Participation in and adherence to physical exercise after completion of primary cancer treatment.
﻿The purpose of this study was  to identify demographic, clinical, psychosocial, physical and environmental factors that are associated with participation in and adherence to a combined resistance and endurance exercise program among cancer survivors, shortly after completion of primary cancer treatment. Data from the randomized controlled Resistance and Endurance exercise After ChemoTherapy (REACT) study were used for this study.



The participants of the REACT study were randomly allocated to either a high intensity (HI) or low-to-moderate intensity (LMI) exercise program. Patients' participation rate was defined as the cancer survivors' decision to participate in the REACT study. Exercise adherence reflected participants' attendance to the scheduled exercise sessions and their compliance to the prescribed exercises. High session attendance rates were defined as attending at least 80 % of the sessions. High compliance rates were defined as performing at least of 90 % of the prescribed exercise across all sessions. Correlates of exercise adherence were studied separately for HI and LMI exercise. Demographic, clinical, and physical factors were assessed using self-reported questionnaires. Relevant clinical information was extracted from medical records. Multivariable logistic regression analyses were applied to identify correlates that were significantly associated with participation, high session attendance, high compliance with resistance and high compliance with endurance exercises.



Participants were more likely to have higher education, be non-smokers, have lower psychological distress, higher outcome expectations, and perceive more exercise barriers than non-participants. In HI exercise, higher self-efficacy was significantly associated with high session attendance and high compliance with endurance exercises, and lower psychological distress was significantly associated with high compliance with resistance exercises. In LMI exercise, being a non-smoker was significantly associated with high compliance with resistance exercises and higher BMI was significantly associated with high compliance with resistance and endurance exercises. Furthermore, breast cancer survivors were less likely to report high compliance with resistance and endurance exercises in LMI exercise compared to survivors of other types of cancer. The discriminative ability of the multivariable models ranged from 0.62 to 0.75.



Several demographic, clinical and psychosocial factors were associated with participation in and adherence to exercise among cancer survivors. Psychosocial factors were more strongly associated with adherence in HI than LMI exercise.



This study was registered at the Netherlands Trial Register [ NTR2153 ] on the 5(th) of January 2010.
Department of Public & Occupational Health, and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
Caroline S
CS
Kampshoff
Department of Public & Occupational Health, and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
Willem
W
van Mechelen
Department of Sports Medicine, Máxima Medical Center, Veldhoven, The Netherlands.
Goof
G
Schep
Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands.
Marten R
MR
Nijziel
Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Center, De Boelelaan 1089a, 1081 HV, Amsterdam, The Netherlands.
Lenja
L
Witlox
Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Center, De Boelelaan 1089a, 1081 HV, Amsterdam, The Netherlands.
Lisa
L
Bosman
Department of Public & Occupational Health, and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
Mai J M
MJ
Chinapaw
Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Center, De Boelelaan 1089a, 1081 HV, Amsterdam, The Netherlands.
Johannes
J
Brug
Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Center, De Boelelaan 1089a, 1081 HV, Amsterdam, The Netherlands. l.buffart@vumc.nl.
Laurien M
LM
Buffart
D000328:Adult; D000368:Aged; D001943:Breast Neoplasms; D015444:Exercise; D005081:Exercise Therapy; D005221:Fatigue / Q000517:prevention & control; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy; D009426:Netherlands; D010349:Patient Compliance / Q000706:statistics & numerical data; D010809:Physical Fitness; D011788:Quality of Life; D011795:Surveys and Questionnaires; D017741:Survivors
Cancer survivors; Compliance; Correlates; Exercise; Exercise adherence; Participation; Session attendance