Jill A. Bennett

Motivational interviewing to increase physical activity in long-term cancer survivors: A randomized controlled trial

Background: Physical activity can confer many benefits on cancer survivors, including relief of persistent symptoms related to cancer treatment. Objectives: To evaluate the effect of a motivational interviewing (MI) intervention on increasing physical activity (Community Healthy Activities Model Program for Seniors questionnaire) and improving aerobic fitness (6-minute walk), health (Medical Outcomes Study Short-Form 36), and fatigue (Schwartz Cancer Fatigue Scale) in cancer survivors. A secondary purpose was to evaluate whether the effect of MI on physical activities depended on self-efficacy. Methods: Fifty-six physically inactive adult cancer survivors (mean = 42 months since completion of treatment) were assigned randomly to intervention and control groups. The MI intervention consisted of one in-person counseling session followed by two MI telephone calls over 6 months. Control group participants received two telephone calls without MI content. Outcomes were measured at baseline, 3 months, and 6 months, and were analyzed using multilevel modeling. Results: The results of the MI intervention explained significant group differences in regular physical activities (measured in caloric expenditure per week), controlling for time since completion of cancer treatment (p <.05). Aerobic fitness, physical and mental health, and fatigue were not different between groups. In the intervention group, individuals with high self-efficacy for exercise at baseline increased their physical activity more than those with low self-efficacy (p <.05). In the control group, increases in physical activity did not depend on self-efficacy. Discussion: Use of MI may increase physical activity in long-term cancer survivors, especially in persons with high self-efficacy for exercise. Multilevel modeling analysis revealed individual changes that would not have been shown by analysis of group means. Future studies with larger samples or more intense MI interventions may show changes in aerobic fitness, physical and mental health, and fatigue.

Unrecognized chronic dehydration in older adults: examining prevalence rate and risk factors.

Dehydration has serious consequences for older adults, including increased risk of illness or death. This retrospective review of medical records describes the prevalence, assessment, and risk factors for chronic dehydration in 185 older adults who visited an emergency department in June 2000. Results showed chronic dehydration was present in 89 (48%) patients. Physicians documented assessment for signs of dehydration in 23 (26%) of the dehydrated older adults, but no independent assessments for dehydration were recorded by nurses. These findings indicate many older adults may suffer from unrecognized dehydration, and nurses should be alert to the possibility that dehydration may be present in community-dwelling older adults as well as those who live in residential facilities.

Strength, Physical Activity, and Age Predict Fatigue in Older Breast Cancer Survivors

PURPOSE/OBJECTIVES To determine whether clinical characteristics, physical fitness, or physical activity predict fatigue in older, long-term breast cancer survivors. DESIGN Cross sectional. SETTING National Cancer Institute-designated cancer center in Portland, OR. SAMPLE 47 women (X age = 69 years) who were at least one year beyond treatment completion, including surgery, radiation, chemotherapy, or hormone therapy, for early-stage breast cancer. METHODS Participants completed one two-hour testing session to determine fatigue ratings, clinical information, submaximal aerobic fitness, lower-extremity muscle strength, body composition, and physical activity levels. MAIN RESEARCH VARIABLES Self-reported fatigue assessed by the Schwartz Cancer Fatigue Scale, cancer and treatment history obtained by self-report, submaximal aerobic fitness assessed by 12-minute walk distance, lower-extremity muscle strength assessed by number of chair stands completed in 30 seconds, body composition assessed as percentage of body fat, and physical activity levels assessed by self-reported hours per week. FINDINGS Fatigue was significantly correlated with all independent variables, with the exception of aerobic fitness. Fatigue was higher with lower age, greater percentage of body fat, fewer years after diagnosis, more adjuvant treatments, poorer lower-extremity muscle strength, and less physical activity. In regression analyses, lower-extremity muscular strength, physical activity levels, and age each were significant independent predictors of fatigue. Lower-extremity muscle strength, physical activity, and age all were inversely related to fatigue and accounted for 15%, 7%, and 15% of the variance in fatigue scores, respectively. CONCLUSIONS In this sample of older breast cancer survivors, fatigue was linked to physical activity and muscle strength; women with better lower-extremity muscle strength, higher physical activity levels, and advanced age reported less fatigue. IMPLICATIONS FOR NURSING A physical activity program aimed at improving lower body strength could mitigate persistent fatigue in older, long-term breast cancer survivors.

A telephone-only motivational intervention to increase physical activity in rural adults: a randomized controlled trial.

