Active Living After Cancer: An evidence-based intervention for cancer survivors and caregivers to help increase quality of life and physical functioning through increasing physical activity
Introduction
The importance of increasing exercise in cancer survivors is to boost quality of life, reduce recurrence and improve survival.1 Data shows that higher levels of physical activity are associated with lower overall cancer mortality, however, only 14.8% of cancer survivors are meeting the Federal physical activity guidelines of 150-minutes per week.2 The Transtheoretical model of behavior change (TTM) has been suggested as an effective approach to promoting physical activity, however more research is needed to look at long-term adherence.3-4 Active Living After Cancer (ALAC) is an evidence-based 12-week physical activity program based on the TTM for all cancer survivors and caregivers that aims to improve physical functioning and health-related quality of life (HRQOL) through behavior change toward physical activity. ALAC provides in-person, hybrid, and virtual classes every week and is funded by the Cancer Prevention and Research Institute of Texas (CPRIT).
Methods
A retrospective approach was used to evaluate HRQOL, stages of change, Moderate-to-Physical Physical Activity (MVPA), and 30 second sit-to-stand (STS) gathered at baseline and upon completion of the 12-week program. This Phase 2 intervention included 474 participants in which 406 were cancer survivors and 68 were caregivers. Participants who finished baseline and follow-up surveys were included in the data. The PROMIS Global Health questionnaire, TTM, MVPA, and 30 second STS were measured to assess participant outcomes. These tests evaluated how HRQOL outcomes improved as the stages of change, MVPA, and 30 second STS increased. The PROMIS Global Health questionnaire was used to assess HRQOL using the T-score. Stages of change were assessed using the TTM. Self-reported time and frequency of both moderate and vigorous physical activity were multiplied and summed to calculate the total MVPA (min/week). Furthermore, the 30-second STS test was used to assess participant outcomes and support behavior change.
Results
From baseline to follow-up, there was an average 2.1 increase in repetitions for the 30 second STS among cancer survivors. However, there was an average 1.0 increase in repetitions among caregivers. Furthermore, the PROMIS t-score mean difference for physical health among cancer survivors was 1.7, while caregivers had a t-score of 1.2. The PROMIS t-score mean difference for mental health among cancer survivors was 2.3, while caregivers had a t-score of 2.6. MVPA showed an average increase of 152.6 min/week for cancer survivors. Comparatively, MVPA increased an average of 122.3 min/week for caregivers. P-values for cancer survivors for all measures were statistically significant (p<.001), while caregivers had statistically significant measures for MPVA (p=.001), 30 second STS (p=.034), and PROMIS mental health (p=.001). The PROMIS physical health for caregivers was the only measure not statistically significant (p=.178). The TTM preliminary RedCap data show an increase in stages of change among cancer survivors and caregivers, however, further analysis is needed to assess this variable.
Conclusion
This analysis underlines the importance of utilizing the evidence-based interventions of Active Living After Cancer (ALAC) that focuses on behavioral change to improve physical functioning and quality of life in cancer survivors and caregivers.