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Long-Term Maintenance of Physical Activity in Breast Cancer Survivors: A Behavioral Intervention Study

This study examines the effectiveness of a behavioral intervention in promoting physical activity in breast cancer survivors. Results show significant improvements in quality of life and fatigue. Although the intervention groups reported increased physical activity at 6 months follow-up, further efforts are needed to enhance long-term adherence. The study suggests providing ongoing support through telephone, mailings, or email for maintaining physical activity. Distance-based interventions show promise in benefiting a larger number of survivors.

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Long-Term Maintenance of Physical Activity in Breast Cancer Survivors: A Behavioral Intervention Study

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  1. Maintenance of physical activity in breast cancer survivors after a randomized trial J Vallance1, KS Courneya2, RC Plotnikoff3, I Dinu3, & JR Mackey4 1 Centre for Nursing and Health Studies, Athabasca University 2 Faculty of Physical Education and Recreation, University of Alberta 3 School of Public Health, University of Alberta 4 Department of Oncology, University of Alberta, Cross Cancer Institute *(Vallance et al., Med Sci Sports Exerc, 2008;40:173-180)

  2. Background and Rationale • Recent systematic reviews: Cardiorespiratory fitness, QoL, fatigue. • Post treatment PA associated with a 26% to 40% risk reduction in breast cancer recurrence, breast cancer-specific mortality, and all-cause mortality. • Majority of breast cancer survivors are still not meeting public health PA guidelines. (McNeely et al., 2006, Can Med Assoc J; Schmitz et al., 2005, Cancer Epi Bio Prev Holmes et al., 2005, J Amer Med Assoc Irwin et al., 2003, Cancer; 2004, Med Sci Sports Ex; Bellizzi et al., 2005, J Clin Oncol

  3. Activity Promotion Trial • Compared breast cancer-specific PA print materials and step pedometers to a verbal public health recommendation for PA in breast cancer survivors. • 12 weeks: 40-60 minwk more PA and 60-90 minwk more brisk walking (d = .25 to .62). • Combined approach yielded clinically meaningful improvements in QoL and fatigue.

  4. Exercise for health Vallance et al., in press, Health Educ Behav • Core message was to engage in moderate PA on at least 5 days of the week for 30 minutes.

  5. 6 month follow-up assessment • Mailed survey at 6 months post intervention. • Godin Leisure Time Exercise Questionnaire. • Modified Godin to assess brisk walking. • QoL (FACT-Anemia). • 266/377 (71%) completed f/u assessment. • Completers weighed less (3.5kg less), were more likely to be on Tamoxifen (51 vs 41%), and more likely to be meeting PA guidelines at baseline (37 vs 26%).

  6. Participants • Mean age 58 years (Rg: 30-90 years) • Mean BMI 27.7 (5.6) • Obese class I 20% • Months post-Dx 39 months (~3 years) • Postmenopausal 62% • Stage I or IIa 81%

  7. Uptake of intervention materials • PEDOMETER and COMBINED groups: • ~40% wore pedometer during f/u (52/136). • ~80% felt pedometer helped them increase their activity (104/136). • Pedometer was motivating (40%). • Knew how much they were doing (34%). • PRINT MATERIAL and COMBINED groups: • 60% read resource at least once during f/u.

  8. Change in self-reported PA *Baseline to 6 months f/u +30 +60 +47

  9. Change in self-reported brisk walking *Baseline to 6 months f/u +35 +42 +47

  10. Conclusions • INT groups reported 30-60 minwk more PA and 35-50 minwk more brisk walking at 6 months f/u. • Comparable to 3-month intervention effects (i.e., 40-60 more PA; 60-90 min more brisk walking). • Groups were not statistically superior to SR. • Loss of power due to increase in variability. • Maintained small to mod effect sizes (0.18 to 0.38). • Behavioral relevance of findings.

  11. Recommendations • Examine ways of improving longer term adherence. • Telephone support, frequent mailings, email. • Motivated group of survivors. • Preliminary support for INT tools in maintaining PA after distance-based behavior interventions. • Distance-based trials and programs have the opportunity to benefit the greatest # of survivors.

  12. Acknowledgements • CCS/NCIC Sociobehavioral Cancer Research Network. • Co-investigators. • Labmates and participants who contributed to this research.

  13. Questions?

  14. Study flow 1590 Northern Alberta breast cancer survivors received a letter of invitation 1192 survivors excluded Did not respond (n=678) Interested but study full (n=310) 377 randomized (23%) 96 allocated to SR 94 allocated to PM 94 allocated to PED 93 allocated to COM 90% 85 followed up at posttest 81 followed up at posttest 88 followed up at posttest 84 followed up at posttest 71% 68 followed up at 6 months 62 followed up at 6 months 69 followed up at 6 months 67 followed up at 6 months

  15. Change in self-reported PA *Postintervention to 6 months f/u

  16. Change in self-reported brisk walking *Postintervention to 6 months f/u

  17. Physical Activity and Cancer Diagnosis Health Promotion Rehabilitation Prevention Detection Coping Survival Palliation Prescreening Screening Pretreatment Treatment Posttreatment Resumption Prediagnosis Postdiagnosis (Courneya, 2001, Annals Behav Med)

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