Chris M. Blanchard

Cancer Survivors’ Adherence to Lifestyle Behavior Recommendations and Associations With Health-Related Quality of Life: Results From the American Cancer Society's SCS-II

PURPOSE To examine the prevalence and clustering of physical activity (PA), fruit and vegetable consumption (5-A-Day), and smoking across six major cancer survivor groups and to identify any associations with health-related quality of life (HRQoL). METHODS A total of 9,105 survivors of six different cancers completed a national cross-sectional survey that included the lifestyle behavior questions and the RAND-36 Health Status Inventory. RESULTS Only a minority of cancer survivors were meeting the 5-A-Day (14.8% to 19.1%) or PA (29.6% to 47.3%) recommendations, whereas most were meeting the smoking recommendation (82.6% to 91.6%). In terms of the lifestyle behavior clusters, only 5% of cancer survivors were meeting all three recommendations. Analyses of covariance generally showed higher HRQoL in survivors who were meeting versus not meeting each lifestyle behavior recommendation with the strongest associations emerging for PA. Trend analyses showed a steep positive association between the number of lifestyle behavior recommendations being met and HRQoL for breast (P < .001), prostate (P < .001), colorectal (P < .001), bladder (P < .001), uterine (P < .001), and skin melanoma (P < .001) cancer survivors. CONCLUSION Few cancer survivors are meeting the PA or 5-A-Day recommendations, and even fewer are meeting all three lifestyle recommendations. The association between the current lifestyle recommendations and HRQoL in cancer survivors appears to be cumulative. Interventions to increase PA and fruit and vegetable consumption and reduce smoking are warranted and may have additive effects on the HRQoL of cancer survivors.

Task and scheduling self-efficacy as predictors of exercise behavior

Social cognitive theory (Bandura, 1986, 1995, 1997) has figured prominently among social psychological approaches taken to the investigation of exercise behavior. The present study validated two measures of self-efficacy (scheduling and task) through confirmatory factor analytic procedures. In a separate study, the resultant factors were then used as independent variables in the prediction of exercise behavior and behavioral intention in a structural equation model. Task self-efficacy was found to be more related to behavioral intention than scheduling self-efficacy. Scheduling self-efficacy was found to be more related to behavior than task self-efficacy or behavioral intention. Results support different types and motivational functions of self-efficacy for exercise intentions and behavior.

Prediction of leisure-time walking: an integration of social cognitive, perceived environmental, and personality factors

BackgroundWalking is the primary focus of population-based physical activity initiatives but a theoretical understanding of this behaviour is still elusive. The purpose of this study was to integrate personality, the perceived environment, and planning into a theory of planned behaviour (TPB) framework to predict leisure-time walking.MethodsParticipants were a random sample (N = 358) of Canadian adults who completed measures of the TPB, planning, perceived neighbourhood environment, and personality at Time 1 and self-reported walking behaviour two months later.ResultsAnalyses using structural equation modelling provided evidence that leisure-time walking is largely predicted by intention (standardized effect = .42) with an additional independent contribution from proximity to neighbourhood retail shops (standardized effect = .18). Intention, in turn, was predicted by attitudes toward walking and perceived behavioural control. Effects of perceived neighbourhood aesthetics and walking infrastructure on walking were mediated through attitudes and intention. Moderated regression analysis showed that the intention-walking relationship was moderated by conscientiousness and proximity to neighbourhood recreation facilities but not planning.ConclusionOverall, walking behaviour is theoretically complex but may best be addressed at a population level by facilitating strong intentions in a receptive environment even though individual differences may persist.

Validation of the Decisional Balance Scales in the Exercise Domain From the Transtheoretical Model: A Longitudinal Test

This study examined the validity and reliability of decisional balance scales for exercise (i.e., pros and cons) in a large longitudinal population-based randomized sample of Canadian adults ages 18 to 65 years (N = 703). Assessments were taken over 3 time points with 6-month intervals between testing. Content, factorial, concurrent, and construct validity along with internal consistency and test-retest reliability were established for the decisional balance scales. The developed measures have utility for researchers and practitioners who test and apply the exercise decisional balance constructs of the Transtheoretical Model.

