Background
Aim
Method
Search strategy
Data extraction
Synthesis of results
Risk of bias
Results
Study selection
Study | Participants; mean age; cancer type; time since diagnosis | Intervention (type, intensity, duration) | Study design and evaluation | Outcomes | Results | Retention |
---|---|---|---|---|---|---|
PA-only studies | ||||||
Country: Australia |
Participants: N = 330
Mean age: 55 years
Cancer type: breast
Time since diagnosis: 41 months since active treatment (SD = 39) |
G1: Standard recommendation control group received national PA guidelines brochure
G2: tailored-print: computer-tailored A4 4-page newsletters (3)
G3: targeted-print intervention: 54-page A5 booklet “Exercise for Health” (1)
Type: aerobic PA, at least moderate intensity, for 30 min or more on most days of the week. In G2 and G3, participants were also encouraged to perform resistance training exercises 1–3 times per week
Intensity: G2 had 3 newsletters over 12 weeks. G3 had 1 mailout over 12 weeks
Duration: G2 received one newsletter each 6 weeks |
Study design: 3 arm RCT
Follow-up: 4, 10 months
Comparison group: usual care |
Outcome measures: Godin leisure time PAa, adherence to meeting aerobic and resistance training guidelines, mean daily steps (pedometer) |
Primary: G2 reported statistically significant effect on self-reported resistance activity (P < 0.01) and on meeting the resistance training guidelines (P < 0.01). G2 and G3 reported nonsignificant improvements to self-reported aerobic activity. There was no significant effect for meeting the aerobic PA guidelines
Other behaviors: nonsignificant increase in step counts for G2 and G3 participants. G1 step counts decreased | 90 % (n = 299) |
Valle et al. [56]
Country: USA |
Participants: N = 86
Mean age: 31.7 years
Cancer type: 31 % hematologic; 20 % breast; 15 % gynecologic
Time since diagnosis: 58.2 months (SD = 44.0) |
G1: Facebook-based self-help comparison group
G2: Facebook-based intervention group with weekly behavioral lesson on PA and behavioral strategies (12) (FITNET)
Type: 150 min of moderate intensity PA per week
Intensity: 12 weekly behavioral lessons (sent via Facebook message), discussion questions posted on Facebook (16 total), resources and reminders each posted once per week (24)
Duration: minimum of 4 contacts per week over 12 weeks |
Study design: 2 arm RCT
Follow-up: 12 weeks
Comparison group: self-directed Facebook group |
Outcome measures: Godin leisure time exercise questionnairea, intervention adherence and acceptability |
Primary: significant difference between groups in estimated change in light PA mins per week over 12 weeks. G2 participants reported increases in mins of moderate to vigorous PA and total PA; however, these were not significant | 77 % (n = 66) |
Country: not explicitly stated. Authors based in Illinois, USA |
Participants: N = 41
Mean age: 53 years
Cancer type: breast
Time since diagnosis: 34 months since surgery (0.7–134) |
G1: wait-list control
G2: discussion group sessions (6), individual-supervised exercise (12), individual face-to-face counseling (3), transition to home-based program
Type: moderate intensity with the aim of building up to 150 min of moderate walking per week
Intensity: 21 sessions over 3 months
Duration: multiple exposure (minimum weekly) |
Study design: 2 arm RCT
Follow-up: 3, 6 months
Comparison group: wait-list control |
Outcome measures: total activity countsa, steps, mins of moderate-vigorous PA (accelerometer); Godin leisure time PA |
Primary: significant increase in total activity counts (mean difference = 72,103). Effect size d = 1.02 (P = 0.004) as measured by accelerometer at 3 months and remained significant at 6 months (mean difference = 61,651; P = 0.06)
Other behaviors: significant increase in moderate and vigorous minutes (d = 0.57; d = 0.54 (P = 0.09)). Nonsignificant increase in self-reported moderate and vigorous activity (d = 0.16; P = 0.63) | 92 % (n = 38) |
Country: not explicitly stated. Authors based in Rhode Island, USA |
Participants: N = 86
Mean age: 53 years
Cancer type: early stage breast cancer
Time since diagnosis: 1.74 years (SD 1.49) |
G1: contact control, weekly phone call and cancer survivorship written sheets
G2: weekly telephone counseling (12) and customized written feedback (4), home exercise logs, pedometer
Type: moderate intensity PA (55–65 % of maximum heart rate) walking gradually building up to goal of 30 min of accumulated PA per day on at least 5 days per week
Intensity: 16 contacts over 3 months
Duration: multiple exposure (minimum weekly) |
Study design: 2 arm RCT
Follow-up: 12 weeks, 6 months, 9 months
Comparison group: attention control |
Outcome measures: 7 day PA recalla, 1 mile walk testa, accelerometera, percentage of body fat (skinfold thickness)a, body mass indexa
|
Primary: significant increase in mins of PA, and 1 mile walk test (P < 0.001). Significant between group differences were evident for total mins of PA on 7 day PA recall (P < 0.001), higher weekly mins of moderate intensity PA (P < 0.001), higher total energy expenditure (P < 0.001) at 12 weeks No difference in body mass index or percentage of body fat
Other behaviors
| 95 % (n = 82) |
Bennett et al. [57]
Country: not explicitly stated. First author based in New Zealand; co-authors based in Portland, USA |
Participants: N = 56
Mean age: intervention 56 years; control 60 years
Cancer type: any
Time since diagnosis: 4.8 years (SD 3.0) intervention |
G1: contact control
G2
: single face-to-face counseling (30 min) with 3 follow-up telephone calls (20 min per call), pedometer
Type: physical activity aim to reach 30 min of moderate intensity PA on most days of week
Intensity: 4 contacts over 18 weeks
Duration: multiple exposure (at least 2 weeks apart) |
Study design: 2 arm RCT
Follow-up: 3, 6 months
Comparison group: attention control |
Outcome measures: Community Healthy Activities Model Program for Seniors (CHAMPS) (caloric expenditure per week in kilocalories per week)a
|
Primary: significant increase in PA at 6 months (d = 0.55; P < 0.05) with a difference in PA increase over time of 1159 kcal per week between the two groups
Other behaviors
| Intervention. 71.4 % (n = 20); control, 92.9 % (n = 26) |
Matthews et al. 2007 [58]
Country: USA |
Participants: N = 36
Mean age: intervention 51 years; control 57 years
Cancer type: postmenopausal breast
Time since diagnosis: 0.9 years (range 0.7–1) intervention |
G1: wait-list control
G2: face-to-face behavioral counseling (1) and telephone counseling (5)
Type: walking (moderate intensity) building from 20 to 30 min per session, 3 times per week to 30–40 min per session, 5 times per week
Intensity: 6 sessions over 12 weeks
Duration: decreasing frequency over 12 weeks. Face-to-face counseling (30 min). Telephone counseling (10–15 min per call) |
Study design: 2 arm RCT
Follow-up: 6, 12 weeks
Comparison group: wait-list control |
