Supporting Physical Activity in Adults Living With and Beyond Cancer (2018–2022)

Abstract

Systematic review briefs provide a summary of the findings from systematic reviews evaluated in conjunction with the American Occupational Therapy Association’s Evidence-Based Practice Program. Each systematic review brief summarizes the evidence on a theme related to a systematic review topic. This systematic review brief presents findings from the systematic review on the effectiveness of interventions addressing physical activity in adults living with and beyond cancer.

Full Systematic Review Question

This systematic review addressed the question “What is the evidence for the effectiveness of interventions within the scope of occupational therapy practice to improve performance and participation for adults living with cancer?”

Current Theme Reported

The main theme of the studies included in this systematic review brief includes interventions to support physical activity.

Clinical Scenario

As more people are surviving cancer, some have called upon redefining cancer as a chronic condition due to the long-lasting effects of treatment (Baxter et al., 2017) and the need for interventions aimed at prevention through lifestyle changes and health management activities. Occupational therapy practitioners (OTPs) can address the health management of adults living with and beyond cancer by developing, managing, and maintaining health and wellness routines to support physical activity and reduce the chronic side effects of cancer that impact occupational performance (American Occupational Therapy Association, 2020). Specifically, lifestyle changes such as reducing sedentary behavior and increasing physical activity by using health management activities can additionally impact cancer-related fatigue and cancer-related cognitive impairments that create barriers to occupational performance.

Summary of Key Findings

Three systematic reviews were included related to interventions focusing on physical activity for people after a cancer diagnosis (Table 1). The levels of evidence used in this review are from Oxford Centre for Evidence-Based Medicine (2009). The strength-of-evidence designations are based on the guidelines of the U.S Preventive Services Task Force (2018).

Table 1.

