Adults diagnosed with gynecologic cancer and their relationship with their body: A study on the supportive role of yoga using interpretative phenomenological analysis.

The purpose of this qualitative study was to explore the thoughts, feelings, attitudes, and perceptions of adults diagnosed with gynecologic cancer on their body, and the role of yoga in shaping these aspects. A phenomenological research design was used. Fifteen women (Mage=50.1 ± 13.5 years, range=28-66) who practice yoga at least once/week completed a sociodemographic survey online, two semi-structured interviews, and a 30-day journal online. Quantitative data were analysed using descriptive statistics. Qualitative data were analysed using interpretative phenomenological analysis. Participants' responses and the authors' interpretations were summarized into four main superordinate themes: (1) internal monologue of the changed body, (2) balancing act between acceptance and improvement, (3) value of taking time to prioritize oneself by practicing yoga, and (4) transformative catalysts of expectation and mindset on body-related self-perceptions after yoga. Body functionality and appearance, and their sexual health were often deeply interconnected, and impacted participants' self-perceptions and behaviours. Yoga was a vehicle for growth and acceptance; however, participants' expectations and mindsets before and during yoga could lead to negative self-perceptions after yoga. The findings underscore the importance of integrating yoga - a holistic practice - into survivorship care programs, while emphasizing the need to address expectations and attitudes that could hinder positive outcomes.

Feasibility and acceptability of study methods and psychosocial interventions for body image among women diagnosed with breast cancer: A systematic review and narrative synthesis.

OBJECTIVE: This systematic review aimed to summarize evidence for the feasibility and acceptability of psychosocial interventions for body image among women diagnosed with breast cancer and the study methods used to evaluate the interventions in question. METHODS: Articles were identified via MEDLINE, CINAHL, CENTRAL, PsychINFO, and EMBASE. Inclusion criteria were: (1) peer-reviewed publication in English from 2000 onward with accessible full-text, (2) reported data on the feasibility and/or acceptability of psychosocial interventions and/or study methods, (3) included at least one measure of body image or reported a body-related theme, and (4) sample comprised women diagnosed with breast cancer. All study designs were eligible. Two reviewers independently performed study selection, data extraction, and quality assessment. RESULTS: Sixty-two articles were included. Participants and comparator groups varied as did interventions. Feasibility and acceptability of the interventions and study methods were inconsistently operationalized and reported across studies. Evidence of feasibility and acceptability was heterogeneous within and across studies, though mostly positive. CONCLUSION: Published psychosocial interventions for body image and study methods are generally feasible and acceptable. Findings should be used to advance the development, implementation, and evaluation of interventions designed to improve outcomes (body image or otherwise) for women diagnosed with breast cancer. SYSTEMATIC REVIEW REGISTRATION: This review was registered with the International Prospective Register of Systematic Reviews (PROSPERO; ID: CRD42021269062, 11 September 2021).

A single-subject research design evaluating a co-created yoga program for adults with gynecologic cancer: feasibility study protocol.

BACKGROUND: Worldwide, > 1.3 million adults are diagnosed with a gynecologic cancer each year, affecting their wellbeing and quality of life. This manuscript describes the protocol for a study that sought to assess the feasibility, acceptability, and fidelity of a community-based co-created yoga program and proposed evaluative methods, and estimate program effects on self-reported outcomes. METHODS: Using a multiple baseline single-subject research design with a follow-up phase (ABA), quantitative and qualitative data were collected from program participants and the instructor. Participants were randomly assigned to varying baseline lengths and completed weekly surveys for 3-5 weeks pre-program. Then, participants engaged in a bi-modal 12-week hatha yoga program consisting of 2 60-min group classes a week, with optional supplemental features (January-April, 2023). Participants completed surveys after classes 1, 12, and 24. All yoga classes were audio- and video-recorded. Post-program, participants completed surveys 1, 4, and 8 weeks after the last class and took part in a semi-structured interview 1 week after to discuss program acceptability, suitability, relevance, and potential benefits. Feasibility outcomes (i.e., recruitment, retention, and program adherence rates, engagement with optional program features) were tracked by the instructor assistant and study team during the study. The yoga instructor was interviewed about their experience delivering the program 2 weeks after the last class. PLANNED ANALYSIS: Feasibility outcomes will be analyzed using descriptive statistics. Interview transcripts will be coded using reflexive thematic analysis. Class recordings will be coded using duration and frequency coding. Survey responses for self-reported outcomes will be analyzed visually and using multilevel modeling. EXPECTED OUTCOMES: Data will help determine refinements, if any, required to the program and instructor guidebook, implementation approach, and proposed evaluation methods before scale-up projects and definitive trials are started. TRIAL REGISTRATION: ClinicalTrials.gov NCT05610982. November 3, 2022.

