Purpose: The purpose of this scoping review is to classify, describe, and map the existing knowledge on: a) non-curative cancer patients’ preferences for, barriers to and facilitators of engagement in an exercise program; and b) strategies or interventions for practitioners to increase the uptake of non-curative cancer patients into exercise programs.

Methods: In accordance with Joanna Briggs Institute (JBI) methodology a scoping review was conducted. Six databases (MEDLINE, CINAHL, EMBASE, PsychInfo, Scopus and SportDiscus) were searched resulting in 5,284 identified records. Following screening, hand-searching and a gray literature search, 28 studies were included in the analysis. Studies included had to detail out barriers, facilitators, preference or interventions for exercise program for non-curative cancer patients in any healthcare setting. Data was extracted by two reviewers and coded using the Behaviour Change Wheel (BCW), Capability, Opportunity, Motivation- Behaviour (COM-B) model and intervention functions.

Results: A thematic analysis was conducted, and barriers were broken up into two categories: 1) non-curative cancer specific barriers and 2) general barriers. Non-curative cancer specific barriers included treatment related side effects, lack of practitioner expertise in area, and individuals believed there was no need to partake in exercise and were emotionally and mentally not ready to exercise. Facilitators to partaking in an exercise program included maintaining activities of daily living, being with likeminded people, having support from their healthcare provider, and having professional expertise in the area. Preferences included being led by a trained health professional and having an individualized program within a group-based environment. Current interventions were focussed on training, education and enablement.

Conclusions: The results show the need for specialized training for fitness professionals to work with individuals with a non-curative cancer diagnosis.  Participants see exercise as a way to increase their social network and increase their quality of life. Future interventions should support maintaining physical functioning and activities of daily living as well, studies should ensure they are addressing barriers and enhancing facilitators and preferences to aid in creating programs that are enjoyable for participants and can be sustained in a community setting.

Introduction: An increasing number of Canadians are living with the late and long-term side effects of cancer treatment. Of these side-effects, cognitive impairment (CI), known colloquially as chemobrain, is particularly intrusive, impacting survivors’ daily functioning, quality of life, and psychosocial wellbeing. Exercise has been suggested to reduce CI in cancer survivors, however, the state of research examining exercise’s effects on CI consist mainly of randomized-control trials, limiting the transferability of findings to larger, uncontrolled populations of cancer survivors.

Purpose: The purpose of this study was to investigate the effects of a 12-week mixed modal exercise intervention on CI in a heterogeneous sample of cancer survivors in real-world settings.

Methods: This study was a secondary data analysis of data collected from the Activating Cancer Communities Exercise Strategy for Survivors (ACCESS) program. Post-intervention changes in perceived CI and fatigue (known correlate of CI) were assessed using the Functional Assessment of Cancer Therapy – Cognitive (FACT-Cog) and FACT-Fatigue. Perceived cognitive ability (PCA) and perceived cognitive impairment (PCI) subscales of the FACT-Cog were used to draw conclusions regarding CI. Changes in physical activity (PA) were measured using the Leisure Score Index (LSI) as measured by the Godin-Shephard Leisure-Time Physical Activity Questionnaire. Total PA and moderate-to-vigorous LSI scores were calculated, FACT-Cog was analyzed using Wilcoxon Signed Rank Test, and fatigue and PA were assessed using a paired-samples t-test. Effect sizes were presented for all data.

Results: Both total LSI and MVPA improved significantly (p<0.05, h2=0.22). Fatigue also improved significantly (p=0.00, h2==0.49). Changes in FACT-Cog measures did not yield statistically significant results (p>0.05), however effect sizes were large (r=0.55 and 0.51 for PCI and PCA, respectively). Improvements in fatigue as measured by FACT-F were statistically significant (p=0.00).

Conclusions: After a 12-week individualized exercise intervention, CI in this sample improved with large effect sizes, in addition to significant improvements in fatigue and PA levels. Given the pragmatic nature of study and future studies, findings can be applied to cancer survivors with various diagnoses, aiming to decrease their CI symptoms. Large effect sizes advocate that future research be conducted with larger heterogeneous samples of survivors.

Purpose: The COVID-19 pandemic has presented novel challenges to physical activity (PA) participation among cancer survivors, resulting in fewer survivors meeting PA guidelines (≥150 minutes/week of moderate-to-vigorous PA [MVPA]). Social cognitive, self-regulatory, reflexive processes, and environmental factors have been associated with PA during the pandemic in the general population, however correlates of change in PA among cancer survivors remains unknown. The purpose of this study is to examine demographic, medical, motivational, and environmental correlates of changes in PA in cancer survivors during the COVID-19 pandemic.