Evidence Table for Interventions Supporting Physical Activity

Author, YearLevel of Evidence (types of study designs)Risk of BiasSetting	Systematic Review Details	Findings From Reviews
Physical Activity One Level 1a systematic review and meta-analyses and two Level 2a systematic reviews with low-moderate risk of bias provide moderate strength of evidence to support motivational strategies, behavior change theories, and mobile health interventions to promote physical activity in those with a diagnosis of cancer.
Pudkasam et al. (2021) Level 1a—Systematic review with meta-analyses RoB Low Setting Home & community	Participants N = 1,668 participants (n = 953 intervention and n = 715 control), 100% were female, mean age of 49.5–61.90 yr, with a diagnosis of breast cancer (stages 0–III) and had completed treatment at least three months prior to the study and no evidence of recurrence. Number of Articles 16 RCT. Countries: US (10/16), Australia (3/16), Canada (2/16), UK (1/16) Databases Searched Cochrane Breast Cancer Group’s Specialized Register, Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, CINAHL with full text (EBSCOhost), PsycINFO (EBSCOhost) and Sportdiscuss with full text (EBSCOhost) Outcome(s) of Interest Physical activity/exercise adherence. Specific measures included weekly intensity of physical activity (MET), weekly minutes of moderate-vigorous physical activity, daily steps (one study), participants who met physical activity goals and % of participants who met physical activity recommendations Intervention(s) of Interest Self-directed physical activity including home-based physical activity, walking programs, and supervised tapering to home-based physical activity interventions. Classified as: a) pedometer + counseling*, b) pedometer + motivational interviewing*, c) pedometer + print material*, d) (1 study) pedometer + social media, e) (1 study) motivational interviewing *included in meta-analysis Theoretical Lens Application of Transtheoretical Model (4/16 studies), Social Cognitive Theory (5/16 studies), Combined Transtheoretical and Social Cognitive Theory (1/16 study), Social Cognitive Theory of Planned Behavior (1/16 study), Theory of Planned Behavior (2/16 studies), motivational strategies (2/16 studies), motivational interviewing (3/16 studies) Delivery Methods home, telephone, face-to-face sessions, printed materials, Facebook (social media) Dose Ranges Intensity of exercise: moderate (5/16 studies). Duration of programs ranged from 10 wk–6 mo. Other details not reported.	Step tracker interventions combined with counseling and motivational interviewing, based on behavioral change theory, provided a significant improvement on self-directed physical activity adherence among those living with and beyond breast cancer.
Khoo et al. (2021) Level 2a—Systematic review RoB Moderate Setting Not clearly reported (implied: clinic, home and community)	Participants N = 1,977 people undergoing or have completed cancer treatments. Age and sex not reported. The sample size ranged from 10 to 365 participants with the following type of cancer(s) present: 13/32 breast cancer, 2/32 primarily prostate cancer, 2/32 (colorectal and colon cancer), 1/32 brain tumors, 1/32 endometrial, 1/32 pediatric 1/32 hepatocellular; 8/32 various cancer types; several studies focused on two cancer types 3/32: colorectal and gynecologic, breast and colorectal, breast and endometrial Number of Articles 32 articles reporting on 31 interventions with RCT (n = 16), Quasi-experimental (n = 3), and Pretest/Posttest (n = 12) designs. Countries: US (n = 14), Australia (n = 5), Republic of Korea (n = 4), Canada (n = 2), France (n = 2), Netherlands (n = 1), Germany (n = 1), Spain (n = 1), and UK (n = 1) Databases Searched Web of Science, PubMed, Scopus, CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), and SPORTDiscus Outcome(s) of Interest All 31 included studies measured PA outcomes. MVPA (18 studies), total activity (13 studies), step counts (11 studies) Intervention(s) of Interest Multicomponent interventions with mHealth combined with or without personal contact (25/31). Including reliance on mHealth intervention components (6), activity trackers (10), a combination of activity trackers with text messages (4), smart phone apps (8), and regular text messages (3). One study combined activity trackers, app, and text messages. Delivery Methods Text messaging, e-mail, phone calls, supervised exercise, in-person session to set PA goals, Web site, Facebook, phone app, printed materials, group setting Dose Ranges Duration: 2 wk to 6 mo	mHealth interventions in conjunction with personal contact components can lead to significant increases in MVPA among those living with and beyond cancer based on seven out of eight (87.5%) controlled trials with either low-risk of bias [5 articles] or moderate risk of bias [2 articles].
Liu et al. (2022) Level 2a—Systematic review and meta-analysis RoB Low Setting Community & home	Participants N = 1,966 participants (n = 1,054 intervention group, n = 912 control group) with breast cancer. 16/19 trials: mean age 52.7 yr; 6/19 included all stages of BC; 13/19 early stage or nonmetastatic cancer only; 14/19 reported cancer stage: stage 0 = 4%, stage I = 38%, stage II = 43%, stage III = 15%, and stage IV = 1%; 8/19 (47%) trials were conducted while participants underwent active treatment with the remaining conducted after completion of active treatment Number of Articles 40 articles using a randomized or quasi-randomized design with control groups Databases Searched MEDLINE, EMBASE, PsycINFO, the Cochrane Library, CINAHL, Web of Science, and Scopus online databases Outcome(s) of Interest Physical activity measured with questionnaires or objective activity trackers Intervention(s) of Interest 19/19 included home-based physical activity 6/19 center-based exercise component, 9/16 telephone calls, 5/19 group discussion, 2/19 combination of individual counseling session and group discussion, 2/19 online/e-mail delivery 2/19 written material alone, 1/19 training nurses to engage with participant during treatment visits. Theoretical Lens Twelve (63%) trials reported using theory to develop the intervention, and eight trials (42%) reported using theory to tailor the intervention to participants. The most frequently applied techniques included those associated with goals and planning (n = 18), shaping of knowledge (i.e., education and instruction) (n = 18), feedback and monitoring (n = 17), comparisons of outcomes (e.g., pros and cons) (n = 17), repetition and substitution (n = 14), social support (n = 11), and associations (e.g., prompts and cues) (n = 10). Delivery Methods Telephone, group, one-on-one professional or research assistant, e-mail, printed materials; group discussions (5), phone calls (9), a combination of individual counseling sessions and group discussions (2), nursing engagement (1) Dose Ranges Duration: 12 wk to 8 mo (mean 16.5 wks)	Pooled postintervention effect estimates showed medium effect size of improvement in self-reported physical activity, objectively measured physical activity, and physical function. At follow-up assessments (range 4 mo to 5 yrs., majority 6 mo), there was only a small effect size for improvement that was made for self-reported physical activity.

Note. BC = breast cancer; CINAHL = Cumulative Index to Nursing and Allied Health Literature; MET = Metabolic Equivalent of Task; mHealth = mobile health interventions; MVPA = moderate to vigorous physical activity; PA = physical activity; RCT = randomized clinical trial; RoB = risk of bias.

Bottom Line for Occupational Therapy Practice

OTPs can treat adults living with and beyond cancer with a focus on lifestyle changes and health management interventions aiming to increase physical activity, thus reducing the impact of side effects and improving overall occupational performance. In the included studies, for women with breast cancer, the use of motivational strategies and behavior-change theories and approaches provided a positive effect on change in physical activity. Particularly, OTPs could integrate common behavior change techniques such as goal setting and revision, planning, monitoring physical activity levels, and shaping knowledge through feedback to change physical activity. OTPs could apply motivational improvement strategies to improve health outcomes over time. Specifically, a combination of behavioral change-based strategies such as pedometers and counseling, print material, and/or motivational interviewing in OT intervention is recommended to improve adherence to physical activity in women with breast cancer. Mobile health interventions (mHealth) that include personal contact components are likely more effective in increasing physical activity than mHealth interventions without such components among those with cancer. Therefore, OTPs could integrate mHealth interventions that include personal contact components such as in-person sessions, phone calls, or group consultations alongside activity trackers and apps to increase the physical activity of those living with and beyond cancer.