Acceptability and Usability of a Theory-Driven Intervention via Email to Promote Physical Activity in Women Who Are Overweight or Obese: Substudy Within a Randomized Controlled Trial.

BACKGROUND: Insufficient physical activity (PA) and excess weight increase illness risk for women. Face-to-face interventions can increase PA levels; however, they are often inaccessible. With growing interest in digital interventions, a Self-Determination Theory (SDT)-driven intervention was developed and delivered via email to promote PA in women who were insufficiently active and overweight or obese. OBJECTIVE: This substudy explores users' perspectives about the acceptability and usability of the intervention, which was coupled with a wearable activity monitor and PA recommendations. METHODS: A 3-arm, parallel group, randomized controlled trial (unblinded) was conducted in Ontario, Canada. Recruitment occurred from September 2018 to March 2019 via advertising through social media, web-based boards, and posters in publicly accessible areas. In total, 47 women with a BMI of ≥25 kg/m2 who were not meeting the Canadian PA guidelines were randomly assigned to 1 of 3 arms (arm 1: n=15, 32%; arm 2: n=16, 34%; arm 3: n=16, 34%). This substudy focused on the 15 participants allocated to the main intervention arm. Participants received an automated intervention consisting of (1) 6 weekly emails, (2) a Polar Electro Inc A300 activity monitor (with access to the Polar Flow website and companion smartphone app), and (3) a copy of the Canadian PA guidelines for adults. Emails were developed using SDT and designed to enhance autonomous motivation by fostering the psychological needs of competence, autonomy, and relatedness. Well-established motivational and behavior change techniques were embedded in the emails to promote needs satisfaction. After the intervention (ie, 7 weeks after randomization), participants were invited to complete a web-based acceptability and usability survey containing open-ended and closed-ended questions; responses were analyzed using descriptive and content analyses, respectively. RESULTS: The analyses included data from 93% (14/15) of the women (age: mean 33.4, SD 7.5; range 24-44 years; BMI: mean 31.3, SD 5.8 kg/m2; range 25-40.5 kg/m2) who received the main intervention and completed the postintervention survey. Open-ended responses indicated that participants were generally satisfied with the intervention and appreciated that emails prompted self-reflection, kept them on track and accountable, provided informational support, and were nonpressuring. Furthermore, they suggested that the monitor was "enjoyable" and "helpful"; quantitative data corroborated this, as 71% (10/14) said that the monitor was "very valuable/absolutely valuable," 71% (10/14) would "very probably/definitely" still use one, and 86% (12/14) wore it for ≥5 days per week for ≥8 hours per day and checked it "occasionally/frequently/very frequently." Potential threats to acceptability included "long" and "text-heavy" emails; lack of personal contact; and cumbersome, unaesthetic monitors. CONCLUSIONS: Results suggest that this SDT-driven, email-delivered intervention may be an acceptable low-contact approach to promote PA in women who are overweight or obese and insufficiently active; however, improvements are warranted and studies ascertaining its effectiveness are needed. TRIAL REGISTRATION: ClinicalTrials.gov NCT03601663; http://clinicaltrials.gov/ct2/show/NCT03601663. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1177/20552076221093134.

Women's experiences with yoga after a cancer diagnosis: a qualitative meta-synthesis-part I.