Understanding Adherence to 5 Servings of Fruits and Vegetables per Day: A Theory of Planned Behavior Perspective

OBJECTIVE The primary purpose of the present study was to examine the utility of the Theory of Planned Behavior (TPB) in explaining the 5-A-Day intentions and behavior of college students. A secondary purpose was to determine whether any of the TPB relationships were moderated by gender or ethnicity. DESIGN A prospective design that asked college students to complete a baseline TPB 5-A-Day questionnaire and a fruit and vegetable consumption measure 1 week later. SETTING Undergraduate fitness and health classes at 2 universities in the southern United States. PARTICIPANTS 511 college students with a mean age of 19.8 years (standard deviation = 2.71). MAIN OUTCOME MEASURES TPB variables and fruit and vegetable consumption. ANALYSES Path analyses and invariance (ie, to examine ethnic and gender moderated) analyses. RESULTS Affective attitude (beta = .16, P < .05) and perceived behavioral control (beta = .59, P < .05) were significant predictors of intention, which in turn was a significant predictor of behavior (beta = .32, P < .05). Follow-up invariance analyses showed that none of the TPB relationships was moderated by gender or ethnicity. CONCLUSIONS AND IMPLICATIONS The TPB may be a useful framework on which to base a 5-A-Day intervention for male and female college students of different ethnic backgrounds.

Spatial classification of youth physical activity patterns.

BACKGROUND Physical activity is an essential element in reducing the prevalence of obesity, but much is unknown about the intensity and location of physical activity among youth-this is important because adolescent health behaviors are predictive of behaviors in adults. PURPOSE This study aims to identify the locations where youth moderate-to-vigorous physical activity (MVPA) occurs, and to examine how MVPA varies according to urbanicity (urban, suburban, rural). METHODS Participants included adolescent students (N=380, aged 12-16 years) from Halifax, Nova Scotia. Locations of MVPA were measured using accelerometers and GPS data loggers for up to 7 days. Specialized software was developed to integrate and process the data. Frequencies of MVPA by location were determined, and differences in MVPA were assessed for association with urbanicity. RESULTS Active commuting accounted for the largest proportion of time in MVPA among urban and suburban students. Rural students achieved most MVPA at school. Other residential locations, shopping centers, and green spaces accounted for a majority of the remaining MVPA. Minutes in MVPA varied significantly overall (196.6 ± 163.8, 84.9 ± 103.2, 81.7 ± 98.2); at school (45.7 ± 45.2, 18.6 ± 28.0, 29.8 ± 39.7); while commuting (110.3 ± 107.1, 31.5 ± 55.2, 19.5 ± 39.7); and at other activity locations (19.7 ± 27.1, 14.8 ± 26.8, 12.0 ± 22.1) and by urbanicity. CONCLUSIONS Findings reveal that the journeys between locations are as important as home and school settings in contributing to greater MVPA in adolescent youth. The relative importance of context as a contributor to MVPA varies with urbanicity. Combining actimetry and GPS data provides a precise link between physical activity measurements and contexts of the built environment.

Determinants of physical activity after hospitalization for coronary artery disease: the Tracking Exercise After Cardiac Hospitalization (TEACH) Study

Background Little is known about physical activity levels in patients with coronary artery disease (CAD) who are not engaged in cardiac rehabilitation. We explored the trajectory of physical activity after hospitalization for CAD, and examined the effects of demographic, medical, and activity-related factors on the trajectory. Design A prospective cohort study. Methods A total of 782 patients were recruited during CAD-related hospitalization. Leisure-time activity energy expenditure (AEE) was measured 2, 6 and 12 months later. Sex, age, education, reason for hospitalization, congestive heart failure (CHF), diabetes, and physical activity before hospitalization were assessed at recruitment. Participation in cardiac rehabilitation was measured at follow-up. Results AEE was 1948 ± 1450, 1676 ± 1290, and 1637 ± 1486 kcal/week at 2, 6 and 12 months, respectively. There was a negative effect of time from 2 months post-hospitalization on physical activity (P<0.001). Interactions were found between age and time (P = 0.012) and education and time (P = 0.001). Main effects were noted for sex (men more active than women; P<0.001), CHF (those without CHF more active; P<0.01), diabetes (those without diabetes more active; P<0.05), and previous level of physical activity (those active before hospitalization more active after; P<0.001). Coronary artery bypass graft patients were more active than percutaneous coronary intervention (PCI) patients (P = 0.033). Conclusions Physical activity levels declined from 2 months after hospitalization. Specific subgroups (e.g. less educated, younger) were at greater risk of decline and other subgroups (e.g. women, and PCI, CHF, and diabetic patients) demonstrated lower physical activity. These groups need tailored interventions.