Background: Both urban and rural adults are likely to be inactive, but rural adults have less access to exercise classes or facilities to increase physical activity. Objectives: To evaluate whether a telephone-only motivational interviewing (MI) intervention would increase daily physical activity of rural adults. Methods: This randomized controlled trial enrolled 86 physically inactive adults living in rural communities (mean age = 58 years, range = 30-81 years) who stated that they were ready to increase physical activity during the next 6 months. Participants were assigned randomly to MI intervention (n = 43) or control (n = 43) groups. The MI group participants received a pedometer and monthly MI telephone calls over 6 months from a counselor. Control group participants received an equal number of telephone calls without MI content. Physical activity was measured by self-report using the Community Healthy Activities Model Program For Seniors Physical Activity Questionnaire for Older Adults. Data were collected by mailed surveys and analyzed using analysis of variance. Results: Seventy-two participants completed the study (35 in the intervention group and 37 in the control group). The telephone-only MI intervention increased self-efficacy for exercise (p = .019) but did not increase levels of physical activity (p = .572) compared with controls. Discussion: The intervention increased self-efficacy for exercise but did not increase physical activity, possibly due to seasonal effects, the control condition, or the length of the MI intervention. Even so, future studies are warranted because telephone-only MI has potential as a practical, relatively inexpensive method to provide health counseling to rural adults in a broad geographic area. This study produced an effect size on physical activity that will be useful to guide future studies.

Heart-to-Heart: Promoting walking in rural women through motivational interviewing and group support

Background: Walking can significantly increase cardiorespiratory fitness and thereby reduce the incidence of heart disease in women. However, there is a paucity of research aimed at increasing walking in rural women, a high-risk group for heart disease and one for which exercise strategies may pose particular challenges. Purpose: This study tested Heart-to-Heart (HTH), a 12-week walking program, designed to increase fitness through walking in rural women. Heart-to-Heart integrated individual-oriented strategies, including motivational interviewing, and group-based strategies, including team building. Methods: Forty-six rural women were randomized to either HTH or a comparison group. The primary outcome of cardiorespiratory fitness and secondary outcomes of self-efficacy and social support were measured preintervention and postintervention. Group differences were analyzed with repeated-measures analysis of variance. Results: Women in HTH group had a greater improvement in cardiorespiratory fitness (P =.057) and in social support (P =.004) compared with women in the comparison group. Neither group of women experienced a change in exercise self-efficacy (P =.814). Conclusions: HTH was effective in improving cardiorespiratory fitness in a sample of rural women. Further research is needed to refine HTH and determine the optimal approach in rural women to increase their walking.

The mediating effect of pain and fatigue on level of functioning in older adults.

BackgroundMedical conditions and symptoms have been shown to predict level of functioning in older adults, but medical conditions and symptoms have rarely been investigated together in a comprehensive model that included both medical conditions and symptoms as predictors of functioning in older adults. ObjectiveThe purpose of this study was to determine whether the adverse effect of medical conditions on different aspects of functioning in older adults is mediated by the level of symptoms (pain and fatigue). If so, level of functioning may improve if pain or fatigue can be mitigated, even when underlying medical conditions cannot be cured. MethodData from 225 adults aged 65–90 were used to test whether medical conditions, symptoms (pain and fatigue), and six covariates predicted lower body performance, self-reported physical functioning, and self-reported role and social functioning. The fit of a series of models to the data was analyzed using structural equation modeling. ResultsMedical conditions affected self-reported physical functioning and self-reported role and social functioning by increasing the level of symptoms, rather than by direct association. Further descriptive studies are needed to identify other symptoms and modifiable mechanisms by which medical conditions affect functioning. Researchers who investigate the causes of poor functioning in older adults are encouraged to include symptoms in models that hypothesize medical conditions as predictors of functioning outcomes.

Resistance Training Reduces Disability in Prostate Cancer Survivors on Androgen Deprivation Therapy: Evidence From a Randomized Controlled Trial

OBJECTIVES To investigate whether functionally based resistance exercise could improve strength, physical function, and disability among prostate cancer survivors (PCS) on androgen deprivation therapy (ADT); and to explore potential mediators of changes in outcomes from exercise. DESIGN Randomized controlled trial. SETTING Academic medical center. PARTICIPANTS PCS (N=51; mean age, 70.2y) on ADT. INTERVENTION PCS were randomized to moderate to vigorous intensity resistance training or stretching (placebo control) for 1 year. MAIN OUTCOME MEASURES Maximal leg press and bench press strength, objective and self-reported physical function, and self-reported disability. Hierarchical linear modeling was used to test for significant group × time differences adjusting for covariates. RESULTS Retention in the study was 84%, and median attendance to supervised classes was 84% in the resistance group. No study-related injuries occurred. Maximal leg strength (P=.032) and bench press strength (P=.027) were improved after 1 year of resistance training, whereas little change occurred from stretching. Self-reported physical function improved with resistance training, whereas decreases occurred from stretching (P=.016). Disability lessened more with resistance training than stretching (P=.018). One-year change in leg press strength mediated the relation between groups (resistance or stretching) and 1-year change in self-reported disability (P<.05). CONCLUSIONS One year of resistance training improved muscle strength in androgen-deprived PCS. Strengthening muscles using functional movement patterns may be an important feature of exercise programs designed to improve perceptions of physical function and disability. Findings from this study contribute to the mounting evidence that exercise should become a routine part of clinical care in older men with advanced prostate cancer.