BACKGROUND: Qualitative research on women's experiences participating in yoga after a cancer diagnosis is growing; systematic synthesis and integration of results are necessary to facilitate the transfer and implementation of knowledge among researchers and end-users. Thus, the purpose of this meta-synthesis was to: (1) integrate findings from qualitative studies, (2) compare and contrast findings to elucidate patterns or contradictions in conclusions, and (3) develop an overarching interpretation of women's experiences participating in yoga after a cancer diagnosis. METHODS: Using meta-study methodology, six electronic databases were searched using a sensitive search strategy in November 2020, a supplemental scan of reference lists was conducted in August 2021, and the database search was replicated in October 2021. Two reviewers independently screened titles/abstracts and full-texts to determine eligibility. RESULTS: The searches yielded 6804 citations after de-duplication. Data from 24 articles meeting the eligibility criteria were extracted, and the results, methods, and theoretical approach(es) were analyzed. The analysis revealed that there was a predominant focus on two focal points in the primary articles: (1) women's well-being and quality of life (QoL; part I) and (2) intervention preferences (part II). Five overarching categories emerged related to well-being and QoL: (1) yoga can support improvements in multiple dimensions of QoL in women diagnosed with cancer, (2) women diagnosed with cancer experience an interaction between QoL dimensions, (3) elements of yoga that support improvements in QoL dimensions, (4) breathwork and meditation are integral elements of yoga, and (5) yoga practice may support lifestyle behavior change. The articles reviewed had notable limitations related to: (1) reporting about instructor(s), content of the intervention, and environmental characteristics of the setting, (2) identifying and incorporating optimal features in the intervention design, (3) incorporating theory and real-world considerations into the study procedures, and (4) including positive and negative conceptualizations of QoL as an interconnected and multidimensional concept. CONCLUSION: Moving forward, it remains critical to identify the ideal structure and content of yoga programs for promoting well-being and QoL among women diagnosed with cancer, as well as to explore barriers and facilitators to sustainable program implementation. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42021229253.

Women's experiences with yoga after a cancer diagnosis: A qualitative meta-synthesis - Part II.

A review of qualitative research exploring women's experiences with yoga after a cancer diagnosis can provide important insights into their motives, barriers, and preferences for yoga participation, which can be used to enhance engagement. In this meta-study meta-synthesis, 6 electronic databases were systematically searched to identify qualitative studies focused on women diagnosed with cancer who engage in yoga. The search yielded 6878 results after de-duplication; of these, 24 articles were eligible and included. Extracted data pertaining to the results, methods, and theoretical approach(es) were analyzed. This paper synthesizes and integrates results from 16 of the 24 articles focused on women's motives, barriers, and preferences for participating in yoga programs and interventions; it is Part II of a 2-part meta-study meta-synthesis. Motives to participate in yoga included: rehabilitation, physical activity, social support, and novel experience. Barriers centred around time constraints, lack of intentionality, online adaptation difficulties, health condition, and cost. Main approaches to delivering yoga comprised: in-person, in-person with an at-home component, asynchronous online, and synchronous online. Each mode of delivery presented its own benefits and challenges, with suggestions for improvement; participants highlighted the value of supportive and knowledgeable instructors, the ability to connect with others, and the importance of comprehensive classes focused on more than just movement. Participants' challenges also highlighted a need to actively seek solutions to anticipated challenges prior to delivering interventions and programs. Findings provide information that can be used to develop and deliver yoga interventions and programs to women diagnosed with cancer that prioritize their needs and preferences. REGISTRATION: PROSPERO; registration number: CRD42021229253; February 17, 2021.

The physicAl aCtivity Counselling for young adult cancEr SurvivorS (ACCESS) trial: A protocol for a parallel, two-arm pilot randomized controlled trial.

