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Fatigue, barriers to physical activity and predictors for motivation to exercise in advanced Cancer patients.

ABSTRACT: BACKGROUND:In order to counteract fatigue, physical activity (PA) is recommended for all stages of cancer. However, only few advanced cancer patients (ACP) are physically active. Quantitative data with high numbers of ACP reporting barriers to PA are missing. This study aimed to identify barriers to PA in ACP with tiredness/weakness and investigate their motivation towards it. METHODS:Outpatients with metastatic cancer receiving cancer care at a German Cancer Center reporting moderate/severe tiredness/weakness during self-assessment (MIDOS II) were enrolled. We assessed Fatigue-(FACF-F) and Depression (PHQ8) Scores, demographics, cancer-specific parameters, motivation for PA, physical, psychological and social barriers. RESULTS:141 of 440 eligible patients (32.0%) with different diagnoses agreed to participate. Patients frequently reported "I feel weakened due to my tumor therapy" (n =?108; 76.6%), physical symptoms (tiredness, weakness, dyspnea, joint-problems, pain, nausea [n?= 107; 75.9%]) and fatigue (n =?99; 70.2%) as barriers to PA. However, no significant group differences regarding these barriers were found between physically active and inactive patients. Social barriers were rarely chosen. Motivated patients were 5.6 times more likely to be physically active (p?< 0.001), also motivation turned out to be the strongest predictor for a physically active behavior (??=?1.044; p =?0.005). Motivated attitude towards PA was predicted by fatigue (??=?-?2.301; p =?0.008), clinically relevant depression (??=?-?1.390, p?= 0.039), knowledge about PA and quality of life (QoL) (??=?0.929; p?= 0.002), PA before diagnosis (??=?0.688; p?= 0.005 and Interest in exercise program (??=?0.635; p?= 0.008). CONCLUSION:"I feel weakened due to my tumor therapy" is the most reported barrier to PA among both, physically and inactive patients. Motivation for PA is the strongest predictor of performing PA. Interest in PA, knowledge about PA/QoL and PA before diagnosis are main predictors of a motivated attitude. Absence/presence of social barriers did not associate with motivation, fatigue and depression proved to be a negative predictor. Programs including information, motivational counseling and individualized training should be offered for ACP to overcome barriers and reduce fatigue. TRIAL REGISTRATION:German Register of Clinical Trials DRKS00012514, registration date: 30.5.2017.

SUBMITTER: Frikkel J

PROVIDER: S-EPMC7110817 | biostudies-literature | 2020 Mar

REPOSITORIES: biostudies-literature

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Fatigue, barriers to physical activity and predictors for motivation to exercise in advanced Cancer patients.

Frikkel J J Götte M M Beckmann M M Kasper S S Hense J J Teufel M M Schuler M M Tewes M M

BMC palliative care 20200331 1

<h4>Background</h4>In order to counteract fatigue, physical activity (PA) is recommended for all stages of cancer. However, only few advanced cancer patients (ACP) are physically active. Quantitative data with high numbers of ACP reporting barriers to PA are missing. This study aimed to identify barriers to PA in ACP with tiredness/weakness and investigate their motivation towards it.<h4>Methods</h4>Outpatients with metastatic cancer receiving cancer care at a German Cancer Center reporting mode ...[more]

PMID: 32234027

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Project description:BACKGROUND:Physical activity (PA) can support cancer patients during medical treatment by reducing side-effects and increasing quality of life. However, PA levels mostly decline after diagnosis. Which factors can explain if patients are able to remain or even increase their PA level? Self-efficacy is an important cognitive factor that has been linked to cancer patients' PA across many studies. In contrast, affective factors such as PA enjoyment have rarely been examined. We compare the influence of self-efficacy and PA enjoyment on cancer patients' PA levels after completion of an exercise or stress-management intervention. METHODS:Outpatient cancer patients [N = 72; 54% female; M = 56 years, SD = 12.34; most with breast or colon cancer (34%, 15%)] were enrolled in the MOTIVACTION study, a 4-week intervention (1 h counseling followed by weekly phone calls), with pre-test (T1), post-test (T2), and a 10-week follow-up (T3). Participants were randomized to either an exercise intervention (emphasizing self-regulatory strategies for behavior change) or to a stress management intervention (coping and relaxation techniques). Sixty-seven patients remained in the study and completed the SQUASH assessment of PA, a measure of maintenance self-efficacy (7 items, Cronbach's ? = 0.88) and PA enjoyment (2 items, Cronbach's ? = 0.89). Regression analyses were calculated with PA level (at T2 and T3) as dependent variable and relative weight analyses were conducted. The study was registered at clinicalTrials.gov (unique identifier:NCT01576107; URL: https://clinicaltrials.gov/ct2/show/NCT01576107?term=motivaction&rank=1). RESULTS:Baseline self-efficacy and change in PA enjoyment significantly predicted cancer patients' PA level at T2 adjusting for baseline PA and type of intervention. Relative weight (RW) analysis revealed that PA enjoyment (baseline and change together) explained 34.3% of the dependent variable, self-efficacy (baseline and change) explained 38.4%. At follow-up, self-efficacy was still a significant predictor of PA (RW = 74.6%), whereas PA enjoyment was no longer a relevant factor (RW = 5.2%). CONCLUSION:The affective factor PA enjoyment was equally important as self-efficacy for predicting cancer patient' PA level directly after completion of the intervention. Reasons for the reduced relevance at follow-up and a broader range of affective factors should be analyzed in future studies on cancer patients' PA level.