Outcome measures: Community Healthy Activities Model Program for Seniors (CHAMPS) (energy expenditure MET-h per week)a, accelerometer (subsample only), 21-item diet habits questionnaire, 19-item fruit and vegetable screener |
Primary: significant increase in self-reported walking (P = 0.01), MET-h per week (P = 0.01) with difference of 10.2 MET-h per week of walking at 12 weeks between the groups
Other behaviors: No significant changes to fruit and vegetable consumption and overall dietary habits and no significant changes were noted, although the data was not shown | Not reported |
Ligibel et al. [49]
Country: USA |
Participants: N = 121
Mean age: 54 years
Cancer type: breast, colon or rectal cancer
Time since diagnosis: not reported |
G1: usual care, offered one consultation with exercise trainer
G2: semistructured telephone counseling and participant workbook
Type: physical activity
Intensity: 10–11 semistructured telephone calls (30–45 min each) over 16 weeks
Duration: decreasing frequency over 16 weeks |
Study design: 2 arm RCT
Follow-up: 16 weeks
Comparison group: usual care |
Outcome measures: 7 day PA recall interview (change in minutes of weekly PA)a
|
Primary: nonsignificant increase in physical activity minutes per week by 40 min (P = 0.13), and MET-h per week by 2 h (P = 0.23)
Other behaviors
| Intervention, 79 % (n = 48); control, 85 % (n = 51) |
Wang et al. [52]
Country: Taiwan |
Participants: N = 72
Mean age: 50 years
Cancer type: newly diagnosed breast, scheduled to start chemotherapy
Time since diagnosis: First meeting is 24 h prior to participant surgery |
G1: usual care
G2: weekly telephone call and weekly individual face-to-face meetings (heart rate monitor, pedometer, exercise diary, and role model story)
Type: home-based walking program of low to moderate intensity from 40 to 60 %, 3 to 5 times per week, at least 30 min per session or the accumulation of 30 min per session
Intensity: 12 telephone and face-to-face contacts over 6 weeks
Duration: 2 sessions per week |
Study design: 2 arm RCT
Follow-up: 24 h prior to day 1 of chemotherapy, the day of chemotherapy mid-cycle, 6 weeks
Comparison group: usual care |
Outcome measures: exercise behavior (Godin leisure time questionnaire)a
|
Primary: significant increases in physical activity at all follow-up time points for the intervention group (all P < 0.05). The difference between the groups was 62.7, 58.2, and 38.8 min at the second, third, and fourth follow-up (P < 0.001)
Other behaviors
| Intervention, 86 % (n = 30); control, 86 % (n = 32) |
Pinto et al. [53]
Country: USA |
Participants: N = 46
Mean age: 57 years
Cancer type: colon or rectal cancer
Time since diagnosis: 3.1 years (SD 1.6) (intervention) |
G1: contact control group offered written material at study completion
G2: one face-to-face appointment, one weekly telephone call (12), weekly PA and cancer survivorship tip sheet (12), feedback letter summarizing progress (4), pedometer
Type: moderate intensity home-based PA with goal to perform moderate intensity activity aerobic activities at 64–76 % of estimated maximum heart rate
Intensity: 29 contacts over 12 weeks
Duration: 2 contacts per week minimum |
Study design: 2 arm RCT
Follow-up: 3, 6, 12 months
Comparison group: contact control, offered written materials at study completion |
Outcome measures: 7 day PA recall (self-reported PA)a, Community Healthy Activities Model Program for Seniors (CHAMPS), accelerometer |
Primary: Significant increase in PA at 3 months in intervention (d = 1.93) (P = 0.02), but increases were not maintained at 6 and 12 month follow-ups. There was a significant difference between groups at 3 months by 117 min/week (P < 0.05) but not at 6 or 12 months
Other behaviors
| Intervention, 95 % (n = 19); control, 88 % (n = 23) |
Hatchett et al. [48]
Country: not explicitly reported. Lead author: Mississippi, USA |
Participants: N = 85
Mean age: not reported
Cancer type: breast cancer
Time since diagnosis: 44 % between 0 and 20 months; 27 % between 21 and 40 months; 19 % between 41 and 70 months |
G1: wait-list control
G2: email messages (8), access to an e-counselor (experienced exercise physiologist)
Type: physical activity (emails focused on changing SCT constructs)
Intensity: total 8 email messages, weekly for 5 weeks, then fortnightly for next 6 weeks
Duration: once per week (5 weeks), then fortnightly for 6 weeks for a total of 8 messages over 12 weeks |
Study design: 2 arm RCT
Follow-up: 6, 12 weeks
Comparison group: wait-list control |
Outcome measures: 7 day PA recalla
|
Primary: At 12 weeks, for total days of exercise, there was a significant difference between the groups (P < 0.001) with the intervention reporting 2.05 more days of exercise compared to the control group (P < 0.001)
Other behaviors
| Intervention, 88.4 % (n = 38); control, 85.7 % (n = 36) |
Diet only | ||||||
Parsons et al. [59]
Country: USA |
Participants: N = 43
Mean age: 64 years
Cancer type: prostate
Time since diagnosis: not reported—receiving only active surveillance as treatment |
G1: standard care control
G2: telephone counseling
Type: diet (7 servings/day vegetables; 2 servings/day whole grains, 1 serving/day beans/legumes)
Intensity: total of 13 sessions
Duration: 13 structured telephone counseling sessions over 6 months. Call duration of 25–50 min |
Study design: 2 arm RCT
Follow-up: 6 months
Comparison group: usual care |
Outcome measures: 24 h dietary recalla, blood samples (plasma carotenoid concentration)a
|
Primary: Total vegetable and tomato product intake significantly increased in the intervention (P < 0.05). No significant changes in fruit, whole grain, beans, grams of fiber per day, or fat intake
Other behaviors
| 96.7 % (n = 42) |
Multiple behavior studies | ||||||
Demark-Wahnefried et al. STRENGTH trial [60]
Country: USA |
Participants: n = 90
Mean age: 41.8 years
Cancer type: premenopausal breast
Time since diagnosis: not reported, intervention occurs during chemotherapy |
G1: attention control (calcium-rich diet)
G2: calcium-rich diet and exercise (telephone counseling contacts (14), exercise equipment, heart rate monitor, workbook, videotape)
G3: calcium-rich diet and exercise and high fruit and vegetable, low-fat diet (resources provided to G2 + encouraged to maintain high fruit and vegetable, low-fat diet to reduce energy density of the diet). Goal levels of <20 % of energy from fat, and >5 servings fruit and vegetables per day
Type: diet (high fruit and vegetable, low fat) and exercise (aerobic and strength training) (aerobic exercise >3 times/week, strength training every other day)
Intensity: multiple contacts (at least fortnightly)
Duration: 14 telephone counseling contacts (10–30 min) over 6 months |
Study design: 3 arm RCT
Follow-up: 3, 6 months
Comparison group: attention control |
Outcome measures: % body fat (whole body DXA scans)a, 144-item diet history questionnaire, Longitudinal Study Physical Activity Questionnaire (MET-h/week), accelerometer (kcal/day) |
