1. Maintenance of physical activity in breast cancer survivors after a randomized trial J Vallance 1, KS Courneya 2, RC Plotnikoff 3, I Dinu 3, & JR Mackey 4 1 Centre for Nursing and Health Studies, Athabasca University 2 Faculty of Physical Education and Recreation, University of Alberta 3 School of Public Health, University of Alberta 4 Department of Oncology, University of Alberta, Cross Cancer Institute *(Vallance et al., Med Sci Sports Exerc, 2008;40:173-180)

2. Background and Rationale Recent systematic reviews: Cardiorespiratory fitness, QoL, fatigue. Post treatment PA associated with a 26% to 40% risk reduction in breast cancer recurrence, breast cancer- specific mortality, and all-cause mortality. Majority of breast cancer survivors are still not meeting public health PA guidelines. Irwin et al., 2003, Cancer; 2004, Med Sci Sports Ex; Bellizzi et al., 2005, J Clin Oncol Holmes et al., 2005, J Amer Med Assoc (McNeely et al., 2006, Can Med Assoc J; Schmitz et al., 2005, Cancer Epi Bio Prev

3. Activity Promotion Trial Compared breast cancer-specific PA print materials and step pedometers to a verbal public health recommendation for PA in breast cancer survivors. 12 weeks: 40-60 min  wk more PA and 60-90 min  wk more brisk walking (d =.25 to.62). Combined approach yielded clinically meaningful improvements in QoL and fatigue.

4. Exercise for health Core message was to engage in moderate PA on at least 5 days of the week for 30 minutes. Vallance et al., in press, Health Educ Behav

5. 6 month follow-up assessment Mailed survey at 6 months post intervention. Godin Leisure Time Exercise Questionnaire. Modified Godin to assess brisk walking. QoL (FACT-Anemia). 266/377 (71%) completed f/u assessment. Completers weighed less (3.5kg less), were more likely to be on Tamoxifen (51 vs 41%), and more likely to be meeting PA guidelines at baseline (37 vs 26%).

6. Participants Mean age58 years (Rg: 30-90 years) Mean BMI27.7 (5.6) Obese class I20% Months post-Dx39 months (~3 years) Postmenopausal62% Stage I or IIa81%

7. Uptake of intervention materials PEDOMETER and COMBINED groups: ~40% wore pedometer during f/u (52/136). ~80% felt pedometer helped them increase their activity (104/136). Pedometer was motivating (40%). Knew how much they were doing (34%). PRINT MATERIAL and COMBINED groups: 60% read resource at least once during f/u.

8. Change in self-reported PA *Baseline to 6 months f/u +30+60+47

9. Change in self-reported brisk walking *Baseline to 6 months f/u +35+42+47

10. Conclusions INT groups reported 30-60 min  wk more PA and 35- 50 min  wk more brisk walking at 6 months f/u. Comparable to 3-month intervention effects (i.e., 40-60 more PA; 60-90 min more brisk walking). Groups were not statistically superior to SR. Loss of power due to increase in variability. Maintained small to mod effect sizes (0.18 to 0.38). Behavioral relevance of findings.

11. Recommendations Examine ways of improving longer term adherence. Telephone support, frequent mailings, email. Motivated group of survivors. Preliminary support for INT tools in maintaining PA after distance-based behavior interventions. Distance-based trials and programs have the opportunity to benefit the greatest # of survivors.

12. Acknowledgements CCS/NCIC Sociobehavioral Cancer Research Network. Co-investigators. Labmates and participants who contributed to this research.

13. Questions?

14. 377 randomized (23%) 1590 Northern Alberta breast cancer survivors received a letter of invitation 96 allocated to SR 94 allocated to PM 85 followed up at posttest 81 followed up at posttest 94 allocated to PED 88 followed up at posttest Study flow 93 allocated to COM 84 followed up at posttest 1192 survivors excluded Did not respond (n=678) Interested but study full (n=310) 68 followed up at 6 months 62 followed up at 6 months 69 followed up at 6 months 67 followed up at 6 months 90% 71%

15. Change in self-reported PA *Postintervention to 6 months f/u

16. Change in self-reported brisk walking *Postintervention to 6 months f/u

17. Physical Activity and Cancer (Courneya, 2001, Annals Behav Med) PrescreeningScreeningPretreatmentTreatmentPosttreatmentResumption Diagnosis PrediagnosisPostdiagnosis PreventionDetectionCoping Rehabilitation Palliation Health Promotion Survival