Showing papers by "Kerry S. Courneya published in 2004"

Effects of an oncologist's recommendation to exercise on self-reported exercise behavior in newly diagnosed breast cancer survivors: a single-blind, randomized controlled trial.

Abstract: Background: Increased attention has focused on exercise as a quality of life intervention for breast cancer survivors during and after adjuvant therapy.Purpose: Our objective was to examine the effects of an oncologist’s recommendation to exercise on self-reported exercise behavior in newly diagnosed breast cancer survivors attending their first adjuvant therapy consultation.Methods: Using a single-blind, 3-armed, randomized controlled trial, 450 breast cancer survivors were randomly assigned to receive an oncologist exercise recommendation only, an oncologist exercise recommendation plus referral to an exercise specialist, or usual care. The primary outcome was self-reported total exercise (in metabolic equivalent [MET] hours per week) at 5 weeks postconsultation.Results: The follow-up assessment rate was 73% (329 of 450). Intention-to-treat analysis based on participants with follow-up data indicated a significant difference in total exercise in favor of the recommendation-only group over the usual care group (mean difference, 3.4 MET hr per week; 95% confidence interval [CI], 0.7–6.1 MET hr per week; p = .011). There was no significant difference between the recommendation-plus-referral group and the usual care group (mean difference, 1.5 MET hr per week; 95% CI, −1.0 to 4.0 MET hr per week; p = .244). Ancillary on-treatment analyses showed that participants who recalled an exercise recommendation reported significantly more total exercise than participants who did not recall an exercise recommendation (mean difference, 4.1 MET hr per week; 95% CI, 1.9–6.4 MET hr per week; p < .001).Conclusions: Our findings suggest that an oncologist recommendation may increase exercise behavior in newly diagnosed breast cancer survivors, particularly if it is recalled 1 week after the recommendation.

Association between current lifestyle behaviors and health-related quality of life in breast, colorectal, and prostate cancer survivors

Abstract: The purpose of the present study was to compare cancer survivors on three different lifestyle behaviors (i.e., physical activity, fruit and vegetable (F&V) consumption, and smoking) and examine the association between these lifestyle behaviors and health-related quality of life (HRQOL). Breast (n = 123), colorectal (n = 86), and prostate (n = 107) cancer survivors completed a survey that included lifestyle behavior questions and the RAND-36 Health Status Inventory (HSI). Results showed that similar percentages of breast, colorectal, and prostate cancer survivors met the lifestyle behavior recommendations. Overall, 69.9 and 26.3% reported meeting the recommendations for physical activity and F&V consumption while 94.3% did not smoke. In addition, survivors who met the physical activity recommendation had significantly higher HRQOL than those who did not, however, meeting the F&V recommendation was not related to HRQOL. Nonetheless, survivors who met more than one lifestyle behavior recommendation had signi...

A pilot study of a randomized controlled trial to evaluate the effects of progressive resistance exercise training on shoulder dysfunction caused by spinal accessory neurapraxia/neurectomy in head and neck cancer survivors

Abstract: Background. Shoulder dysfunction remains a frequent complication after neck dissection procedures for head and neck cancer. Methods. We conducted a pilot study to evaluate the effects of progressive resistance exercise training (PRET) on shoulder dysfunction caused by spinal accessory neurapraxia/neurectomy in patients with head and neck cancer. Twenty patients (mean age, 61 ± 7.7 years) were randomly assigned to PRET or standard care intervention. Subjects assigned to the PRET group exercised three times per week for 12 weeks. The goal of the exercise program was to enhance scapular stability and strength of the upper extremity. The resistance-training program was progressive in terms of number of sets and repetitions performed, as well as the amount of weight lifted, depending on performance status. Results. The completion rate for the trial was 85% (17 of 20). The exercise group completed 93% of scheduled exercise sessions. Significant improvements were found in favor of the PRET group in active shoulder external rotation (p = .001), shoulder pain (p = .038), and overall score for shoulder pain and disability (p = .045). Conclusions. The study results demonstrate a high rate of completion and adherence with our PRET program among patients with head and neck cancer. The preliminary findings, although limited, also suggest a potential therapeutic role for resistance exercise as an adjunct to standard physical therapy treatment. © 2004 Wiley Periodicals, Inc. Head Neck26: 518–530, 2004

Differentiating motivation and control in the Theory of Planned Behavior

Abstract: Ajzen has distinguished between self-efficacy (i.e., confidence, ease-difficulty) and controllability (i.e., control, up to me) item clusters when measuring perceived behavioural control (PBC). Rather than a two-factor control construct, we have suggested that confidence and ease-difficulty items possess measurement complexity between intention and PBC and do not measure Ajzen's PBC construct as cleanly as do control items unless a phrase is included to hold motivation constant (e.g., if I was really motivated…). The purpose of this study was to include PBC items with and without phrases that hold motivation constant and test the effects of measurement redundancy on other TPB coefficients when predicting/explaining exercise intentions. Participants were 241 undergraduate students who completed measures of the TPB. Results supported our theorizing for a single control construct by showing that confidence and ease-difficulty items without motivation held constant displayed factor complexity between PBC and ...