BACKGROUND: Young adults aged 18-39 years commonly experience persistent side effects following cancer treatment that can impair their quality of life. Physical activity (PA) holds promise as a behavioral intervention to mitigate persistent side effects and improve quality of life. Yet, few young adults are active enough to incur these benefits and efforts to promote PA after cancer treatment ends are lacking. Therefore, we developed a novel theory-driven behavior change intervention to promote PA via videoconferencing technology in young adults who have completed cancer treatment, and are undertaking a pilot randomized controlled trial (RCT) to gather evidence to inform the design of a large, full-scale RCT. The specific aims of this parallel, two-arm pilot RCT are to: (1) assess intervention and trial protocol feasibility and acceptability; and (2) generate data on PA behavior. To promote transparency, improve reproducibility, and serve as a reference for forthcoming publication of results, we present the study protocol for this pilot RCT (version 7) within this paper. METHODS: Young adults who have completed cancer treatment are being recruited from across Canada. After informed consent is obtained and baseline assessments are completed, participants are randomized to the intervention group (i.e., a 12-week behavior change intervention delivered via videoconferencing technology by trained PA counsellors) or usual care group (i.e., no intervention). Several feasibility outcomes covering enrollment, allocation, follow-up, and analysis are tracked by study staff. Acceptability is assessed through interviews exploring participants' experiences, thoughts, and perspectives of the trial protocol (i.e., intervention and usual care groups), as well as participants' views of the intervention and its mode of delivery (i.e., intervention group only) and PA counsellors' experiences delivering the intervention. PA behavior is measured using accelerometers at baseline (pre-randomization), post-intervention, and at follow-up (24 weeks post-baseline). DISCUSSION: There are growing calls to develop interventions to support young adults' motivation to engage in PA and adopt an active lifestyle to improve their quality of life after cancer treatment ends. Real-time videoconferencing shows promise for disseminating behavior change interventions to young adults and addressing participation barriers. Considering the importance of establishing intervention and trial protocol feasibility and acceptability prior to evaluating intervention efficacy (or effectiveness), this pilot RCT is critical to understand how participants embrace, engage with, and complete the intervention and trial protocol. Indeed, these data will help to determine which refinements, if any, are required to the intervention and trial protocol (e.g., implementation approach, evaluation methods) prior to a large, full-scale RCT aiming to test the effects of the intervention on PA behavior. Additionally, the PA behavior data collected will be useful to inform the sample size calculation for a large, full-scale RCT. TRIAL REGISTRATION: The trial was registered with the ClinicalTrials.gov database (ID: NCT04163042) on November 14, 2019, prior to the start of the trial in February, 2021.

Exploring women's experiences participating in yoga after a cancer diagnosis: a protocol for a meta-synthesis.

BACKGROUND: The benefits of yoga for clinical and non-clinical populations have been summarized in published systematic reviews. The vast majority of systematic reviews on the topic are syntheses of quantitative research that evaluated the effects of yoga. As qualitative research related to women's experiences participating in yoga after a cancer diagnosis is growing in quantity, systematic synthesis and integration of qualitative research are necessary to facilitate the transfer of knowledge. This paper describes the protocol for a meta-synthesis of qualitative research exploring women's experiences participating in yoga after a cancer diagnosis. METHODS: Using a meta-study methodology, six electronic databases were searched to identify relevant articles. Additionally, the reference lists of relevant articles retrieved during the electronic database search were scanned to identify other relevant articles. Two reviewers independently screened the titles and abstracts, retaining those that appeared to relate to the review objectives. Next, they reviewed the retained full-text articles to assess eligibility according to four inclusion criteria. They will extract data from eligible studies and assess the quality of included studies. Data analysis will involve three main analytical steps: meta-data analysis, meta-method analysis, and meta-theory analysis. Findings from the three analytical steps will be interpreted collectively to generate additional insights beyond the findings of the primary studies to facilitate a more comprehensive understanding of women's experiences participating in yoga after a cancer diagnosis. DISCUSSION: By systematically collecting, analysing, and interpreting findings across multiple primary qualitative studies, we will develop an overarching narrative and interpretation of the role and value of yoga for women diagnosed with cancer. A synthesis of qualitative research is vital as it embraces the heterogeneity of the research so as to provide important context for understanding the experiences of various women participating in yoga. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42021229253.

Body image in women diagnosed with breast cancer: A grounded theory study.

