Online Exclusive Article

Development of an Instrument to Measure Adherence to Strength Training in Postmenopausal Breast Cancer Survivors

Jennifer L. Huberty

Jamie Vener

Nancy Waltman

Carol Ott

Janice J. Twiss

Gloria Gross

Rita McGuire

Andrew Dwyer

exercise, Assessment, Screening
ONF 2009, 36(5), E266-E273. DOI: 10.1188/09.ONF.E266-E273

Purpose/Objectives: To develop a theory-based instrument for assessing barriers and motivators to strength- or weight-training exercise (SWTE) in postmenopausal breast cancer survivors with measurable bone loss after treatment.

Design: Exploratory, descriptive, and methodologic.

Setting: Academic oncology clinics in the midwestern United States, homes, and a fitness center.

Sample: 85 women, predominantly Caucasian (99%), breast cancer survivors, aged 35-75 years, six months after treatment, who were enrolled in a larger study were randomized to receive SWTE; 65 completed the instrument.

Methods: Development of a 47-item Likert-type instrument using interviews, contributions from experts, published research, and Self-Efficacy Theory.

Main Research Variables: Barriers and motivators of adherence to SWTE.

Findings: Four subscales emerged that accounted for 26%-59% of the variance. Factor subscales for barriers were "not prioritizing time for self" and "overcoming other barriers to adherence." Subscales for motivators included "education and feedback" and "social support."

Conclusions: The final instrument contained 47 items dispersed across four subscales. Additional psychometric testing of the instrument with a larger population is indicated.

Implications for Nursing: Nurses and healthcare professionals may use the instrument to readily identify barriers and motivators to SWTE adherence to improve program design and implementation efforts aimed at facilitating enhanced exercise adherence in breast cancer survivors with measurable bone loss after treatment.

