The primary purpose of this narrative review was to evaluate the current literature and to provide further insight into the role physical inactivity plays in the development of chronic disease and premature death. We confirm that there is irrefutable evidence of the effectiveness of regular physical activity in the primary and secondary prevention of several chronic diseases (e.g., cardiovascular disease, diabetes, cancer, hypertension, obesity, depression and osteoporosis) and premature death. We also reveal that the current Health Canada physical activity guidelines are sufficient to elicit health benefits, especially in previously sedentary people. There appears to be a linear relation between physical activity and health status, such that a further increase in physical activity and fitness will lead to additional improvements in health status.

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Health benefits of physical activity: the evidence

The author discusses 3 variables that assess different aspects of social relationships—social support, social integration, and negative interaction. The author argues that all 3 are associated with health outcomes, that these variables each influence health through different mechanisms, and that associations between these variables and health are not spurious findings attributable to our personalities. This argument suggests a broader view of how to intervene in social networks to improve health. This includes facilitating both social integration and social support by creating and nurturing both close (strong) and peripheral (weak) ties within natural social networks and reducing opportunities for negative social interaction. Finally, the author emphasizes the necessity to understand more about who benefits most and least from socialconnectedness interventions.

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Social relationships and health.

This article examines health promotion and disease prevention from the perspective of social cognitive theory. The areas of overlap with some of the most widely applied psychosocial models of health are identified. The models of health promotion and disease prevention have undergone several generational changes. We have shifted from trying to scare people into health, to rewarding them into health, to equipping them with self-regulatory skills to manage their health habits, to shoring up their habit changes with dependable social supports. These transformations have evolved a multifaceted approach that addresses the reciprocal interplay between self-regulatory and environmental determinants of health behavior. Social cognitive theory addresses the socio structural determinants of health as well as the personal determinants. A comprehensive approach to health promotion requires changing the practices of social systems that have widespread detrimental effects on health rather than solely changing t...

https://www.uky.edu/~eushe2/Bandura/Bandura1998PH.pdf

Health promotion from the perspective of social cognitive theory

Objective. —To evaluate how well quality of life is being measured in the medical literature and to offer a new approach to the measurement. Data Sources. —Original English-language articles having the term "quality of life" in their titles were identified from a recent Quality-of-Life Bibliography and from two MEDLINE searches. Articles were eligible for review only if they described or used one or more "quality-of-life" instruments. Study Selection. —Twenty-five articles were randomly selected from each of the three data sources. Data Extraction. —Each article was reviewed for its compliance with two sets of criteria having several components, which are cited under "Data Synthesis." Data Synthesis. —(1) Investigators conceptually defined quality of life in only 11 (15%) of the 75 articles; identified the targeted domains in only 35 (47%); gave reasons for selecting the chosen quality-of-life instruments in only 27 (36%); and aggregated their results into a composite quality-of-life score in only 27 (38%) of 71 eligible articles. (2) No article distinguished "overall" quality of life from health-related quality of life; patients were invited to give their own separate rating for quality of life in only 13 articles (17%); and among 71 eligible articles, patients were asked to supplement the stipulated items with personal responses in only nine (13%) and to rate the importance of individual items in only six (8.5%). Conclusions. —Because quality of life is a uniquely personal perception, denoting the way that individual patients feel about their health status and/or nonmedical aspects of their lives, most measurements of quality of life in the medical literature seem to aim at the wrong target. Quality of life can be suitably measured only by determining the opinions of patients and by supplementing (or replacing) the instruments developed by "experts." (JAMA. 1994;272:619-626)

https://jamanetwork.com/journals/JAMA/articlepdf/378367/jama_272_8_045.pdf

A critical appraisal of the quality of quality-of-life measurements

Objective: The objective of this study was to assess the effects of participation in a mindfulness meditation‐ based stress reduction program on mood disturbance and symptoms of stress in cancer outpatients. Methods: A randomized, wait-list controlled design was used. A convenience sample of eligible cancer patients enrolled after giving informed consent and were randomly assigned to either an immediate treatment condition or a wait-list control condition. Patients completed the Profile of Mood States and the Symptoms of Stress Inventory both before and after the intervention. The intervention consisted of a weekly meditation group lasting 1.5 hours for 7 weeks plus home meditation practice. Results: Ninety patients (mean age, 51 years) completed the study. The group was heterogeneous in type and stage of cancer. Patients’ mean preintervention scores on dependent measures were equivalent between groups. After the intervention, patients in the treatment group had significantly lower scores on Total Mood Disturbance and subscales of Depression, Anxiety, Anger, and Confusion and more Vigor than control subjects. The treatment group also had fewer overall Symptoms of Stress; fewer Cardiopulmonary and Gastrointestinal symptoms; less Emotional Irritability, Depression, and Cognitive Disorganization; and fewer Habitual Patterns of stress. Overall reduction in Total Mood Disturbance was 65%, with a 31% reduction in Symptoms of Stress. Conclusions: This program was effective in decreasing mood disturbance and stress symptoms in both male and female patients with a wide variety of cancer diagnoses, stages of illness, and ages. Key words: meditation, cancer, stress, mood, intervention, mindfulness. ANOVA 5 analysis of variance; MANOVA 5 multiple analysis of variance; POMS 5 Profile of Mood States; SOSI 5 Symptoms of Stress Inventory.