Exploring social cognitive theory constructs for promoting exercise among breast cancer patients.

Abstract: Physical activity during breast cancer treatment can significantly reduce treatment-related fatigue and improve quality of life. Unfortunately, the majority of women with breast cancer either do not exercise at all or exercise below recommended levels. Little is known about how to enhance physical activity among breast cancer patients. The social cognitive theory, a useful framework for the design of physical activity interventions, has not been studied among breast cancer patients. Our study purpose was to explore physical activity knowledge, attitudes, and behaviors among breast cancer patients during adjuvant therapy utilizing social cognitive theory constructs in preparation for a larger, survey study and future intervention research. Twelve breast cancer patients attended 1 of 3 focus group sessions. Focus group questions were based on the social cognitive theory constructs of self-efficacy, environment, behavioral capability, expectations, expectancies, self-control and performance, observational learning, and reinforcement. The focus group participants generally felt confident in their ability to exercise during treatment if fatigue, time management, and social networking were addressed. The majority of participants had not been given information related to exercise by their physicians during treatment. The participants felt that exercise was more beneficial than harmful during treatment, with the 2 most important benefits identified as reduced fatigue and the potential for improved survival. The use of reinforcements by participants was minimal. The participants consistently expressed the desire for education and guidance by knowledgeable staff during an exercise program. Walking was the most acceptable exercise modality. Social cognitive theory may be a useful framework for future study of exercise behavior among breast cancer patients and measurement of constructs related to this theory should be included in such studies. Future exercise intervention studies should consider the unique barriers and program preferences of breast cancer patients while focusing on self-efficacy, outcome expectations/ expectancies, observational learning, and reinforcements.

Case-Control Study of Lifetime Total Physical Activity and Prostate Cancer Risk

Abstract: A population-based case-control study of physical activity and prostate cancer risk was conducted in Alberta, Canada, between 1997 and 2000. A total of 988 incident, histologically confirmed cases of stage T2 or greater prostate cancer were frequency matched to 1,063 population controls. The Lifetime Total Physical Activity Questionnaire was used to measure occupational, household, and recreational activity levels from childhood until diagnosis. Multivariable logistic regression analyses were conducted. No association for total lifetime physical activity and prostate cancer risk was found (odds ratio (OR) for > or =203 vs. 6 metabolic equivalents), vigorous activity decreased prostate cancer risk (OR=0.70, 95% CI: 0.54, 0.92). This study provides inconsistent evidence for the association between physical activity and prostate cancer risk.

Promoting exercise behaviour: An integration of persuasion theories and the theory of planned behaviour

Abstract: Objectives: The purpose of this study was to examine the effectiveness of a theoretical integrated persuasive message on exercise motivation in college students. Method: Four hundred and fifty introductory psychology students (M age = 20.02 years;SD = 3.94) were randomly assigned to reading positively or negatively framed strong messages advocating exercise. The messages were attributed to a credible source, a non-credible source or to a no-source control condition. Theory of planned behaviour (TPB) constructs (i.e. attitude, subjective norm, perceived behavioural control) and cognitive responses (i.e. thought listing) were measured immediately and 2 weeks following the delivery of the intervention. Results: Unfortunately, the results did not corroborate previous research, as we did not find any significant effects between experimental groups on any psychological or behavioural variable. Conclusions: There may be several potential explanations for the lack of effects, including the interaction between the type of persuasive information (TPB implications) and sources of persuasion and how these persuasive messages are processed (elaboration likelihood model/cognitive response implications). The theoretical implications of this research are discussed with a view towards future directions for exercise promotion initiatives using theoretically driven interventions.

Predictors of adherence and contamination in a randomized trial of exercise in colorectal cancer survivors

Abstract: The purpose of this study was to examine predictors of exercise adherence (i.e. exercise in the intervention group) and exercise contamination (i.e. exercise in the control group) in a randomized controlled trial of home-based exercise in colorectal cancer survivors. At baseline, 102 participants completed measures of the theory of planned behavior, personality, past exercise, exercise stage of change, physical fitness, and medical/demographics and then were randomly assigned in a 2:1 ratio to an exercise (n=69) or control (n=33) group. Exercise was monitored weekly for 16 weeks using self-reports by telephone. Ninety-three (91%) participants completed the trial. Adherence was 76% in the exercise group and contamination was 52% in the control group. Hierarchical stepwise regression analyses indicated that baseline exercise stage of change (beta=0.35; p=0.001), employment status (beta=-0.28; p=0.010), treatment protocol (beta=-0.26; p=0.018), and perceived behavioral control (beta=0.20; p=0.055) explained 39.6% of the variance in exercise adherence. Intentions (beta=0.36; p=0.049) and baseline exercise stage of change (beta=0.30; p=0.095) explained 29.9% of the variance in exercise contamination. These findings may have implications for conducting clinical trials of exercise in colorectal cancer survivors and for promoting exercise to colorectal cancer survivors outside of clinical trials.

