Supportive Care in Cancer

, Volume 20, Issue 10, pp 2511–2521 | Cite as

Theory-based predictors of follow-up exercise behavior after a supervised exercise intervention in older breast cancer survivors

  • Paul D. LoprinziEmail author
  • Bradley J. Cardinal
  • Qi Si
  • Jill A. Bennett
  • Kerri M. Winters-Stone
Original Article



Supervised exercise interventions can elicit numerous positive health outcomes in older breast cancer survivors. However, to maintain these benefits, regular exercise needs to be maintained long after the supervised program. This may be difficult, as in this transitional period (i.e., time period immediately following a supervised exercise program), breast cancer survivors are in the absence of on-site direct supervision from a trained exercise specialist. The purpose of the present study was to identify key determinants of regular exercise participation during a 6-month follow-up period after a 12-month supervised exercise program among women aged 65+ years who had completed adjuvant treatment for breast cancer.


At the conclusion of a supervised exercise program and 6 months later, 69 breast cancer survivors completed surveys examining their exercise behavior and key constructs from the Transtheoretical Model.


After adjusting for weight status and physical activity at the transition point, breast cancer survivors with higher self-efficacy at the point of transition were more likely to be active 6 months after leaving the supervised exercise program (odds ratio [95% confidence interval, 1.10 [1.01–1.18]). Similarly, breast cancer survivors with higher behavioral processes of change use at the point of transition were more likely to be active (odds ratio [95% confidence interval], 1.13 [1.02–1.26]).


These findings suggest that self-efficacy and the behavioral processes of change, in particular, play an important role in exercise participation during the transition from a supervised to a home-based program among older breast cancer survivors.


Behavior Cancer Determinants Oncology Physical activity 



This study was made possible through Grant No. 5RO1CA120123-03, “Comparison of aerobic and resistance exercise in older breast cancer survivors,” National Cancer Institute, National Institutes of Health, awarded to Kerri M. Winters-Stone, Ph.D., Principal Investigator.

Conflict of Interest

The authors declare no conflicts of interest and have full control of all primary data and agree to allow the journal to review the data if requested.


