No votes yet

Open Access Article
Online Exclusive Article

Correlates of Physical Activity in Young Adult Survivors of Childhood Cancers

Lorna Finnegan
Diana J. Wilkie
JoEllen Wilbur
Richard T. Campbell
Shiping Zong
Sarah Katula
ONF 2007, 34(5), E60-E69 DOI: 10.1188/07.ONF.E60-E69

Purpose/Objectives: To examine correlates of participation in regular physical activities among young adult survivors of childhood cancers.

Design: Descriptive, correlational.

Setting: Web-based survey.

Sample: 117 well-educated, predominately Caucasian survivors of various types of childhood cancers (X age = 24 years).

Methods: Participants completed four rating scales, a stages of change measure, and background questions. Logistic regression and graphical methods were used to examine relationships among physical activity correlates and physical activity.

Main Research Variables: Physical activity stages of change, autonomous motivation, physical activity pros and cons, self-efficacy, and self-reported worries.

Findings: More than 80% of participants reported that they were physically active. Survivors who were autonomously motivated and who perceived fewer cons to being physically active were more likely to report being active than survivors with lower autonomous motivation scores and higher physical activity cons scores. Worries about the present and future moderated the effect of physical activity cons on physical activity. The estimated probabilities of reporting being active for women and men changed as the collective contribution of autonomous motivation, physical activity cons, and worries varied from low to high values.

Conclusions: Engaging in physical activity willingly and without a sense of pressure (autonomous motivation), perceiving fewer cons to physical activity participation (cognitive appraisal), and worrying about the present and future (affective response) were important correlates of self-reported physical activity beyond the influence of gender.

Implications for Nursing: Interventions that promote autonomous motivation, decrease physical activity cons, and address present and future worries may increase physical activity in young adult cancer survivors and may have a greater impact on women than men.


Benisovich, S.V., Rossi, J.S., Norman, G.J., & Nigg, C.R. (1998). <i>A multidimensional approach to exercise self-efficacy: Relationship with exercise behavior and attitudes towards exercise.</i> Paper presented at the annual meeting of the New England Psychological Association, Boston, MA.

Blanchard, C.M., Baker, F., Denniston, M.M., Courneya, K.S., Hann, D.M., Gesme, D.H., et al. (2003). Is absolute amount or change in exercise more associated with quality of life in adult cancer survivors? <i>Preventive Medicine, 37</i>, 389-395.

Boch, B., Marcus, B.H., Rossi, J.S., & Redding, C.A. (1998). Motivational readiness for change: Diet, exercise, and smoking. <i>American Journal of Health Behavior, 22</i>, 248-258.

Brown, J.K., Byers, T., Doyle, C., Courneya, K.S., Demark-Wahnefried, W., Kushi, L.H., et al. (2003). Nutrition and physical activity during and after cancer treatment: An American Cancer Society guide for informed choices. <i>CA: A Cancer Journal for Clinicians, 53</i>, 268-291.

Butterfield, R.M., Park, E.R., Puleo, E., Mertens, A., Gritz, E.R., Li, F.P., et al. (2004). Multiple risk behaviors among smokers in the Childhood Cancer Survivors Study cohort. <i>Psycho-Oncology, 13</i>, 619-629.

Courneya, K.S. (2003). Exercise in cancer survivors: An overview of research. <i>Medicine and Science in Sports and Exercise, 35</i>, 1846-1852.

Cox, C.L. (1982). An interaction model of client health behavior: Theoretical prescription for nursing. <i>Advances in Nursing Science, 5</i>, 41-56.

Cox, C.L. (2003). A model of health behavior to guide studies of childhood cancer survivors. <i>Oncology Nursing Forum, 30</i>, 92-99.

Cox, C.L., McLaughlin, R.A., Steen, B.D., & Hudson, M.M. (2006). Predicting and modifying substance abuse in childhood cancer survivors: Application of a conceptual model. <i>Oncology Nursing Forum, 33</i>, 51-60.

Dannecker, E.A., Hausenblas, H.A., Connaughton, D.P., & Lovins, T.R. (2003). Validation of stages of exercise change questionnaire (measurement and evaluation). <i>Research Quarterly for Exercise and Sport, 74</i>, 236-247.

Deci, E., & Ryan, R. (2002). <i>Handbook of self-determination research.</i> Rochester, NY: University of Rochester Press.

Demark-Wahnefried, W., Werner, C., Clipp, E., Guill, A., Bonner, M., Jones, L., et al. (2005). Survivors of childhood cancer and their guardians: Current health behaviors and receptivity to health promotion programs. <i>Cancer, 103</i>, 2171-2180.

Haase, J., & Rostad, M. (1994). Experiences of completing cancer therapy: Children's perspectives. <i>Oncology Nursing Forum, 21</i>, 1483-1494.

Hewitt, M., Weiner, S.L., & Simone, J.V. (2003). <i>Childhood cancer survivorship: Improving care and quality of life.</i> Washington, DC: National Academies Press.

Hollen, P.J., Hobbie, W.L., Finley, S.M., & Hiebert, S.M. (2001). The relationship of resiliency to decision making and risk behaviors of cancer-surviving adolescents. <i>Journal of Pediatric Oncology Nursing, 18</i>, 188-204.

