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Predicting Physical Activity in Survivors of Breast Cancer: the Health Action Process Approach at the Intrapersonal Level

International Journal of Behavioral Medicine (2022)Cite this article

Abstract

Background

Benefits have been established for regular physical activity (PA) and exercise after breast cancer, but a decline of PA has also been a reported result of breast cancer diagnosis and treatments. The Health Action Process Approach (HAPA) model has been shown to predict various health behaviors, but few studies have tested it at the intrapersonal level. The aim of the present study was to test whether the HAPA constructs that are well confirmed at the interpersonal level also hold at the intrapersonal level in a group of women survivors of breast cancer.

Method

PA behaviors (N = 338) by nine survivors of breast cancer were observed for 6 weeks, and the associations between the HAPA constructs and PA over time were examined. Participants completed a questionnaire with the HAPA constructs related to PA behavior (direct step count and self-reported).

Results

A multilevel model of behavior prediction found that optimistic beliefs about ability to initiate and maintain PA (self-efficacy) were positively related to intentions to be active, and these intentions predicted plans to be active. PA was directly and positively predicted by planning and by confidence in the ability to resume PA after a break.

Conclusion

Self-efficacy and planning are associated with PA behavior within women survivors of breast cancer over time, which was not the case for the outcome expectancies, social support, and action control at this intrapersonal level. A multilevel approach for psychological predictors of PA can be useful in grounding interventions for survivors of breast cancer.

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Data Availability

Data is made available upon request.

References

  1. Patel AV, Friedenreich CM, Moore SC, et al. American College of Sports Medicine roundtable report on physical activity, sedentary behavior, and cancer prevention and control. Med Sci Sport Exerc. 2019;51:2391–402.

    Article  Google Scholar 

  2. Ortega MA, Fraile-Martínez O, García-Montero C, et al. Physical activity as an imperative support in breast cancer management. Cancers. 2021;13:1–30.

    Google Scholar 

  3. Furmaniak AC, Menig M, Markes MH. Exercise for women receiving adjuvant therapy for breast cancer. Markes M, editor. Cochrane Database Syst Rev. 2016;21.

  4. Johnsson A, Johnsson A, Johansson K. Physical activity during and after adjuvant chemotherapy in patients with breast cancer. Physiotherapy. 2013;99:221–7.

    Article  PubMed  Google Scholar 

  5. Lahart IM, Metsios GS, Nevill AM, Carmichael AR. Physical activity for women with breast cancer after adjuvant therapy. Cochrane Database Syst Rev. 2018;103.

  6. Bernard P, Savard J, Steindorf K, et al. Effects and moderators of exercise on sleep in adults with cancer: Individual patient data and aggregated meta-analyses. J Psychosom Res. 2019;124(March):1–9.

    Google Scholar 

  7. Bluethmann SM, Vernon SW, Gabriel KP, Murphy CC, Bartholomew LK. Taking the next step: a systematic review and meta-analysis of physical activity and behavior change interventions in recent post-treatment breast cancer survivors. Breast Cancer Res Treat. 2015;3(149):331–42.

    Article  Google Scholar 

  8. American Cancer Society. Cancer treatment & survivorship facts & figures 2019–2021. 2019.

  9. Buffart LM, Ros WJG, Chinapaw MJM, et al. Mediators of physical exercise for improvement in cancer survivors’ quality of life. Psychooncology. 2014;23:330–8.

    Article  CAS  PubMed  Google Scholar 

  10. Stacey FG, James EL, Chapman K, Courneya KS, Lubans DR. A systematic review and meta-analysis of social cognitive theory-based physical activity and/or nutrition behavior change interventions for cancer survivors. J Cancer Surviv. 2015;9:305–38.

    Article  PubMed  Google Scholar 

  11. Rossi A, Friel C, Carter L, Garber CE. Effects of theory-based behavioral interventions on physical activity among overweight and obese female cancer survivors: a systematic review of randomized controlled trials. Integr Cancer Ther. 2018;17:226–36.

