Increasing fruit and vegetable intake: "Five a day" versus "just one more"

The present randomized controlled intervention study tested the hypothesis that a personally adaptable and realistic "just 1 more" goal would be more effective for increasing fruits and vegetables (FV) intake compared to the common "5 a day" goal. Study participants (N = 84 students, 85% female) consumed less than 4 servings of FVs per day at recruitment. During the 1-week intervention, participants randomized to the 5aday-group were asked to eat 5 servings of FVs/day; participants of the just1more-group were asked to eat 1 serving more of FVs than they usually did, and participants of the control group were instructed to eat as usual. Measurements were taken before (T1), directly following (T2), and 1 week after (T3) the intervention. Participants in the 5aday-group increased their average FV intake significantly by about one serving from 2.49 at T1 to 3.45 servings/day at T3. At T3, only the 5aday-group — not the just1-more-group — had a significantly higher FV intake than the control group. Contrary to the hypothesis, the "5 a day" goal was more effective than "just 1 more" for increasing FV intake. Results of our study support the rationale of the "5 a day" campaign, at least in the short term

The role of social influences and cognitive self-regulation in supporting cancer patients to engage in physical activity

Cancer patients are recommended to engage in regular physical activity, as research has identified various beneficial effects of exercise both during and after medical treatment (Schmitz et al., 2010; Speck, Courneya, Mâsse, Duval, & Schmitz, 2010). Most cancer patients are motivated to adopt a healthy lifestyle including regular physical activity (Demark-Wahnefried, Aziz, Rowland, & Pinto, 2005). However, it has been shown that only a minority of cancer patients meet the exercise guidelines (Blanchard, Courneya, & Stein, 2008). This thesis aims to (1) determine factors that explain the (low) level of physical activity among cancer patients and (2) help cancer patients to increase their exercise level. Thereby, the first focus of this thesis was placed on cognitive self-regulation examined within the frameworks of the Theory of Planned Behavior (Ajzen, 1991) and the Health Action Process Approach (Schwarzer, 2001, 2008). Self-regulation is assumed to be a relevant factor to adopt and maintain health-enhancing behaviors by bridging the gap between intention and behavior (De Ridder & De Wit, 2006; Schwarzer, 2008). Besides these patient centric self-regulatory factors, social influences have consist-ently been found to be important predictors of physical activity among cancer patients (e.g. Barber, 2012). This thesis adds to previous research by (1) including the perspective of a family member, (2) examining the distinction between social support, social control and its re-lations to reactance, and (3) incorporating role model support in an intervention study. This publication based dissertation comprises three manuscripts, which present results of three different studies. All are part of the MOTIVACTION-project (MOTivational InterVention enhancing physical ACTivity In ONcological patients) and were designed successively to build on each other’s results. The first study applied the Theory of Planned Behavior in a qualitative and a quantitative cross-sectional design. The aim of this study was to elicit a broad spectrum of attitudes – especially negative ones – and to compare already physically active and insuffi-ciently active patients within the framework of the Theory of Planned Behavior. Attitude turned out to be a relevant predictor of the intention to exercise for insufficiently active patients, whereas social influences were especially important to maintain an active lifestyle. Additionally, self-efficacy discriminated best between active and insufficiently active patients. The second study was a longitudinal study among patients and their family members. Through this design, the relation between perceived and relative-reported social support and control could be determined (moderate associations occurred). Gender differences revealed that female patients perceived and received less support and control by their relatives. Fur-thermore, reactance might especially impede male patients to build up a physically active lifestyle. Relative-reported social support was the only significant predictor of physical activity at follow-up. Finally, the third study was a behavior change intervention designed as a randomized controlled trial. It compared an exercise intervention focusing on self-regulation strategies from the Health Action Process Approach and role model support with stress management training. The exercise intervention was able to increase the physical activity level especially among patients who realized contact with a role model. Thus, the combination of self-regulation and social influence turned out to be most effective. All in all, this thesis provides encouraging results that cognitive self-regulation and social influences can explain and increase the physical activity level of cancer patients