Jump to a section

    References

    Ainsworth, B. (2000). Physical activity patterns in women. Physician and Sports Medicine, 28(10), 2.
    American Cancer Society. (2007). Cancer facts and figures 2007. Atlanta, GA: Author.
    American College of Sports Medicine. (2006). ACSM's resource manual for guidelines for exercise testing and prescription (7th ed.). Baltimore, MD: Human Kinetics.
    Baber, R., Hickey, M., & Kwik, M. (2005). Therapy for menopausal symptoms during and after treatment for breast cancer: Safety considerations. Drug Safety, 28(12), 1085-1100.
    Bandura, A. (1986). Social foundation of thought and action: A social cognitive theory. Englewood Cliffs, NJ: Prentice Hall.
    Bandura, A. (1997). Self-efficacy: The exercise of control. New York: Freeman.
    Brassington, G.S., Atienza, A.A., Perczek, R.E., DiLorenzo, T.M., & King, A.C. (2002). Intervention-related cognitive versus social mediators of exercise adherence in the elderly. American Journal of Preventive Medicine, 23(2S), 80-86.
    Burnham, T.R., & Wilcox, A. (2002). Effects of exercise on physiological and psychological variables in cancer survivors. Medicine and Science in Sports and Exercise, 34(12), 1863-1867.
    Coleman, E.A., Hall-Barrow, J., Coon, S., & Stewart, C.B. (2003). Facilitating exercise adherence for patients with multiple myeloma. Clinical Journal of Oncology Nursing, 7(5), 529-534.
    Courneya, K.S., Blanchard, C.M., & Laing, D.M. (2001). Exercise adherence in breast cancer survivors training for a dragon boat race competition: A preliminary investigation. Psycho-Oncology, 10(5), 444-452.
    Daley, A.J., Crank, H., Mutrie, N., Saxton, J.M., & Coleman, R. (2007). Determinants of adherence to exercise in women treated for breast cancer. European Journal of Oncology Nursing, 11(5), 392-399.
    Dishman, R.K., & Buckworth, J. (1996). Increasing physical activity: A quantitative synthesis. Medicine and Science in Sports and Exercise, 28(6), 706-719.
    Eyler, A.A., Matson-Koffman, D., Vest, J.R., Evenson, K.R., Sandereson, B., Thompson, J.L., et al. (2002). Environmental, policy, and cultural factors related to physical activity in a diverse sample of women: The Women's Cardiovascular Health Network Project—Summary and discussion. Women and Health, 36(2), 123-134.
    Eyler, A.A., & Vest, J.R. (2002). Environmental and policy factors related to physical activity in rural white woman. Women and Health, 36(2), 111-121.
    Fairey, A.S., Courneya, K.S., Field, C.J., Bell, G.J., Jones, L.W., & Mackey, J.R. (2003). Effects of exercise training on fasting insulin, insulin resistance, insulin-like growth factors, and insulin-like growth factor binding proteins in postmenopausal breast cancer survivors: A randomized controlled trial. Cancer Epidemiology, Biomarkers, and Prevention, 12(8), 721-727.
    Gross, G., Ott, C., Lindsey, A., Twiss, J., & Waltman, N. (2002). Postmenopausal breast cancer survivors at risk for osteoporosis: Physical activity, vigor, and vitality. Oncology Nursing Forum, 29(9), 1295-1300.
    Irwin, A.L., & Ainsworth, B.E. (2004). Physical activity interventions following cancer diagnosis: Methodologic challenges to delivery and assessment. Cancer Investigation, 22(1), 30-50.
    Johnson, R.A., & Tsui, K.W. (1998). Statistical reasoning and methods. New York: Wiley.
    Jones, F., Harris, P., Waller, H., & Coggins, A. (2005). Adherence to an exercise prescription scheme: The role of expectations, self-efficacy, stage of change, and psychological well-being. British Journal of Healthy Psychology, 10(Pt. 3), 359-378.
    Kerr, D., Morton, A., Dick, I., & Prince, R. (1996). Exercise effects on bone mass in postmenopausal women are site-specific and load-dependent. Journal of Bone Mineral Research, 11(2), 218-225.
    Kraemer, W.J., Adams, K., Cararelli, E., Dudley, G.A., Dooly, C., Feignenbaum, M.S., et al. (2002). American College of Sports Medicine position stand. Progression models in resistance training for healthy adults. Medicine and Science in Sports and Exercise, 34(2), 364-380.
    Lynn, M.R. (1986). Determination and quantification of content validity. Nursing Research, 35(6), 382-385.
    McAuley, E., Jerome, G.J., Marquez, D.X., Elavsky, S., & Blissmer, B. (2003). Exercise self-efficacy in older adults: Social, affective, and behavioral influences. Annals of Behavioral Medicine, 25(1), 1-7.