Methods: This study was a secondary analysis from an online survey administered to a global sample of cancer survivors. Demographic (e.g., age, sex, employment), medical (e.g., BMI, cancer type) and environmental variables (e.g., access to equipment, space at home/neighborhood for PA) were assessed via self-report. Motivational variables from the Multi-process Action Control Framework included reflective (i.e., affective judgements, instrumental attitudes, perceived capability, perceived opportunity), regulatory (e.g., planning, self-monitoring), and reflexive (i.e., habit, identity) processes towards PA. PA before and since the start of the pandemic was measured using the modified Godin-Leisure Time Exercise Questionnaire. Multinomial logistic regressions compared correlates across MVPA change categories: non-exercisers (not meeting guidelines before or during), adopters (met guidelines during, but not before), relapsers (met guidelines before, but not during), and maintainers (met guidelines before and during).

Results: Participants (N=346; Mage=48.3±15.5) were primarily post-treatment (80.3%), and breast (27.5%), or hematologic (11.0%) cancer survivors. Compared to non-exercisers, adopters were more likely to have more positive affective judgements (p=.047) and relapsers were more likely to have discussed PA with a healthcare provider (HCP; p=.047). Maintainers were more likely to be employed (p=.04), have more positive affective judgements (p=.045), greater PA identity (p<.001), and have exercise equipment at home (p=.03) compared to non-exercisers. Compared to relapers, maintainers were more likely to be ≥5 years from diagnosis (p=.01) and have not discussed PA with an HCP (p=.01).

Conclusions: Individual, motivational, and environmental factors are associated with changes in PA during the COVID-19 pandemic. Health promotion efforts should consider social-ecological approaches to behaviour change, especially enhancing affective attitudes and PA identity among cancer survivors.

Purpose: The purpose of this study was to capture the meaning of nutrition for Irish Cancer Survivors who are post cancer treatment using a method of participatory photography known as photovoice. 

Methods: This study followed the procedure for conducting photovoice studies outlined by Wang and Burris (1). Recruitment took place via email invitation through existing links with participants from a previous qualitative study. The participants were tasked with taking photographs to represent the meaning of nutrition for them post treatment. Group workshops and semi-structured interviews were conducted to facilitate reflection, dialogue and analysis. Data analysis followed Braun and Clarke’s updated six phase thematic analysis (2). 

Results/findings: One man and seven women (n = 8) across the Island of Ireland were recruited (mean age 51 years, the majority (n=7) finished treatment within the last 5 years). Participants identified six main themes (themes are illustrated with photographs) which reflected meaning of nutrition for them: (i) Food for the Soul – Healthy Mind. Healthy Body, (ii) Fresh is Best, (iii) Be kind to yourself, (iv) Building Blocks. Be Informed, (v) Post Treatment Healing Changes (vi) Chemo Rituals. These themes captured the importance of both physical activity and dietary intake of fresh fruit and vegetables post treatment to recover and maintain health. Participants expressed celebration through food with a reminder to be kind to yourself. Although different dietary choices and believes were present within the cohort; all agreed it is essential to be informed and build on their nutrition knowledge. While diverse; participants made post treatment changes to their dietary intake by introducing and eliminating certain foods or food groups. The cohort added the theme ‘chemo rituals’ as particular foods are now associated with their time receiving chemotherapy. 

Conclusions: Overall our findings suggest how the meaning of nutrition for Irish cancer survivors is individual and often shaped by self-directed research. Photovoice was a highly effective tool to capture and communicate these differences. It is important to consider and clarify the implications this has had on those post treatment when providing nutrition guidance and advice to ensure that it is appropriate and specific.

Aim: To analyze the association between physical activity, weight regain, metabolic risk factors, and quality of life (QOL) in patients undergoing bariatric surgery. It also intends to evaluate how physical activity and weight regain may be associated with sleep quality and sedentary behavior.

Method: Observational study, with retrospective data collection. The study had the participation of 84 individuals, who underwent bariatric gastric bypass surgery for more than 5 years, in a Center for Integrated Responsibility for Surgery of Obesity and Metabolic Diseases. A data collection instrument was developed, with validated questionnaires (IPAQ-International physical activity questionnaire is a measure of physical activity; IWQOL-Impact of weight on the quality-of-life questionnaire; PSQI-Pittsburgh- Sleep quality index) and collection in the form of telephone interviews, to which data were added from the patient’s clinical process. Chi-square, Mann-Whitney and ANOVA were used to analyze associations between several groups, namely health data, associated comorbidities, QOL, physical activity, sedentary behaviors, and sleep. 

Results: We found that in the study sample only two levels of physical activity were present, the sedentary and irregularly active, with low levels of physical activity indicating more weight regain (x2=7,872; p=0,005). Quality of life (p=0,005), as well as sleep quality (x2=4,356; p=0,037), are inversely related to weight regain, as well as sedentary behavior in general (p=0,010). Metabolic risk factors are only associated with surgery variables (p=0,134; p=0,701; p=0,224).