Primary: Consistent increases for all measures of adiposity were observed over time and among all groups. G3 had significantly lower scores for % of body fat (minus the trunk) (P < 0.05)
Other behaviors: no significant changes in physical activity over time or between study arms There were no differences in energy intake among study arms. However, G3 exhibited higher fruit and vegetable intakes (by 1.7 serves) and lower fat intakes (reduction of 5.2 % calories from fat) at 6 months | 91.2 % (n = 82) |
Country: USA |
Participants: N = 922 (n = 266 colorectal cancer survivors)
Mean age: 66.5 years
Cancer type: colorectal cancer
Time since diagnosis: 7.6 %: less than 1 year ago; 29 %: 1–2 years ago; 57 %: 2–5 years ago |
G1: generic health education (2 mailings) and tailored-print newsletters (4) after follow-up completed
G2: 4 tailored-print newsletters
G3: 4 telephone calls (20 min duration)
G4: 4 tailored-print newsletters +4 telephone calls (20 min duration)
Type: diet, physical activity, colorectal cancer screening
Intensity: multiple exposure (less than monthly)
Duration: 1 year |
Study design: 4 arm RCT. 2 × 2 design—stratified by colorectal cancer and noncolorectal cancer status
Follow-up: 6, 12 months
Comparison group: usual care with tailored newsletters at study completion |
Outcome measures: modified Block Food Frequency Questionnaire (36 item)a, 2-item fruit and vegetable screening questionsa, modified 7 day PA recall (moderate to vigorous PA score) |
Primary: There were no significant changes in fruit and vegetable consumption in colorectal cancer survivors, using the Food Frequency Questionnaire. There was a nonsignificant increase in G2 intervention by a mean of 1.0 serves/day Using the 2-item screening questions, all 3 intervention groups showed statistically significant increases among colorectal cancer survivors
Other behaviors: No significant change on physical activity, and participants in all 4 groups were less active at follow-up compared to baseline | 79.7 % (n = 735) from total sample |
Country: USA |
Participants: N = 45
Mean age: 55 years
Cancer type: endometrial cancer
Time since diagnosis: 20.6 months median (intervention) |
G1: standard care
G2: face-to-face group sessions, telephone, or written newsletters
Type: weight loss, PA, eating behaviors
Intensity: weekly contact
Duration: total of 21 sessions of face-to-face (11), telephone (5), written newsletters (5) over 6 months |
Study design: 2 arm RCT
Follow-up: 3, 6, 12 months
Comparison group: usual care |
Outcome measures: weight change (kilograms)—measureda, PA using Leisure Score Index of the Godin leisure time exercise questionnaire (frequency per week on Leisure Score Index for mild, moderate, strenuous PA), 3 day food record (vitamin C and folate as marker of fruit and vegetable intake, kilocalories) |
Primary: The mean difference in weight change between the two groups was −4.9 kg (P = 0.018) at 12 months. The control group did not demonstrate any significant changes in weight from baseline. Mean weight change expressed as a percentage from baseline to 12 months was −3.1 % in the intervention compared to 1.0 % in the control group (mean difference −4.1 %, P = 0.020)
Other behaviors: At 12 months, there was a significant difference in Leisure Score Index between groups (mean group difference 17.8, P = 0.002) There were no significant changes in diet. The intervention group had a lower energy intake (kilocalories) but was not statistically significant from the control group | Intervention, 78 % (n = 18); control, 90 % (n = 20) |
Von Gruenigen et al. [67]
Country: USA |
Participants: N = 75
Mean age: 58.0 years
Cancer type: endometrial cancer
Time since diagnosis: 20.7 months |
G1: standard care
G2: face-to-face group sessions, individual physician counseling, newsletters, telephone, and email contact with registered dietician. Received pedometer, heart rate monitor, hand and ankle weights
Type: weight loss, PA, resistance exercises, diet quality
Intensity: weekly (10), then biweekly (6) group sessions. Physician counseling at 3, 6, and 12 months
Duration: minimum of 19 contacts for 12 months |
Study design: 2 arm RCT
Follow-up: 3, 6, 12 months
Comparison group: standard care received one information brochure |
Outcome measures: measured weighta and height, waist circumference, hip circumference, Godin leisure time exercise questionnaire, 2 × 24 h dietary recalls, pedometer step counts |
Primary: significant differences for weight change from baseline to 3, 6, and 12 months (P < 0.001). Mean (95 % CI) difference between groups at 6 months was −4.4 kg [−5.3, −3.5], P < 0.001 and at 12 months was −4.6 kg [−5.8, −3.5], P < 0.001. Mean percent weight change in the intervention was −4.1 % as compared to −0.8 % in controls at 6 months and −3.0 % and +1.4 % at 12 months
Other behaviors: mean (95 % CI) difference in change at 6 months was 100 min per week [6, 94], P = 0.038 and at 12 months was 89 min per week [14, 163], P = 0.020. Mean change in pedometer step counts from baseline to 6 months was 2353 in the intervention group versus −9.4 steps per day in the usual care group (difference of [95 % CI] of 2362 (494, 4230); P = 0.015) Mean difference in change in total fruit and vegetable intake was 0.91 servings per day (P < 0.001) at 6 months and 0.92 (P < 0.001) at 12 months. Mean difference in change in kilocalories between groups was −228.8, −217.8, and −187.2 kcal at 3, 6, and 12 months (P < 0.001) | 78.7 % (n = 59). Intervention, 85.4 % (n = 35); control, 70.6 % (n = 24) |
Demark-Wahnefried et al. [62]; Demark-Wahnefried et al. [63]; Mosher et al. [78]; Wilkinson et al. [113]; Christy et al. [74].—FRESH START
Country: USA |
Participants: N = 543
Mean age: 57 years
Cancer type: breast, prostate
Time since diagnosis: 3.83 months (SD 2.74) |
G1: attention control
G2: tailored-print newsletters and workbook
Type: diet and physical activity
Intensity: initial workbook and (6) tailored newsletters every 7–9 weeks for 10 months
Duration: total of 7 contacts for 10 months |
Study design: 2 arm RCT
Follow-up: 1 year, 2 years
Comparison group: attention control |
Outcome measures: number of goal behaviors practiced (percentage adopting goal behavior in at least 2 areas)a, 7 day PA recall, diet history questionnaire, Diet Quality Index mean score |
Primary: both arms significantly improved their lifestyle behaviors (P < 0.05). Significant difference between groups in practice of 2 or more goal behaviors (P < 0.0001) (16 % greater in intervention participants)
Other behaviors: significant differences between groups in exercise minutes per week (P = 0.02) (+20 min/week intervention), fruit and vegetables per day (P = 0.01) (+0.5 servings intervention), total fat (P < 0.0001) (−2.3 % intervention), saturated fat (P < 0.0001) (−1.0 %) | Intervention, 93.4 % (n = 253); control, 97.8 % (n = 266) |
Djuric et al. [64]
Country: USA |
Participants: N = 40
Mean age: 52 years
Cancer type: breast