    Article  PubMed  Google Scholar 

  12. Webb TL, Sheeran P. Does changing behavioral intentions engender behavior change? A meta-analysis of the experimental evidence. Psychol Bull. 2006;132:249–68.

    Article  PubMed  Google Scholar 

  13. Grimmett C, Corbett T, Brunet J, et al. Systematic review and meta-analysis of maintenance of physical activity behaviour change in cancer survivors. Int J Behav Nutr Phys Act. 2019;16:1–20.

    Article  Google Scholar 

  14. Michie S, Richardson M, Johnston M, et al. The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: Building an international consensus for the reporting of behavior change interventions. Ann Behav Med. 2013;46:81–95.

    Article  PubMed  Google Scholar 

  15. Knittle K, Nurmi J, Crutzen R, et al. How can interventions increase motivation for physical activity? A systematic review and meta-analysis. Health Psychol Rev. 2018;12:211–30.

    Article  PubMed  Google Scholar 

  16. Schwarzer R. Modeling health behavior change: How to predict and modify the adoption and maintenance of health behaviors. Appl Psychol. 2008;57:1–29.

    Google Scholar 

  17. Sniehotta FF, Scholz U, Schwarzer R. Bridging the intention–behaviour gap: Planning, self-efficacy, and action control in the adoption and maintenance of physical exercise. Psychol Health. 2005;20:143–60.

    Article  Google Scholar 

  18. Schwarzer R, Luszczynska A. Health action process approach. In: Conner M, Norman P, editors. Predicting and changing health behaviour-Research and Practice with Social Cognition Models. 3rd ed. McGraw Hill Education - Open University Press; 2015. p. 252–78.

    Google Scholar 

  19. Parschau L, Barz M, Richert J, et al. Physical activity among adults with obesity: Testing the health action process approach. Rehabil Psychol. 2014;59:42–9.

    Article  PubMed  Google Scholar 

  20. Fernández BR, Montenegro EM, Knoll N, Schwarzer R. Self-efficacy, action control, and social support explain physical activity changes among Costa Rican older adults. J Phys Act Heal. 2014;11:1573–8.

    Article  Google Scholar 

  21. Caudroit J, Stephan Y, Le Scanff C. Social cognitive determinants of physical activity among retired older individuals: an application of the health action process approach. Br J Health Psychol. 2011;16:404–17.

    Article  PubMed  Google Scholar 

  22. Barg CJ, Latimer AE, Pomery EA, et al. Examining predictors of physical activity among inactive middle-aged women: an application of the health action process approach. Psychol Health. 2012;27:829–45.

    Article  PubMed  Google Scholar 

  23. Paxton RJ. The health action process approach applied to African American breast cancer survivors. Psychooncology. 2016;25:648–55.

    Article  PubMed  Google Scholar 

  24. Bierbauer W, Inauen J, Schaefer S, et al. Health behavior change in older adults: Testing the health action process approach at the inter- and intraindividual level. Appl Psychol Heal Well-Being. 2017;9:324–48.

    Article  Google Scholar 

  25. Molenaar PCM, Campbell CG. The new person-specific paradigm in psychology. Curr Dir Psychol Sci. 2009;18:112–7.

    Article  Google Scholar 

  26. Quinn F, Johnston M, Johnston DW. Testing an integrated behavioural and biomedical model of disability in N-of-1 studies with chronic pain. Psychol Heal. 2013;28:1391–406.

    Article  Google Scholar 

  27. Scholz U, Keller R, Perren S. Predicting behavioral intentions and physical exercise: a test of the health action process approach at the intrapersonal level. Heal Psychol. 2009;28:702–8.

    Article  Google Scholar 

  28. Kwasnicka D, Inauen J, Nieuwenboom W, et al. Challenges and solutions for N-of-1 design studies in health psychology. Health Psychol Rev. 2019;13:163–78.

