Behavior change techniques for increasing physical activity in cancer survivors: a systematic review and meta-analysis of randomized controlled trials

Emily Finne, Melanie Glausch, Anne-Kathrin Exner, Odile Sauzet, Friederike Stölzel, Nadja Seidel, Emily Finne, Melanie Glausch, Anne-Kathrin Exner, Odile Sauzet, Friederike Stölzel, Nadja Seidel

Abstract

Purpose: The purpose of this systematic review and meta-analysis is to investigate how physical activity (PA) can be effectively promoted in cancer survivors. The effect of PA-promoting interventions in general, behavior change techniques (BCTs), and further variables as moderators in particular are evaluated.

Methods: This study included randomized controlled trials of lifestyle interventions aiming at an increase in PA that can be carried out independently at home, published by December 2016, for adults diagnosed with cancer after completion of the main treatment. Primary outcomes were subjective and objective measures of PA prior to and immediately after the intervention. Meta-analysis and meta-regression were used to estimate effect sizes (ES) in terms of standardized mean differences, variation between ES in terms of heterogeneity indices (I2), and moderator effects in terms of regression coefficients.

Results: This study included 30 studies containing 45 ES with an overall significant small positive effect size of 0.28 (95% confidence interval=0.18-0.37) on PA, and I2=54.29%. The BCTs Prompts, Reduce prompts, Graded tasks, Non-specific reward, and Social reward were significantly related to larger effects, while Information about health consequences and Information about emotional consequences, as well as Social comparison were related to smaller ES. The number of BCTs per intervention did not predict PA effects. Interventions based on the Theory of Planned Behavior were associated with smaller ES, and interventions with a home-based setting component were associated with larger ES. Neither the duration of the intervention nor the methodological quality explained differences in ES.

Conclusion: Certain BCTs were associated with an increase of PA in cancer survivors. Interventions relying on BCTs congruent with (social) learning theory such as using prompts and rewards could be especially successful in this target group. However, large parts of between-study heterogeneity in ES remained unexplained. Further primary studies should directly compare specific BCTs and their combinations.

Keywords: behavior change; exercise; intervention methods; lifestyle; moderator effects; tumor.

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
PRISMA flow chart of literature search for PA interventions in cancer survivors. Abbreviations: CG, Control group; PA, physical activity; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses; RCT, randomized controlled trial.
Figure 2
Figure 2
Quality assessment results presented as percentages across all included studies (k=30).
Figure 3
Figure 3
Forest plot of included studies. Abbreviations: CI, confidence interval; COM, combination of PM and PED; IG, intervention group; MET, metabolic equivalent; MVPA, moderate to vigorous physical activity; PA, physical activity; PED, step pedometer; PM, print materials; RE model, random-effects model.
Figure 4
Figure 4
Prediction of effect sizes by number of BCTs. Notes: Solid line: predicted effect size of mixed-effects model; dashed lines: 95% confidence bounds; dotted line: reference line for null effect; bubbles: individual study effect sizes with size relative to inverse variance weight; red: subjective PA outcome; black: objective PA outcome. Abbreviations: BCTs, Behavior Change Techniques; PA, physical activity.

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