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1.  Psychosocial Outcomes of an Exercise Maintenance Intervention After Phase II Cardiac Rehabilitation 
PURPOSE
Maintenance of exercise after completing Phase II cardiac rehabilitation (CR) is challenging for many patients. We offered a telephone-based maintenance intervention and found improvement in exercise participation in the intervention group at 12 months post-CR discharge. We examined the effects of the intervention on psychosocial outcomes.
METHODS
The effects of a home-based exercise maintenance intervention on psychosocial outcomes among patients who had completed Phase II CR vs. contact control was evaluated in a randomized controlled trial. Data were collected in 2005–2010 and analyzed in 2011. One hundred thirty patients (mean age=63.6 years [SD=9.7], 20.8% female) were randomized to exercise counseling (Maintenance Counseling group, n=64) or contact control (Contact Control group, n=66). Maintenance Counseling group participants received exercise counseling (based on the Transtheoretical Model and Social-Cognitive Theory) delivered via telephone for 6 months, as well as print materials and feedback reports. Assessments of depression, quality of life and mental health were conducted at baseline, 6, and 12 months.
RESULTS
The Maintenance Counseling group reported statistically significant higher quality of life than the Contact Control group at 6 (b=0.29, se=0.08, P<.001) and 12 months (b=0.27, se=0.09, P=.002). Intervention effects on depressive symptoms were significant at 12 months (b=−6.42, se=2.43, P=.009). Effects on overall mental health were nonsignificant at both followups. No significant moderators of treatment effects were found.
CONCLUSION
A telephone-based intervention that helped to maintain exercise showed statistically significant improvements in quality of life and reduced depressive symptoms in this patient population.
doi:10.1097/HCR.0b013e3182825531
PMCID: PMC3586302  PMID: 23422351
Exercise maintenance; cardiac rehabilitation; psychosocial outcomes
2.  Maintenance of Exercise After Phase II Cardiac Rehabilitation 
Background
Patients who have completed Phase II cardiac rehabilitation have low rates of maintenance of exercise after program completion, despite the importance of sustaining regular exercise to prevent future cardiac events.
Purpose
The efficacy of a home-based intervention to support exercise maintenance among patients who had completed Phase II cardiac rehabilitation versus contact control was evaluated.
Design
An RCT was used to evaluate the intervention. Data were collected in 2005–2010 and analyzed in 2010.
Setting/participants
One hundred and thirty patients (mean age = 63.6 years [SD=9.7], 20.8% female) were randomized to exercise counseling (Maintenance Counseling group, n=64) or contact control (Contact Control group, n=66).
Intervention
Maintenance Counseling group participants received a 6-month program of exercise counseling (based on the Transtheoretical Model and Social–Cognitive Theory) delivered via telephone, as well as print materials and feedback reports.
Main outcome measures
Assessments of physical activity (7-Day PAR), motivational readiness for exercise, lipids and physical functioning were conducted at baseline, 6 and 12 months. Objective accelerometer data were collected at the same time-points. Fitness was assessed via maximal exercise stress tests at baseline and 6 months.
Results
The Maintenance Counseling group reported significantly higher exercise participation than the Contact Control group at 12 months (difference of 80 minutes, 95% CI 22,137). Group differences in exercise at 6 months were nonsignificant. The intervention significantly increased the probability of participants’ exercising at or above physical activity guidelines and attenuated regression in motivational readiness versus the Contact Control Group at 6 and 12 months. Self-reported physical functioning was significantly higher in the Maintenance Counseling group at 12 months. No group differences were seen in fitness at 6 months or lipid measures at 6 and 12 months.
Conclusions
A telephone-based intervention can help maintain exercise, prevent regression in motivational readiness for exercise and improve physical functioning in this patient population.
doi:10.1016/j.amepre.2011.04.015
PMCID: PMC3160619  PMID: 21855741
3.  Maintenance of Effects of a Home-Based Physical Activity Program among Breast Cancer Survivors 
Purpose
Although physical activity (PA) adoption improves fitness and psychological well-being among cancer survivors, PA maintenance has not been examined. This paper presents follow-up of a home-based PA program for women treated for early-stage breast cancer.
Patients and Methods
Eighty-six sedentary women (mean age=53.14 years, SD=9.70) were randomly assigned to a PA or Contact Control group. The PA group received a 12-week telephone counseling program to adopt PA. Assessments were conducted at baseline, end-of-intervention (12-weeks), 6 and 9 months post-baseline.
