title: Mediators of physical exercise for improvement in cancer survivors' quality of life.
abstract: OBJECTIVE
  Mediating mechanisms of a 12-week group-based exercise intervention on cancer survivors' quality of life (QoL) were examined to inform future exercise intervention development.
  
  
  METHODS
  Two hundred nine cancer survivors ≥ 3 months posttreatment (57% breast cancer) aged 49.5 (± 10.4) years were assigned to physical exercise (n = 147) or wait-list control (n = 62). QoL, fatigue, emotional distress, physical activity, general self-efficacy and mastery were assessed at baseline and post-intervention using questionnaires. Path analysis was conducted using Mplus to explore whether improved physical activity, general self-efficacy and mastery mediated the effects of exercise on fatigue and distress and consequently QoL.
  
  
  RESULTS
  The intervention was associated with increased physical activity (β = 0.46, 95% confidence interval (CI) = 0.14;0.59), general self-efficacy (β = 2.41, 95%CI = 0.35;4.73), and mastery (β = 1.75, 95%CI = 0.36;2.78). Further, the intervention had both a direct effect on fatigue (β = -1.09, 95%CI = -2.12;0.01), and an indirect effect (β = -0.54, 95%CI = -1.00;-0.21) via physical activity (β = -0.29, 95%CI =  -0.64;-0.07) and general self-efficacy (β = -0.25, 95%CI = -0.61;-0.05). The intervention had a borderline significant direct effect on reduced distress (β = -1.32, 95%CI = -2.68;0.11), and a significant indirect effect via increased general self-efficacy and mastery (β = -1.06, 95%CI = -1.89;-0.38). Reductions in fatigue (β = -1.33, 95%CI =-1.85;-0.83) and distress (β = -0.86, 95%CI = -1.25;-0.52) were associated with improved QoL. Further, increased physical activity was directly associated with improved QoL (β = 3.37, 95%CI = 1.01;5.54).
  
  
  CONCLUSIONS
  The beneficial effect of group-based physical exercise on QoL was mediated by increased physical activity, general self-efficacy and mastery, and subsequent reductions in fatigue and distress. In addition to physical activity, future interventions should target self-efficacy and mastery. This may lead to reduced distress and fatigue, and consequently improved QoL of cancer survivors.
authors.affiliation: Department of Epidemiology and Biostatistics, VU University Medical Center Amsterdam, EMGO Institute for Health and Care Research, Amsterdam, the Netherlands.
authors.forename: L M
authors.initials: LM
authors.lastname: Buffart
authors.forename: W J G
authors.initials: WJ
authors.lastname: Ros
authors.forename: M J M
authors.initials: MJ
authors.lastname: Chinapaw
authors.forename: J
authors.initials: J
authors.lastname: Brug
authors.forename: D L
authors.initials: DL
authors.lastname: Knol
authors.forename: I
authors.initials: I
authors.lastname: Korstjens
authors.forename: E
authors.initials: E
authors.lastname: van Weert
authors.forename: I
authors.initials: I
authors.lastname: Mesters
authors.forename: B
authors.initials: B
authors.lastname: van den Borne
authors.forename: J E H M
authors.initials: JE
authors.lastname: Hoekstra-Weebers
authors.forename: A M
authors.initials: AM
authors.lastname: May
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000523:psychology* / Q000534:rehabilitation; D015444:Exercise; D005081:Exercise Therapy; D005221:Fatigue / Q000209:etiology* / Q000534:rehabilitation; D005260:Female; D006801:Humans; D008875:Middle Aged; D009043:Motor Activity; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D020377:Self Efficacy; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology*; D016896:Treatment Outcome
keywords: fatigue; mediators; neoplasms; physical activity; quality of life