A mixed-methods evaluation of a group based trail walking program to reduce anxiety in cancer survivors
Tóm tắt
Cancer survivorship results in an increased number of physical and psychosocial health issues. Engaging in physical activity in natural environments is often thought of as restorative. Despite the potential benefits of engaging in physical activity in natural environments there are no sustainable community-based programs for cancer survivors that employ this form of physical activity. This study aims to evaluate the impact of an 8-week trail-walking (TW) program on anxiety in a population of adult cancer survivors. The TW program consisted of two trail walks per week for 8 weeks led by a hiking guide. Individuals were eligible to participate if they were 19 years or older, were a cancer survivor, were not on active immunotherapy, and had medical clearance from their physician for physical activity. While 12 participants signed up for the program, 9 participants (N = 9, 8 F, 1 M) completed the program. A mixed methodology included pre-and-post quantitative program surveys and post-program interviews. Questionnaires measured generalized anxiety, sleep disturbances, self-efficacy, self-esteem, psychological well-being and depression as well as pre-and-post hike state anxiety. Data was analysed using paired t-tests. Interviews were transcribed verbatim and an inductive thematic analysis was conducted to consolidate meaning and identify themes using NVivo 11 software. Average attendance was 74% of the 16 hikes. There was no significant reduction in the primary outcome of generalized anxiety (p = .38). There was a significant reduction in perceived stress after 8-weeks (p = .03) and a significant reduction in state anxiety after TW (p < .001). None of the other secondary outcomes were statistically significant (p > .05). Four overarching themes, or benefits, emerged from qualitative data analysis: (a) benefits of program design (b) physical benefits, (c) psychological benefits, and (d) social benefits. These findings demonstrate the utility of a TW program for cancer survivors in order to promote physical, psychological and social health. Feasibility of a TW program would be contingent on access to natural areas for TW and an instructor-led program with other cancer survivors.
Tài liệu tham khảo
Abbott RA, Ploubidis GB, Huppert FA, Kuh D, Wadsworth ME, Croudace TJ. Psychometric evaluation and predictive validity of Ryff's psychological well-being items in a UK birth cohort sample of women. Health Qual Life Outcomes. 2006;4:76.
Abend R, Dan O, Maoz K, Raz S, Bar-Haim Y. Reliability, validity and sensitivity of a computerized visual analog scale measuring state anxiety. J Behav Ther Exp Psychiatry. 2014;45:447–53. https://doi.org/10.1016/j.jbtep.2014.06.004.
About Cancer Survivorship Research: Survivorship definitions. The National Cancer Institute; (Accessed 11 Oct 2012). Available at: http://dccps.cancer.gov/ocs/definitions.html.
Awick EA, Phillips SM, Lloyd GR, McAuley E. Physical activity, self-efficacy and self-esteem in breast cancer survivors: a panel model. Psychooncology. 2017;26(10):1625–31.
Bernd L, Decker O, Müller S, Brähler E, Schellberg D, Herzog W, et al. Validation and standardization of the generalized anxiety disorder screener (GAD-7) in the general population. Med Care. 2008;46(3):266.
Barber FD. Social support and physical activity engagement by cancer survivors. Clin J Oncol Nurs. 2012;16(3):84–98.
Bratman G, Hamilton J, Hahn K, Daily G, James J. Nature reduces rumination and sgPFC activation. Natl Acad Sci. 2015;112(28):8567–72.
Blaschke S. The role of nature in cancer patients’ lives: a systematic review and qualitative meta-synthesis. BMC Cancer. 2017;17(1):1–13. https://doi.org/10.1186/s12885-017-3366-6.
Burke S, Wurz A, Bradshaw A, Saunders S, West MA, Brunet J. Physical activity and quality of life in cancer survivors: a meta-synthesis of qualitative research. Cancers (Basel). 2017;9(5):53.
Canadian Cancer Statistics (2019) Canadian Cancer Society. Retrieved from: http://www.cancer.ca/~/media/cancer.ca/CW/publications/Canadian%20Cancer%20Statistics/Canadian-Cancer-Statistics-2019-EN.pdf.
Campbell KL, Winters-Stone KM, Wiskemann J, May AM, Schwartz AL, Courneya KS, et al. Exercise guidelines for cancer survivors: consensus statement from international multidisciplinary roundtable. Med Sci Sports Exerc. 2019;11:2375.
CDC: Centers for Disease and Control. Anxiety and depression medicine use among cancer survivors; 2016. Retrieve from: https://www.cdc.gov/cancer/dcpc/research/articles/anxiety_dep_med_survivors.htm.
