Abstract
The purpose of this study is to explore the mediators associated with physical activity (PA) within the adoption and maintenance phase of a PA intervention trial among breast cancer survivors. Overall, 192 breast cancer survivors (average age = 55.9 years) were randomized to an Intervention or Control group. Both groups received 8 calls in the first 3-months, 3 monthly calls, and then entered a no-contact maintenance phase for the remaining 6-months. Assessments were completed at baseline, 3-months, 6-months and 12-months. On average, participants were 55.9 years of age (SD = 9.8) and 2.9 years since diagnosis (SD = 2.2). In the adoption phase, all significant univariate mediators (self-efficacy, cognitive and behavioral processes and decisional balance cons) were included in the multivariate model. Results suggest self-efficacy (ab = 13.56, SE = 7.04) and behavioral processes (ab = 36.10, SE = 12.22) were significant for PA adoption. No mediators were identified in the maintenance phase. In the adoption phase, there were significant indirect effects of group on PA adoption through self-efficacy and behavioral processes. There were no indirect effects of group on PA maintenance.
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Baldwin, M. K., & Courneya, K. S. (1997). Exercise and self-esteem in breast cancer survivors: An application of the exercise and self-esteem model. Journal of Sport and Exercise Psychology,19, 347–358.
Bandura, A. (1986). Social foundations of thought and action: A social cognitive theory. Englewood Cliffs, NJ: Prentice Hall.
Baruth, M., Wilcox, S., Dunn, A. L., King, A. C., Marcus, B. H., Rejeski, W. J., et al. (2010). Psychosocial mediators of physical activity and fitness changes in the activity counseling trial. Annals of Behavioral Medicine,39, 274–289. https://doi.org/10.1007/s12160-010-9178-4
Blair, S. N., Haskell, W. L., Ho, P., Paffenbarger, R. S., Jr., Vranizan, K. M., Farquhar, J. W., et al. (1985). Assessment of habitual physical activity by a seven-day recall in a community survey and controlled experiments. American Journal of Epidemiology,122, 794–804.
Blanchard, C. M., Denniston, M. M., Baker, F., Ainsworth, S. R., Courneya, K. S., Hann, D. M., et al. (2003). Do adults change their lifestyle behaviors after a cancer diagnosis? The American Journal of Health Behavior,27, 246–256.
Bluethmann, S. M., Vernon, S. W., Gabriel, K. P., Murphy, C. C., & Bartholomew, L. K. (2015). Taking the next step: A systematic review and meta-analysis of physical activity and behavior change interventions in recent post-treatment breast cancer survivors. Breast Cancer Research and Treatment,149, 331–342. https://doi.org/10.1007/s10549-014-3255-5
Bock, B. C., Marcus, B. H., Pinto, B. M., & Forsyth, L. H. (2001). Maintenance of physical activity following an individualized motivationally tailored intervention. Annals of Behavioral Medicine,23, 79–87. https://doi.org/10.1207/S15324796ABM2302_2
Courneya, K. S. (2003). Exercise in cancer survivors: An overview of research. Medicine and Science in Sports and Exercise,35, 1846–1852. https://doi.org/10.1249/01.MSS.0000093622.41587.B6
Courneya, K. S., Rogers, L. Q., Campbell, K. L., Vallance, J. K., & Friedenreich, C. M. (2015). Top 10 research questions related to physical activity and cancer survivorship. Research Quarterly for Exercise and Sport,86, 107–116. https://doi.org/10.1080/02701367.2015.991265
Cress, M. E., Buchner, D. M., Prohaska, T., Rimmer, J., Brown, M., Macera, C., et al. (2005). Best practices for physical activity programs and behavior counseling in older adult populations. Journal of Aging and Physical Activity,13, 61–74.
