Telephone counseling plus physician advice key to motivating breast cancer survivors to exercise

(Press-News.org) PROVIDENCE, R.I. – Telephone-based counseling, when combined with physician advice, can help breast cancer survivors become more physically active, which can improve quality of life and lessen the side effects of cancer treatment, according to new research from The Miriam Hospital.

Researchers say women who received exercise advice from their surgeon or oncologist, followed by three months of telephone support, reported 30 more minutes of physical activity per week than patients who received exercise advice and follow-up calls about their general health.

The findings, published in the June issue of Health Psychology, reinforce the benefits of exercise in cancer recovery, including improved physical functioning. Physical activity has also been shown to reduce cancer-related fatigue and the risk for other chronic diseases, such as cardiovascular disease, obesity and osteoporosis.

"Breast cancer patients are followed by their health care providers for a long time after treatment, which presents many opportunities for providers to share advice about physical activity and other healthy lifestyle changes," said lead author Bernardine M. Pinto, Ph.D., of The Miriam Hospital's Centers for Behavioral and Preventive Medicine.

She points out there are more than 11 million cancer survivors in the United States. "As survival rates improve, cancer is often viewed less as a death sentence and more as a chronic disease," said Pinto. "Cancer patients are interested in what they can do to improve their well-being, and getting advice from the care providers they see regularly can certainly help in adopting healthy lifestyles, including becoming physically active."

Telephone-based interventions to promote exercise in the general population have been successful, offering such unique advantages such as convenience and access. However, researchers say that previous interventions promoting exercise among cancer survivors did not involve health care providers and most studies to date have not assessed long-term physical activity outcomes.

Pinto and colleagues conducted a randomized trial involving 192 breast cancer patients. In the study, oncologists and surgeons were asked to provide brief physical activity advice to patients who had completed treatment for Stage 0-IV breast cancer, including a recommendation of 30 minutes of moderate intensity exercise most days of the week and scheduling follow-up with research staff..

The 106 women who were randomized to the telephone counseling group received eight telephone calls over 12 weeks from counselors who monitored and supported their physical activity efforts. The remaining 86 participants assigned to the control group received the same number and frequency of telephone calls that focused on their general health. All participants were assessed at baseline and again at three, six and 12 months .

Pinto and her team say patients in the telephone counseling group had considerably higher levels of physical activity and were almost twice as likely to meet national recommendations of 150 minutes per week of exercise three and six months later. Telephone counseling also significantly improved patients' motivational readiness throughout the 12-month study period, suggesting the potential for exercise promotion in cancer follow-up care.

Pinto notes this is the first trial that has included a role for the cancer provider and integrated advice about exercise into regular medical appointments.

"Our study clearly shows it's possible for motivated health care providers to provide brief advice to their patients during a follow-up visit," she said. "While we can't be sure physician advice alone would suffice, our results do suggest that health care provider advice will require supplementation, whether it's telephone counseling or some other mode of delivery, to support the adoption and maintenance of physical activity in cancer patients."

### The study was funded by a grant from the American Cancer Society and Rays of Hope. Co-authors include George D. Papandonatos, Ph.D., of Brown University's Program in Public Health, and Michael Goldstein, M.D., of the VHA National Center for Health Promotion and Disease Prevention in Durham, N.C.

The principal affiliation of Bernardine M. Pinto, Ph.D., is The Miriam Hospital (a member hospital of the Lifespan health system in Rhode Island), and direct financial and infrastructure support for this project was received through the Lifespan Office of Research Administration. Dr. Pinto is also a professor of psychiatry/human behavior (research) at The Warren Alpert Medical School of Brown University.

About The Miriam Hospital The Miriam Hospital is a 247-bed, not-for-profit teaching hospital affiliated with The Warren Alpert Medical School of Brown University. It offers expertise in cardiology, oncology, orthopedics, men's health, and minimally invasive surgery and is home to the state's first Joint Commission-certified Stroke Center and robotic surgery program. The hospital is nationally known for its HIV/AIDS and behavioral and preventive medicine research, including weight control, physical activity and smoking cessation. The Miriam Hospital has been awarded Magnet Recognition for Excellence in Nursing Services four consecutive times and is a founding member of the Lifespan health system. Follow us on Facebook and on Twitter (@MiriamHospital).