Skip to main content
SpringerLink
Log in

Translating Physical Activity Interventions for Breast Cancer Survivors into Practice: An Evaluation of Randomized Controlled Trials

  • Original Article
  • Published:
Annals of Behavioral Medicine

Abstract

Background

Although physical activity (PA) interventions have been effective for improving health outcomes in breast cancer survivors, little is known relative to their potential for translation into practice.

Purpose

This review was designed to provide a quantitative estimate of the reporting of both internal and external validity in recent studies of PA in breast cancer survivors (BCS).

Methods

The Reach, Efficacy/Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework was utilized to assess the reporting of internal and external validity in 25 randomized controlled trials (RCTs) of PA and BCS published between 1998 and 2008. Each trial was evaluated relative to the degree it met criteria for each of the above dimensions.

Results

The majority of studies in this review reported dimensions reflecting internal validity. The overall level of detail relative to external validity of PA interventions was rarely reported, limiting the generalizability of study findings.

Conclusions

As with many RCTs of health behavior change, detail relative to contextual elements of published PA interventions in BCS is limited. It is recommended that future physical activity interventions in BCS be designed to facilitate scalable and sustainable interventions for improving health outcomes in this population.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Ries LAG, Melbert D, Krapcho M, et al., eds. SEER Cancer Statistics Review, 1975–2004. Bethesda, MD: National Cancer Institute; 2006.

  2. Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin. 2005; 55: 74–108.

    Article  PubMed  Google Scholar 

  3. Ganz PA, Desmond KA, Leedham B, Rowland JH, Meyerowitz BE, Belin TR. Quality of life in long term, disease-free survivors of breast cancer: A follow-up study. J Natl Cancer Inst. 2002; 94: 39–49.

    PubMed  Google Scholar 

  4. Hewitt M, Rowland JH, Yancik R. Cancer survivors in the United States: Age, health, and disability. J Gerontol A Biol Sci Med Sci. 2003; 58: 82–91.

    PubMed  Google Scholar 

  5. Holmes MD, Chen WY, Feskanich D, Kroenke CH, Colditz GA. Physical activity and survival after breast cancer diagnosis. JAMA. 2005; 293: 2479–2486.

    Article  PubMed  Google Scholar 

  6. Kirshbaum MN. A review of the benefits of whole body exercise during and after treatment for breast cancer. J Clin Nurs. 2007; 16: 104–121.

    Article  PubMed  Google Scholar 

  7. McNeely ML, Campbell KL, Rowe BH, Klassen TP, Mackey JR, Courneya KS. Effects of exercise on breast cancer patients and survivors: A systematic review and meta-analysis. Can Med Assoc J. 2006; 175: 34–41.

    Article  Google Scholar 

  8. Redd WH, Montgomery GH, DuHamel KN. Behavioral intervention for cancer treatment side effects. J Natl Cancer Inst. 2001; 93: 810–823.

    Article  PubMed  Google Scholar 

  9. Holick CN, Newcomb PA, Trentham-Dietz A, et al. Physical activity and survival after diagnosis of invasive breast cancer. Cancer Epidemiol Biomarkers Prev. 2008; 17: 379–386.

    Article  PubMed  Google Scholar 

  10. Glasgow RE, Klesges LM, Dzewaltowski DA, Bull SS, Estabrooks P. The future of behavior change research: What is needed to improve translation of research into health promotion practice. Ann Behav Med. 2004; 27: 3–12.

    Article  PubMed  Google Scholar 

  11. Glasgow RE, Vogt TM, Boles SM. Evaluating the public health impact of health promotion interventions: The RE-AIM framework. Am J Public Health. 1999; 89: 1322–1327.

    Article  PubMed  Google Scholar 

  12. Estabrooks PA, Gyurcsik NC. Evaluating the impact of behavioral interventions that target physical activity: Issues of generalizability and public health. Psychol Sport Exerc. 2003; 4: 41–55.

    Article  Google Scholar 

  13. Glasgow RE. Chapter 23: Evaluation of theory-based interventions: The RE-AIM model. In: Glanz K, Rimer BK, Lewis FM, eds. Health Behavior and Health Education. San Francisco: Wiley; 2002.

    Google Scholar 

  14. Glasgow RE, Nelson CC, Strycker LA, King DK. Using RE-AIM metrics to evaluate diabetes self-management support interventions. Am J Prev Med. 2006; 30: 67–73.