    Article  PubMed  Google Scholar 

  29. Maher JP, Dzubur E, Huh J, Intille S, Dunton GF. Within-day time-varying associations between behavioral cognitions and physical activity in Adults. J Sport Exerc Psychol. 2016;38:423–34.

    Article  PubMed Central  PubMed  Google Scholar 

  30. Hobbs N, Dixon D, Johnston M, Howie K. Can the theory of planned behaviour predict the physical activity behaviour of individuals? Psychol Health. 2013;28:234–49.

    Article  PubMed  Google Scholar 

  31. Smith G, Williams L, O’Donnell C, McKechnie J. A series of n-of-1 studies examining the interrelationships between social cognitive theory constructs and physical activity behaviour within individuals. Psychol Health. 2019;34:255–70.

    Article  PubMed  Google Scholar 

  32. Scholz U, Nagy G, Schüz B, Ziegelmann JP. The role of motivational and volitional factors for self-regulated running training: Associations on the between- and within- person level. Br J Soc Psychol. 2008;47:421–39.

    Article  PubMed  Google Scholar 

  33. Maher JP, Conroy DE. A dual-process model of older adults’ sedentary behavior. Heal Psychol. 2016;35:262–72.

    Article  Google Scholar 

  34. Zhang C-Q, Zhang R, Schwarzer R, Hagger MS. A meta-analysis of the health action process approach. Heal Psychol. 2019;38:623–37.

    Article  Google Scholar 

  35. Kampshoff CS, Jansen F, van Mechelen W, May AM, et al. Determinants of exercise adherence and maintenance among cancer survivors: a systematic review. Int J Behav Nutr Phys Act. 2014;11:1–13.

    Article  Google Scholar 

  36. Hefferon K, Murphy H, McLeod J, Mutrie N, Campbell A. Understanding barriers to exercise implementation 5-year post-breast cancer diagnosis: a large-scale qualitative study. Health Educ Res. 2013;28:843–56.

    Article  PubMed  Google Scholar 

  37. Pino-Ortega J, Gómez-Carmona CD, Rico-González M. Accuracy of Xiaomi Mi Band 2.0, 3.0 and 4.0 to measure step count and distance for physical activity and healthcare in adults over 65 years. Gait Posture. 2021;87:6–10.

  38. Martínez-Martínez FJ, Concheiro-Moscoso P, Miranda-Duro MDC, et al. Validation of self-quantification Xiaomi band in a clinical sleep unit. Proceedings. 2020;29.

  39. Marszalek J, Morgulec-Adamowicz N, Rutkowska I, Kosmol A. Using ecological momentary assessment to evaluate current physical activity. Biomed Res Int. 2014;2014:1–9.

    Article  Google Scholar 

  40. Degroote L, DeSmet A, De Bourdeaudhuij I, Van Dyck D, Crombez G. Content validity and methodological considerations in ecological momentary assessment studies on physical activity and sedentary behaviour: a systematic review. Int J Behav Nutr Phys Act. 2020;17:35.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  41. Berli C, Ochsner S, Stadler G, Knoll N, Hornung R, Scholz U. Volitional processes and daily smoking: Examining inter- and intraindividual associations around a quit attempt. J Behav Med. 2015;38:306–17.

    Article  PubMed  Google Scholar 

  42. Peters EN, Hughes JR. The day-to-day process of stopping or reducing smoking: a prospective study of self-changers. Nicotine Tob Res. 2009;11:1083–92.

    Article  PubMed Central  PubMed  Google Scholar 

  43. Gwaltney CJ, Shiffman S, Sayette MA. Situational correlates of abstinence self-efficacy. J Abnorm Psychol. 2005;114:649–60.

    Article  PubMed  Google Scholar 

  44. Loehr VG, Baldwin AS, Rosenfield D, Smits JA. Weekly variability in outcome expectations: examining associations with related physical activity experiences during physical activity initiation. J Health Psychol. 2014;19:1309–19.