Time since diagnosis: not reported although either scheduled for or starting chemotherapy in the next 2 weeks |
G1: control group received written diet and physical activity materials and pedometer (same as G2), and bimonthly study newsletters
G2: written diet and physical activity materials, pedometer, telephone counseling (by a dietician trained in motivational interviewing)
Type: high fruit and vegetable, low-fat diet, weight control, 30 min per day of moderate-to-vigorous PA
Intensity: multiple contacts (at least monthly)
Duration: total of 19 calls, written materials, and pedometer, over 12 months |
Study design: 2 arm RCT
Follow-up: 6, 12 months
Comparison group: attention control with written materials and pedometer (same as the intervention group) |
Outcome measures: measured weight and body fata, 19-item fruit and vegetable screener, 17-item percentage of energy from fat, 24 h diet recall, Women’s Health Initiative validated PA questionnaire |
Primary: the percentage of body fat increased by 1.2 % in the control group and decreased by 0.07 % in the intervention group. Weight decreased by 0.8 kg at 12 months
Other behaviors: Total physical activity increased to a mean of 364 min per week and moderate/vigorous activity increased to a mean of 315 min per week at 12 months, slightly below the target of 350 min per week of moderate/vigorous activity. For fruit and vegetable intakes from unannounced recalls, the number of servings/day increased only in the telephone arm, and the mean reported intake at 12 months was just above the minimum intervention goal of 7 servings per day, not counting potatoes. There was a significant increase in fruit and vegetable servings by 3.1 serves from baseline to 12 months | Intervention. 65 % (n = 13); control. 85 % (n = 17) |
Djuric et al. [66]
Country: USA |
Participants: N = 48
Mean age: mean: 51.7 years Cancer type: breast
Time since diagnosis: not reported—although needed to have been diagnosed within the past 4 years |
G1: standard care
G2: weight watchers (free coupons to attend each week) (52)
G3: telephone counseling by dietician (24 calls), and mailed written material (12) G4: weight watchers free coupons (52), dietician-delivered telephone counseling (24), mailed written material (12)
Type: weight loss goal (10 % baseline weight over 6 months) by decreasing energy and fat intake, and 30–45 min moderate activity most days of the week
Intensity: multiple contacts (minimum monthly)
Duration: Total contacts varied from 36 (G3), 52 (G2), 88 (G4), in 12 month intervention |
Study design: 4 arm RCT
Follow-up: 3, 6, 12 months
Comparison group: usual care |
Outcome measures: weighta, 3 day food record, physical activity logs (self-reported intentional exercise) |
Primary: significant difference in weight loss at 12 months for participants in G3 (mean 8 kg loss) and G4 (mean 9.4 kg loss). There was a nonsignificant loss of 2.5 kg in G2, and an increase of 0.85 kg in G1 (control group)
Other behaviors: nonsignificant decreases in energy intake (kilocalories per day) in each of the three intervention groups (by 447–616 kcal per day), and nonsignificant decrease in fat intake (% of energy from fat) in the 3 intervention groups (by 2–11 %) at 12 months. The control group energy intake remained the same (decrease of 126 kcal per day), and increased fat intake (by 7 %) There was no difference in weight loss between women who self-reported intentional exercise (beyond daily activities), and those who reported no intentional activities in each study group | 81.3 % (n = 39) |
Risk of bias assessment
Study | (a) Selection bias | (b) Study design | (c) Confounders | (d) Blinding | (e) Data collection method | (f) Withdrawals and dropouts | Global rating |
---|---|---|---|---|---|---|---|
PA-only studies | |||||||
Weak | Strong | Strong | Moderate | Strong | Strong | Moderate | |
Valle et al. [56] | Weak | Strong | Strong | Moderate | Strong | Moderate | Moderate |
Moderate | Strong | Moderate | Moderate | Strong | Strong | Strong | |
Moderate | Strong | Strong | Moderate | Strong | Strong | Strong | |
Bennett et al. [57] | Weak | Strong | Strong | Weak | Strong | Moderate | Weak |
Matthews et al. [58] | Weak | Strong | Strong | Weak | Moderate | Weak | Weak |
Ligibel et al. [49] | Moderate | Strong | Strong | Moderate | Strong | Moderate | Strong |
Wang et al. [52] | Moderate | Strong | Strong | Moderate | Strong | Strong | Strong |
Pinto et al. [53] | Weak | Strong | Strong | Moderate | Strong | Strong | Moderate |
Hatchett et al. [48] | Moderate | Strong | Strong | Moderate | Strong | Strong | Strong |
Diet only | |||||||
Parsons et al. [59] | Moderate | Strong | Weak | Moderate | Strong | Strong | Moderate |
Multiple behavior studies | |||||||
Demark-Wahnefried et al.—STRENGTH [60] | Strong | Strong | Strong | Moderate | Strong | Strong | Strong |
Campbell et al. [61] | Weak | Strong | Strong | Moderate | Strong | Strong | Moderate |
Weak | Strong | Strong | Moderate | Strong | Moderate | Moderate | |
Von Gruenigen et al. [67] | Weak | Strong | Strong | Weak | Strong | Moderate | Weak |
Weak | Strong | Strong | Moderate | Strong | Strong | Moderate | |
Djuric et al. [64] | Weak | Strong | Strong | Moderate | Strong | Moderate | Moderate |
Djuric et al. [66] | Weak | Strong | Weak | Moderate | Strong | Strong | Weak |
Physical activity trials
Participants
Intervention characteristics
Outcome assessment
Meta-analysis of SCT intervention effects on physical activity
Diet-only trial
Multiple behavior trials
Participants
Intervention characteristics
Outcome assessment
Theoretical framework
SCT construct | Behavior change technique number | Behavior change technique description |
---|---|---|
Knowledge | 1 | Provide information on consequences of behavior in general |
2 | Provide information on consequences of behavior to the individual | |
Self-efficacy | 16 | Prompt self-monitoring of behavior |
17 | Prompt self-monitoring of behavioral outcome | |
21 | Provide instruction on how to perform the behavior | |
22 | Model/demonstrate the behavior | |
26 | Prompt practice | |
27 | Use of follow-up prompts | |
Goals | 5 | Goal setting (behavior) |
6 | Goal setting (outcome) | |
7 | Action planning | |
10 | Prompt review of behavioral goals | |
11 | Prompt review of outcome goals | |
Outcome expectations | 16 | Prompt self-monitoring of behavior |
17 | Prompt self-monitoring of behavioral outcome | |
23 | Teach to use prompts/cues | |
24 | Environmental restructuring | |
28 | Facilitate social comparison | |
29 | Plan social support/social change | |
31 | Prompt anticipated regret | |
35 | Relapse prevention/coping planning | |
Facilitators/impediments | 8 | Barrier identification/problem solving |
18 | Prompting focus on past success | |
29 | Plan social support/social change |
Study | Theoretical basis | SCT constructs operationalized | How constructs were operationalized | Constructs measured (no. of items) | Results |
---|---|---|---|---|---|