    Article  PubMed  Google Scholar 

  15. Glasgow RE, McKay HG, Piette JD, Reynolds KD. The RE-AIM framework for evaluating interventions: What can it tell us about approaches to chronic illness management. Patient Educ Couns. 2001; 44: 119–127.

    Article  PubMed  Google Scholar 

  16. Glasgow RE, Klesges LM, Dzewaltowski DA, Estabrooks PA, Vogt TM. Evaluating the impact of health promotion programs: Using the RE-AIM framework to form summary measures for decision making involving complex issues. Health Educ Res. 2006; 21: 688–694.

    Article  PubMed  Google Scholar 

  17. Courneya KS, Segal RJ, Mackey JR, et al. Effects of aerobic and resistance exercise in breast cancer patients receiving adjuvant chemotherapy: A multicenter randomized controlled trial. J Clin Oncol. 2007; 25: 4396–4404.

    Article  PubMed  Google Scholar 

  18. Daley AJ, Crank H, Saxton JM, Mutrie N, Coleman R, Roalfe A. Randomized trial of exercise therapy in women treated for breast cancer. J Clin Oncol. 2007; 25: 1713–1721.

    Article  PubMed  Google Scholar 

  19. Ware J, Sherbourne C. The MOS 36-item short-form health survey (SF-36): I. Conceptual framework and item selection. Med Care. 1992; 30: 473–483.

    Article  PubMed  Google Scholar 

  20. Basen-Enquist K, Carmack Taylor CL, Rosenblum C, et al. Randomized pilot test of a lifestyle physical activity intervention for breast cancer survivors. Patient Educ Couns. 2006; 64: 225–234.

    Article  Google Scholar 

  21. McKenzie DC, Kalda AL. Effect of upper extremity exercise on secondary lymphedema in breast cancer patients: A pilot study. J Clin Oncol. 2003; 21: 463–466.

    Article  PubMed  Google Scholar 

  22. Sandel SL, Judge JO, Landry N, Faria L, Ouellette R, Majczak M. Dance and movement program improves quality-of-life measures in breast cancer survivors. Cancer Nurs. 2005; 28: 301–309.

    Article  PubMed  Google Scholar 

  23. Mock V, Frangakis C, Davidson NE, et al. Exercise manages fatigue during breast cancer treatment: A randomized controlled trial. Psychooncology. 2005; 14: 464–477.

    Article  PubMed  Google Scholar 

  24. Mock V, Pickett M, Ropka ME, et al. Fatigue and quality of life outcomes of exercise during cancer treatment. Cancer Pract. 2001; 9: 119–127.

    Article  PubMed  Google Scholar 

  25. Dzewaltowski DA, Estabrooks PA, Glasgow RE. The future of physical activity behavior change research: What is needed to improve translation of research into health promotion practice. Exerc Sport Sci Rev. 2004; 32: 57–63.

    Article  PubMed  Google Scholar 

  26. Patrick K, Scutchfield FD, Woolf SH. External validity reporting in prevention research. Am J Prev Med. 2008; 34: 260–262.

    Article  PubMed  Google Scholar 

  27. Steckler A, McLeroy KR. The importance of external validity. Am J Public Health. 2008; 98: 9–10.

    Article  PubMed  Google Scholar 

  28. Estabrooks P, Dzewaltowski DA, Glasgow RE, Klesges LM. Reporting of validity from school health promotion studies published in 12 leading journals, 1996–2000. J Sch Health. 2003; 73: 21–28.

    Article  PubMed  Google Scholar 

  29. Klesges LM, Dzewaltowski DA, Glasgow RE. Review of external validity reporting in childhood obesity prevention research. Am J Prev Med. 2008; 34: 216–223.

    Article  PubMed  Google Scholar 

  30. Dzewaltowski DA, Estabrooks PA, Klesges LM, Bull S, Glasgow RE. Behavior change intervention research in community settings: How generalizable are the results. Health Promot Int. 2004; 19: 235–245.

    Article  PubMed  Google Scholar 

  31. Victora CG, Habicht JP, Bryce J. Evidence-based public health: Moving beyond randomized trials. Am J Public Health. 2004; 94: 400–405.

    Article  PubMed  Google Scholar 

  32. Klesges LM, Estabrooks PA, Dzewaltowski DA, Bull SS, Glasgow RE. Beginning with the application in mind: Designing and planning health behavior change interventions to enhance dissemination. Ann Behav Med. 2005; 29: 66–75.