    Article  PubMed  Google Scholar 

  45. Haskell WL. Physical activity by self-report: a brief history and future issues. J Phys Act Heal. 2012;9:S5-10.

    Article  Google Scholar 

  46. Ainsworth BE, Haskell WL, Herrmann SD, et al. 2011 compendium of physical activities: a second update of codes and MET values. Med Sci Sports Exerc. 2011;43:1575–81.

    Article  PubMed  Google Scholar 

  47. Miller R, Brown W, Tudor-Locke C. But what about swimming and cycling? How to “count” non-ambulatory activity when using pedometers to assess physical activity. J Phys Act Heal. 2006;3:257–66.

    Article  Google Scholar 

  48. IPAQ Research Committee. Guidelines for data processing and analysis of the International Physical Activity Questionnaire (IPAQ) – Short and Long Forms. IPAQ. 2005:1–15.

  49. Muthén LK, Muthén BO. Mplus User’s Guide. 6th ed. Muthén & Muthén., editor. Los Angeles; 2010.

  50. Hox J, Moerbeek M, van de Schoot R. Multilevel analysis. Routledge; 2010.

  51. Sander AP, Wilson J, Izzo N, Mountford SA, Hayes KW. Factors that affect decisions about physical activity and exercise in survivors of breast cancer: a qualitative study. Phys Ther. 2012;92:525–36.

    Article  PubMed  Google Scholar 

  52. Emery CF, Yang H-C, Frierson GM, Peterson LJ, Suh S. Determinants of physical activity among women treated for breast cancer in a 5-year longitudinal follow-up investigation. Psychooncology. 2009;18:377–86.

    Article  PubMed Central  PubMed  Google Scholar 

  53. Luszczynska A, Mazurkiewicz M, Ziegelmann JP, Schwarzer R. Recovery self-efficacy and intention as predictors of running or jogging behavior: a cross-lagged panel analysis over a two-year period. Psychol Sport Exerc. 2007;8:247–60.

    Article  Google Scholar 

  54. Godin G, Sheeran P, Conner M, Germain M. Asking questions changes behavior: Mere measurement effects on frequency of blood donation. Heal Psychol. 2008;27:179–84.

    Article  Google Scholar 

  55. Clifford BK, Mizrahi D, Sandler CX, et al. Barriers and facilitators of exercise experienced by cancer survivors: a mixed methods systematic review. Support Care Cancer. 2018;26:685–700.

    Article  PubMed  Google Scholar 

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Funding

This work received national funding from Fundação para a Ciência e a Tecnologia (FCT), I.P—through the Research Center for Psychological Science of the Faculty of Psychology, University of Lisbon (UIDB/04527/2020; UIDP/04527/2020).

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Authors and Affiliations

  1. CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Lisbon, Portugal

    Margarida Sequeira & Maria-João Alvarez

  2. CIIAS, Escola Superior de Saúde, Instituto Politécnico de Setúbal, Setubal, Portugal

    Margarida Sequeira

  3. ICS, Instituto de Ciências Sociais da Universidade de Lisboa, Lisbon, Portugal

    Cícero Pereira

Authors
  1. Margarida Sequeira
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  2. Cícero Pereira
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  3. Maria-João Alvarez
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Correspondence to Margarida Sequeira.

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Ethical Approval

All procedures performed in the study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Sequeira, M., Pereira, C. & Alvarez, MJ. Predicting Physical Activity in Survivors of Breast Cancer: the Health Action Process Approach at the Intrapersonal Level. Int.J. Behav. Med. (2022). https://doi.org/10.1007/s12529-022-10140-3

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  • DOI: https://doi.org/10.1007/s12529-022-10140-3

Keywords

  • N-of-1 designs
  • Survivors of breast cancer
  • Physical activity
  • HAPA