Iris Kanera

6 147 Long-term effects of the Kanker Nazorg Wijzer Overall, the long-term effect of the KNW on moderate PA was clinically relevant; with an average increase of 92.2 min p/w moderate PA in the entire IC and 226.5 min p/w among younger participants. Based on this considerable PA increase and maintenance, positive long-term health benefits may be expected, such as improvements in QoL and a reduced risk of all-cause mortality (Schmid & Leitzmann, 2014; Smits et al., 2015; Van Dijck et al., 2016; Wen et al., 2011). Among participants of 57 years of age and older, the intervention was not effective. This is in line with findings from Niu et al. (2015), reporting that cancer survivors aged 65 years and older were less likely to meet the PA recommendations, and less likely to improve and maintain their level of PA compared with younger survivors. Age-related co-morbid conditions and physical symptoms, such as bone- or muscle loss, might impede an increase in moderate PA in older cancer survivors (Bluethmann et al., 2015; Kampshoff et al., 2016). Moreover, the web-based delivery mode and/or the content of the KNW might be more in line with relatively younger cancer survivors, who possibly better process and convert the information, with the result of higher levels of moderate PA. Possibly, cognitive skills might play a role in processing the comprehensive information supplied on the KNW portal. Recently, associations were found between age and cognitive recovery among breast cancer survivors, indicating that attention deteriorated among older survivors (≥ 60 years; Huang et al., 2016). This might indicate that the fully automated tailored support was well applicable for the younger subgroup. However, the older subgroup (in our analysis aged 57 years and older), might need different or additional support for successfully increasing moderate PA on long term. As previously reported, there were indications that using the PA module might positively affected moderate PA outcomes after six months (Kanera et al., 2016b). However, in the present study, no significant moderation effects for use of the PA module were found at both time points. The lack of a moderation effect of module use might be explained by the small number of PA module users, which might have affected the power of analyses. Users of the PA module were encouraged to apply behavior change methods, aiming to adopt and maintain the desired amount of PA in the long term, which may have contributed to the long-term effects (Baumeister et al., 1994; de Vries et al., 2013; de Vries et al., 2003). Participants of the IC who did not use the module PA might have been triggered and encouraged to be more physically active by receiving feedback on their PA scores after completing the baseline questionnaire. Furthermore, the advantages of adopting sufficient PA in daily life were also strongly emphasized in other KNW self-management trainings modules (e.g. fatigue and mood), in the news items, and in the discussion forum. While the KNW was beneficial in influencing vegetable consumption after six months, this positive effect was not maintained after 12 months. The lack of sustained long-term effect in vegetable consumption in the present study is in line with results of previously