PA-only trials | |||||
One intervention group (G2) received computer-tailored newsletters based on SCT G3 (targeted-print) intervention received a Theory of Planned Behavior-based booklet (previously evaluated) | Knowledge of PA guidelines, beneficial outcomes of PA, action planning, feedback on PA performance, social support, role modeling, physical environment | G2: tailored-print newsletters (n = 3) tailored using information from individual assessments at baseline, and “update cards” assessing PA and goal setting behavior over the last month. Newsletter 1 strategies were advice for meeting the PA guidelines for cancer survivors, information about the beneficial outcomes of PA, advice on exercising safely, and action planning. Newsletter 2 strategies were expert advice from a behavior change expert, feedback on PA performance, a testimonial, advice on enhancing social support, and action planning. Newsletter 3 contained expert advice from an exercise physiologist, feedback on PA performance, tips on changing the PA environment, information on gaining further support, and action planning | Outcome expectations (11 items); outcome expectancies (1 item); task self-efficacy (7 items); barrier self-efficacy (17 items); behavioral capability (6 items); social support (15 items); perceived built environment (7 items); self-regulation (12 items); action planning (4 items) | Not reported | |
Valle et al. [56] | SCT with focus on strategies to enhance self-efficacy, behavioral capability, self-monitoring, and social support | Social support, problem solving, self-monitoring, maintaining PA, goal setting, personalized feedback | FITNET intervention goal was to meet PA recommendation for cancer survivors (150 min moderate intensity PA/week). Behavioral capability was operationalized through links to publicly available websites related to PA and/or cancer survivorship, 12 weekly Facebook messages with expanded behavioral lessons on PA topics and behavioral strategies; self-efficacy was operationalized by pedometer which provides feedback on daily walking, website with weekly goal setting and charts providing feedback on performance relative to weekly exercise goal, previous weeks and overall intervention goal; self-monitoring was operationalized with a pedometer to monitor steps, website with diary to record walking steps and PA type, duration, and intensity; and social support was operationalized through the Facebook group with moderated discussion prompts to encourage support, links, and weekly reminders | None reported | |
SCT self-efficacy, emotional coping, reciprocal determinism, perceived barriers, outcome expectations, behavioral capability, goal setting, environment, observational learning, and self-control | Social support, exercise barriers, self-efficacy, goal setting, environment, self-monitoring, barrier self-efficacy, task self-efficacy, barrier interference, outcome expectations, value (outcome importance), enjoyment, fear of exercise, role model, exercise partner | Participants attended 6 discussion group sessions with a clinical psychologist who encouraged social support, provided breast cancer survivor exercise role models, and covered the following topics: journaling, time management, stress management, dealing with exercise barriers, and behavior modification. The specific SCT constructs addressed by the group sessions included self-efficacy, emotional coping, reciprocal determinism, perceived barriers, outcome expectations, behavioral capability, goal setting, environment, observational observational learning, and self-control. Participants also attended 12 individual supervised exercise and 3 individual “face-to-face” update counseling sessions with an exercise specialist that tapered to a home-based program by the end of the intervention. The specific SCT constructs addressed by the individual sessions included self-efficacy, outcome expectations, behavioral capability, perceived barriers, and goal setting with self-monitoring. To further enhance self-monitoring, participants were encouraged to “convert” the minutes spent in PA recorded on their weekly exercise logs into “miles” (i.e., 1 min = 2 miles), which were graphed on a map | PA stage of change (5 items); barrier self-efficacy (9 items); task self-efficacy (4 items); barrier interference (21 items); social support (4 items), positive expectations (14 items); negative outcome expectations (3 items); fear of exercise (1 item); PA enjoyment (1 item); exercise role models (3 items); exercise partner (1 item) | Medium-to-large effect size increase was noted for stage of change (mean difference = 0.95; 95 % CI = 0.75–1.83; d = 0.71; P = 0.034). Compared with usual care, the intervention group reported lower barriers interference (mean difference = −7.8; P = 0.04) and greater PA enjoyment (mean difference = 0.7; P = 0.06). Statistically nonsignificant small-to-medium positive effect size increases were noted for barrier self-efficacy, family social support, and total social support, while positive outcome expectations, negative outcome expectations, and negative outcome values demonstrated small-to-medium negative effect size changes for the intervention compared to the usual care group. Little to no change was noted for task self-efficacy, friend social support, importance of positive outcomes, fear of exercise, exercise partner, and role models
Mediation: Barriers interference mediated 39 % (P = 0.004) of the intervention effect on PA 3 months postintervention. PA enjoyment was not a significant mediator. Reducing barriers to PA partially explained intervention effect | |
Intervention based on transtheoretical model (TTM) and SCT. Pinto et al. 2005 [50] state that intervention is based on TTM only | TTM: counseling tailored to participant’s stage of readiness to change, SCT: self-efficacy, goals, PA barriers | Each PA participant received in-person instructions on how to exercise at a moderate intensity level, how to monitor heart rate, and how to warm up before exercise and cool down after exercise. They were given home logs to monitor PA participation and a pedometer. Each participant received a weekly telephone call over 12 weeks from research staff to monitor PA participation, identify relevant health problems, problem solve any barriers to PA, and reinforce participants for their efforts. Finally, a feedback letter summarizing the participant’s progress (e.g., number of PA sessions, average duration of each session, and the participant’s barriers to PA and suggestions to overcome them) was sent to the patient at weeks 2, 4, 8, and 12. At the weekly calls, subjects reported on the PA recorded on home logs, and they received feedback | Decisional balance pros and cons (16 items), exercise self-efficacy (5 items), stage of motivational readiness for PA (4 items) | No significant changes in decisional balance pros, decisional balance cons, or stage of change. Baseline self-efficacy was a significant positive predictor of mean minutes of weekly exercise (B = 79.46 min; P = 0.004), mean pedometer steps per week (B = 2636.9 steps; P = 0.0006) | |
