Abstract
Introduction:Adherence to exercise interventions in patients with cancer is often poorly described. Further, it is unclear if self-regulatory behavior change techniques (BCTs) can improve exercise adherence in cancer populations. We aimed to (1) describe exercise adherence in terms of frequency, intensity, time, type (FITT-principles) and dropouts, and (2) determine the effect of specific self-regulatory BCTs on exercise adherence in patients participating in an exercise intervention during curative cancer treatment.Methods:This study was a secondary analysis using data from a Swedish multicentre RCT. In a 2×2 factorial design, 577 participants recently diagnosed with curable breast, colorectal or prostate cancer were randomized to 6 months of high (HI) or low-to-moderate intensity (LMI) exercise, with or without self-regulatory BCTs (e.g., goal-setting and self-monitoring). The exercise program included supervised group-based resistance training and home-based endurance training. Exercise adherence (performed training/prescribed training) was assessed using attendance records, training logs and heart rate monitors, and is presented descriptively. Linear regression and logistic regression were used to assess the effect of self-regulatory BCTs on each FITT-principle and dropout rates, according to intention-to-treat.Results:For resistance training (groups with vs without self-regulatory BCTs), participants attended on average 52% vs 53% of prescribed sessions, performed 79% vs 76% of prescribed intensity, and 80% vs 77% of prescribed time. They adhered to exercise type in 71% vs 68% of attended sessions. For endurance training (groups with vs without self-regulatory BCTs), participants performed on average 47% vs 51% of prescribed sessions, 57% vs 62% of prescribed intensity, and 71% vs 72% of prescribed time. They adhered to exercise type in 79% vs 78% of performed sessions. Dropout rates (groups with vs without self-regulatory BCTs) were 29% vs 28%. The regression analysis revealed no effect of the self-regulatory BCTs on exercise adherence.Conclusion:An exercise adherence rate ≥50% for each FITT-principle and dropout rates at ~30% can be expected among patients taking part in long-term exercise interventions, combining resistance and endurance training during curative cancer treatment. Our results indicate that self-regulatory BCTs do not improve exercise adherence in interventions that provide evidence-based support to all participants (e.g., supervised group sessions).Trial registration:NCT02473003
Highlights
Adherence to exercise interventions in patients with cancer is often poorly described
Exercise interventions involving patients with cancer often include self-regulatory behavior change techniques (BCTs) such as goal-setting, self-monitoring, action planning, review of behavioral goals and problem solving.[16,17,19,20,21]. 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.[22,23]
The aims of this study were to (1) provide a detailed description of exercise adherence according to the FITT-principles and dropout rates, and (2) determine the effect of specific self-regulatory BCTs on exercise adherence in patients participating in a 6-month exercise intervention during curative cancer treatment
Summary
Adherence to exercise interventions in patients with cancer is often poorly described. It is challenging for many patients to be physically active after a cancer diagnosis.[13,14,15] 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.[16,17,19,20,21] 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. perform exercise according to the intervention protocol).[22,23] A detailed description of adherence should include reports of adherence to frequency, intensity, time and type of exercise (FITT-principles).[24] Other metrics such as dropout rates should be included to provide insight into the efficacy and feasibility of exercise interventions.[23]
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