Using a Straussian grounded theory methodology, we explored the meaning women attribute to body image and how they understand their breast cancer experience as influencing their body image to develop a grounded theory of body image for women diagnosed with breast cancer. Interviews were conducted with 27 women who had completed treatment for breast cancer in Canada. Data were analyzed through a process of open, axial, and selective coding using constant comparison techniques and memo-writing. A grounded theory of body image for women diagnosed with breast cancer was developed around the core category of body image: what it means to women, which was underpinned by six themes and 17 subthemes. This theory explains how women diagnosed with breast cancer define body image and illustrates intrapersonal and interpersonal factors that can undermine or support their body image, along with strategies they used to manage their body image. This theory can guide research and practice aimed at enhancing body image and minimizing its consequences for women diagnosed with breast cancer.

Understanding rural-living young adult cancer survivors' motivation during a telehealth behavior change intervention within a single-arm feasibility trial.

A single-arm feasibility trial was conducted to explore rural-living young adult cancer survivors' physical activity, fruit and vegetable consumption, and motivational processes underlying any behavior changes during a telehealth behavior change intervention grounded in self-determination theory. Participants (n = 7; 85.7% female; Mage = 33.9, range = 28-37) met with a health coach once a week for 60 min for 12 weeks. Participants completed pre- and post-intervention surveys that assessed their behaviors, basic psychological needs satisfaction, and behavioral regulations. Participants also completed a semi-structured interview post-intervention. Quantitative results indicate behavioral outcomes, basic psychological needs satisfaction, and behavioral regulations increased from pre- to post-intervention. Five themes provide context for the observed increases. Results provide preliminary evidence that motivation for physical activity and fruit and vegetable consumption may be facilitated by a one-on-one telehealth intervention among rural-living young adult cancer survivors. Large scale studies are needed to determine effectiveness of the intervention and identify mechanisms underpinning behavioral outcomes.

Boxing with Parkinson's Disease: findings from a qualitative study using self-determination theory.

PURPOSE: Adults with Parkinson's disease (PD) experience debilitating symptoms that may be mitigated by boxing. Yet, attrition from boxing programs is problematic. Understanding whether PD-specific boxing programs can enhance motivation to remain physically active is important. This study investigated adults' experiences within a PD-specific boxing program and explored their perspectives on how the program has influenced physical activity motivational processes using a self-determination theory (SDT) lens. METHODS: Nine adults with PD who took part in the Boxing 4 Health PD-specific boxing program completed face-to-face, semi-structured interviews. Data were analyzed using a hybrid approach of inductive and deductive thematic analysis. RESULTS: The analysis yielded five themes: (1) I made an informed decision to participate and it feels good, (2) Boxing helps me stay active and keep moving, (3) To keep me going, the boxing program needs to have variety and allow for input, (4) A program that can be adapted to me is important, and (5) The instructor and the group facilitate my continued participation in the program. CONCLUSION: Providing participants with adapted exercises, varied sessions, and opportunities to provide input in a group-based PD-specific boxing program may be conducive to enhancing motivation for physical activity. Further, SDT may be a useful theoretical framework for developing and evaluating PD-specific programs.IMPLICATIONS FOR REHABILITATIONAdults with Parkinson's disease (PD) have many reasons for not engaging in physical activity, including a lack of motivation.A group-based PD-specific boxing program may be conducive to increasing motivation for physical activity.Professionals should consider: (1) educating adults with PD on the benefits of boxing, (2) offering group-based PD-specific boxing programs that are adaptable, varied, and open to input, and (3) fostering social support and networking opportunities within such programs.

A qualitative study exploring middle-aged women's experiences with yoga.

The purpose of this study was to explore how yoga impacts body-related thoughts, feelings, perceptions and attitudes, well-being, and self-care behaviors in a sample of middle-aged women who regularly engage in yoga in their communities. The sample included 22 women; 10 self-identified as beginners or novices and 12 self-identified as experienced in yoga. Interpretive phenomenological analysis guided the data collection, analysis, and interpretation. Four key themes were identified around the topics of: supportive yoga environment, mindfulness, self-care behaviors, and body-related perceptions. Results highlight potential elements of yoga that can support positive body-related experiences in middle-aged women.

Exploring cancer survivors' experiences in a group-based walking program before and during the COVID-19 pandemic: a qualitative study.

