Determinants and Correlates of Physical Activity in Breast Cancer Survivors

描述(申请人提供)：美国有超过240万乳腺癌幸存者(BC)，占所有癌症幸存者的22%[1]。88.6%的5年存活率[1]，再加上被诊断为乳腺癌的八分之一的终生机会[2]，导致越来越多的人口因现有治疗方法的副作用而有不同的公共卫生需求[3]。此外，BCS的癌症复发、合并症、过早死亡和生活质量(QOL)下降的风险增加[4-6]。体力活动(PA)已被确定为一种生活方式因素，具有极好的潜力来改善治疗的不良副作用，并积极影响与疾病相关的结果[7，8]。然而，只有1/3的BCS符合当前PA的公共卫生指南[9，10]。在BCS中确定影响PA参与的因素以及PA与生活质量的关系，对于制定可转化为实践的有效干预措施非常重要。本项目将采用前瞻性设计来测试完整的社会认知理论(SCT)模型，在为期6个月的过程中解释BCS中的PA。以前的研究已经使用SCT的个别元素来理解和预测普通人群中的PA行为[11-13]，但完整的模型还有待测试，特别是在BCS中。拟议的研究将包括测试完整SCT的措施：自我效能、目标、结果期望、社会文化因素(促进者和障碍)和PA行为[14]。PA也被证明对BCS的生活质量有积极的影响[7，8]。然而，很少有人进行研究来解释这种关系。因此，拟议的研究还将包括测试McAuley和他的同事在BCS[15]提出的PA和QOL模型的措施。该模型提出PA通过对自我效能感和健康相关的生活质量(身心健康)的影响间接影响总体生活质量，而自我效能感通过对健康相关的生活质量的影响直接或间接地影响总体生活质量。这项研究的公共卫生意义在于，它有可能对PA在BCS中的行为有更好的、理论上的理解，以及对PA和QOL之间的关系有更好的理解。这些发现可能会导致针对BCS的更好设计、更有效的PA计划，最终有可能降低与BCS的癌症复发、合并症和过早死亡相关的医疗费用。

DESCRIPTION (provided by applicant): There are over 2.4 million breast cancer survivors (BCS) in the U.S. accounting for 22% of all cancer survivors [1]. The 5-year survival rate of 88.6% [1] coupled with a 1 in 8 lifetime chance of a breast cancer diagnosis [2] has resulted in an increasingly growing population with distinct public health needs resulting from side effects associated with current available treatments [3]. In addition, BCS are at an increased risk of cancer recurrence, comborbidites, premature death and decreased quality of life (QOL) [4-6]. Physical activity (PA) has been identified as a lifestyle factor with excellent potential for ameliorating the aversive side effects of treatment and positively influencing disease-related outcomes [7, 8]. However, only 1/3 of BCS meet the current public health guidelines for PA [9, 10]. Identifying factors influencing PA participation and how PA is related to QOL in BCS is important for developing effective interventions which can be translated into practice. This project will adopt a prospective design to test the full Social Cognitive Theory (SCT) model for explaining PA in BCS over the course of a 6-month period. Previous research has used individual elements of SCT to understand and predict PA behavior in the general population [11-13], but the full model has yet to be tested, particularly in BCS. The proposed study will include measures to test the full SCT: self-efficacy, goals, outcome expectations, sociocultural factors (facilitators and impediments), and PA behavior [14]. PA has also been shown to positively influence QOL in BCS [7, 8]. However, very little research has been conducted to explain this relationship. Thus, the proposed study will also include measures to test the PA and QOL model proposed by McAuley and colleagues [15] in BCS. This model proposes PA influences global QOL indirectly through its effects on self-efficacy and health related QOL (physical and mental health) whereby self-efficacy is both directly and indirectly related to global QOL through its effect on health related QOL. The public health significance of this study lies in its potential to develop an improved, theoretically sound understanding of PA behavior in BCS as well as a better understanding of the relationship between PA and QOL. These findings could potentially result in better designed, more effective PA programs for BCS which ultimately has the potential to reduce healthcare costs associated with cancer recurrence, comorbidities, and premature death in BCS.