Physical activity in a German breast cancer patient cohort: one-year trends and characteristics associated with change in activity level.

BACKGROUND: Physical activity (PA) is increasingly discussed as concomitant therapy after breast cancer diagnosis and can add to the alleviation of therapy- and disease-related symptoms. The objectives of this study were to describe PA behaviour in the course of breast cancer and to identify factors associated with change in PA. METHODS: 1,067 German postmenopausal breast cancer patients were asked about their PA behaviour before breast cancer diagnosis, during therapy and 1year after surgery. MET-hours per week (MET=metabolic equivalent) were calculated based on quantitative information about walking, bicycling for transportation purposes and sports by multiplying the average hours per week spent at each activity with an individual intensity score. Factors associated with change in MET·h/week in the course of breast cancer were identified using multiple linear regression. RESULTS: Median PA decreased significantly during therapy from 36 to 14MET·h/week (p<.001). Patients treated with chemo- and/or radiotherapy had a stronger decline in PA compared to patients without adjuvant therapy or those treated only with hormones (adjusted ß=-9.73 to -13.54). The presence of medical risk factors (ß=-5.56) was also associated with a decrease of PA during therapy. In contrast, participation in rehabilitation (ß=7.62) was associated with an increase of PA after therapy. CONCLUSION: In the light of the drastic decline in PA during therapy, programs promoting PA seem obligatory for all breast cancer patients. Patients treated with chemo- and/or radiotherapy and those with medical risk factors should particularly be assisted in reaching recommended activity levels by targeted interventions during and after therapy.

Smoking cessation during pregnancy: a systematic literature review.

ISSUES: Second-hand smoke presents a health risk for a large group of entirely helpless nonsmokers: unborn children. Reliable data on women continuing to smoke during pregnancy are essential for effective preventive and interventional programs. The aim of this review is therefore to identify this risk group compared with spontaneous quitters of smoking. APPROACH: This systematic literature review is based solely on empirical original papers derived from samples of pregnant women smoking at the beginning of pregnancy. In accordance with the QUOROM Statement all population or clinic-based samples were included. Collectives from intervention studies were not included. All studies were from developed nations and published between January 1997 and March 2008. KEY FINDINGS: A total of 19 studies were identified. The rate of quitters was between 4.0% and 69.7% for population-based studies, and 26.5% and 47.0% for clinic-based studies. A smoking partner, a large number of children, a high rate of tobacco consumption, as well as deficiencies in prenatal care were predictors of smoking during pregnancy. IMPLICATIONS: This study identifies risk factors and correlates and indicates common obstacles for women to quit smoking during pregnancy. CONCLUSION: The risk groups that can be defined based on our results are a key target population for preventive measures.

Optimising lifestyle interventions: identification of health behaviour patterns by cluster analysis in a German 50+ survey.

BACKGROUND: Many prevention and intervention measures are still targeting isolated behaviours such as tobacco use or physical inactivity. Cluster analysis enables the aggregation of single health behaviours in order to identify distinctive behaviour patterns. The purpose of this study was to group a sample of the over-50 population into clusters that exhibit specific health behaviour patterns regarding regular tobacco use, excessive alcohol consumption, unhealthy diet and physical inactivity. METHODS: From the total population of the federal state of Baden-Wuerttemberg, Germany, 982 men and 1020 women aged 50-70 were randomly selected. Subjects were asked by trained interviewers in computer-assisted telephone interviews (CATI) about health behaviour and sociodemographic characteristics. Cluster analysis was conducted to identify distinct health behaviour patterns. Multinomial logistic regression was used to characterize clusters by specific social attributes. RESULTS: Five homogeneous health behaviour clusters were identified: 'No Risk Behaviours' (25.3%), 'Physically Inactives' (21.1%), 'Fruit and Vegetable Avoiders' (18.2%), 'Smokers with Risk Behaviours' (12.7%) and 'Drinkers with Risk Behaviours' (22.7%). Whereas the first cluster is the ideal in terms of risk and prevention, the latter two groups include regular users of tobacco and excessive consumers of alcohol, who also engage in other risk behaviours like inactivity and maintaining an unhealthy diet. These two risk groups also exhibit specific sociodemographic attributes (male, living alone, social class affiliation). CONCLUSION: Unhealthy behaviours evidently occur in typical combinations. An awareness of this clustering enables prevention and intervention measures to be planned so that multiple behaviours can be modified simultaneously.

Health, medical risk factors, and bicycle use in everyday life in the over-50 population.

Few middle-aged and elderly people get enough exercise from sports or leisure-time physical activity. Therefore, the impact of everyday physical activity on health is a matter of interest. The main objective of this study was to establish whether bicycle use in everyday life is positively associated with health. A sample of 982 randomly selected men and 1,020 women age 50-70 were asked in a computer-assisted telephone interview to provide information including a self-assessment of their health and physical activity. Self-assessed health correlates positively with bicycle use in everyday life (OR = 1.257; 95% CI: 1.031-1.532). Likewise, people who regularly cycle for transport are less likely to have medical risk factors (OR = 0.794; 95% CI: 0.652-0.967). This negative correlation is not diminished when sporting activity is controlled for. This indicates that positive effects of physical activity on risk factors can be also achieved solely by integrating more physical activity into routine everyday life.

[Instrument for the assessment of middle-aged and older adults' physical activity: design, eliability and application of the German-PAQ-50+]. / Instrument für die Erfassung der physischen Aktivität bei Personen im mittleren und höheren Erwachsenenalter: Entwicklung, Prüfung und Anwendung des "German-PAQ-50+".

Existing physical activity questionnaires have focused either on young and middle-aged adults or on the elderly. They have mainly assessed only a portion of possible physical activities or contained nation-specific sports. As there is no gold standard for a questionnaire-based assessment of physical activity in the over-50 population, recommendations for such a questionnaire relating to German-speaking countries were developed. This work included a systematic literature research, a survey of experts, and the design of a questionnaire based on validated measuring instruments. Finally, to test its reliability and application in the field, the complete questionnaire, including a retest, was applied by telephone interview (n = 57). The test-retest-correlation was r = 0.60 for the total time of physical activity and r = 0.52 for total energy expenditure. The researchers determined that the instrument is comprehensive in its coverage of all relevant domains of physical activity for the over-50 population; it is economically feasible and showed good acceptance.