Hudson, M.M., Mertens, A.C., Yasui, Y., Hobbie, W., Chen, H., & Gurney, J.G., et al. (2003). Health status of adult long-term survivors of childhood cancer: A report from the Childhood Cancer Survivor Study. <i>JAMA, 290</i>, 1583-1592.

Hudson, M.M., Tyc, V.L., Jayawardene, D.A., Gattuso, J., Quargnenti, A., Greenwald, C., et al. (1999). Feasibility of implementing health promotion interventions to improve health-related quality of life. <i>International Journal of Cancer, 12</i>(Suppl.), 138-142.

Ingledew, D.K., Markland, D., & Medley, A.R. (1998). Exercise motives and stages of change. <i>Journal of Health Psychology, 3</i>, 477-489.

Jones, L.W., & Courneya, K.S. (2002). Exercise counseling and programming preferences of cancer survivors. <i>Cancer Practice, 10</i>, 208-215.

Kadan-Lottick, N.S., Robison, L.L., Gurney, J.G., Neglia, J.P., Yasui, Y., Hayashi, R., et al. (2002). Childhood cancer survivors' knowledge about their past diagnosis and treatment: Childhood Cancer Survivor Study. <i>JAMA, 287</i>, 1832-1839.

Keats, M.R., Courneya, K.S., Danielsen, S., & Whitsett, S.F. (1999). Leisure-time physical activity and psychosocial well-being in adolescents after cancer diagnosis. <i>Journal of Pediatric Oncology Nursing, 16</i>, 180-188.

Koocher, G.P., & O'Malley, J.E. (1981). <i>The Damocles syndrome: Psycho-social consequences of surviving childhood cancer.</i> New York: McGraw-Hill.

Langeveld, N.E., Grootenhuis, M.A., Voute, P.A., de Haan, R.J., & van den Bos, C. (2004). Quality of life, self-esteem and worries in young adult survivors of childhood cancer. <i>Psycho-Oncology, 13</i>, 867-881.

Marcus, B.H., Albrecht, A.E., King, T.K., Parisi, A.F., Pinto, B.M., Roberts, M., et al. (1999). The efficacy of exercise as an aid for smoking cessation in women: A randomized controlled trial. <i>Archives of Internal Medicine, 159</i>, 1229-1234.

Marcus, B.H., Albrecht, A.E., Niaura, R.S., Taylor, E.R., Simkin, L.R., Feder, S.I., et al. (1995). Exercise enhances the maintenance of smoking cessation in women. <i>Addictive Behaviors, 20</i>, 87-92.

Marcus, B.H., Selby, V.C., Niaura, R.S., & Rossi, J.S. (1992). Self-efficacy and the stages of exercise behavior change. <i>Research Quarterly for Exercise and Sport, 63</i>, 60-66.

Markland, D., & Tobin, V. (2004). A modification of the behavioral regulation in exercise questionnaire to include an assessment of amotivation. <i>Journal of Sport and Exercise Psychology, 26</i>, 191-196.

Marshall, S.J., & Biddle, S.J. (2001). The transtheoretical model of behavior change: A meta-analysis of applications to physical activity and exercise. <i>Annals of Behavioral Medicine, 23</i>, 229-246.

Matsumoto, H., & Takenaka, K. (2004). Motivational profiles and stages of exercise behavior change. <i>International Journal of Sport and Health Science, 2</i>, 89-96.

McTiernan, A. (2004). Physical activity after cancer: Physiologic outcomes. <i>Cancer Investigation, 22</i>, 68-81.

Mitchell, M., & Chen, X. (2005). Visualizing main effects and interactions for binary logit models. <i>Stata Journal, 5</i>, 64-82.

Mock, V., Frangakis, C., Davidson, N.E., Ropka, M.E., Pickett, M., & Poniatowski, B., et al. (2005). Exercise manages fatigue during breast cancer treatment: A randomized controlled trial. <i>Psycho-Oncology, 14</i>, 464-477.

Mulhern, R.K., Tyc, V.L., Phipps, S., Crom, D.B., Barclay, D., Greenwald, C., et al. (1995). Health-related behaviors of survivors of childhood cancer. <i>Medical and Pediatric Oncology, 25</i>, 159-165.

Mullan, E., & Markland, D. (1997). Variations in self-determination across the stages of change for exercise in adults. <i>Motivation and Emotion, 21</i>, 349-362.

Nigg, C., Hellsten, L., Norman, G., Burbank, P., Braun, L., Breger, R., et al. (2005). Physical activity staging distribution: Establishing a heuristic using multiple studies. <i>Annals of Behavioral Medicine, 29</i>(Suppl.), 35-45.

Ntoumanis, N. (2002). Motivational clusters in a sample of British physical education classes. <i>Psychology of Sport and Exercise, 3</i>, 177-194.

Oeffinger, K.C., Mertens, A.C., Sklar, C.A., Kawashima, T., Hudson, M.M., & Meadows, A.T., et al. (2006). Chronic health conditions in adult survivors of childhood cancer. <i>New England Journal of Medicine, 355</i>, 1572-1582.