Association between exercise and quality of life in multiple myeloma cancer survivors.

Abstract: Goals of the work The goal of this study was to examine the association between exercise and quality of life (QOL) in multiple myeloma cancer survivors.

Exercise issues in older cancer survivors

Abstract: Older cancer survivors experience the combined deleterious effects associated with aging and a cancer diagnosis. The purpose of the present paper is to review the potential role of physical exercise in attenuating the effects of cancer and its treatments in older cancer survivors. Noting the limited direct research on exercise in older cancer survivors, we review the literature on: (a) older adults in general; and (b) cancer survivors in general. We conclude that although there is limited direct evidence on the benefits of exercise in older cancer survivors, there is compelling evidence of the benefits of exercise in cancer survivors in general and other older populations. We also conclude that exercise adherence will be a significant challenge in this population. Based on this evidence, we tentatively recommend exercise to older cancer survivors using the American College of Sports Medicine's [Med Sci Sports Exerc 30 (6) (1998) 992] guidelines for older adults in general. Finally, we offer future research directions that will provide important evidence needed to guide clinical decisions about exercise in older cancer survivors.

Effects of different combinations of intensity categories on self-reported exercise.

Abstract: Self-reports of exercise are used extensively in behavioral, social psychological, and epidemiological research (Ainsworth, Montoye, & Leon, 1994; Caspersen, 1997). Schwarz (1999) noted that many characteristics strongly influence self-reports of behavior, including question wording, format, and context. Of particular interest in the present study is the possible effect of providing different combinations of intensity categories (i.e., light/mild, moderate, and vigorous/strenuous) on self-reported exercise. A review of the exercise measurement literature indicates that researcher-developed and published questionnaires have varied in the number of exercise intensity categories they present to respondents. For example, researcher-developed questionnaires have often used only one category of exercise intensity, such as moderate (e.g., Miller, Trost, & Brown, 2002; Wallace, Buckworth, Kirby, & Sherman, 2000) or vigorous (e.g., Owen, Sedgwick, & Davies, 1988; Washburn, Goldfield, Smith, & McKinlay, 19...

Exercise motivation and adherence in cancer survivors after participation in a randomized controlled trial: An attribution theory perspective

Abstract: The purpose of this study was to examine postprogram exercise motivation and adherence in cancer survivors who participated in the Group Psychotherapy and Home-Based Physical Exercise (GROUP-HOPE; Courneya, Friedenreich, Sela, Quinney, & Rhodes, 2002) trial. At the completion of the GROUP-HOPE trial, 46 of 51 (90%) participants in the exercise group completed measures of attribution theory constructs. A5-week follow-up self-report of exercise wasthen completed by 30 (65%) participants. Correlational analyses indicated that program exercise, perceived success, expected success, and affective reactions were strong predictors of postprogram exercise. In multivariate stepwise regression analyses, program exercise and perceived successwere the strongest predictors of postprogram exercise. Additionally, perceived success was more important than objective success in understanding the attribution process, and it interacted with personal control to influence expected success and negative affect. Finally, postprogram quality of life and changes in physical fitness were correlates of perceived success. We concluded that attribution theory may have utility for understanding postprogram exercise motivation and adherence in cancer survivors.

Physical activity in cancer survivors: implications for recurrence and mortality

Abstract: Summary Advances in cancer detection and treatments have resulted in improved survival rates for cancer survivors. These advances have created an opportunity to examine the potential role of lifestyle factors in further reducing the risk of recurrence and extending overall survival. The purpose of the present paper is to review the literature on physical exercise and clinical endpoints in cancer survivors. Our review found that there is very limited research on this topic. Evidence from other populations on cancer incidence, cancer-specific mortality, and all-cause mortality, however, suggests that exercise could potentially affect these endpoints in cancer survivors. Moreover, evidence on the effects of exercise on the purported biological mechanisms for the clinical endpoints also suggests that a relationship is plausible. Despite the limited evidence for a role of exercise in cancer survival, however, we still recommend exercise to cancer survivors based on preliminary evidence for a quality of life benefit. We conclude by suggesting some future research directions that will begin to answer the question of whether or not exercise can affect clinical endpoints in cancer survivors.

Resistance exercise for post neck dissection shoulder pain: three case reports

Abstract: Nodal dissection of the neck is often performed in conjunction with surgical resection of the primary tumour site for head and neck cancers. A major complication of neck dissection procedures is loss of trapezius muscle function due to temporary damage to, or resection of, the spinal accessory nerve. Over time, the resulting shoulder dysfunction may deteriorate to a chronic state that includes glenohumeral joint restriction and marked deformity of the shoulder complex. Patients with severe discomfort may require long-term use of narcotic analgesics. Although successful outcomes from physiotherapy have been reported in the literature for over 20 years, research in the area is sparse and uncertainty remains over the most effective therapeutic interventions. We present 3 case reports that illustrate the beneficial role of progressive resistance exercise training (PRET) to alleviate shoulder pain and dysfunction in head and neck cancer patients with spinal accessory nerve damage.