Behavior change techniques for increasing physical activity in cancer survivors: a systematic review and meta-analysis of randomized controlled trials

Abstract

PurposeThe purpose of this systematic review and meta-analysis is to investigate how physical activity (PA) can be effectively promoted in cancer survivors. The effect of PA-promoting interventions in general, behavior change techniques (BCTs), and further variables as moderators in particular are evaluated.MethodsThis study included randomized controlled trials of lifestyle interventions aiming at an increase in PA that can be carried out independently at home, published by December 2016, for adults diagnosed with cancer after completion of the main treatment. Primary outcomes were subjective and objective measures of PA prior to and immediately after the intervention. Meta-analysis and meta-regression were used to estimate effect sizes (ES) in terms of standardized mean differences, variation between ES in terms of heterogeneity indices (I2), and moderator effects in terms of regression coefficients.ResultsThis study included 30 studies containing 45 ES with an overall significant small positive effect size of 0.28 (95% confidence interval=0.18–0.37) on PA, and I2=54.29%. The BCTs Prompts, Reduce prompts, Graded tasks, Non-specific reward, and Social reward were significantly related to larger effects, while Information about health consequences and Information about emotional consequences, as well as Social comparison were related to smaller ES. The number of BCTs per intervention did not predict PA effects. Interventions based on the Theory of Planned Behavior were associated with smaller ES, and interventions with a home-based setting component were associated with larger ES. Neither the duration of the intervention nor the methodological quality explained differences in ES.ConclusionCertain BCTs were associated with an increase of PA in cancer survivors. Interventions relying on BCTs congruent with (social) learning theory such as using prompts and rewards could be especially successful in this target group. However, large parts of between-study heterogeneity in ES remained unexplained. Further primary studies should directly compare specific BCTs and their combinations.

Exercise Adherence and Effect of Self-Regulatory Behavior Change Techniques in Patients Undergoing Curative Cancer Treatment: Secondary Analysis from the Phys-Can Randomized Controlled Trial

“…Our results are in contrast with previous studies, where self-regulatory BCTs were found to be associated with higher adherence to exercise interventions in patients with cancer. 17 , 20 However, it is important to take into account that all groups in the Phys-Can study were provided with evidence-based support such as supervision, instructions on how to exercise, graded tasks, self-registration of exercise, feedback on exercise behavior as well as social support from coaches and peers. 16 , 17 , 19 , 21 This was done to ensure that all participants achieved a minimum exercise volume in order to detect possible effects of exercise intensity on the Phys-Can study’s main outcome.…”

“… 13 - 15 However, recent reviews indicate that patients with cancer may benefit from behavioral interventions promoting physical activity and exercise. 16 , 17 Such interventions typically involve strategies to facilitate exercise, including the use of behavior change techniques (BCTs), defined as active ingredients or practical components of an intervention designed to change a behavior. 18 A taxonomy of 93 BCTs has been developed by Michie et al 18 to provide a standardized method of classifying such intervention components.…”

“…Using this taxonomy, exercise interventions involving patients with cancer often include self-regulatory BCTs such as goal-setting, self-monitoring, action planning, review of behavioral goals and problem solving. 16 , 17 , 19 - 21 Several of these self-regulatory BCTs have been identified as having the potential to increase adherence to exercise interventions in patients with cancer. 16 , 17 , 19 , 20 Exercise adherence in this context is defined as the extent to which intervention participants follow the exercise prescription (i.e.…”

The Development of the MedEx IMPACT Intervention: A Patient-Centered, Evidenced-Based and Theoretically-Informed Physical Activity Behavior Change Intervention for Individuals Living With and Beyond Cancer

“…2 The term cancer survivor can be applied to an individual from the point of cancer diagnosis throughout the remainder of life. 3,4 The long-term and latent effects of cancer and its treatment can pose a number of challenges for these individuals including reductions in physical function and quality of life, the presence of cancer-related fatigue, increased risk of cancer morbidity and mortality, and increased risk for the development of other chronic conditions (eg, cardiovascular diseases, osteoporosis). [5][6][7][8][9] To assist in addressing many of these negative consequences and to support the optimization of physical and psychosocial well-being, the inclusion of physical activity (PA) as an adjunct to cancer treatment has been advocated.…”

Agent-based Modeling for Ontology-driven Analysis of Patient Trajectories

“…[24,38]. Although there is evidence that specific changes in behavior can lead to better outcomes for survivors [21] -e.g., changes in diet, moderate exercise, cognitive therapies-in practice, it is difficult to adapt these recommendations to individual needs, preferences, expectations, and motivation factors.…”