Worse or even better than expected? Outcome expectancies and behavioral experiences in the context of physical activity among cancer patients

Expectancies of cancer patients regarding their physical activity before they took part in a behavior change intervention were compared with their experiences during the intervention period. A total of 66 cancer patients completed either a randomly assigned 4-week physical activity or a stress-management counseling intervention. On average, participants had positive expectancies toward physical activity. Outcome expectancies predicted outcomes (e.g. physical activity) at a 10-week follow-up. Outcome realization (discrepancy between expectancies and experiences) further increased explained variance in self-efficacy and physical activity enjoyment. In conclusion, not only initial outcome expectancies but also their realizations seem to be important for subsequent behavior and cognitions

Health Care Professionals’ Perception of Contraindications for Physical Activity During Cancer Treatment

IntroductionSuggested medical contraindications for physical activity (PA) during cancer therapy might have an influence on PA recommendation behavior of Health Care Professionals (HCP). The purpose of the present study was to examine perceptions of physicians and oncology nurses (ON) toward specific medical conditions as contraindications for PA during cancer treatment.Materials and methodsA total of 539 physicians and 386 ON were enrolled in this cross-sectional survey. HCP judged 13 medical conditions as to whether they are contraindications for PA during cancer treatment. Answering format was “no contraindication”/“potentially a contraindication”/“yes, a contraindication.”Resultsχ2 analyses revealed significant differences between general practitioners, specialized physicians, and ON in their perception of 10 medical conditions. Approximately half of the medical conditions were answered cautiously, showing high numbers on the response option potentially (36–72%). Moreover, physicians’ ratings differed significantly depending on their practical experience with particular medical conditions. Those being familiar with a specific medical condition was more permissive to PA during treatment, with effect sizes (Cramer’s V) ranging from 0.13 to 0.27.ConclusionResults indicate high cautiousness among HCP in judging medical conditions and their impact on PA during cancer treatment. However, group comparisons show that familiarity and clinical experience with potential contraindications facilitate a confident handling of safety issues, which at best leads to higher levels of PA recommendations during cancer treatment

Impact and Determinants of Structural Barriers on Physical Activity in People with Cancer

Background: A better understanding of the role of structural barriers for physical activity (PA) after a cancer diagnosis could help to increase PA among people with cancer. Thus, the present study aimed to identify determinants of structural barriers to PA in people with cancer and investigate the association between structural barriers and insufficient post-diagnosis PA, taking different PA change patterns into account. Methods: A total of 1299 people with breast, prostate, or colorectal cancer completed a questionnaire assessing their socio-demographic and medical characteristics, pre- and post-diagnosis PA, and perceived PA impediment by seven structural barriers. Regression analyses were used to investigate determinants of the perception of structural barriers and to examine the association between structural barriers and insufficient post-diagnosis PA, also with regard to different pre-diagnosis PA levels. Results: Overall 30-60% of participants indicated to feel impeded by structural barriers. The analyses revealed a younger age, higher BMI, lower educational level, no current work activity, co-morbidities, and lacking physicians' exercise counseling as significant determinants of the perception of structural barriers. Individuals reporting stronger impediments by structural barriers were significantly less likely to be meeting PA guidelines post-diagnosis, particularly those with sufficient pre-diagnosis PA levels. Conclusions: The study highlights the need for tailored PA programs for people with cancer as well as for more guidance and support in overcoming structural barriers to improve PA behavior

The Relationship between Exercise Self-Efficacy, Intention, and Structural Barriers for Physical Activity after a Cancer Diagnosis