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A randomized, wait-list controlled clinical trial: the effect of a mindfulness meditation-based stress reduction program on mood and symptoms of stress in cancer outpatients.

In order to test the effect of a psychological intervention on survival from cancer, 66 women with metastatic breast cancer, all receiving standard medical care, were randomly assigned into two groups; one group (n = 30) attended the psychological intervention, consisting of 35 weekly, 2 h sessions of supportive plus cognitive behavioral therapy; the control group (n = 36) received only a home study cognitive behavioral package. No significant difference was found in survival post-randomization between the groups as assessed by a log rank test 5 years after the commencement of the study. As expected, several prognostic factors were significant predictors of survival: metastatic site, hormonal receptor status, and chemotherapy prior to randomization. While many personal and demographic variables did not influence survival, there was a significant effect of self-reported exercise (possibly due to better health). A small subgroup of intervention subjects who attended outside support groups also survived significantly longer than those who did not. The strengths and limitations of the present study are discussed, and the results contrasted with those of a well known study by Spiegel et al. (Spiegel, D., Bloom, J.R., Kraemer, H.C. and Gottheil, E. (1989) Lancet ii, 888-891). We propose that a different experimental design (correlative) may be needed to show any effect of self-help behaviors and psychological attributes in a small minority of patients.

A randomized controlled trial of the effects of group psychological therapy on survival in women with metastatic breast cancer

A relationship between perceived self-efficacy and quality of life in cancer patients.

Research has demonstrated that short term psychological interventions improve the quality of life of cancer patients. However, there is much less evidence for the efficacy of longer term interventions. We report the psychometric results from a randomized clinical trial (n=66) assessing the effects of an 8 month, weekly psychological intervention on 30 metastatic breast cancer patients. Subjects were assessed at baseline, 4, 8 and 14 months for mood, quality of life and adjustment to cancer. Results demonstrated little psychometric difference between the control (n=36) and intervention groups over this length of time, in spite of the fact that when the intervention subjects attended a weekend of support and training in coping skills, the usual significant, short term changes were observed. In the long term intervention, subjects did experience more anxious preoccupation and less helplessness than the controls but no recorded improvements in mood or quality of life. However, profound clinical changes were observed by the therapists, similar to those noted by Spiegel et al. (1981). We conclude that many of the psychological changes made by subjects in longer term interventions may elude conventional psychometric assessment. Further research, of a rigorous qualitative nature, is required to develop a clearer understanding of the experience of living and eventually dying of cancer within the context of a long term intervention. Copyright © 1999 John Wiley & Sons, Ltd.

Psychological response to long-term group therapy: a randomized trial with metastatic breast cancer patients.

A randomized trial of group psychoeducational therapy for cancer patients

Objective We present here a point of view about the logical role of group psychological therapies in the care of cancer patients, and propose a comprehensive, four-stage program that could be implemented at any large cancer treatment center. Method Our proposals rest on a review of the literature, and on our own experience with various kinds of psychological help for cancer patients, some of which is described. Results It is clear that group psychological therapies improve the quality of life of many participating cancer patients, and there is preliminary evidence that it may prolong life in some cases. We describe five main kinds of adjuvant psychological therapy, arranging them on a hierarchy of increasingly active participation by the recipient, and noting the status of evidence for their efficacy. They are: providing information, emotional support, behavioral training in coping skills, psychotherapy (of various kinds), and more speculatively, spiritual/existential therapy. Conclusions We propose that it is time to consider psychological therapy as an adjuvant in cancer management, analogous to adjuvant chemotherapy. The main indication for advocating group psychological therapy to patients should, we argue, be an expert assessment that the patient is likely to benefit, and should not (as is usual at present) be restricted to either 1) those patients with overt psychopathology, or 2) those few who specifically request it.

Alastair J. Cunningham

Papers

A randomized controlled trial of the effects of group psychological therapy on survival in women with metastatic breast cancer

A relationship between perceived self-efficacy and quality of life in cancer patients.

Psychological response to long-term group therapy: a randomized trial with metastatic breast cancer patients.

A randomized trial of group psychoeducational therapy for cancer patients

Group psychological therapy for cancer patients: a point of view, and discussion of the hierarchy of options