Basics of qualitative research: Grounded theory procedures and techniques

The Theory of Planned Behaviour (TPB) has received considerable attention in the literature. The present study is a quantitative integration and review of that research. From a database of 185 independent studies published up to the end of 1997, the TPB accounted for 27% and 39% of the variance in behaviour and intention, respectively. The perceived behavioural control (PBC) construct accounted for significant amounts of variance in intention and behaviour, independent of theory of reasoned action variables. When behaviour measures were self-reports, the TPB accounted for 11% more of the variance in behaviour than when behaviour measures were objective or observed (R2s = .31 and .21, respectively). Attitude, subjective norm and PBC account for significantly more of the variance in individuals' desires than intentions or self-predictions, but intentions and self-predictions were better predictors of behaviour. The subjective norm construct is generally found to be a weak predictor of intentions. This is partly attributable to a combination of poor measurement and the need for expansion of the normative component. The discussion focuses on ways in which current TPB research can be taken forward in the light of the present review.

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Efficacy of the Theory of Planned Behaviour: a meta-analytic review.

The purpose of this Position Stand is to provide guidance to professionals who counsel and prescribe individualized exercise to apparently healthy adults of all ages. These recommendations also may apply to adults with certain chronic diseases or disabilities, when appropriately evaluated and advised by a health professional. This document supersedes the 1998 American College of Sports Medicine (ACSM) Position Stand, "The Recommended Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory and Muscular Fitness, and Flexibility in Healthy Adults." The scientific evidence demonstrating the beneficial effects of exercise is indisputable, and the benefits of exercise far outweigh the risks in most adults. A program of regular exercise that includes cardiorespiratory, resistance, flexibility, and neuromotor exercise training beyond activities of daily living to improve and maintain physical fitness and health is essential for most adults. The ACSM recommends that most adults engage in moderate-intensity cardiorespiratory exercise training for ≥30 min·d on ≥5 d·wk for a total of ≥150 min·wk, vigorous-intensity cardiorespiratory exercise training for ≥20 min·d on ≥3 d·wk (≥75 min·wk), or a combination of moderate- and vigorous-intensity exercise to achieve a total energy expenditure of ≥500-1000 MET·min·wk. On 2-3 d·wk, adults should also perform resistance exercises for each of the major muscle groups, and neuromotor exercise involving balance, agility, and coordination. Crucial to maintaining joint range of movement, completing a series of flexibility exercises for each the major muscle-tendon groups (a total of 60 s per exercise) on ≥2 d·wk is recommended. The exercise program should be modified according to an individual's habitual physical activity, physical function, health status, exercise responses, and stated goals. Adults who are unable or unwilling to meet the exercise targets outlined here still can benefit from engaging in amounts of exercise less than recommended. In addition to exercising regularly, there are health benefits in concurrently reducing total time engaged in sedentary pursuits and also by interspersing frequent, short bouts of standing and physical activity between periods of sedentary activity, even in physically active adults. Behaviorally based exercise interventions, the use of behavior change strategies, supervision by an experienced fitness instructor, and exercise that is pleasant and enjoyable can improve adoption and adherence to prescribed exercise programs. Educating adults about and screening for signs and symptoms of CHD and gradual progression of exercise intensity and volume may reduce the risks of exercise. Consultations with a medical professional and diagnostic exercise testing for CHD are useful when clinically indicated but are not recommended for universal screening to enhance the safety of exercise.

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Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory, Musculoskeletal, and Neuromotor Fitness in Apparently Healthy Adults: Guidance for Prescribing Exercise

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

Conceptual and methodological ambiguities surrounding the concept of perceived behavioral control are clarified. It is shown that perceived control over performance of a behavior, though comprised of separable components that reflect beliefs about self-efficacy and about controllability, can nevertheless be considered a unitary latent variable in a hierarchical factor model. It is further argued that there is no necessary correspondence between self-efficacy and internal control factors, or between controllability and external control factors. Self-efficacy and controllability can reflect internal as well as external factors and the extent to which they reflect one or the other is an empirical question. Finally, a case is made that measures of perceived behavioral control need to incorporate self-efficacy as well as controllability items that are carefully selected to ensure high internal consistency.

Summary and Conclusions
Perceived control over performance of a behavior can account for consider- able variance in intentions and actions. However, ambiguities surrounding the concept of perceived behavioral control have tended to create uncertainties and to impede progress. The present article attempted to clarify conceptual ambiguities and resolve issues related to the operationalization of perceived behavioral control. Recent research has demonstrated that the overarching concept of perceived behavioral control, as commonly assessed, is comprised of two components: self-efficacy (dealing largely with the ease or difficulty of performing a behavior) and controllability (the extent to which performance is up to the actor). Contrary to a widely accepted view, it was argued that self-efficacy expectations do not necessarily correspond to beliefs about internal control factors, and that controllability expectations have no necessary basis in the perceived operation of external factors. Instead, it was suggested that self-efficacy and controllability may both reflect beliefs about the presence of internal as well as external factors. Rather than making a priori assumptions about the internal or external locus of self-efficacy and controllability, this issue is best treated as an empirical question.