Demark-Wahnefried, W., Morey, M. C., Sloane, R., Snyder, D. C., Miller, P. E., Hartman, T. J., et al. (2012). Reach out to enhance wellness home-based diet-exercise intervention promotes reproducible and sustainable long-term improvements in health behaviors, body weight, and physical functioning in older, overweight/obese cancer survivors. Journal of Clinical Oncology,30, 2354–2361. https://doi.org/10.1200/JCO.2011.40.0895
Fjeldsoe, B., Neuhaus, M., Winkler, E., & Eakin, E. (2011). Systematic review of maintenance of behavior change following physical activity and dietary interventions. Health Psychology,30, 99–109. https://doi.org/10.1037/a0021974
Humpel, N., Owen, N., & Leslie, E. (2002). Environmental factors associated with adults’ participation in physical activity: A review. American Journal of Preventive Medicine,22, 188–199.
Jankowski, C. M., Ory, M. G., Friedman, D. B., Dwyer, A., Birken, S. A., & Risendal, B. (2014). Searching for maintenance in exercise interventions for cancer survivors. Journal of Cancer Survivorship,8, 697–706. https://doi.org/10.1007/s11764-014-0386-y
Lewis, B. A., Marcus, B. H., Pate, R. R., & Dunn, A. L. (2002). Psychosocial mediators of physical activity behavior among adults and children. American Journal of Preventive Medicine,23, 26–35.
Lewis, B. A., Williams, D. M., Martinson, B. C., Dunsiger, S., & Marcus, B. H. (2013). Healthy for life: A randomized trial examining physical activity outcomes and psychosocial mediators. Annals of Behavioral Medicine,45, 203–212. https://doi.org/10.1007/s12160-012-9439-5
Marcus, B. H., Dubbert, P. M., Forsyth, L. H., McKenzie, T. L., Stone, E. J., Dunn, A. L., et al. (2000). Physical activity behavior change: Issues in adoption and maintenance. Health Psychology,19, 32–41.
Marcus, B. H., Rakowski, W., & Rossi, J. S. (1992a). Assessing motivational readiness and decision making for exercise. Health Psychology,11, 257–261.
Marcus, B. H., Selby, V. C., Niaura, R. S., & Rossi, J. S. (1992b). Self-efficacy and the stages of exercise behavior change. Research Quarterly for Exercise and Sport,63, 60–66. https://doi.org/10.1080/02701367.1992.10607557
Marcus, B. H., & Simkin, L. R. (1993). The stages of exercise behavior. Journal of Sports Medicine and Physical Fitness,33, 83–88.
Marcus, B. H., Williams, D. M., Dubbert, P. M., Sallis, J. F., King, A. C., Yancey, A. K., et al. (2006). Physical activity intervention studies: What we know and what we need to know—a scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity); Council on Cardiovascular Disease in the Young; and the Interdisciplinary Working Group on Quality of Care and Outcomes Research. Circulation,114, 2739–2752. https://doi.org/10.1161/CIRCULATIONAHA.106.179683
McAuley, E., & Blissmer, B. (2000). Self-efficacy determinants and consequences of physical activity. Exercise and Sport Sciences Reviews,28, 85–88.
