Promoting physical activity among cancer survivors: Meta-analysis and meta-CART analysis of randomized controlled trials.

Abstract

Promoting physical activity among cancer survivors: meta analysis and metacart analysis of randomized controlled trials Article (Accepted Version) (2019) Promoting physical activity among cancer survivors: meta-analysis and meta-cart analysis of randomized controlled trials. Health Psychology.We thank Jennifer Walker and Rachael Posey (Medical Librarians) for invaluable assistance with the computerized literature searches. AbstractObjective: We conducted a meta-analysis of physical activity interventions among cancer survivors in order to (a) quantify the magnitude of intervention effects on physical activity, and (b) determine what combination of intervention strategies maximizes behavior change.Methods: Out of 32,626 records that were located using computerized searches, 138 independent tests (N = 13,050) met the inclusion criteria for the review. We developed a bespoke taxonomy of 34 categories of techniques designed to promote psychological change, and categorized sample, intervention, and methodological characteristics. Random effects meta-analysis and meta-regressions were conducted; effect size data were also submitted to Meta-CART analysis. Results: The sample-weighted average effect size for physical activity interventions was d+ = .35, equivalent to an increase of 1,149 steps per day. Effect sizes exhibited both publication bias and small sample bias but remained significantly different from zero, albeit of smaller magnitude (d+ ≥ .20), after correction for bias. Meta-CART analysis indicated that the major difference in effectiveness was attributable to supervised versus unsupervised programs (d+ = .49 vs. .26). Greater contact time was associated with larger effects in supervised programs. For unsupervised programs, establishing outcome expectations, greater contact time, and targeting overweight or sedentary participants each predicted greater program effectiveness, whereas prompting barrier identification and providing workbooks were associated with smaller effect sizes. Conclusion: The present review indicates that interventions have a small but significant effect on physical activity among cancer survivors, and offers insights into how the effectiveness of future interventions might be improved.

Exercise is medicine in oncology: Engaging clinicians to help patients move through cancer

“…Patients may underestimate how the treatment might affect their ability to exercise on their own. Also, current evidence indicates that exercise under supervision yields better outcomes . Therefore, even for currently active patients, regular evaluation of activity levels is needed, and referral to exercise programming could be valuable.…”

“…A meta‐analysis of 14 randomized controlled trials among breast cancer survivors found that, although large effects on physical activity were reported by programs that provided more supervision, interventions by telephone or email were also effective . A recent comprehensive review of interventions for cancer survivors across different approaches, samples, and settings (128 randomized controlled trials, for a total of 13,050 patients with cancer) revealed that supervised programs produced larger effects on physical activity than unsupervised programs . Another review concluded that interventions that have used behavioral theory tend produce the largest overall effect size for behavior change .…”

“…Also, current evidence indicates that exercise under supervision yields better outcomes. 10,[43][44][45][46][47] Therefore, even for currently active patients, regular evaluation of activity levels is needed, and referral to exercise programming could be valuable. The provider's willingness to discuss exercise during patient visits expresses confidence in the benefits of regular exercise during and after treatment.…”

“…44 A recent comprehensive review of interventions for cancer survivors across different approaches, samples, and settings (128 randomized controlled trials, for a total of 13,050 patients with cancer) revealed that supervised programs produced larger effects on physical activity than unsupervised programs. 47 Another review concluded that interventions that have used behavioral theory tend produce the largest overall effect size for behavior change. 64 Interventions that may be less intensive can produce smaller effects on outcomes, such as fitness and functioning; however, these interventions (distance-based by print, telephone, web, etc) can reach more survivors and can be less burdensome for patients who experience travel and scheduling barriers.…”

Sugary drink warnings: A meta-analysis of experimental studies

“…For the moderation analyses examining hypothetical purchases by warning topic, we used 2 effect sizes from Ang et al [41], 1 for health warning versus control and 1 for nutrient warning versus control. For these 2 effect sizes, we partitioned the control group sample size equally across the 2 treatment arms, following others [42,43]. This approach partially (but not completely) corrects for correlation among effect sizes, so this moderation analysis should be interpreted with caution [43].…”