Park, E.B., Emmons, K.M., Malloy, N.W., & Seifer, E. (2002). A qualitative exploration of health perceptions and behaviors among adult survivors of childhood cancers. <i>Journal of Cancer Education, 17</i>, 211-215.

Parry, C. (2003). Embracing uncertainty: An exploration of the experiences of childhood cancer survivors. <i>Qualitative Health Research, 13</i>, 227-246.

Plotnikoff, R.C., Blanchard, C.M., Hotz, S.B., & Rhodes, R.E. (2001). Validation of the decisional balance scales in the exercise domain from the Transtheoretical Model: A longitudinal test. <i>Measurement in Physical Education and Exercise Science, 5</i>, 191-206.

Prochaska, J.O., & Velicer, W.F. (1997). The Transtheoretical Model of health behavior change. <i>American Journal of Health Promotion, 12</i>, 38-48.

Prochaska, J.O., Velicer, W.F., Rossi, J.S., Goldstein, M.G., Marcus, B.H., Rakowski, W., et al. (1994). Stages of change and decisional balance for 12 problem behaviors. <i>Health Psychology, 13</i>, 39-46.

Robison, L.L., Mertens, A.C., Boice, J.D., Breslow, N.E., Donaldson, S.S., Green, M.D. et al. (2002). Study design and cohort characteristics of the Childhood Cancer Survivor Study: A multi-institutional collaborative project. <i>Medical Pediatric Oncology, 38</i>, 229-239.

Rodgers, W.M., Courneya, K.S., & Bayduza, A.L. (2001). Examination of the Transtheoretical Model and exercise in 3 populations. <i>American Journal of Health Behavior, 25</i>, 33-41.

Rose, E., Parfitt, G., & Williams, S. (2005). Exercise causality orientations, behavioral regulation for exercise and stage of change for exercise: Exploring their relationships. <i>Psychology of Sport and Exercise, 6</i>, 399-414.

Schwartz, A.L. (2004). Physical activity after a cancer diagnosis: Psychosocial outcomes. <i>Cancer Investigation, 22</i>, 82-92.

Thorsen, L., Nystad, W., Dahl, O., Klepp, O., Bremnes, R.M., Wist, E., et al. (2003). The level of physical activity in long-term survivors of testicular cancer. <i>European Journal of Cancer, 39</i>, 1216-1221.

Tyc, V.L., Hadley, W., & Crockett, G. (2001). Prediction of health behaviors in pediatric cancer survivors. <i>Medical and Pediatric Oncology, 37</i>, 42-46.

U.S. Department of Health and Human Services. (2000). <i>Healthy people 2010: Understanding and improving health.</i> Washington, DC: U.S. Government Printing Office.

Vandelanotte, C., & De Bourdeaudhuij, I. (2003). Acceptability and feasibility of a computer-tailored physical activity intervention using stages of change: Project FAITH. <i>Health Education Research, 18</i>, 304-317.

Weigers, M.E., Chesler, M.A., Zebrack, B.J., & Goldman, S. (1998). Self-reported worries among long-term survivors of childhood cancer and their peers. <i>Journal of Psychosocial Oncology, 16</i>, 1-23.

Wilbur, J., Miller, A., Chandler, P., & McDevitt, J. (2003). Determinants of physical activity and adherence to a 24-week home-based walking program in African American and Caucasian women. <i>Research in Nursing and Health, 26</i>, 213-224.

Williams, G.C., McGregor, H.A., Sharp, D., Levesque, C., Kouides, R.W., Ryan, R.M., et al. (2006). Testing a self-determination theory intervention for motivating tobacco cessation: Supporting autonomy and competence in a clinical trial. <i>Health Psychology, 25</i>, 91-101.

Williams, G.C., McGregor, H.A., Zeldman, A., Freedman, Z.R., & Deci, E.L. (2004). Testing a self-determination theory process model for promoting glycemic control through diabetes self-management. <i>Health Psychology, 23</i>, 58-66.

Wilson, P., Rodger, W., Fraser, S., & Murray, T. (2004). Relationships between exercise regulations and motivational consequences in university students. <i>Research Quarterly for Exercise and Sport, 75</i>, 81-91.

Wilson, P.M., Blanchard, C.M., Nehl, E., & Baker, F. (2006). Predicting physical activity and outcome expectations in cancer survivors: An application of Self-Determination Theory. <i>Psycho-Oncology, 15</i>, 567-578.

Woodgate, R.L. (1999). Conceptual understanding of resilience in the adolescent with cancer: Part I. <i>Journal of Pediatric Oncology Nursing, 16</i>, 35-43.

Wyse, J., Mercer, T., Ashford, B., Buxton, K., & Gleeson, N. (1995). Evidence for the validity and utility of the stages of exercise behaviour change scale in young adults. <i>Health Education Research, 10</i>, 365-377.

Zebrack, B.J., & Chesler, M.A. (2001). Health-related worries, self-image, and life outlooks of long-term survivors of childhood cancer. <i>Health and Social Work, 26</i>, 245-256.