Muller-Riemenschneider, F., Reinhold, T., Nocon, M., & Willich, S. N. (2008). Long-term effectiveness of interventions promoting physical activity: A systematic review. Preventive Medicine,47, 354–368. https://doi.org/10.1016/j.ypmed.2008.07.006
Murray, J. M., Brennan, S. F., French, D. P., Patterson, C. C., Kee, F., & Hunter, R. F. (2018). Mediators of behavior change maintenance in physical activity interventions for young and middle-aged adults: A systematic review. Annals of Behavioral Medicine,52, 513–529. https://doi.org/10.1093/abm/kay012
Musanti, R. (2012). A study of exercise modality and physical self-esteem in breast cancer survivors. Medicine and Science in Sports and Exercise,44, 352–361. https://doi.org/10.1249/MSS.0b013e31822cb5f2
Mutrie, N., Campbell, A., Barry, S., Hefferon, K., McConnachie, A., Ritchie, D., et al. (2012). Five-year follow-up of participants in a randomised controlled trial showing benefits from exercise for breast cancer survivors during adjuvant treatment. Are there lasting effects? Journal of Cancer Survivorship,6, 420–430. https://doi.org/10.1007/s11764-012-0233-y
Nieman, D. C., Cook, V. D., Henson, D. A., Suttles, J., Rejeski, W. J., Ribisl, P. M., et al. (1995). Moderate exercise training and natural killer cell cytotoxic activity in breast cancer patients. International Journal of Sports Medicine,16, 334–337. https://doi.org/10.1055/s-2007-973015
Perez, A., Fleury, J., & Belyea, M. (2016). Environmental resources in maintenance of physical activity 6 months following cardiac rehabilitation. Clinical Nursing Research,25, 391–409. https://doi.org/10.1177/1054773815627277
Pinto, B. M., Papandonatos, G. D., & Goldstein, M. G. (2013). A randomized trial to promote physical activity among breast cancer patients. Health Psychology,32, 616–626. https://doi.org/10.1037/a0029886
Preacher, K. J., & Hayes, A. F. (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods,40, 879–891.
Prochaska, J. O., & DiClemente, C. C. (1983). Stages and processes of self-change of smoking: Toward an integrative model of change. Journal of Consulting and Clinical Psychology,51, 390–395.
Rhodes, R. E., & Pfaeffli, L. A. (2010). Mediators of physical activity behaviour change among adult non-clinical populations: A review update. International Journal of Behavioral Nutrition and Physical Activity,7, 37. https://doi.org/10.1186/1479-5868-7-37
Rock, C. L., Flatt, S. W., Byers, T. E., Colditz, G. A., Demark-Wahnefried, W., Ganz, P. A., et al. (2015). Results of the exercise and nutrition to enhance recovery and good health for you (ENERGY) trial: A behavioral weight loss intervention in overweight or obese breast cancer survivors. Journal of Clinical Oncology,33, 3169–3176. https://doi.org/10.1200/JCO.2015.61.1095
Saelens, B. E., Sallis, J. F., Black, J. B., & Chen, D. (2003). Neighborhood-based differences in physical activity: An environment scale evaluation. American Journal of Public Health,93, 1552–1558.
Sallis, J. F., Grossman, R. M., Pinski, R. B., Patterson, T. L., & Nader, P. R. (1987). The development of scales to measure social support for diet and exercise behaviors. Preventive Medicine,16, 825–836.
Sallis, J. F., Haskell, W. L., Wood, P. D., Fortmann, S. P., Rogers, T., Blair, S. N., et al. (1985). Physical activity assessment methodology in the Five-City Project. American Journal of Epidemiology,121, 91–106.
Schmitz, K. H., Courneya, K. S., Matthews, C., Demark-Wahnefried, W., Galvao, D. A., Pinto, B. M., et al. (2010). American College of Sports Medicine roundtable on exercise guidelines for cancer survivors. Medicine and Science in Sports and Exercise,42, 1409–1426. https://doi.org/10.1249/MSS.0b013e3181e0c112
Seymour, R. B., Hughes, S. L., Ory, M. G., Elliot, D. L., Kirby, K. C., Migneault, J., et al. (2010). A lexicon for measuring maintenance of behavior change. The American Journal of Health Behavior,34, 660–668.