Social ecological correlates of physical activity in normal weight, overweight, and obese individuals

OBJECTIVE:Research is limited concerning the moderating influence of weight status (ie normal, over, and obese) on the social ecological correlates of physical activity (PA) in adults. Therefore, the present study attempted to shed light on this issue.DESIGN:In 2001, a national cross-sectional mail out panel survey was conducted over a 3-month period in the United States.SUBJECTS:There were 1867 normal weight (ie body mass index (BMI)=20–24.99 kg/m2), 2145 overweight (ie BMI=25–29.99 kg/m2), and 1902 obese (ie BMI>30 kg/m2) adults.MEASURES:Various demographic measurements were taken in addition to social support (SS), self-efficacy (SE), access to facilities, and PA.RESULTS:Normal weight individuals engaged in significantly more PA than overweight individuals, who in turn engaged in significantly more PA than obese individuals F(2,5991)=55.51, P<0.01. Further regression analyses showed that higher SE, SS, the access to facilities in a neighborhood, and various interactions among these constructs were significantly and positively associated with PA. Interestingly, the strength of these relationships varied depending on weight status.CONCLUSION:Weight status needs to be taken into consideration when examining social ecological correlates of PA.

Understanding Physical Activity Behavior in African American and Caucasian College Students: An Application of the Theory of Planned Behavior

Only 30% of college students meet the recommended amount of physical activity (PA) for health benefits, and this number is lower for African American students. Moreover, the correlates of PA may vary by ethnicity. Objective: In the present study, the authors tested the utility of the theory of planned behavior for explaining PA intentions and behavior in Caucasian and African American students. Participants and Methods: Participants were 238 African American (M age = 20.05 years, SD = 2.28) and 197 Caucasian (M age = 19.50 years, SD = 2.28) students who completed a baseline theory of planned behavior questionnaire and a follow-up PA measure 1 week later. Results: Hierarchical regression analyses showed that affective (β = .23) and instrumental (β = .28) attitudes and perceived behavioral control (β = .59) were significantly predictive of intention for the Caucasian students, whereas affective attitude (β = .18) and perceived behavioral control (β = .56) were significant for African American students. Furthermore, intention (β = .33) was the lone significant predictor of PA for Caucasian students, whereas perceived behavioral control (β = .23) was the significant predictor of PA for African American students. Conclusions: These data suggest that practitioners may need to consider ethnicity when developing PA interventions for college students based on the theory of planned behavior.

Correlates of exercise among coronary heart disease patients: review, implications and future directions

Despite the well-documented benefits of exercise, adherence among patients with coronary heart disease (CHD) has been low during and after cardiac rehabilitation (CR) as well as among patients not attending CR. Therefore, an understanding of the factors that influence exercise in this population is crucial to assist in the development of effective interventions. The goal of this review was to document the correlates of exercise of CHD patients in all CR contexts from a social-ecological perspective that addresses multiple levels of influence on exercise. The search strategy included PubMed, PsychINFO and Web of Science databases. In all, 121 studies, examining 32 different correlates of exercise, with a total of 25 217 participants were included. Across all CR contexts, six variables were consistently related to exercise (self-regulatory self-efficacy, health status, intention, perceived control, beliefs/benefits and previous physical activity). Several variables were also related to exercise in three of four contexts (e.g. task self-efficacy, perceived barriers, attitude, action planning, sex and employment status). Many of the variables consistently related to exercise may be amenable to change through the development and implementation of appropriate interventions. Specific suggestions are made for each relevant variable to assist CR staff and other healthcare practitioners in 32 promoting exercise among CHD patients. Current gaps in literature such as a lack of prospective studies and research examining broader (e.g. policy level) correlates are also discussed.