Conclusions:  Bariatric surgery induces a significant weight loss in the first year. Physical activity, even at irregular levels, was associated with better weight loss maintenance for consecutive years, suggesting that for this population lower levels of physical activity than the recommended for the normal weight population might be beneficial. Less weight regain allows to maintain good levels of quality of life and sleep quality and, in turn, less sedentary behavior is associated with lower weight regain. We did not obtain a relationship between metabolic syndrome and physical activity, or weight regain, contrary to the literature consulted.
Keywords: Physical Activity, Bariatric Surgery, Weight Gain, Quality of Life, Metabolic Risk Factors, Sleep Quality

Purpose: Regular physical activity (PA) participation (≥150 minutes per week of moderate-to-vigorous PA; MVPA) has been shown to improve the well-being of cancer survivors. The COVID-19 pandemic restrictions have created challenges for PA participation and exacerbated existing discrepancies in the well-being among cancer survivors. The purpose of this study was to examine the associations between changes in PA and well-being in cancer survivors during the COVID-19 pandemic.

Methods: An online, cross-sectional survey was administered globally to cancer survivors (≥18 years of age). The 20-Item Short Form Survey (SF-20) and a modified Godin Leisure Time Exercise Questionnaire were used to assess self-reported well-being and PA, respectively. Cancer survivors were categorized as ‘non-exercisers (i.e., consistently not meeting guidelines)’, ‘adopters (i.e., meeting guidelines during COVID-19, but not prior to)’, ‘relapsers (i.e., meeting guidelines prior to, but not during COVID-19)’, and ‘maintainers (i.e., meeting guidelines prior to and during COVID-19)’. An analysis of covariance was used to identify significant differences in well-being across the MVPA categories. Domains of the SF-20 (physical functioning, role functioning, social functioning, pain and health perception) were analyzed separately.  

Results: Cancer survivors (N=493; Mage = 48.7 ± 15.5 years) were primarily females (70.4%), diagnosed with breast cancer (28.8%), gynecologic cancer (11.6%) or skin cancer (9.2%) and were 87.1 ± 81.6 months since diagnosis. Cancer survivors predominantly resided in the United Kingdom (37.5%), United States (22.7%) and Canada (21.3%). There were no significant changes in mental health (p=.21) or social functioning (p=.62) between MVPA groups. Non-exercisers had significant declines in physical functioning compared with adopters (p<.001), relapsers (p<.01) and maintainers (p<.001). Non-exercisers had significant declines in role functioning compared to adopters (p<.01), relapsers (p<.01) and maintainers (p<.001). Non-exercisers had significant declines in health perception compared to adopters (p<.01) and maintainers (p<.01). Non-exercisers had significantly more pain than adopters (p<.001). Adopters had significantly less pain than relapsers (p<.01) and maintainers (p<.01). 

Conclusion: Reductions in MVPA during the COVID-19 pandemic significantly impacted well-being in cancer survivors, particularly among non-exercising groups. Health promotion efforts should focus on increasing MVPA among cancer survivors to improve physical functioning, role functioning, pain, and health perception. 

Purpose: Multiple intervention strategies have been found to be effective for increasing physical activity among breast cancer survivors. However, implementation and dissemination of physical activity interventions into real-world settings requires development of optimized interventions to ensure effective and efficient delivery. The purpose of this analysis is to concurrently evaluate effects of four intervention strategies for increasing physical activity in breast cancer survivors.

Methods: The PACES trial implemented a full-factorial randomized design based on the Multiphase Optimization Strategy framework, which aims to identify effective and efficient intervention strategies. 337 breast cancer survivors were randomized to receive a combination of four intervention strategies: 1) supervised exercise sessions, 2) facility membership, 3) Active Living Every Day, and 4) Fitbit. Physical activity outcomes were measured at baseline, 3 months, and 6 months with an Actigraph GT3X+ worn on the hip. Normal linear mixed models with separate intercepts for each subject were fit in the SAS 9.4 Mixed procedure. Each model consisted of the baseline covariates (age, sex, race, ethnicity, baseline weight, and baseline physical activity), a categorical time variable, and four categorical intervention variables each intervention along with and two-way interaction terms across all interventions.

Results/findings: Using repeated measures analysis , we found that participants who received supervised exercise sessions engaged in more moderate-to-vigorous physical activity (MVPA) (F = 4.3, p = 0.041) compared to participants who did not receive supervised exercise sessions. The effects of the three other intervention components were not significant, nor were there any significant interaction effects. Supervised exercise sessions also resulted in greater light-intensity PA (F=4.5, p = 0.035), while those that received ALED engaged in less light-intensity physical activity (F=6.7, p = 0.011).

Conclusion: While all intervention strategies increased MVPA and light PA in breast cancer survivors, supervised exercise sessions resulted in significantly greater increases in MVPA and light PA . Of note, these sessions were provided only during the first 6 weeks of the intervention and effects remained significant at 6 months. Results of this trial could inform future implementation efforts to ensure effective and efficient delivery of physical activity programs for breast cancer survivors.