    Article  PubMed  Google Scholar 

  33. Vallance JKH, Courneya KS, Plotnikoff RC, Yasui Y, Mackey JR. Effects of print materials and step pedometers on physical activity and quality of life in breast cancer survivors: A randomized controlled trial. J Clin Oncol. 2007; 25: 2352–2359.

    Article  PubMed  Google Scholar 

  34. Marcus BH, Dubbert PM, Forsyth LH, et al. Physical activity behavior change: Issues in adoption and maintenance. Health Psychol. 2000; 19: 32–41.

    Article  PubMed  Google Scholar 

  35. Courneya KS, Friedenreich CM, Reid RD, et al. Predictors of follow-up exercise behavior 6 months after a randomized trial of exercise training during breast cancer chemotherapy. Breast Cancer Res Treat. 2009; 114: 179–187.

    Article  PubMed  Google Scholar 

  36. Altman DG, Schulz KF, Moher D, et al. The revised CONSORT statement for reporting randomized trials: Explanation and elaboration. Ann Intern Med. 2001; 134: 663–694.

    PubMed  Google Scholar 

  37. Moher D, Schulz KF, Altman DG. The CONSORT statement: Revised recommendations for improving the quality of reports of parallel-group randomized trials. J Am Podiatr Med Assoc. 2001; 91: 437–442.

    PubMed  Google Scholar 

  38. The Diabetes Prevention Program Research Group. The Diabetes Prevention Program (DPP): Description of lifestyle intervention. Diabetes Care. 2002; 25: 2165–2171.

    Article  Google Scholar 

  39. The Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002; 346: 393–403.

    Article  Google Scholar 

  40. The Diabetes Prevention Program Research Group. Impact of intensive lifestyle and metformin therapy on cardiovascular disease risk factors in the Diabetes Prevention Program. Diabetes Care. 2005; 28: 888–894.

    Article  Google Scholar 

  41. The Diabetes Prevention Program Research Group. Within-trial cost-effectiveness of lifestyle intervention or metformin for the primary prevention of type 2 diabetes. Diabetes Care. 2003; 26: 2518–2523.

    Article  Google Scholar 

  42. Battaglini C, Bottaro M, Dennehy C, et al. The effects of an individualized exercise intervention on body composition in breast cancer patients undergoing treatment. Sao Paulo Med J. 2007; 125: 22–28.

    Article  PubMed  Google Scholar 

  43. Campbell A, Mutrie N, White F, McGuire F, Kearney N. A pilot study of a supervised group exercise program as a rehabilitation treatment for women with breast cancer receiving adjuvant treatment. Eur J Oncol Nurs. 2005; 9: 56–63.

    Article  PubMed  Google Scholar 

  44. Courneya KS, Mackey JR, Bell GJ, Jones LW, Field CJ, Fairey AS. Randomized controlled trial of exercise training in postmenopausal breast cancer survivors: Cardiopulmonary and quality of life outcomes. J Clin Oncol. 2003; 21: 1600–1668.

    Article  Google Scholar 

  45. Culos-Reed SN, Carlson LE, Daroux LM, Hately-Aldous S. A pilot study of yoga for breast cancer survivors: Physical and psychological benefits. Psychooncology. 2006; 15: 891–897.

    Article  PubMed  Google Scholar 

  46. Drouin JS, Armstrong H, Krause S, Orr J. Effects of aerobic exercise training on peak aerobic capacity, fatigue, and psychological factors during radiation for breast cancer. Rehabilitation Oncology. 2005; 23: 11–17.

    Google Scholar 

  47. Galantino ML, Capito L, Kane RJ, Ottey N, Switzer S, Packel L. The effects of tai chi and walking on fatigue and body mass index in women living with breast cancer: A pilot study. Rehabilitation Oncology. 2003; 21: 17–22.

    Google Scholar 

  48. Headley JA, Ownby KK, John LD. The effect of seated exercise on fatigue and quality of life in women with advanced breast cancer. Oncol Nurs Forum. 2004; 31: 977–983.

    Article  PubMed  Google Scholar 

  49. Herrero F, San Juan AF, Fleck SJ, et al. Combined aerobic and resistance training in breast cancer survivors: A randomized, controlled pilot trial. Int J Sports Med. 2006; 27: 573–580.

    Article  PubMed  Google Scholar 

  50. Kim CJ, Kang DH, Smith BA, Landers KA. Cardiopulmonary responses and adherence to exercise in women newly diagnosed with breast cancer undergoing adjuvant therapy. Cancer Nurs. 2006; 29: 156–165.