PURPOSE: Physical activity (PA) can help reduce side effects related to cancer whilst promoting quality of life. This qualitative study explored cancer survivors' experiences in an 8-week group-based walking program with behavioural support that was delivered within the community to highlight factors central to successful adoption and sustainability of such programs. METHODS: Eleven cancer survivors who took part in the program before (n = 7) or during (n = 4) the COVID-19 pandemic were interviewed and asked to discuss their PA behaviour, motivation to join and complete the program, and experienced benefits and barriers, as well as offer feedback that could be incorporated into future programs. Interview transcripts were thematically analysed using a hybrid deductive-inductive approach. RESULTS: Participants' experiences were summarised into six themes: (1) PA behaviour and motivation were enhanced, (2) seeking accountability to take steps for better health, (3) mutual support encourages in-group bonding, (4) placing value on building PA confidence, (5) the impact of the COVID-19 pandemic and (6) recommendations for future programs. By receiving social and behavioural support, and thus experiencing increased PA confidence, participants felt the program supported their PA behaviour. However, key differences were evident for participants attending the program during the pandemic. CONCLUSIONS: Exploring strategies that foster a communal focus amongst participants within community-based walking programs may be beneficial. Moreover, findings underscore the value of offering PA programming (walking or otherwise) with behavioural support during a pandemic with appropriate safety measures, though social relationships may not be fully fostered.

Feasibility and acceptability of study methods and psychosocial interventions for body image targeting women diagnosed with breast cancer: a protocol for a systematic review.

INTRODUCTION: Improving body image may help to enhance the quality of life of women diagnosed with breast cancer. Although evidence suggests psychosocial interventions can effectively improve body image in this population, no review to date has assessed their feasibility or acceptability. This manuscript reports the protocol for a review summarising current evidence for the feasibility and acceptability of psychosocial interventions for body image targeting women diagnosed with breast cancer and the study methods used to evaluate the interventions in question to provide recommendations to optimise the success and sustainability of psychosocial interventions for body image and future studies. Results will also help to identify gaps in the existing evidence to provide direction for future research. METHODS AND ANALYSIS: We searched the following databases for articles published in the English language from January 2000 to June 2021 using a systematic search strategy: MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials, PsychINFO and EMBASE. This search will be supplemented with a manual search of reference lists from relevant systematic reviews and included articles. Eligible studies will include peer-reviewed publications reporting on feasibility and acceptability in the evaluation of psychosocial interventions for body image targeting women diagnosed with breast cancer. All study designs are eligible, although articles are required to have reported on an intervention evaluation. Two reviewers will independently carry out study selection, extraction of quantitative and qualitative data and quality assessment. Data will be summarised in a narrative review and thematic analysis. ETHICS AND DISSEMINATION: No ethical approval is required because this is a protocol for a systematic review. On completion, results will be submitted for publication in a peer-reviewed scientific journal and for presentation at a relevant conference. TRIAL REGISTRATION: This protocol has been registered in the Prospective Register of Systematic Reviews international registry (ID: CRD42021269062, 11 September 2021).

Women's Preferences for Body Image Programming: A Qualitative Study to Inform Future Programs Targeting Women Diagnosed With Breast Cancer.

Purpose: This paper describes women's opinions of the attributes of the ideal body image program to inform the design, development, and implementation of future programs for those diagnosed with breast cancer. Methods: Deductive-inductive content analysis of semi-structured interviews with 26 women diagnosed with breast cancer (mean age = 55.96 years; mean time since diagnosis = 2.79 years) was performed. Findings: Participants' opinions regarding the ideal body image program are summarized into five themes, mapping the where (community-based, hospital-based, or online), when (across the cancer continuum or at specific points), how (peer-led programs, professional help, events, presentations/workshops, resources, support groups), what (self-care, counseling and education for one self, education for others, support for addressing sexuality/sexual health concerns, and concealing treatment-related changes), and who (team approach or delivered by women, health professionals, make-up artists). Conclusion: This study provides useful data on what women believe are the attributes of the ideal body image program, which can contribute to efforts aimed at developing and delivering body image programs for women diagnosed with breast cancer that prioritize their needs and preferences.

