NIHR Post Doctoral Fellowship - Peer-support to promote habitual physical activity in cancer survivors

Background: Physical inactivity costs the NHS in excess of £1billion a year and studies suggest cancer survivors are less active than those without a history of the disease, making them an important population for targeted interventions to increase activity levels. There is good evidence that physical activity can improve many of the distressing problems often experienced after cancer, such as fatigue, depressed mood, declining mobility and loss of function. Furthermore, in some cancer types studies suggest physical activity may reduce the risk of a cancer returning and death from cancer. Cancer survivors (and the health care system) have much to gain from being physically active. A recent report from the Independent Cancer Taskforce (who developed a strategy for improving the lives of people diagnosed with cancer), recommended all cancer patients be given advice to improve lifestyle behaviours, including physical activity. Intervention studies to support cancer survivors to increase their activity have been successful in the short-term (e.g. 3 months). However, these improvements tend to diminish over time and we know little about how to encourage long-term behaviour change. Without sustained, long-term physical activity the benefits described above will not to be maintained. Aims: 1) To better understand factors that promote and inhibit participation in sustained physical activity after cancer: 2) To develop a model to describe the processes involved in adopting and maintaining participation in regular physical activity after colorectal cancer: 3) To design an intervention to support long-term physical activity participation in cancer survivors. Methods: The aims of this fellowship will be achieved through the activities of four related work packages (WP). WP1: The evidence from reviews of studies describing long-term change after physical activity interventions in cancer survivors will be summarised in an overview of reviews to establish which intervention components achieve sustained increases in physical activity. A systematic review of exploratory studies describing how physical activity interventions are incorporated into participants' lives will then be conducted. This will identify factors that promote and inhibit engagement in physical activity as part of everyday life. WP2: An interview study will explore the determinants and strategies for sustaining physical activity in bowel cancer survivors (N~30). Survivors who have previously taken part in an intervention study to increase physical activity will be identified (via National Cancer Research Institute clinical studies groups). They and their partner/carer will be invited to attend an interview. The facilitators to maintenance of habitual physical activity will be explored among those who participate in regular physical activity. The barriers described by those who have tried, but failed to increase their activity levels in the long-term will also be explored. WP3: Results from WP1 & 2, existing behaviour change theories, Social Network Theory and Burden of Treatment Theory will inform the identification of factors that promote or inhibit engagement in sustained physical activity. Explanations of the mechanisms by which they impact on behaviour will be proposed. The model will then be reviewed by two groups of cancer survivors and carers to discuss its relevance to them. WP 4: Using the model developed in WP3 and in collaboration with patients, carers, clinicians, academics and stakeholders, an intervention to support long-term physical activity in colorectal cancer survivors will be designed. The intervention will be reviewed by patients and carers for its utility and acceptability and refinements made as required. Further funding will be sought to trial the intervention. Patient and public involvement: Patients have been involved in the conception of the application and their continued involvement will be integral throughout the fellowship, particularly in the development of the intervention as part of the Study Advisory Team. They will also help with the development of study materials, and dissemination to patient groups and wider public audiences. Impact: Physical inactivity has a significant impact on NHS costs and resources. A novel model of sustained physical activity behaviour change and the development of an intervention, which importantly, could be translated to suit people with other types of cancer and chronic diseases, has the potential for considerable cost benefits. Participants who habitually increase their activity levels will benefit from numerous improvements in physical and emotional health and a reduced risk of comorbid disease. Dissemination: Academic papers will be published in peer reviewed journals and the work presented at carefully chosen national and international conferences to ensure dissemination to appropriate academic and clinical audiences. Outputs will be shared with relevant stakeholders, including charities such as Macmillan Cancer Support, and clinical commissioning groups.