Previous research has shown that structural barriers negatively influence the physical activity (PA) behavior of cancer patients, but underlying mechanisms are unclear. The aim of the current study was to explore the potential mediating role of social-cognitive factors, namely PA self-efficacy and PA intention in this context. A total of 856 cancer patients completed a questionnaire on sociodemographic and medical characteristics, pre- and post-diagnosis PA, PA self-efficacy, PA intention, and PA impediment by structural barriers. A serial mediation model was used to test whether the association between structural barriers and post-diagnosis PA was mediated by PA self-efficacy and/or PA intention, in the overall sample and in subsamples defined by individuals’ pre-diagnosis PA. The results confirmed that structural barriers were not directly (95%CI [−0.45; 0.10]) but indirectly associated with post-diagnosis PA. Higher impediment by structural barriers decreased the likelihood of sufficient post-diagnosis PA via lower PA self-efficacy (95%CI [−0.25; −0.06]) and via the serial pathway of lower PA self-efficacy and lower PA intention (95%CI [−0.19; −0.05]). Investigating differences in these mediations by pre-diagnosis PA yielded significance only among previously active cancer patients. Both structural barriers and PA self-efficacy might hence be relevant target points for interventions aiming to improve PA behavior, especially among pre-diagnosis active cancer patients

Prevalence and frequency of self-management strategies among female cancer survivors: the neglected roles of social relations and conscious living

Objective To assess prevalence and frequency of use of self-management strategies among female cancer survivors and to empirically identify categories of self-management. Methods Female cancer survivors (N=673, mean age 51 years; >90% with breast cancer; M=5 years since diagnosis) completed an Internet survey indicating the frequency (never to very often) with which they had employed each strategy since diagnosis. The survey included commonly assessed self-management strategies, such as complementary and alternative medicine (CAM), religious practices, and exercise. Additionally we assessed the use of further strategies identified from recommendations of cancer survivors shared in Internet forums. Results A principal component analysis yielded five categories: More Conscious Living, Turning to Family/Friends, CAM, Religious/Spiritual Practices, and Exercise. Prevalence rates of commonly measured strategies like CAM, Religious Practices, and Exercise were similar to previous studies. Considering frequency of use, however, revealed that only few participants reported frequent use of these strategies (50%) reported Turning to Family/Friends and engaging in More Conscious Living strategies (very) often. Conclusions Relying on prevalence assessments of commonly investigated behaviors such as CAM or exercise may overestimate their use among cancer survivors. Cancer survivors engage in a wide range of self-management strategies. Encouraging living more consciously and cultivating social relations might be of greater relevance compared with CAM use or exercise

Joint Goals in Older Couples : Associations With Goal Progress, Allostatic Load, and Relationship Satisfaction

Older adults often have long-term relationships, and many of their goals are intertwined with their respective partners. Joint goals can help or hinder goal progress. Little is known about how accurately older adults assess if a goal is joint, the role of over-reporting in these perceptions, and how joint goals and over-reporting may relate to older partners' relationship satisfaction and physical health (operationally defined as allostatic load). Two-hundred-thirty-six older adults from 118 couples (50% female; Mage = 71 years) listed their three most important goals and whether they thought of them as goals they had in common with and wanted to achieve together with their partner (self-reported joint goals). Two independent raters classified goals as “joint” if both partners independently listed open-ended goals of the same content. Goal progress and relationship satisfaction were assessed 1 week later. Allostatic load was calculated using nine different biomarkers. Results show that 85% self-reported at least one goal as joint. Over-reporting– the perception that a goal was joint when in fact it was not mentioned among the three most salient goals of the spouse – occurred in one-third of all goals. Multilevel models indicate that the number of externally-rated joint goals was related to greater goal progress and lower allostatic load, but only for adults with little over-reporting. More joint goals and higher over-reporting were each linked with more relationship satisfaction. In conclusion, joint goals are associated with goal progress, relationship satisfaction, and health, but the association is dependent on the domain of functioning.Arts, Faculty ofPsychology, Department ofMedicine, Faculty ofMedicine, Department ofFamily Practice, Department ofNon UBCReviewedOpen access funding provided by the UBC Open Access Fund for Humanities and Social Sciences Research.FacultyGraduatePostdoctora