Colorectal cancer survivors' exercise experiences and preferences: qualitative findings from an exercise rehabilitation programme immediately after chemotherapy.

Little is known about cancer survivors' experiences with and preferences for exercise programmes offered during rehabilitation (immediately after cancer treatment). This study documented colorectal cancer survivors' experiences in an exercise rehabilitation programme and their preferences for programme content and delivery. At the completion of 12 weeks of supervised exercise, 10 participants took part in one-on-one semi-structured interviews. Data from these interviews were coded, and themes were identified using qualitative software. Key findings were that most participants experienced improvements in treatment symptoms, including reduced fatigue and increased energy and confidence to do activities of daily living. They also reported that interactions with the exercise trainer and a flexible programme delivery were important aspects of the intervention. Most participants reported that they preferred having a choice of exercise, starting to exercise within a month after completing treatment, having supervision and maintaining a one-on-one format. Frustrations included scheduling conflicts and a lack of a transition out of the programme. The findings indicate that colorectal cancers experience benefits from exercise offered immediately after treatment and prefer individual attention from exercise staff. They further indicate directions for the implementation of future exercise programmes with this population.

A systematic review of the association between physical activity and colorectal cancer risk.

This review evaluated the strength of the evidence for a causal relationship between physical activity (PA) and colorectal cancer (CRC). A systematic review of databases through February 2008 was conducted to identify studies that assessed the association between total or recreational PA and incidence or mortality of CRC (including CRC, rectal cancer, colon cancer, and proximal or distal colon cancer). Studies were evaluated for significant associations between PA and risk of CRC endpoints and for evidence of dose-response relationships in the highest quality studies. Twenty cohort studies were evaluated; 11 were high-quality. Fifty percent of all studies and 64% of highest quality studies reported at least one significant association between PA and risk of a CRC endpoint (P<0.05). However, only 28% of all analyses (31% of analyses of highest quality studies) were significant (P<0.05). Only 40% of analyses of highest quality studies resulted in a significant P for trend (P<0.05); however, a non-significant inverse linear association between PA and colon cancer risk was apparent. Heterogeneity in the evidence from all studies and from the highest quality studies was evident. Evidence from cohort studies is not sufficient to claim a convincing relationship exists between PA and CRC risk.

Do walking and leisure-time physical activity protect against arthritis in older women?

OBJECTIVE: To examine the prospective dose-response relationships between both leisure-time physical activity (LTPA) and walking with self-reported arthritis in older women. DESIGN, SETTING AND PARTICIPANTS: Data came from women aged 73-78 years who completed mailed surveys in 1999, 2002 and 2005 for the Australian Longitudinal Study on Women's Health. Women reported their weekly minutes of walking and moderate to vigorous physical activities. They also reported on whether they had been diagnosed with, or treated for, arthritis since the previous survey. General estimating equation analyses were performed to examine the longitudinal relationship between LTPA and arthritis and, for women who reported walking as their only physical activity, the longitudinal relationship between walking and arthritis. Women who reported arthritis or a limited ability to walk in 1999 were excluded, resulting in data from 3613 women eligible for inclusion in these analyses. MAIN RESULTS: ORs for self-reported arthritis were lowest for women who reported "moderate" levels of LTPA (OR 0.78; 95% CI 0.67 to 0.92), equivalent to 75 to <150 minutes of moderate-intensity LTPA per week. Slightly higher odds ratios were found for women who reported "high" (OR 0.81; 95% CI 0.69 to 0.95) or "very high" (OR 0.84; 95% CI 0.72 to 0.98) LTPA levels, indicating no further benefit from increased activity. For women whose only activity was walking, an inverse dose-response relationship between walking and arthritis was seen. CONCLUSIONS: The results support an inverse association between both LTPA and walking with self-reported arthritis over 6 years in older women who are able to walk.

Prospective association between physical activity and falls in community-dwelling older women.

OBJECTIVE: To explore associations between physical activity and the risk of falls and fractured bones in community-dwelling older women. DESIGN, SETTING AND PARTICIPANTS: A prospective observational survey with three and six-year follow-ups. The sample included 8188 healthy, community-dwelling women, aged 70-75 years in 1996, who completed surveys as participants in the Australian Longitudinal Study on Women's Health. Women who reported a recent serious injury from falling were excluded. Outcomes were reports of a fall to the ground, injury from a fall, and a fractured bone in 1999 and 2002. The main predictor variable was physical activity level in 1996, categorised on the basis of weekly frequency as none/very low, low, moderate, high and very high. Covariates were demographic and health-related variables. Logistic regression models were computed separately for each outcome in 1999 and 2002. MAIN RESULTS: In multivariable models, very high physical activity was associated with a decreased risk of reporting a fall in 1999 (odds ratio (OR) 0.67; 95% CI 0.47 to 0.95) and in 2002 (OR 0.64; 95% CI 0.43 to 0.96). High/very high physical activity was associated with a decreased risk of a fractured bone in 2002 (OR 0.53; 95% CI 0.34 to 0.83). No significant association was found between physical activity and injury from a fall. CONCLUSIONS: The results suggest that at least daily moderate to vigorous-intensity physical activity is required for the primary prevention of falls to the ground and fractured bones in women aged 70-75 years.

Using Rasch modeling to re-evaluate three scales related to physical activity: enjoyment, perceived benefits and perceived barriers.