  1. 1.
    Friedenreich CM, Cust AE (2008) Physical activity and breast cancer risk: impact of timing, type and dose of activity and population subgroup effects. Br J Sports Med 42:636–647PubMedCrossRefGoogle Scholar
  2. 2.
    Ibrahim EMAl-Homaidh A (2010) Physical activity and survival after breast cancer diagnosis: meta-analysis of published studies. Med Oncol.Google Scholar
  3. 3.
    Andrykowski MA, Beacham AO, Jacobsen PB (2007) Prospective, longitudinal study of leisure-time exercise in women with early-stage breast cancer. Cancer Epidemiol Biomarkers Prev 16:430–438PubMedCrossRefGoogle Scholar
  4. 4.
    Knols RH, de Bruin ED, Shirato K, Uebelhart D, Aaronson NK (2010) Physical activity interventions to improve daily walking activity in cancer survivors. BMC Cancer 10:406PubMedCrossRefGoogle Scholar
  5. 5.
    Servaes P, Verhagen S, Bleijenberg G (2002) Determinants of chronic fatigue in disease-free breast cancer patients: a cross-sectional study. Ann Oncol 13:589–598PubMedCrossRefGoogle Scholar
  6. 6.
    Palesh OG, Collie K, Batiuchok D, Tilston J, Koopman C, Perlis ML et al (2007) A longitudinal study of depression, pain, and stress as predictors of sleep disturbance among women with metastatic breast cancer. Biol Psychol 75:37–44PubMedCrossRefGoogle Scholar
  7. 7.
    Ott CD, Twiss JJ, Waltman NL, Gross GJ, Lindsey AM (2006) Challenges of recruitment of breast cancer survivors to a randomized clinical trial for osteoporosis prevention. Cancer Nurs 29:21–31, quiz 32-23PubMedCrossRefGoogle Scholar
  8. 8.
    Satariano WA, Ragland DR (1996) Upper-body strength and breast cancer: a comparison of the effects of age and disease. J Gerontol A Biol Sci Med Sci 51:M215–M219PubMedCrossRefGoogle Scholar
  9. 9.
    MacVicar MG, Winningham ML, Nickel JL (1989) Effects of aerobic interval training on cancer patients' functional capacity. Nurs Res 38:348–351PubMedCrossRefGoogle Scholar
  10. 10.
    Denmark-Wahnefried W, Peterson BL, Winer EP (2001) Changes in weight, body composition, and factors influencing energy balance among premenopausal breast cancer patients receiving adjuvant chemotherapy. J Clin Oncol 19:2381–2389Google Scholar
  11. 11.
    Montazeri A, Vahdaninia M, Harirchi I, Ebrahimi M, Khaleghi F, Jarvandi S (2008) Quality of life in patients with breast cancer before and after diagnosis: an eighteen months follow-up study. BMC Cancer 8:330PubMedCrossRefGoogle Scholar
  12. 12.
    Courneya KS, Friedenreich CM, Reid RD, Gelmon K, Mackey JR, Ladha AB et al (2009) Predictors of follow-up exercise behavior 6 months after a randomized trial of exercise training during breast cancer chemotherapy. Breast Cancer Res Treat 114:179–187PubMedCrossRefGoogle Scholar
  13. 13.
    Prochaska JO, Di Clemente CC (1983) Stages and processes of self-change of smoking: toward an integrative model of change. J Consult Clin Psychol 51:390–395PubMedCrossRefGoogle Scholar
  14. 14.
    Prochaska JO, DiClemente CC, Norcross JC (1992) In search of how people change. Applications to addictive behaviors. Am Psychol 47:1102–1114PubMedCrossRefGoogle Scholar
  15. 15.
    Prochaska JO, Velicer WF (1997) The Transtheoretical Model of health behavior change. Am J Health Promot 12:38–48PubMedCrossRefGoogle Scholar
  16. 16.
    Cardinal BJ, Engels HJ, Smouter J (2001) Changes in preadolescents' stage of change for exercise behavior following “Health Kids 2000-Get With It”. Am J Med Sport 3:272–278Google Scholar
  17. 17.
    Cardinal BJ, Engels HJ, Zhu W (1998) Application of the Transtheoretical Model of behavior change to preadolescents' physical activity and exercise behavior. Ped Exerc Sci 10:69–80Google Scholar
  18. 18.
    Cardinal BJ, Kosma M (2004) Self-efficacy and the stages and processes of change associated with adopting and maintaining muscular fitness-promoting behaviors. Res Q Exerc Sport 75:186–196PubMedGoogle Scholar
  19. 19.
    Cardinal BJ, Lee J, Kim Y (2010) Predictors of transitional shifts in college students' physical activity behavior. International Journal of Applied Sports Sciences 22:24–32Google Scholar
  20. 20.
    Cardinal BJ, Sachs ML (1995) Prospective analysis of stage-of-exercise movement following mail-delivered, self-instructional exercise packets. Am J Health Promot 9:430–432PubMedCrossRefGoogle Scholar
  21. 21.
    Cardinal BJ, Tuominen KJ, Rintala P (2004) Cross-cultural comparison of American and Finnish college students' exercise behavior using Transtheoretical Model constructs. Res Q Exerc Sport 75:92–101PubMedGoogle Scholar
  22. 22.
    Cardinal BJ (2002) Facilitating physical activity and health behavior change among older adults. Contemporary Psychology, APA Review of Books 49:15–17Google Scholar
  23. 23.
    Cardinal BJ, Kosma M, McCubbin JA (2004) Factors influencing the exercise behavior of adults with physical disabilities. Med Sci Sports Exerc 36:868–875PubMedCrossRefGoogle Scholar
  24. 24.
    Levy SS, Li K, Cardinal BJ, Maddalozzo GF (2009) Transitional shifts in exercise behavior among women with multiple sclerosis. Disability and Health Journal 2:216–223PubMedCrossRefGoogle Scholar
  25. 25.
    Courneya KS, Segal RJ, Reid RD, Jones LW, Malone SC, Venner PM et al (2004) Three independent factors predicted adherence in a randomized controlled trial of resistance exercise training among prostate cancer survivors. J Clin Epidemiol 57:571–579PubMedCrossRefGoogle Scholar
  26. 26.
    Courneya KS, Friedenreich CM, Quinney HA, Fields AL, Jones LW, Fairey AS (2004) Predictors of adherence and contamination in a randomized trial of exercise in colorectal cancer survivors. Psychooncology 13:857–866PubMedCrossRefGoogle Scholar
  27. 27.
