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Abstract

Although the benefits of physical activity (PA) for the physical and psychological health of people with cancer are widely acknowledged, studies have shown that cancer patients tend to decrease their PA after the diagnosis, resulting in a majority of individuals who are insufficiently active. In order to increase the number of physically active cancer patients, it appears important to obtain a comprehensive understanding of how a cancer diagnosis affects the PA behavior of those concerned. This comprises profound insights into how patients from different cancer types change their activity levels from pre- to post-diagnosis as well as which factors determine whether or not they perform sufficient activity after the diagnosis. Previous research has endeavored to answer these research questions, but left some uncertainties. First, looking at change patterns of PA, the heterogeneity concerning different PA intensities as well as different cancer types has not been sufficiently investigated. Second, with regard to determinants of post-diagnosis PA, several sociodemographic and medical factors have been shown to be associated with PA after the diagnosis, yet the results appear to be inconsistent across studies. This could potentially be due to a large heterogeneity in study samples, but direct comparisons between cancer types are lacking. Moreover, although previous research has examined certain external determinants in terms of barriers and facilitators for patients’ post-diagnosis PA, the role of structural barriers and physicians’ exercise counseling have not been evaluated in detail so that their impact as well as potentially underlying mechanisms remain obscure. This dissertation aimed to address these objectives by comprehensively investigating pre-to post-diagnosis change patterns and determinants of post-diagnosis PA in a large German-wide cross-sectional study of 1,299 cancer patients, including 631 breast, 344 prostate, and 324 colorectal cancer patients. Despite an overall decrease in PA levels, an encouragingly high number of more than 50% of study participants reported being sufficiently active after the diagnosis with different patient characteristics determining the likelihood of sufficient PA for each cancer type. Previously insufficiently active prostate cancer patients and recently diagnosed individuals undergoing treatment constituted the subgroups with the highest risk of remaining or becoming insufficiently active. Looking at external factors that might exacerbate or facilitate cancer patients’ PA, results revealed that structural barriers were generally perceived as impeding for PA, but that the perception differed with regard to individuals’ sociodemographic and medical characteristics such as their age, educational level, BMI, or co-morbidities. As expected, the perception of structural barriers seemed to actually contribute to insufficient activity levels after the diagnosis with particularly strong associations for barriers concerning disease-adjusted PA offers and support. Subsequent analyses further pointed out that the impact was considerably high among exercise experienced individuals. One possible way to reduce PA impediment by structural barriers could be a comprehensive PA counseling by physicians such as that proposed by the 5A framework. Yet, in practice, only basic recommendations seemed to be largely implemented, whereas more profound counseling steps were still rarely undertaken. A more comprehensive exercise counseling might, however, actually positively impact cancer patients’ post-diagnosis PA behavior. Interestingly, the analyses revealed that the contribution may thereby happen via different pathways depending on patients’ previous PA levels: For individuals with low pre-diagnosis PA, a direct association of physicians’ PA counseling and post-diagnosis PA emerged, whereas for previously highly active individuals, the effect was mediated by satisfaction with counseling. The valuable new insights into cancer patients’ change in PA behavior and the enlightening results regarding post-diagnosis PA determinants appear worth being validated in future research using longitudinal or randomized controlled study designs and objective assessments. The current findings enabled the identification of certain risk groups for insufficient activity after the cancer diagnosis and further revealed how PA determinants might affect patients’ PA behavior. Therefore, the results serve as an important foundation for the development and implementation of tailored strategies to promote and improve PA for individuals with cancer and might consequently contribute to enhanced physical and psychological well-being for many cancer patients.