Studies suggest that enjoyment, perceived benefits and perceived barriers may be important mediators of physical activity. However, the psychometric properties of these scales have not been assessed using Rasch modeling. The purpose of this study was to use Rasch modeling to evaluate the properties of three scales commonly used in physical activity studies: the Physical Activity Enjoyment Scale, the Benefits of Physical Activity Scale and the Barriers to Physical Activity Scale. The scales were administered to 378 healthy adults, aged 25-75 years (50% women, 62% Whites), at the baseline assessment for a lifestyle physical activity intervention trial. The ConQuest software was used to assess model fit, item difficulty, item functioning and standard error of measurement. For all scales, the partial credit model fit the data. Item content of one scale did not adequately cover all respondents. Response options of each scale were not targeting respondents appropriately, and standard error of measurement varied across the total score continuum of each scale. These findings indicate that each scale's effectiveness at detecting differences among individuals may be limited unless changes in scale content and response format are made.

Does adherence to a lifestyle physical activity intervention predict changes in physical activity?

This study examined whether adherence to a lifestyle physical activity intervention predicted weekly participation in at least 150 min of moderate to vigorous physical activity among 244 sedentary healthy adults. Structural equation modeling was used to assess the association between adherence and physical activity. Markers of adherence were attendance, homework completion, and self-monitoring for a group-based intervention and telephone call completion, homework completion, and self-monitoring for a telephone and mail-delivered intervention. For both interventions, adherence significantly predicted moderate to vigorous physical activity. Adherence to lifestyle physical activity interventions ought to be encouraged to increase the likelihood that participants will engage in an adequate amount of physical activity for health benefits to occur.

Field evaluation of energy expenditure from continuous and intermittent walking in women.

RATIONALE: Recent physical activity recommendations suggest that comparable amounts of prescribed physical activity, done as a single continuous bout or as a set of intermittent bouts, will produce equal amounts of energy expenditure (EE) during the prescribed activity as well as throughout the day. HYPOTHESES: In a field setting, we tested two hypotheses: (1) continuous and intermittent walking conditions will result in significantly greater total daily EE than a control condition, and (2) continuous and intermittent walking conditions will result in similar total daily METHODS: Thirty women (mean age [yr] = 43.7+/-5.8; mean body mass index [kg x m(-2)]= 24.7+/-4.0) participated in a repeated-measures design so that each woman participated in three walking conditions on successive days of the week: a single 30-min brisk walk (continuous): three 10-min brisk walks (intermittent); and no activity (control). Throughout the study protocol, women wore a TRITRAC-R3D accelerometer programmed to estimate EE in 2-min intervals. RESULTS: Mean total EE estimates (kcal) for the three walking conditions were as follows: continuous: 2181+/-308; intermittent: 2121+/-305; and control: 1948+/-270. A repeated-measures analysis of variance omnibus test indicated that EE differed significantly by experimental condition [F(2,58) = 40.2, P < 0.001). To test the first hypothesis, contrasts were examined revealing that EE in the continuous and intermittent conditions was significantly greater than EE in the control condition [F(1,29) = 58.2, P < 0.001]. To test the second hypothesis, contrasts revealed that EE in the continuous condition was significantly greater than EE in the intermittent condition [F(1,29) = 7.0, P = 0.013]. CONCLUSION: For the purposes of total EE, selecting a continuous mode of walking may offer additional benefit over an intermittent mode, given the same total prescribed duration.

Perceptions of sedentary African-American women about continuous versus intermittent walking.

To meet current physical activity recommendations, a person may chose to adopt a continuous or an intermittent physical activity program, as long as they accumulate 30 minutes of moderate-intensity physical activity most days of the week. Sixty-four sedentary African-American women were surveyed to assess whether perceptions about continuous and intermittent walking programs differed. Specifically, we assessed whether perceptions of self-efficacy, outcome expectations, social support, and the environment varied with respect to walking programs. Results indicated that the women perceived higher self-efficacy for the intermittent walking program and associated this program with more favorable environmental factors (p < .05). However, they expected greater benefits from the continuous walking program (p < .05). Overall, 65% of the women reported that they would prefer to adopt the continuous walking program.

Perceived barriers to exercise and stage of exercise adoption in older women of different racial/ethnic groups.

The purpose of this study was to determine whether barriers to exercise differ among racial/ethnic groups at the same stage of exercise adoption and adjacent stages within racial/ethnic groups. Questions about stage of exercise adoption and perceived barriers to exercise were administered to a cross sectional sample of 745 African American, 660 Hispanic, 738 Native American/Native Alaskan, and 769 Caucasian U.S. women aged 40 years and older. Correlations between rankings of barriers among racial/ethnic groups within the same stage ranged from .43 to .89. For each racial/ethnic group, significant differences existed between adjacent stages in the percentage of women reporting barriers to interfere with exercise (p < .10). Barriers were not similar enough among racial/ethnic groups to recommend that the same barriers be addressed for all races/ethnicities.

Detecting bouts of physical activity in a field setting.

The purposes of this study were to assess the TRITRAC and CSA for: (a) interaccelerometer agreement; (b) agreement in detecting patterns of moderate-intensity physical activity; and (c) agreement in detecting walking patterns recorded in a diary. Thirty-one women wore both the TRITRAC and CSA accelerometers for three consecutive days. Interaccelerometer agreement (measured with generalizability coefficients) ranged from .88 to .99. In total, 71.3% of the accelerometers' patterns agreed in length, with CSA patterns being on average significantly longer. Interaccelerometer agreement in detecting patterns of brisk walking, as recorded in a diary, was comparable (69.4%). Interaccelerometer discrepancies may be related in part to the threshold employed by each instrument for classifying moderate intensity patterns.