    McAuley, E., Mihalko, S.L., & Bane, S.M. (1997). Exercise and self-esteem in middle-aged adults: Multidimensional relationships and physical fitness and self-efficacy influences. Journal of Behavioral Medicine, 20(1), 67-83.
    McNeely, M.L., Campbell, K.L., Rowe, B.H., Klassen, T.P., Mackey, J.R., & Courneya, K.S. (2006). Effects of exercise on breast cancer patients and survivors: A systematic review and meta-analysis. Canadian Medical Association Journal, 175(1), 34-41.
    McNeely, M.L., Peddle, C.J., Parliament, M., & Courneya, K.S. (2006). Cancer rehabilitation: Recommendations for integrating exercise programming in the clinical practice setting. Current Cancer Therapy Reviews, 2(4), 351-360.
    Milne, H.M., Wallman, K.E., Gordon, S., & Courneya, K.S. (2008). Effects of a combined aerobic and resistance exercise program in breast cancer survivors: A randomized controlled trial. Breast Cancer Research and Treatment, 108(2), 279-288.
    Nelson, M.E., Fiatarone, M.A., Morganti, C.M., Trice, L., Greenberg, R.A., & Evans, W.J. (1994). Effects of high-intensity strength training on multiple risk factors for osteoporotic fractures. JAMA, 27(24), 1909-1914.
    Ohira, T., Schmitz, K.H., Ahmed, R.L., & Yee, D. (2006). Effects of weight training on quality of life in recent breast cancer survivors: The Weight Training for Breast Cancer Survivors Study. Cancer, 106(9), 2076-2083.
    Oman, R.F., & King, A.C. (1998). Predicting the adoption and maintenance of exercise participation using self-efficacy and previous exercise participation rates. American Journal of Health Promotion, 12(3), 154-161.
    Ott, C.D., Lindsey, A.M., Waltman, N.L., Gross, G.J., Twiss, J.J., Berg, K., et al. (2004). Facilitative strategies, psychological factors, and strength/weight training behaviors in breast cancer survivors who are at risk for osteoporosis. Orthopedic Nursing, 23(1), 45-52.
    Pedhazur, E.J., & Schmelkin, L.P. (1991). Measurement, design, and analysis: An integrated approach. Mahwah, NJ: Lawrence Erlbaum.
    Pickett, M., Mock, V., Ropka, M.E., Cameron, L., Coleman, M., & Podewils, L. (2002). Adherence to moderate-intensity exercise during breast cancer therapy. Cancer Practice, 10(6), 284-292.
    Prochaska, J.O., & Velicer, W.F. (1997). The transtheoretical model of behavior change. American Journal of Health Promotion, 12(1), 38-48.
    Rogers, L.O., Shah, P., Dunnington, P., Greive, A., Shanmugham, A., Dawson, B., et al. (2005). Social cognitive theory and physical activity during breast cancer treatment. Oncology Nursing Forum, 32(4), 807-815.
    Schwartz, A.L., Winters-Stone, K., & Gallucci, B. (2007). Exercise effects on bone mineral density in women with breast cancer receiving adjuvant chemotherapy. Oncology Nursing Forum, 34(3), 627-633.
    Siris, E.S., Miller, P.D., Barrett-Connor, E., Faulkner, K.G., Wehren, L.E., Abbott, T.A., et al. (2001). Identification and fracture outcomes of undiagnosed low bone mineral density in postmenopausal women: Results from the National Osteoporosis Risk Assessment. JAMA, 286(22), 2815-2822.
    Taaffe, D.R., Pruitt, L., Pyka, G., Guido, D., & Marcus, R. (1996). Comparative effects of high- and low-intensity resistance training on thigh muscle strength, fiber area, and tissue consumption in elderly women. Clinical Physiology, 16(4), 381-392.
    Trost, S.G., Owen, N., Bauman, A.E., Sallis, J.F., & Brown, W. (2002). Correlates of adults' participation in physical activity: Review and update. Medicine and Science in Sports and Exercise, 34(12), 1996-2001.
    Van Poznak, C., & Sauter, N.P. (2005). Clinical management of osteoporosis in women with a history of breast carcinoma. Cancer, 104(3), 443-456.
    Waltman, N.L., Ott, C.D., Twiss, J.J., Gross, G.J., Lindsey, A.M., & Moore, T.E. (2008). Bone mineral density and bone turnover in postmenopausal women treated for breast cancer. Cancer Nursing, 31(3), 182-190.
    Waltman, N.L., Twiss, J.J., Ott, C.D., Gross, G.J., Lindsey, A.M., Moore, T.E., et al. (2003). Testing an intervention for preventing osteoporosis in postmenopausal breast cancer survivors. Journal of Nursing Scholarship, 35(4), 333-338.
    White, J.L., Ransdell, L.B., Vener, J., & Flohr, J.A. (2005). Factors related to physical activity adherence in women: Review and suggestions for future research. Women Health, 41(4), 123-148.
    Wilbur, J., Michaels, M.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. Research in Nursing and Health, 26(3), 213-224.