Effectiveness of Physical Activity Interventions among Rural Cancer Survivors: A Systematic Review and Meta-Analysis

Abstract

This review estimated the effectiveness of behavior change interventions to increase physical activity (PA) among rural adult cancer survivors. PubMed Medline, CINAHL, and PsychINFO were systematically searched through July 2020. Two independent investigators screened citations to identify studies to increase PA in adults residing in rural areas who had received any cancer diagnosis. Meta-analyses were conducted to assess proportion of participants achieving PA goal, paired mean difference (MD) in aerobic PA and strength training, and retention from baseline to post-intervention. Seven studies met inclusion criteria encompassing a total of 722 participants (591 in intervention and 131 controls). Overall quality of evidence was low to medium. The pooled proportion of participants achieving PA goals (150–225 min/wk) was 39% [95% confidence interval (CI), 18%–62%]. The mean time spent engaging in aerobic PA increased from baseline to post-intervention (range, 6–52 weeks) by 97.7 min/wk (95% CI, 75.0–120.4), and the MD in time spent on strength training was 12.2 min/wk (95% CI, −8.3–32.8). The pooled retention rate was 82% (95% CI, 69%–92%) at 6 to 78 weeks. Because of the modest intervention effects, low quality of evidence, and small number of studies, further rigorously designed behavior change interventions, including randomized controlled trials with long-term follow up, are needed to confirm efficacy for increasing PA in rural cancer survivors and to test innovative implementation strategies to enhance reach and effectiveness.

A randomized controlled trial of Promoting Physical Activity in Regional and Remote Cancer Survivors (PPARCS)

“…There have been very few PA interventions that have specifically recruited rural cancer survivors. Of the 5 RCTs included in Mama et al’s review, 21 none reported improvements in MVPA compared to controls. Limitations of previous studies in rural cancer survivors include intensive high-contact interventions (e.g., median intervention contact time was 467 min 21 ), the inclusion of metropolitan cancer survivors, 48 self-reported PA, and interventions focused on multiple health behaviors rather than PA alone.…”

“…Of the 5 RCTs included in Mama et al’s review, 21 none reported improvements in MVPA compared to controls. Limitations of previous studies in rural cancer survivors include intensive high-contact interventions (e.g., median intervention contact time was 467 min 21 ), the inclusion of metropolitan cancer survivors, 48 self-reported PA, and interventions focused on multiple health behaviors rather than PA alone. 23 This is an area in which scalable interventions are greatly needed to increase PA in under-served regional and remote cancer survivors.…”

“…Even internationally there have been very few distance-based PA interventions to recruit rural cancer survivors specifically. 21 These interventions have tended to be intensive, with 16–24 telephone sessions over 6 months, 22 , 23 and have produced mixed findings. Eakin et al 22 conducted a trial involving 16 telephone calls over 8 months and found no effect on moderate-to-vigorous PA (MVPA) in rural breast cancer survivors at follow up (approximately 2 months post intervention).…”

The promoting physical activity in regional and remote cancer survivors (PPARCS) trial: Physical activity maintenance

“…Less than a quarter of studies have examined postintervention maintenance of PA in cancer survivors and, of those that have, just 22% of interventions were effective in promoting PA maintenance 5 . Research limited to PA maintenance in nonmetropolitan cancer survivors is scarce with no evidence for exercise maintenance at follow‐up in the handful of previous studies 6 . Relatively little is known about the effective maintenance of PA in cancer survivors.…”

Designing home-based physical activity programs for rural cancer survivors: A survey of technology access and preferences

“…Unfortunately, the design of traditional PA interventions aimed at eliminating health disparities may reduce access for those cancer survivors who may stand to benefit the most (e.g., rural, functionally impaired/disabled) ( 10 ). The lack of accessible and effective home-based physical activity programs (HBPAP) for rural cancer survivors is a critically unmet need ( 17 ).…”