Project description:The intervention will be a physical exercise program for colorectal cancer patients during the adjuvant chemotherapy. The exercise program aims on reducing the side effects of the treatment and improving patients’ quality of life. In addition, the investigators try to improve endurance and resistance training level, in order to achieve greater physical functionality, survival and general well-being. For this, the investigators will carry out an exercise program based mainly on muscular strength and cardiorespiratory condition. It will last 6 months, with a frequency of 3 days per week, including sessions of 60 minutes. Sessions will consist of three parts: warm-up, main part (endurance and resistance training), and cool down. An individualized and supervised progression of training will take place. The intensity levels will always be adjusted to the initial levels of the participants, always considering their preferences and comfort. Participants’ preferences and exercise history will be considered through an initial interview. Motivational strategies based on self-determination theory will be applied, since it is one of the most used theories in the field of physical exercise. This theory proposes that all people need to feel competent, autonomous and socially related. If these three needs are satisfied, participants will develop more positive (autonomous) forms of motivation, which are related to better consequences such as vitality, enjoyment, quality of life and adherence to physical activity. In addition, motivational strategies will be applied for families and healthcare professionals. Before starting the program and at the end of it, each eligible patient will be evaluated through: * Physical activity: strength test of lower and upper limbs, agility test, stress test for cardiorespiratory fitness, physical activity levels, physical condition and body composition. * Psychological factors: autonomy support, basic psychological need satisfaction, motivation, quality of life, perceived barriers, depression, anxiety, hope, quality of life. * Clinical parameters: survival rate, side effects, biological factors, treatment delays and planned treatment completion.

Project description:Progressive, incurable cancer is associated with increased fatigue, increased muscle weakness, and reduced physical functioning, all of which negatively impact quality of life. Physical activity has demonstrated benefits on cancer-related fatigue and physical functioning in early-stage cancer patients; however, its impact on these outcomes in end-stage cancer has not been established. The aim of this systematic review is to determine the potential benefits, harms, and effects of physical activity interventions on quality of life outcomes in advanced cancer patients.A systematic review of peer-reviewed literature on physical activity in advanced cancer patients will be undertaken. Empirical quantitative studies will be considered for inclusion if they present interventional or observational data on physical activity in advanced cancer patients. Searches will be conducted in the following electronic databases: CINAHL; CIRRIE Database of International Rehabilitation Research; Cochrane Database of Systematic Reviews (CDSR); Database of Abstracts of Reviews of Effects (DARE); Cochrane Central Register of Controlled Trials (CENTRAL); EMBASE; MEDLINE; PEDro: the Physiotherapy Evidence Database; PQDT; PsycInfo; PubMed; REHABDATA; Scopus; SPORTDiscus; and Web of Science, to identify relevant studies of interest. Additional strategies to identify relevant studies will include citation searches and evaluation of reference lists of included articles. Titles, abstracts, and keywords of identified studies from the search strategies will be screened for inclusion criteria. Two independent reviewers will conduct quality appraisal using the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies (EPHPP) and the Cochrane risk of bias tool. A descriptive summary of included studies will describe the study designs, participant and activity characteristics, and objective and patient-reported outcomes.This systematic review will summarize the current evidence base on physical activity interventions in advanced cancer patients. The findings from this systematic review will identify gaps to be explored by future research studies and inform future practice guideline development of physical activity interventions in advanced cancer patients.PROSPERO CRD42015026281.

Project description:Background: A large body of evidence supports the positive effects of leisure time physical activity (LTPA) and exercise on cancer survivors. However, only a fraction of survivors manages to attain international PA recommendations. This can be attributed to several external and internal barriers toward PA those patients seem to encounter, with cancer related fatigue (CRF) being the most reported internal barrier. Nevertheless, self-efficacy and knowledge about the utilization of LTPA can serve as facilitators of PA, which also correspond to certain constituents of physical activity related health competence (PAHCO). Since PAHCO is not investigated in cancer survivors we investigated if PAHCO can mediate the negative relationship between CRF and LTPA. Methods: We surveyed 398 cancer survivors with different cancer types and therapy status. The patients completed the EORTC QLQ-FA12 (EORTC FA12) to assess CRF, the PAHCO questionnaire to assess PAHCO and the SQUASH to assess LTPA. We followed a two-step structural equation modeling approach. The first step established the measurement model, in the second step we fitted the mediation model. Since 163 patients chose not to answer the SQUASH, the mediation model was only fitted to the data of the remaining 235 participants. Results: The proposed measurement model of the PAHCO offered an excellent fit. We found small to moderate positive associations between the PAHCO dimensions and the LTPA, and negative moderate relationships between the PAHCO and the EORTC FA12 dimensions. We did not observe a relationship between the EORTC FA12 dimensions and the LTPA (p > 0.05). The hypothesized mediation models did not display an appropriate fit. Conclusion: The PAHCO confirmed its factorial validity; furthermore, it appears to have a positive relationship to LTPA. Therefore, integrating psycho-educational aspects can be beneficial in order to increase the PAHCO in exercise interventions. Because of the cross-sectional character of this study, causal conclusions are not suitable, therefore the longitudinal relationships of LTPA, CRF, and PAHCO require further investigation.

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Fatigue, barriers to physical activity and predictors for motivation to exercise in advanced Cancer patients.

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Fatigue, barriers to physical activity and predictors for motivation to exercise in advanced Cancer patients.

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