Bennett et al. [57] | TTM and perceived self-efficacy from SCT | Self-efficacy, goals | During the initial counseling session, the participant was encouraged to identify barriers to engaging in regular exercise, and the PA counselor and the participant worked together to develop ideas to overcome barriers. A goal of 30 min of moderate intensity planned PA on most days of the week, but some participants started with more modest goals. Each intervention participant received a pedometer and was shown how to use it as a motivator for walking exercise, but participants were not required to walk if they preferred another form of moderate intensity exercise. Telephone calls were planned to last about 20 min, and the conversation included motivational strategies directed at solving problems, offering encouragement, and reformulating goals, if needed | Self-efficacy for regular PA (6 items); stage of change for exercise (6 items: baseline only) | Self-efficacy was tested as a moderator of intervention effects. Individuals with high self-efficacy in the intervention increased PA levels faster over 6 months than low self-efficacy individuals in the intervention group. In the control group, self-efficacy had no impact on PA levels (B = 121.35; P < 0.05) |
Matthews et al. [58] | Structured behavioral counseling grounded in SCT (using semistructured script) | Goals, PA enjoyment, positive reinforcement, self-reward, personal motivation, barriers, problem solving, social support, goal review, self-efficacy, self-monitoring | The initial counseling session emphasized goal setting and PA safety. Subsequent counseling calls were designed to monitor participant safety and enhance adherence through structured behavioral counseling that was grounded in SCT. A semistructured script was used by the counselors in each of the calls to initiate discussion with participants about their experience in meeting (or not) their walking goals that were agreed upon at the previous intervention contact. Taking their cues from the information provided by the participants in these conversations, the staff then delivered appropriate intervention messages. When participants met their goals, individualized positive reinforcement was provided in the form of a discussion of enjoyment associated with being active and relevant self-rewards. Discussion of personal motivations that helped the individual meet their walking goals was also emphasized. In contrast, if the participant did not meet their walking goals, the conversation naturally led to the barriers participants experienced in the period, and the counselor initiated a conversation about problem solving strategies that might help overcome anticipated barriers in the coming week(s). When appropriate, participants were encouraged to elicit social support from their family and friends that might help them meet their goals (e.g., a walking partner, help with other time commitments). Calls were ended with a recap of the conversation (by the counselor) that included a review of the agreed upon goal for the next week(s), a review of the behavioral issues that were discussed during the call (e.g., positive reinforcements or barriers/problem solving), and an indication of when the next counseling call would occur | None | |
Ligibel et al. [49] | SCT and client-centered counseling | Goal setting, self-efficacy, self-monitoring | Initial calls focused on goal setting and performance assessment so as to build self-efficacy for exercise behaviors, while later calls concentrated upon the adequacy of plans for relapse prevention. Each call reviewed performance on the behaviors previously discussed and encouraged the participant to keep using self-regulatory skills to achieve change. The telephone calls were supplemented by a Participant Workbook, which included additional information regarding the importance of exercise in cancer populations, guidelines for exercise safety, and journal pages to track weekly exercise. Participants were provided with a pedometer. Instructions for using the pedometer were included in the Participant Workbook and were reviewed during the first counseling session. Participants were asked to record the number of minutes of exercise they performed and steps they completed each day in journals, which were reviewed during the telephone counseling calls | Self-efficacy (5 items) | Intervention participants reported trends toward improvement in exercise self-efficacy (0.1 ± 1.2 vs −0.3 ( ± 0.8) (P = 0.06), as compared with controls |
Wang et al. [52] | Bandura’s self-efficacy theory | Self-efficacy | Discuss program with women and make their own weekly walking goal for exercise; encourage women to document weekly walking logs so they can see their own progress during the program; story telling/role model story in booklet; the researcher will make weekly phone calls to understand women’s feelings, the effects, and the countereffects of exercise, and will praise women’s performance and encourage women to keep progressing in the program for their personal goals; self-monitoring with the heart rate ring and pedometer during exercise; introduce the walking program with written material and verbal explanation by the researcher including warm up, cool down, and progressively increasing intensity, frequency, and duration over time | Exercise self-efficacy scale (18 items) | Subjects in the exercise group had significantly better exercise self-efficacy than those in the usual care group over the intervention period. At baseline, the intervention group was +13.5 points higher, and at time 4, the difference had increased to +31.3 (P < 0.001) |
Pinto et al. [53] | Transtheoretical model and the SCT | Self-efficacy, outcome expectations, stimulus control, reinforcement management, self-monitoring, goals, planning | Participants received in-person instructions on how to exercise at a moderate intensity level, how to monitor heart rate, and how to warm up before exercise and cool down after exercise. They were given home logs to monitor PA participation and a pedometer. Each participant received a weekly call over 12 weeks from research staff to monitor PA participation, identify relevant health problems, problem solve any barriers to PA, and reinforce participants for their efforts. Activity counseling was based on the transtheoretical model and the social cognitive theory and tailored to each participant’s motivational readiness. The counseling focused on strengthening self-efficacy for exercise, on setting realistic outcome expectations, and on training participants in using behavioral processes of change such as stimulus control and reinforcement management and in using techniques such as self-monitoring of exercise behavior, setting exercise goals, and planning for exercise. After the 12 week program was completed, monthly phone calls were provided for 3 months to reinforce progress, identify lapses from PA, and recover from any lapses that may have occurred. Finally, a feedback letter summarizing participants’ progress was sent at weeks 2, 4, 8, and 12 | Stage of motivational readiness for PA (5 items) | The intervention produced strong effects on participants’ motivational readiness at 3 months (OR = 5.26, 95 % CI = 1.32–20.93; P = 0.018) that were attenuated at 6 months (OR = 3.81, 95 % CI = 0.90–16.71; P = 0.070) and weakened further at 12 months (OR = 1.89, 95 % CI = 0.52–6.86; P = 0.335) |