Results
When comparing change from end-of-intervention (12 weeks) between groups, a significant reduction was observed in minutes of PA at 6 months (t = −2.10, p<.05), but there was no decrease in intervention effect at 9 months (t =−.19, p=.84). Similarly, post-intervention reductions in fatigue were lost at 6 months (t =3.27, p<.01), but remained present at 9 months (t =1.65, p=.10). PA group’s fitness improvements were maintained at both follow-ups (t = 1.04,
p =.30 and t =.05, p =.96). The previously significant intervention effect on vigor was maintained at 6 months (t=1.32, p=.19) but was significantly reduced at 9 months (t=−2.15, p<.05). PA participants were more likely to progress in motivational readiness at 6 (OR = 5.95, 95% CI =2.30, 15.36) and 9 months (OR = 4.09, 95% CI = 1.69, 9.87); however, group differences in meeting PA guidelines were not maintained.
Conclusion
Some positive effects of a home-based PA intervention for breast cancer patients were maintained at 6 and 9 months.
doi:10.1007/s00520-008-0434-0
PMCID: PMC2747581  PMID: 18414905
breast cancer; physical activity; maintenance
4.  Methodological Issues in Exercise Intervention Research in Oncology 
Seminars in oncology nursing  2007;23(4):297-304.
Objectives
To review randomized controlled trials (RCTs) that offered exercise interventions for adults diagnosed and treated for cancer related to design, sample, type of intervention and outcomes.
Data sources
Several electronic data-bases were searched and recent review papers were scanned to identify relevant publications.
Conclusion
Exercise adoption seems clearly feasible for early-stage cancer patients, particularly breast cancer patients. Data support positive effects for physical functioning, quality of life (QOL), and psychological well-being. Effects for patients with later-stage disease and other cancers are less clear. The impact of exercise adoption on biomarkers of disease status, immune functioning and hormone levels should also be examined.
Implications for nursing practice
There are many opportunities for nurses to promote exercise in clinical care and in a research context.
doi:10.1016/j.soncn.2007.08.006
PMCID: PMC2180155  PMID: 18022057
5.  Home-based Exercise among Cancer Survivors: Adherence and its Predictors 
Psycho-oncology  2009;18(4):369-376.
Objective
Evidence of the benefits of exercise for those treated for cancer has led to several exercise interventions for this population. Some have questioned whether cancer patients offered a home-based intervention adhere to the exercise prescribed.
Method
We examined exercise adherence in a randomized controlled trial of a 12-week, home-based exercise trial for breast cancer patients. Three adherence outcomes were examined: minutes of exercise participation during each week of the intervention, number of steps taken during planned exercise during each intervention week, and whether the participant met her weekly exercise goal. Predictors of adherence (e.g., demographic and medical variables, Transtheoretical Model variables, history of exercise) were examined.
Results
Findings indicate that participants significantly increased their minutes of exercise and steps taken during planned exercise from the first to the last week of the intervention. The percentage of participants achieving exercise goals was highest in the first few weeks of the intervention. Exercise self-efficacy significantly predicted each adherence outcome. Baseline PA predicted mean exercise session steps over the 12 weeks.
Conclusion
Adherence to a home-based exercise intervention for breast cancer patients changes over time and may be related to baseline levels of self-efficacy for exercise.
doi:10.1002/pon.1465
PMCID: PMC2958525  PMID: 19242921
Home-based exercise; adherence; cancer; oncology; breast cancer
6.  Riding the Crest of the Teachable Moment: Promoting Long-Term Health After the Diagnosis of Cancer 
Purpose
Cancer survivors are at increased risk for several comorbid conditions, and many seek lifestyle change to reduce dysfunction and improve long-term health. To better understand the impact of cancer on adult survivors' health and health behaviors, a review was conducted to determine (1) prevalent physical health conditions, (2) persistent lifestyle changes, and (3) outcomes of previous lifestyle interventions aimed at improving health within this population.
Methods
Relevant studies from 1966 and beyond were identified through MEDLINE and PubMed searches.
Results
Cancer survivors are at increased risk for progressive disease but also for second primaries, osteoporosis, obesity, cardiovascular disease, diabetes, and functional decline. To improve overall health, survivors frequently initiate diet, exercise, and other lifestyle changes after diagnosis. However, those who are male, older, and less educated are less likely to adopt these changes. There also is selective uptake of messages, as evidenced by findings that only 25% to 42% of survivors consume adequate amounts of fruits and vegetables, and approximately 70% of breast and prostate cancer survivors are overweight or obese. Several behavioral interventions show promise for improving survivors' health-related outcomes. Oncologists can play a pivotal role in health promotion, yet only 20% provide such guidance.
Conclusion
With 64% of cancer patients surviving > 5 years beyond diagnosis, oncologists are challenged to expand their focus from acute care to managing the long-term health consequences of cancer. Although more research is needed, opportunities exist for oncologists to promote lifestyle changes that may improve the length and quality of life of their patients.
doi:10.1200/JCO.2005.01.230
PMCID: PMC1550285  PMID: 16043830

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