    Courneya KS, Friedenreich CM, Sela RA, Quinney HA, Rhodes RE (2002) Correlates of adherence and contamination in a randomized controlled trial of exercise in cancer survivors: an application of the Theory of Planned Behavior and the five factor model of personality. Ann Behav Med 24:257–268PubMedCrossRefGoogle Scholar
  28. 28.
    Bennett JA, Lyons KS, Winters-Stone K, Nail LM, Scherer J (2007) Motivational interviewing to increase physical activity in long-term cancer survivors: a randomized controlled trial. Nurs Res 56:18–27PubMedCrossRefGoogle Scholar
  29. 29.
    Reed G, Velicer WF, Prochaska JO (1997) What makes a good staging algorithm? Examples from regular exercise. Am J Health Promot 12:57–66PubMedCrossRefGoogle Scholar
  30. 30.
    Levy SS, Cardinal BJ (2006) Factors associated with transitional shifts in college students' physical activity behavior. Res Q Exerc Sport 77:476–485PubMedCrossRefGoogle Scholar
  31. 31.
    Nigg CR, Riebe D (2002) The Transtheoretical Model: research review of exercise behavior and older adults. In: Burbank PM, Riebe D (eds) Promoting exercise and behavior change in older adults: interventions with the Transtheoretical Model. Springer, New York, pp 147–180Google Scholar
  32. 32.
    Marcus BH, Eaton CA, Rossi JS (1994) Self-efficacy, decision-making and stages of change: an integrative model of physical exercise. J Appl Social Psychol 24:489–508CrossRefGoogle Scholar
  33. 33.
    Levy SS, Ebbeck V (2005) The exercise and self-esteem model in adult women: the inclusion of physical acceptance. Psychol Sport Exerc 6:571–584CrossRefGoogle Scholar
  34. 34.
    Plotnikoff RC, Blanchard CHotz SB (2001) Validation of the decisional balance scales in the exercise domain from the Transtheoretical Model: a longitudinal test. Measure Phys Educ Exerc 5:191–206CrossRefGoogle Scholar
  35. 35.
    Giles K, Marshall AL (2009) Repeatability and accuracy of CHAMPS as a measure of physical activity in a community sample of older Australian adults. J Phys Act Health 6:221–229PubMedGoogle Scholar
  36. 36.
    Cyarto EV, Marshall AL, Dickinson RK, Brown WJ (2006) Measurement properties of the CHAMPS physical activity questionnaire in a sample of older Australians. J Sci Med Sport 9:319–326PubMedCrossRefGoogle Scholar
  37. 37.
    Stewart AL, Mills KM, King AC, Haskell WL, Gillis D, Ritter PL (2001) CHAMPS physical activity questionnaire for older adults: outcomes for interventions. Med Sci Sports Exerc 33:1126–1141PubMedGoogle Scholar
  38. 38.
    Milne HM, Wallman KE, Guilfoyle A, Gordon S, Corneya KS (2008) Self-determination theory and physical activity among breast cancer survivors. J Sport Exerc Psychol 30:23–38PubMedGoogle Scholar
  39. 39.
    Pinto BM, Maruyama NC, Clark MM, Cruess DG, Park E, Roberts M (2002) Motivation to modify lifestyle risk behaviors in women treated for breast cancer. Mayo Clin Proc 77:122–129PubMedGoogle Scholar
  40. 40.
    Hong S, Bardwell WA, Natarajan L, Flatt SW, Rock CL, Newman VA et al (2007) Correlates of physical activity level in breast cancer survivors participating in the Women's Healthy Eating and Living (WHEL) Study. Breast Cancer Res Treat 101:225–232PubMedCrossRefGoogle Scholar
  41. 41.
    Courneya KS, Segal RJ, Gelmon K, Reid RD, Mackey JR, Friedenreich CM et al (2008) Predictors of supervised exercise adherence during breast cancer chemotherapy. Med Sci Sports Exerc 40:1180–1187PubMedCrossRefGoogle Scholar
  42. 42.
    Pinto BM, Rabin C, Dunsiger S (2009) Home-based exercise among cancer survivors: adherence and its predictors. Psychooncology 18:369–376PubMedCrossRefGoogle Scholar
  43. 43.
    Montano DE Kasprzyk D (2008) Theory of reasoned action, theory of planned behavior, and the integrated behavioral model. In: Glanz K, Rimer, BK, Viswanath, (ed.) Health behavior and health education: theory, research, and practice, 4th edition. San Francisco: Jossey-Bass :67-96Google Scholar
  44. 44.
    Kosma M, Ellis R, Cardinal BJ, Bauer JJ, McCubbin JA (2007) The mediating role of intention and stages of change in physical activity among adults with physical disabilities: an integrative framework. J Sport Exerc Psychol 29:21–38PubMedGoogle Scholar
  45. 45.
    Marshall SJ, Biddle S (2001) The Transtheoretical Model of behavior change: a meta-analysis of applications to physical activity and exercise. Ann Behav Med 23:229–246PubMedCrossRefGoogle Scholar
  46. 46.
    Irwin ML, McTiernan A, Bernstein L, Gilliland FD, Baumgartner R, Baumgartner K et al (2004) Physical activity levels among breast cancer survivors. Med Sci Sports Exerc 36:1484–1491PubMedGoogle Scholar
  47. 47.
    Reed GR (1999) Adherence to exercise and the Transtheoretical Model of behavior change. In: Bull SS (ed) Adherences issues in sport and exercise. Wiley, New York, pp 19–46Google Scholar
  48. 48.
    Jordan PJ Nigg CR (2002) Applying the Transtheoretical Model: tailoring interventions to stages of change. Promoting exercise and behavior change in older adults: Interventions with the Transtheoretical Model. Springer, New York, pp 181–234Google Scholar
  49. 49.
    Biddle S, Nigg CR (2000) Theories of exercise behavior. International Journal of Sport Psychology 31:290–304Google Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Paul D. Loprinzi
    • 1
    Email author
  • Bradley J. Cardinal
    • 2
  • Qi Si
    • 3
  • Jill A. Bennett
    • 4
  • Kerri M. Winters-Stone
    • 4
  1. 1.Department of Exercise ScienceBellarmine UniversityLouisvilleUSA
  2. 2.Program in Exercise and Sport Science, School of Biological and Population Health Sciences, College of Public Health and Human SciencesOregon State UniversityCorvallisUSA
  3. 3.Department of Physical EducationZhejiang UniversityZhejiangChina
  4. 4.School of NursingOregon Health & Science UniversityPortlandUSA

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