Hatchett et al. [48] | SCT | Self-efficacy, goal setting, anticipated result of exercise, time management, self-monitoring, barriers, relapse prevention | The e-counselor offered advice regarding exercise and PA. The researchers believed that if a participant were asked to offer information regarding her behavior during the intervention, she would be more likely to engage in the desired behavior. The topics of each email are as follows: week 1: goal setting, anticipated result of exercise; week 2: goal setting, time management, self-monitoring; week 3: self-monitoring, description of an exerciser, overcoming barriers; week 4: self-monitoring, barriers to exercise; week 5: self-monitoring, overcoming barriers, describe the anticipated outcomes of exercise; week 7: goal setting, self-monitoring, time management, relapse prevention; week 9: overcoming barriers, goal setting, self-monitoring, time management, relapse prevention; week 11: properties of an exerciser, results of cancer | SCT variables: self-regulation (20 items); outcome expectancy values (19 items); exercise self-efficacy (14 items); exercise role identity (9 items) | Not reported |
Diet-only trials | |||||
Parsons et al. [59] | Strategies adopted from SCT | Not described | The principle strategy to promote dietary change in the intervention arm was a telephone counseling protocol with individualized, direct assistance tailored to each participant. The telephone counseling protocol followed a stepwise, phased approach that used strategies adopted from SCT. Motivational interviewing techniques were used to help participants assume and maintain responsibility for their behavioral change. No other details reported | Not reported | |
Multiple behavior trials | |||||
Demark-Wahnefried et al.—STRENGTH [60] | SCT (key concepts of promoting self-efficacy and behavioral monitoring) | Self-efficacy, behavioral monitoring | Written and verbal instruction based on SCT (key concepts of promoting self-efficacy and behavioral monitoring) (a workbook and telephone counseling). No other details reported | Confidence (self-efficacy) in making changes in their dietary or exercise practices (did not specify number of items) | Not reported |
TTM and SCT | Stages of change, social support, barriers to change, knowledge, role models, self-efficacy | G2 received tailored- print expert feedback driven by baseline data. G3 received motivational interviewing telephone calls that encouraged participants to overcome ambivalence and identify their own strategies for change. G4 received both the tailored-print feedback and motivational interviewing telephone calls | Self-efficacy—eating fruit and vegetables, and engaging in PA (2 items). Social support for healthy eating and exercise (4 items). Perceived barriers to behavior change (6 items), knowledge of recommendations (1 item) |
Mediation: None mediated dietary change. Higher self-efficacy was associated with greater fruit and vegetable consumption at both baseline and follow-up, but increase in self-efficacy did not predict greater change in fruit and vegetable consumption There were no intervention effects for colorectal cancer survivors | |
SCT | Establish short-term goals, build self-efficacy, reinforcement, individual progress toward goals, emphasis on long-term change, patient feedback | The protocol followed a stepwise, phased approach using strategies outlined by SCT, indicating that the optimal intervention for a major behavior change should focus on establishing short-term goals, and enabling the person to build self-efficacy. Participants were contacted by the research dietician by phone or newsletter every week that the group did not meet. Phone calls were structured in content and included reinforcement and discussion regarding the previous week’s topic. Participants were also given feedback on individual progress toward PA and nutrition goals. Newsletter topics included the following: holiday recipes, reinforcement of nutrition goals, ways to increase PA and step count, restaurant menu makeovers, and eating on the run | Self-efficacy using the Weight Efficacy Life-Style (WEL) questionnaire (20 items). Self-efficacy specific to eating behaviors in five situational factors: negative emotions, food availability, social pressure, physical discomfort, and positive activities | Significant difference in “social pressure” subscale (P = 0.03). Increase in self-efficacy related to negative emotions (P < 0.01), food availability (P = 0.03), and physical discomfort (P = 0.01) in those women who lost weight during the year. At 12 months, self-efficacy scores remained high (6 months after intervention had concluded). Morbidly obese patients had significantly decreased self-efficacy when feeling physical discomfort and decreased total self-efficacy score. There was a significant effect for self-efficacy related to social pressure and restraint improved. For self-efficacy related to negative emotions, there was a mean increase of 8.9 in women who lost weight versus 0.6 in those whose weight was stable or who had gained weight | |
Von Gruenigen et al. [67] | SCT with a focus on establishing short-term goals, enabling the person to build self-efficacy | The intervention followed a stepwise, phased approach with a focus on establishing short-term goals, enabling the person to build self-efficacy | Individual expert physician counseling, individual goal setting, goal reinforcement in newsletters, social support and eating in social situations, planning meals and grocery shopping, how to read food labels, pedometers provided feedback and reinforcement of PA goals. Incremental goals (for months 1–2, months 5–6), modeling of resistance exercise. The intervention focused on the adoption of lifelong changes rather than caloric restriction. Education and skill development to increase PA and PA self-efficacy were included using a guide previously developed for breast cancer survivors. Patients were encouraged to add activities that they enjoyed or to begin a walking program or other exercise activity. Long-term changes in everyday activities (for example, climbing stairs instead of taking elevators) and moderate aerobic activity were emphasized. Participants were given pedometers to provide immediate feedback and reinforcement to patients and to provide objective assessment of PA. Patients were given 3 lb hand and adjustable ankle weights and instructed in the proper form and procedure for performing resistance exercises. Heart rate monitors were provided to facilitate monitoring of target heart rate goals. Physician counseling visits (conducted by the PI) at 3, 6, and 12 months focused on nutrition and PA goals for SUCCEED participants in order to augment the group sessions and provide individualized attention | Not reported | |