Also of theoretical significance, the present article tried to dispel the notion that self-efficacy and controllability are incompatible with, or independent of, each other. Although factor analyses of perceived behavioral control items provide clear and consistent evidence for the distinction, there is sufficient commonality between self-efficacy and controllability to suggest a two-level hierarchical model. In this model, perceived behavioral control is the overarching, superordinate construct that is comprised of two lower-level components: self-efficacy and controllability. This view of the control component in the theory of planned behavior implies that measures of perceived behavioral control should contain items that assess self-efficacy as well as controllability. Depending on the purpose of the investigation, a decision can be made to aggregate over all items, treating perceived behavioral control as a unitary factor, or to distinguish between self-efficacy and controllability by entering separate indices into the prediction equation.

Perceived Behavioral Control, Self-Efficacy, Locus of Control, and the Theory of Planned Behavior

e13067Background: Cardiovascular disease (CVD) is one of the most prevalent comorbidities among cancer survivors. Physical activity has been well established to positively control CVD risk factors ...

Relationship between physical activity and cardiovascular disease risk factors in cancer survivors.

Background: Observational studies suggest that physical activity following a diagnosis of breast cancer may be associated with a lower risk of recurrence and death. Some studies also suggest possible effect modification by disease stage, body mass index, and receptor status. To date, however, there are no randomized trials examining the effects of exercise on disease outcomes in any cancer patient group. Here, we report an exploratory follow-up of disease outcomes from the Supervised Trial of Aerobic versus Resistance Training (START). Patients and Methods: The START Trial was a Canadian multicenter trial that randomized 242 breast cancer patients starting adjuvant chemotherapy to either usual care (n = 82) or supervised aerobic (n = 78) or resistance (n = 82) exercise for the duration of their chemotherapy. The primary efficacy endpoint for this exploratory analysis was disease-free survival (DFS). Secondary endpoints were overall survival (OS), distant disease-free survival (DDFS), and recurrence-free interval (RFI). The two exercise arms were combined for the analysis (n = 160) and selected subgroups were explored. Results: After a median follow-up of 89 months (IQR 81 to 96), there were 25/160 (15.6%) DFS events in the exercise groups and 18/82 (22.0%) in the control group (log-rank p = 0.21). Eight-year DFS was 82.7% for the exercise groups compared with 75.6% for the control group (Hazard ratio [HR] = 0.68, 95% CI = 0.37-1.24). There were 13/160 (8.1%) deaths in the exercise groups and 11/82 (13.4%) in the control group (log-rank p = 0.21). Eight-year OS was 91.2% in the exercise groups compared with 82.7% in the control group (HR = 0.60, 95% CI = 0.27 to 1.33. There were 20/160 (12.5%) DDFS events in the exercise groups and 16/82 (19.5%) in the control group (log-rank p = 0.15). Eight-year DDFS was 86.7% in the exercise groups compared with 78.3% in the control group (HR = 0.62, 95% CI = 0.32 to 1.19). Finally, there were 20/160 (12.5%) RFI events in the exercise groups and 17/82 (20.7%) in the control group (Gray9s p = 0.095). Eight-year cumulative incidence of RFI was 12.6% in the exercise groups compared with 21.6% in the control group (HR = 0.58, 95% CI = 0.30 to 1.11). Subgroup analyses for DFS and RFI suggested stronger effects for women who were overweight/obese, had stage II/III cancer, receptor positive tumors, HER2 positive tumors, received taxane-based chemotherapies, and received at least 85% of their intended chemotherapy dose-intensity. The most notable subgroup effect was for patients who received optimal chemotherapy dosing with a borderline significant effect for DFS (HR = 0.50, 95% CI = 0.25 to 1.01) and a significant effect for RFI (HR = 0.38, 95% CI = 0.18 to 0.81). Conclusions: In this exploratory follow-up of the START Trial, there was a suggestion that exercise during adjuvant chemotherapy may improve several efficacy endpoints although none achieved statistical significance. Nevertheless, the magnitude of the effects appear to be meaningful with absolute 8-year survival differences between 7% and 9% and relative rate reductions between 30% and 40%. The START Trial provides the first randomized data to suggest that adding exercise to standard chemotherapy for breast cancer may improve outcomes. A definitive phase III trial is warranted. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P4-08-01.

Abstract P4-08-01: Effects of exercise during adjuvant chemotherapy on clinical outcomes in early stage breast cancer

Effects of a clinician's referral and physical activity program for men who have completed treatment for prostate cancer: a multicentre cluster randomized controlled trial [ENGAGE]

Kerry S. Courneya

Papers

Relationship between physical activity and cardiovascular disease risk factors in cancer survivors.

Abstract P4-08-01: Effects of exercise during adjuvant chemotherapy on clinical outcomes in early stage breast cancer

Effects of a clinician's referral and physical activity program for men who have completed treatment for prostate cancer: a multicentre cluster randomized controlled trial [ENGAGE]

Exercise and Quality of Life in Survivors of Cancer Other Than Breast

Translating Research Into Practice: the Healthy Living After Cancer Partnership Project