caregiving and physical inactivity on mortality, programs to improve healthful behaviors are needed to preserve the health of caregivers as they undertake this important familial and societal role.     

Predicting Objectively Measured Exercise Participation from Motivation and Basic Needs Satisfaction: Does a Mediational Model Exist?

This study (a) explored whether relationships exist between objectively assessed exercise participation and both controlled extrinsic motivation and amotivation, and (b) investigated the possible mediation of the relationships between satisfaction of the basic needs and objectively assessed exercise participation. Participants (n = 162) were members of a worksite wellness program. Before beginning the program, participants completed a 33‐item survey measuring the constructs of self‐determination theory. Objectively assessed exercise participation was measured via attendance. Path analysis revealed that the net effect of external regulation on attendance was positive. Of the basic needs, only autonomy was a significant predictor of attendance, with no mediation of this relationship. Appealing to participants' external regulation and need for autonomy may enhance exercise participation.     

Predictors of exercise adherence following participation in a cardiac rehabilitation program

Patients who participate in cardiac rehabilitation programs (CRP) experience significant improvements in quality of life, rehospatilization rates, and mortality associated with cardiovascular disease. The potential efficacy of CRP is limited however, by significant program dropout rates and poor patient adherence to prescribed exercise regimens following rehabilitation. Recently, models of motivational readiness for behavior change, such as the Transtheoretical Model, have been applied to understanding the process of exercise adoption and maintenance. Interventions based on this dynamic model of behavior change have produced significant improvement in adherence to exercise in community and worksite populations. This study investigates the applicability of this model to this special population. Sixty-two men and women completed measures of motivational readiness, self-efficacy, and decisional balance for exercise adoption upon entry into a 12-week cardiac rehabilitation program at posttreatment and at a 3-month follow-up. Patients made significant gains during CRP in time spent exercising and self-efficacy, but not in utilization of the cognitive processes or in the perceived benefits of exercising. Exercise maintenance at follow-up was differentially associated with self-efficacy, decisional balance and use of behavioral processes at posttreatment. Motivation-based models of exercise adoption may provide insights regarding the adoption and maintenance of regular physical activity in cardiac rehabilitation populations.     

Examining Relationships Between Perceived Psychological Need Satisfaction and Behavioral Regulations in Exercise

The purpose of this study was to examine the proposition that psychological need satisfaction plays a role in the motives regulating exercise behavior. Participants completed self‐report instruments assessing perceived psychological need satisfaction and exercise regulation at the outset and end of a 12‐week structured exercise class. Greater perceived psychological need satisfaction predicted endorsement of more self‐determined exercise regulations in the structural equation modeling analysis. Change score analyses revealed that increased perceived need fulfillment was positively correlated with more self‐determined exercise regulations, although this pattern was most prominent for competence and autonomy. Collectively, these findings indicate perceptions of competence and autonomy—and to a lesser extent relatedness—and represent important factors shaping exercise motivation. Continued investigation of basic psychological need fulfillment via exercise appears justified.     

Exercise and Diet Beliefs of Overweight Women Participating in an Exercise and Diet Program: An Elicitation Study Using the Theory of Planned Behavior1

The purpose of this study was to examine the exercise and diet beliefs of overweight women using the theory of planned behavior. Participants were 104 overweight community women and university students who completed a 4‐week exercise and diet program. The most salient exercise beliefs for the participants were (a) increased motivation, structure and accountability, and social support (behavioral beliefs); (b) job or school responsibilities and traveling (control beliefs); and (c) group members and the program trainer (normative beliefs). The most salient diet beliefs were (a) improved eating habits and convenience (behavioral beliefs), (b) lack of control over food preparation and inconvenience (control beliefs), and (c) family and spouse or significant other (normative beliefs). These results are discussed in comparison to beliefs held by different populations and in regard to implications for intervention design.     

基于保护动机理论的健康教育在乳腺癌术后功能锻炼中的应用

目的:探讨基于保护动机理论(protection motivation theory,PMT)的健康教育对乳腺癌患者术后患肢功能锻炼依从性、患肢肩关节功能及自我效能的影响.方法:采用方便抽样,选择入我科治疗的96例乳腺癌根治术患者作为研究对象,按照随机数字表法分为对照组和实验组,各48例.对照组在患者术后给予常规健康教育,实验组在对照组的基础上实施基于PMT的健康教育.在患者出院3个月后,观察两组功能锻炼依从性、患肢肩关节功能恢复程度以及患者自我效能.结果:实验组功能锻炼依从率为97.87％,高于对照组(84.78％);实验组肩关节完全恢复率为95.74％,高于对照组(82.61％);实验组自我管理效能总分以及正性态度、自我决策、自我减压3个维度得分均高于对照组,上述指标比较差异均有统计学意义(P＜0.05).结论:基于PMT的健康教育可提高乳腺癌患者功能锻炼依从性,促进患者肩关节功能恢复,提高患者自我效能,可在临床中进行推广应用.     

An 8-week exercise study to improve cancer treatment related fatigue and QOL among African American breast cancer patients undergoing radiation treatment: A pilot randomized clinical trial

BackgroundCancer treatment related fatigue (CTRF) is one of the most debilitating side effects of adjuvant radiation therapy (RT). Several studies have found that physical activity (PA) may be an effective intervention to decrease fatigue and enhance QOL in cancer survivors. The primary objective of the PEDLAR study is to test the feasibility of an easily administered 8-week structured moderate-intensity PA intervention, delivered concurrently with RT, in reducing CTRF and improving health-related QOL among African-American breast cancer patients. This study is also designed to provide pilot data on the acceptability and adherence of PA interventions in African-American women with breast cancer.MethodsIt is a prospective, 2-arm, 8-week feasibility trial. Participants are randomized to either a structured, moderate-intensity aerobic training exercise regimen concurrent with radiotherapy or a control group.ResultsParticipants in intervention group reported high satisfaction with exercise and adherence was >75% for exercise sessions.ConclusionsAfrican-American breast cancer patients in a moderate-intensity 75 min/wk aerobic exercise intervention had marginally lower fatigue at 8-wk follow-up compared to baseline. The control group participants had marginally higher fatigue at 8-wk follow-up compared to baseline. Participants in the intervention group reported slightly better quality of life at 8-wk follow-up compared to baseline (P = 0.06).     

Screening adherence and cancer risk perceptions in colorectal cancer survivors with Lynch‐like syndrome

Cancer screening recommendations for patients with Lynch‐like syndrome (LLS) are not well defined. We evaluated adherence to Lynch syndrome (LS) screening recommendations, cancer risk perceptions, and communication within the families among colorectal cancer (CRC) survivors with LLS. Thirty‐four participants with LLS completed a questionnaire about risk perception, adherence to LS screening recommendations, and communication with relatives. Clinical data were obtained from medical records. Most participants (76%) believed they should undergo colonoscopy every 1–2 years. Only 41% correctly interpreted their genetic tests as uninformative negative or as variant of unknown significance for LS. Less than half had had an upper gastrointestinal endoscopy for screening purpose. Among female participants, 86% had been screened for endometrial cancer (EC) and 71% for ovarian cancer. Most participants had informed relatives about the CRC diagnosis and advised them to undergo CRC screening, but only 50% advised female relatives to be screened for EC and only one‐third advised relatives to have genetic counseling. Most CRC survivors with LLS follow the same cancer screening recommended for LS patients but do not understand the meaning of LLS. Greater care must be devoted to communicating the implications of nondiagnostic germline mutation testing among patients with LLS.