Feasibility and acceptability of a telehealth behavior change intervention for promoting physical activity and fruit and vegetable consumption among rural-living young adult cancer survivors.

Purpose: We assessed the feasibility and acceptability of a 12-week telehealth behavior change intervention to promote physical activity and fruit and vegetable consumption among rural-living young adult cancer survivors.Methods: Participants met with a health coach once a week for 60 minutes for 12 weeks. Feasibility measures included rates of recruitment, enrollment, attrition, retention, adherence, and missing data. Acceptability was assessed using semi-structured interviews.Findings: Over 1-year, 18 individuals self-referred, 9 were eligible and consented to participate, and 2 dropped out. Retention was 74% and adherence was 95%. Participants considered the length of the intervention, synchronous communication with the health coach, and the distance-based delivery mode to be acceptable. Moreover, participants described key behavior change techniques and recommended minor changes.Implications: Findings provide information that can help refine future trials seeking to increase access to behavior change interventions and optimize participation in health-promoting behaviors for underserved populations.Trial registration: ClinicalTrials.gov. NCT03691545. Registered on October 1, 2018.

A scoping review of measures used to assess body image in women with breast cancer.

OBJECTIVE: The emergence of body image studies in the oncology setting has led to the use of numerous measures to assess different dimensions of body image. The present study is a scoping review of the literature on body image in women with breast cancer to describe: measures used to assess body image in women with breast cancer, dimensions the measures used tap into, and gaps and issues needing attention going forward. METHODS: Three databases were searched for peer-reviewed original studies that had: (1) full-texts available in English; (2) focused on women with breast cancer; and (3) assessed body image. RESULTS: The search yielded 3,729 peer-reviewed articles; after screening, 562 articles met inclusion criteria. Of the 88 measures used, 28 were used in more than two studies and analyzed herein. The European Organization for Research and Treatment of Cancer Breast Cancer-Specific Quality of Life Questionnaire constituted the most frequently used measure. Most measures used focused on the affective dimension of body image (n = 24/28, 85.7%), followed by the cognitive (n = 20/28, 71.4%), behavioral (n = 13/28, 46.4%), and perceptual dimensions (n = 13/28, 46.4%). CONCLUSIONS: This review provides a current summary of measures used to assess body image in women with breast cancer. Although some further development and refinement of body image measures could benefit the field, depending on the questions researchers or clinicians seek to answer, there are many available for use. Future research should use these measures to assess the effectiveness of interventions aimed at improving body image in women with breast cancer across the lifespan.

Understanding adolescents' and young adults' self-perceptions after cancer treatment in the context of a two-arm, mixed-methods pilot randomized controlled physical activity trial.

PURPOSE: The self-perceptions of adolescents and young adults (AYAs) after cancer treatment are not well understood. As part of a two-arm, mixed-methods pilot randomized controlled trial (RCT), this qualitative sub-study explored AYAs' self-perceptions after cancer treatment and investigated how physical activity (PA) may contribute to their self-perceptions. METHODS: Data were collected from 16 AYAs who completed cancer treatment and who participated in a two-arm, mixed-methods pilot RCT. Recruited AYAs were randomized to a 12-week PA intervention or a wait-list control group, and semi-structured interviews were conducted at baseline (pre-randomization) and 12 weeks later (post-intervention or post-waiting period) to elicit discussions on self-perceptions and PA. Data were analyzed thematically using inductive and deductive approaches. The exercise and self-esteem model (EXSEM) was the theoretical lens for the deductive analysis. RESULTS: Data were organized into four unified main themes: (1) I came out on top and am (re)discovering myself, (2) Comparison to my past self and others induces negative feelings, (3) My changed body brings me down, but it does not rule my life, and (4) My previous experience with PA informs my expectations for my future PA, and two themes contingent on group allocation: (5) Participating in a PA program made me feel better about myself, and (6) I did not notice any changes while waiting for the PA program, but I am anticipating support. CONCLUSION: AYAs' self-perceptions are amenable to change, positively and negatively valenced, and influenced by PA. Although the EXSEM captured intrapersonal factors related to AYAs' self-perceptions after cancer treatment, interpersonal and contextual factors beyond the EXSEM also shaped their self-perceptions. TRIAL REGISTRATION: Clinicaltrials.gov , NCT03016728. Registered January 11, 2017.