Slovinec D’Angelo, M. E., Pelletier, L. G., Reid, R. D., & Huta, V. (2014). The roles of self-efficacy and motivation in the prediction of short- and long-term adherence to exercise among patients with coronary heart disease. Health Psychology,33, 1344–1353. https://doi.org/10.1037/hea0000094
Spark, L. C., Reeves, M. M., Fjeldsoe, B. S., & Eakin, E. G. (2013). Physical activity and/or dietary interventions in breast cancer survivors: A systematic review of the maintenance of outcomes. Journal of Cancer Survivorship,7, 74–82. https://doi.org/10.1007/s11764-012-0246-6
Speck, R. M., Courneya, K. S., Masse, L. C., Duval, S., & Schmitz, K. H. (2010). An update of controlled physical activity trials in cancer survivors: A systematic review and meta-analysis. Journal of Cancer Survivorship,4, 87–100. https://doi.org/10.1007/s11764-009-0110-5
Spruit, M. A., Janssen, P. P., Willemsen, S. C., Hochstenbag, M. M., & Wouters, E. F. (2006). Exercise capacity before and after an 8-week multidisciplinary inpatient rehabilitation program in lung cancer patients: A pilot study. Lung Cancer,52, 257–260. https://doi.org/10.1016/j.lungcan.2006.01.003
Squires, R. W., Shultz, A. M., & Herrmann, J. (2018). Exercise training and cardiovascular health in cancer patients. Current Oncology Reports,20, 27. https://doi.org/10.1007/s11912-018-0681-2
Stout, N. L., Baima, J., Swisher, A. K., Winters-Stone, K. M., & Welsh, J. (2017). A systematic review of exercise systematic reviews in the cancer literature (2005–2017). PMR,9, S347–S384. https://doi.org/10.1016/j.pmrj.2017.07.074
Stull, V. B., Snyder, D. C., & Demark-Wahnefried, W. (2007). Lifestyle interventions in cancer survivors: Designing programs that meet the needs of this vulnerable and growing population. Journal of Nutrition,137, 243S–248S. https://doi.org/10.1093/jn/137.1.243S
Teixeira, P. J., Carraca, E. V., Marques, M. M., Rutter, H., Oppert, J. M., De Bourdeaudhuij, I., et al. (2015). Successful behavior change in obesity interventions in adults: A systematic review of self-regulation mediators. BMC Medicine,13, 84. https://doi.org/10.1186/s12916-015-0323-6
Tomlinson, D., Diorio, C., Beyene, J., & Sung, L. (2014). Effect of exercise on cancer-related fatigue: A meta-analysis. American Journal of Physical Medicine and Rehabilitation,93, 675–686. https://doi.org/10.1097/PHM.0000000000000083
Vallance, J., Plotnikoff, R. C., Karvinen, K. H., Mackey, J. R., & Courneya, K. S. (2010). Understanding physical activity maintenance in breast cancer survivors. The American Journal of Health Behavior,34, 225–236.
White, S. M., McAuley, E., Estabrooks, P. A., & Courneya, K. S. (2009). Translating physical activity interventions for breast cancer survivors into practice: An evaluation of randomized controlled trials. Annals of Behavioral Medicine,37, 10–19. https://doi.org/10.1007/s12160-009-9084-9
Williams, D. M., Lewis, B. A., Dunsiger, S., Whiteley, J. A., Papandonatos, G. D., Napolitano, M. A., et al. (2008). Comparing psychosocial predictors of physical activity adoption and maintenance. Annals of Behavioral Medicine,36, 186–194. https://doi.org/10.1007/s12160-008-9054-7
Winningham, M. (1993). Developing the Symptom Activity 27: An instrument to evaluate perception of symptom effects on activity. Oncology Nursing Forum,20, 330.
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This study was funded by a Grant from the American Cancer Society and Rays of Hope (RSGPB-03-243-01).
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Madison M. Kindred, Bernardine M. Pinto, Shira I. Dunsiger declares that they have no conflict of interest.
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Kindred, M.M., Pinto, B.M. & Dunsiger, S.I. Mediators of physical activity adoption and maintenance among breast cancer survivors. J Behav Med 43, 605–613 (2020). https://doi.org/10.1007/s10865-019-00085-6
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DOI: https://doi.org/10.1007/s10865-019-00085-6