SCT: cues to action, self-efficacy, skill development, goals, goal reinforcement. Messages were customized to stages of change (TTM) | Benchmark behavior, goal, behavior logs, behavioral cues, tailored to stages of change, goal, testimonial, overcoming barriers, benefits, progress to goal | The FRESH START intervention was based on the SCT that emphasizes confidence building and skills development; the transtheoretical model also was used to frame messages on participants’ stage of readiness to motivate behavior change. Participants are encouraged to set small incremental goals, which, when achieved, are reinforced to build self-efficacy. To build upon self-efficacy incrementally, participants are assisted in making changes in one behavioral domain at a time. Participants are first assigned the behavior with the highest self-efficacy score, and behaviors with lower scores are presented subsequently (with the premise that after the participant achieves successful behavior change in the first area, he or she can generalize this success to the next health domain). In situations where self-efficacy scores are equal for the two behaviors, the most advanced stage of readiness will dictate the first domain targeted. For participants reporting 3 deficient behavioral areas, the initial intervention materials target the behavior associated with the highest self-efficacy score, and the second behavioral area is selected at random. In the initial mailing, participants receive a personalized workbook that includes the first unit materials, and a second installment of workbook materials arrives midway through the intervention. For each unit, the first page is a feedback form in which the participant’s behavior is compared with goal behavior, and encouragement is provided to achieve the goal. Each installment of the workbook includes personalized behavior record logs that correspond to the content areas to help participants track behavior (to promote change and improve self-reporting accuracy). In addition, each installment of the workbook includes items that serve as behavioral cues [i.e., a pedometer and Therabands® accompany the exercise unit]. Newsletters are 4 pages of colorful graphics and text that include the following components: (1) a personalized greeting tailored to stage of readiness; (2) a goal statement that reflects engagement in goal setting behavior; (3) a testimonial tailored on age, race, and cancer coping style; (4) an advice column that provides guidance for overcoming barriers—tailored to a subject’s reported barriers; (5) a “Fun Facts” section—untailored; (6) a benefits section that is untailored and emphasizes the benefits of practicing goal behavior; (7) a status section that features a graph depicting the participant’s progress in relation to goal and accompanying tailored messages [i.e., achievement of goal (praise), progress toward goal (praise and encouragement), no progress (encouragement), or the absence of data (encouragement to submit updated data)] | Self-efficacy (PA and diet) (3 items), stage of readiness (range 3–12 items, depending on responses), social support (11 items), barriers (37 items) | The intervention was not significantly associated with self-efficacy for exercise; however, there was a positive correlation obtained between self-efficacy for exercise and total minutes per week of exercise at follow-up
Mediation: Results support the hypothesis that changes in self-efficacy for fat restriction and eating more fruit and vegetables partially mediate the effects of the intervention on diet quality (37.7 % variance, P < 0.001). Furthermore, change in self-efficacy for fat restriction partially mediated the intervention’s effects on the percentage of kilocalories from fat (30.1 % variance, P < 0.001), and change in self-efficacy for fruit and vegetable consumption partially mediated the intervention’s effects on daily servings of fruit and vegetables | |
Djuric et al. [64] | SCT—the telephone counseling approach blended motivational interviewing (MI) with SCT | Goals, self-monitoring, self-efficacy | The telephone counseling approach blended MI with SCT. They also received pedometers, a daily food and exercise log, and example menus at individually appropriate calorie levels. The counseling plan was for the dietician to contact subjects weekly for the first two calls, biweekly for the next 5 months, and monthly for the last 6 months, for a total of 19 calls. The self-monitoring logs were reviewed during the calls. The counseling approach combined principles of SCT and MI. Subjects were involved in deriving their own short-term goals and evaluating their progress toward goals. To build self-efficacy, any positive changes on the self-monitoring sheets were identified and praised | Self-efficacy (6 items), self-confidence for maintaining a healthy lifestyle (6 items) | Not reported |
Djuric et al. [66] | SCT | Self-monitoring, goal setting, self-efficacy, consideration of body image, social support, removing roadblocks, positive thinking, dealing with high-risk situations and slips, and cue elimination | G3 (individualized arm): Monthly written information was prepared on various weight loss topics (environmental control, serving size control, exercise, motivation, goal setting, holiday eating, seasonal foods) and either presented to the women at the monthly meeting or mailed to their homes. Pedometers were provided for self-monitoring and goal setting. It was requested that exercise and dietary logs be kept daily, and these were reviewed together with each subject. Contacts were by phone or in person, and food and exercise records were mailed to the dietician before the scheduled contact. The counseling session varied in length depending on individual needs. The dietician first verified whether or not the participant was meeting behavior change goals set in the previous week. If not, the problem was delineated, and the dietician helped the subject devise a plan that would be used to circumvent the problem. The techniques taught included goal setting, menu planning, self-efficacy, self-monitoring, consideration of body image, social support, social eating, removing roadblocks, positive thinking, dealing with high-risk situations and slips, and cue elimination G4 (comprehensive arm): Subjects received the individualized counseling described above and were asked to attend weekly weight watchers meetings using free coupons | None reported | Not reported |