An exercise trial for adults undergoing neoadjuvant chemoradiotherapy for rectal cancer proves not feasible: recommendations for future trials.

BACKGROUND: The aim of this paper is to share the methodological problems of an unsuccessful prospective single-arm feasibility trial conducted to evaluate the safety and feasibility of a 12-week progressive exercise intervention for adults undergoing neoadjuvant chemoradiotherapy for rectal cancer, as well as offer recommendations for future trials. METHODS: The initial plan was to recruit adults diagnosed with rectal cancer and scheduled for neoadjuvant chemoradiotherapy over a 12-month period. The exercise intervention was to consist of supervised exercise sessions delivered three times per week by a trained exercise specialist. Feasibility (i.e., recruitment, adherence, and compliance rates) and safety (i.e., adverse events) were to be assessed throughout the trial, and patient-reported and physical health outcomes were to be assessed pre- and post-intervention. After 8 months of open recruitment, we had been unable to successfully enroll patients into our trial. We therefore modified our eligibility criteria to increase the number of patients that could be recruited into our trial, and in turn increase our recruitment rate. We also amended our recruitment procedures to ensure we could reach patients who were either awaiting treatment, receiving treatment, or had completed treatments in the past 5 years. In doing so, we added a research objective, namely to determine the optimal timing of conducting an exercise intervention with adults diagnosed with rectal cancer (i.e., during neoadjuvant treatment, after surgery, during adjuvant treatment, or post-treatment). RESULTS: Many problems continued to hinder the progress of our trial, particularly the low recruitment rate and the failure to enroll the required sample size that would make our results reliable. CONCLUSION: This led us to conclude that our trial was not feasible and that it is advisable to consider some elements carefully (e.g., recruitment strategies, communication, and trial location) before designing and conducting future trials. If one or more of these elements still proves to be problematic, trial results risk being compromised and alternative approaches should be considered. TRIAL REGISTRATION: ClinicalTrials.gov NCT03049124 . Registered on 02 September 2017.

Health beliefs and engagement in moderate-to-vigorous-intensity physical activity among cancer survivors: a cross-sectional study.

PURPOSE: Moderate-to-vigorous-intensity physical activity (PA) can alleviate many adverse side effects and symptoms caused by cancer treatments; yet, most cancer survivors are insufficiently active. Evidence shows that theory-based PA behavior change interventions are more effective than non-theory-based interventions; thus, it is necessary to ascertain modifiable theoretical factors associated with moderate-to-vigorous-intensity PA among cancer survivors. Drawing on the health belief model (HBM), the associations between moderate-to-vigorous-intensity PA and (1) perceived susceptibility to cancer recurrence and health problems, (2) perceived severity of cancer recurrence and health problems, (3) perceived benefits of PA for reducing risk of cancer recurrence and health problems, (4) perceived barriers to PA, and (5) PA barrier self-efficacy among cancer survivors were examined. METHODS: A total of 123 adult cancer survivors (Mage = 50.1 ± 15.5 years; 82.9% female) completed an online self-report survey assessing sociodemographic and medical characteristics, moderate-to-vigorous-intensity PA, and the HBM constructs. Data were analyzed descriptively and using hierarchical linear regression analysis. RESULTS: After adjusting for age, sex, body mass index, time since cancer diagnosis, and treatments received, the HBM constructs collectively explained 29% of the variance in moderate-to-vigorous-intensity PA. Perceived benefits of PA (ß = .20, 95% CI [1.81, 11.67], p = .007) and PA barrier self-efficacy (ß = .42, 95% CI [0.26, 0.53], p < .001) were significantly associated with moderate-to-vigorous-intensity PA. CONCLUSION: Raising awareness of the benefits of PA for reducing risk of cancer recurrence and health problems and strengthening self-efficacy to overcome PA barriers may help to promote cancer survivors' attainment of moderate-to-vigorous-intensity PA guidelines.