Bone Health and Falls: Fracture Risk in Breast Cancer Survivors With Chemotherapy-Induced Amenorrhea

Purpose/Objectives: To describe risk factors for fracture-bone health and falls-among breast cancer survivors with chemotherapy-induced amenorrhea.Design: Cross-sectional and prospective cohort.Setting: National Cancer Institute-designated cancer center in the Pacific northwest region of the United States.Sample: Breast cancer survivors with chemotherapy-induced amenorrhea (N = 35; X age = 46 years; one year after chemotherapy) compared to cancer-free controls (N = 26; X age = 41 years).Methods: One two-hour testing session at baseline, 12-month follow-up, monthly postcards.Main Research Variables: Clinical characteristics and number of falls, leg strength, bone mineral density (BMD), body composition, and bone turnover.Findings: No significant differences between groups for BMD at either time point. Significantly more breast cancer survivors had low-spine BMD based on T scores and elevated bone turnover versus controls at baseline and follow-up. Breast cancer survivors with low-spine BMD have significantly lower body mass index, lean mass, and leg strength, and had stage II disease more often than breast cancer survivors with normal BMD. Significantly more breast cancer survivors (75%) experienced at least one fall compared to 46% of controls. Among breast cancer survivors, those who had fallen had significantly lower leg strength and calcium intakes than those who had not.Conclusions: Breast cancer survivors with chemotherapy-induced amenorrhea, particularly those with muscle weakness, may be at increased risk of fracture.Implications for Nursing: Breast cancer survivors with chemotherapy-induced amenorrhea should be evaluated for low bone mass and fall risk and considered for therapeutic intervention to lower fracture risk.

Skeletal Response to Resistance and Impact Training in Prostate Cancer Survivors

INTRODUCTION Androgen deprivation therapy (ADT) is associated with significant bone loss and an increase in fracture risk among prostate cancer survivors (PCS). We investigated whether impact + resistance training could stop ADT-related declines in bone mineral density (BMD) among PCS on ADT. METHODS We randomized 51 PCS (mean age, 70.2 yr) currently prescribed ADT to participate in 1 yr of impact + resistance training (Prevent Osteoporosis with Impact + Resistance (POWIR)) or in an exercise placebo program of stretching exercise (FLEX). Outcomes were proximal femur (total hip, femoral neck, and greater trochanter) and spine (L1-L4) BMD (g·cm) and bone turnover markers (serum osteocalcin (ng·mL) and urinary deoxypyrodinoline cross-links (nmol·mmol Cr)). RESULTS Retention in the 1-yr study was 84% and median attendance to supervised classes was 84% in POWIR and 74% in FLEX. No study-related injuries were reported. There were no significant differences between groups for average L1-L4 BMD or for BMD at any hip site. When examining individual vertebrae, POWIR has a significant effect on preservation of BMD (-0.4%) at the L4 vertebrae compared with losses (-3.1%) in FLEX (P = 0.03). CONCLUSION Impact + resistance training was a safe and acceptable form of exercise for older PCS on ADT. Among our limited sample, POWIR did not appear to have a clinically meaningful effect on hip or spine BMD, but some evidence of skeletal adaptation to resistance + impact training in an androgen-deprived state was apparent. Future studies need to be conducted on a larger sample of patients and should consider modifications to POWIR that could further enhance loading across the spine and at the hip to preserve BMD at these clinically relevant sites.

Time Since Diagnosis as a Predictor of Symptoms, Depression, Cognition, Social Concerns, Perceived Benefits, and Overall Health in Cancer Survivors

PURPOSE/OBJECTIVES To assess whether health and other factors are different in short-term cancer survivors (less than five years since diagnosis), long-term survivors (5-10 years), and very long-term survivors (more than 10 years). DESIGN A cross-sectional survey. SETTING New Zealand. SAMPLE 836 survivors of adult-onset cancers (6 months to 43 years since diagnosis). METHODS Survivors were recruited using community-based methods and answered a mailed questionnaire. MAIN RESEARCH VARIABLES Physical and emotional health, depression, symptoms, cognitive difficulty, social concerns, and perceived benefits of cancer. FINDINGS Physical and emotional health, depression, physical symptoms, and perceived benefits of cancer were not associated with time since diagnosis, but longer time since diagnosis was associated with decreases in cognitive difficulties and social concerns. The survivors in this study reported a mean of 8.4 physical symptoms, regardless of time since diagnosis, with the most frequent being fatigue (76%), aches and pain (75%), and trouble sleeping (68%). CONCLUSIONS Most survivors enjoyed a moderately good level of health. However, some adverse effects, such as symptoms, were similar in short-, long-, and very long-term survivors, suggesting that interventions may be needed to prevent persistent issues as time progresses. IMPLICATIONS FOR NURSING The findings suggest a need to reconsider the common attitude that survivors who finish treatment should be able to return to normal life. Assessment of symptoms, particularly fatigue, pain, and sleep issues, is important even in very long-term survivors.