Chang C, Chen P. Human response to window views and indoor plants in the workplaceHortScience: A Publication of the American Society for Horticultural Science; 2005. p. 5.
Demark-Wahnefried W, Morey MC, Clipp EC, Pieper CF, Snyder DC, Sloane R, et al. Leading the way in exercise and diet (project LEAD): intervening to improve function among older breast and prostate cancer survivors. Control Clin Trials. 2003;24(2):206–23.
Garcia DO, Thomson CA. Physical activity and cancer survivorship. Nutr Clin Pract. 2014;29(6):769.
Groen WG, Harten WH, Vallance JK. Systematic review and meta-analysis of distance-based physical activity interventions for cancer survivors (2013-2018): we still haven’t found what we’re looking for. Cancer Treat Rev. 2018;6:188–203.
Hann D, Winter K, Jacobsen P. Measurement of depressive symptoms in cancer patients: evaluation of the Centre for epidemiological studies depression (CES-D). J Psychosom Res. 1999;46(5):437–43.
Huang HY, Tsai WC, Chou WY, Hung YC, Liu LC, Huang KF, et al. Quality of life of breast and cervical cancer survivors. BMC Womens Health. 2017;17:30.
Lawton E, Brymer E, Clough P, Denovan A. The relationship between the physical activity environment, nature relatedness, anxiety and the psychological well-being benefits of regular exercisers. Front Psychol. 2017;8:1058.
Lee EH. Review of the psychometric evidence of the perceived stress scale. Asian Nurs Res. 2012;6(4):121–7 https://doi-org.proxy.ufv.ca:2443/10.1016/j.anr.2012.08.004.
Liu J, Peh C-X, Simard S, Griva K, Mahendran R. Beyond the fear that lingers: the interaction between fear of cancer recurrence and rumination in relation to depression and anxiety symptoms. J Psychosom Res. 2018;111:120–6. https://doi.org/10.1016/j.jpsychores.2018.06.004.
Mackay GJ, Neill JT. The effect of “green exercise” on state anxiety and the role of exercise duration, intensity, and greenness: a quasi-experimental study. Psychol Sport Exerc. 2010;11:238–45.
Martyn P, Brymer E. The relationship between nature relatedness and anxiety. J Health Psychol. 2016;21(7):1436–45.
Mitchell R. Is physical activity in natural environments better for mental health than physical activity in other environments? Soc Sci Med. 2013;91:130–4.
Neupert SD, Lachman ME, Whitbourne SB. Exercise self-efficacy and control beliefs: effects on exercise behavior after an exercise intervention for older adults. J Aging Phys Act. 2009;17:1–16.
Nguyen J, Brymer B. Nature-based guided imagery as an intervention for state anxiety. Front Psychol. 2018;9:1858.
Plummer F, Manea L, Trepel D, McMillan D. Screening for anxiety disorders with the GAD-7 and GAD-2: a systematic review and diagnostic meta-analysis. Gen Hosp Psychiatry. 2016;39:24–31. https://doi.org/10.1016/j.genhosppsych.2015.11.005.
QSR International (2015) NVivo 11 [computer software]. Available from http://www.qsrinternational.com/.
Robins R, Hendin HM, Trzesniewski KH. Measuring global self- esteem: construct validation of single-item measure and the Rosenburg self-esteem scale. Personal Soc Psychol Bull. 2001;27:151.
Roe J, Aspinall P, Thompson CW. Coping with stress in deprived urban neighborhoods: what is the role of green space according to life stage? Front Psychol. 2017. https://doi.org/10.3389/fpsyg.2017.01760.
Rosenburg M. Society and the adolescent self-image. Princeton: Princeton University Press; 1965. p. p326.
Smith HR. Depression in cancer patients: pathogenesis, implications and treatment (review). Oncol Lett. 2015;9:1509–14. https://doi.org/10.3892/ol.2015.2944.
Viljayvergia D, Denlinger CS. Lifestyle factors in cancer survivorship: where we are and where we are headed. J Personalized Med. 2015;5(3):243–63.
White MP, Alcock I, Grellier J, Wheeler BW, Hartig T, Warber SL, et al. Spending at least 120 minutes a week in nature is associated with good health and wellbeing. Sci Rep. 2019;9:7730.
Yi JC, Syrjala KL. Anxiety and depression in cancer survivors. Med Clin North Am. 2017;101(6):1099–113.
Yu L, Buysse DJ, Germain A, Moul DE, Stover A, Dodds NE, et al. Development of short forms from the PROMIS™ sleep disturbance and sleep-related impairment item banks. Behav Sleep Med. 2011;10(1):6–24. https://doi.org/10.1080/15402002.2012.636266.