    Article  PubMed  Google Scholar 

  51. Ligibel JA, Campbell N, Partridge A, et al. Impact of a mixed strength and endurance exercise intervention on insulin levels in breast cancer survivors. J Clin Oncol. 2008; 26: 907–912.

    Article  PubMed  Google Scholar 

  52. Milne HM, Wallman KE, Gordon S, Courneya KS. Effects of a combined aerobic and resistance exercise program in breast cancer survivors: A randomized controlled trial. Breast Cancer Res Treat. 2008; 108: 279–288.

    Article  PubMed  Google Scholar 

  53. Mustian KM, Katula JA, Gill DL, Roscoe JA, Lang D, Murphy K. Tai Chi Chuan, health-related quality of life and self-esteem: A randomized trial with breast cancer survivors. Support Care Cancer. 2004; 12: 871–876.

    Article  PubMed  Google Scholar 

  54. Mutrie N, Campbell AM, Whyte F, et al. Benefits of supervised group exercise programme for women being treated for early stage breast cancer: Pragmatic randomised controlled trial. BMJ. 2007; 334: 517–523.

    Article  PubMed  Google Scholar 

  55. Pinto BM, Clark MM, Maruyama NC, Feder SI. Psychological and fitness changes associated with exercise participation among women with breast cancer. Psychooncology. 2003; 12: 118–126.

    Article  PubMed  Google Scholar 

  56. Pinto BM, Frierson GM, Rabin C, Trunzo JJ, Marcus BH. Home-based physical activity intervention for breast cancer patients. J Clin Oncol. 2005; 20: 3577–3587.

    Article  Google Scholar 

  57. Schmitz KH, Ahmed RL, Hannan PJ, Yee D. Safety and efficacy of weight training in recent breast cancer survivors to alter body composition, insulin, and insulin-like growth factor axis proteins. Cancer Epidemiol Biomarkers Prev. 2005; 14: 1672–1680.

    Article  PubMed  Google Scholar 

  58. Segal R, Evans W, Johnson D, et al. Structured exercise improves physical functioning in women with stages I and II breast cancer: Results of a randomized controlled trial. J Clin Oncol. 2001; 19: 657–665.

    PubMed  Google Scholar 

  59. Segar ML, Katch VL, Roth RS, et al. The effect of aerobic exercise on self-esteem and depressive and anxiety symptoms among breast cancer survivors. Oncol Nurs Forum. 1998; 25: 107–113.

    PubMed  Google Scholar 

Download references

Acknowledgements

Edward McAuley is supported in part by a Shahid and Ann Carlston Khan Professorship in Applied Health Sciences and a grant from the National Institute on Aging (RO1 AG025667). Kerry S. Courneya is supported by the Canada Research Chairs Program and a Research Team Grant from the National Cancer Institute of Canada (NCIC), with funds from the Canadian Cancer Society (CCS) and the NCIC/CCS Sociobehavioral Cancer Research Network. Paul Estabrooks is supported in part by grants from the National Institute of Diabetes, Digestive, and Kidney Diseases (R01 DK070553; R01 DK071664). We are indebted to two anonymous reviewers and the Editor for their insightful comments on an earlier draft on this manuscript.

The authors have no disclosures.

Author information

Authors and Affiliations

  1. Department of Kinesiology and Community Health, University of Illinois, 336 Freer Hall, 906 S. Goodwin Ave, Urbana, IL, 61801, USA

    Siobhan M. White B.S. & Edward McAuley Ph.D.

  2. Virginia Polytechnic Institute and State University, Blacksburg, VA, USA

    Paul A. Estabrooks Ph.D.

  3. University of Alberta, Edmonton, Canada

    Kerry S. Courneya Ph.D.

Authors
  1. Siobhan M. White B.S.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Edward McAuley Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Paul A. Estabrooks Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kerry S. Courneya Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Siobhan M. White B.S. or Edward McAuley Ph.D..

About this article

Cite this article

White, S.M., McAuley, E., Estabrooks, P.A. et al. Translating Physical Activity Interventions for Breast Cancer Survivors into Practice: An Evaluation of Randomized Controlled Trials. ann. behav. med. 37, 10–19 (2009). https://doi.org/10.1007/s12160-009-9084-9

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12160-009-9084-9

Keywords

Search

Navigation