Iris Kanera

2 45 Prevalence and correlates of lifestyle behaviors Adherence to lifestyle recommendations Significant correlates in explaining adherence to an increasing number of lifestyle recommendations were 1) a more positive intention toward following fruit ( p = .000) recommendation, 2) higher scores on self-efficacy toward not smoking ( p = .000), a more positive attitude toward following the diet recommendations ( p = .010), and 3) three psychological factors (role functioning, p = .027; cognitive functioning, p = .026; positive mental adjustment to cancer, p = .045). In addition, a longer period after completing primary cancer treatment ( p = .024) and female gender ( p = .039) contributed to the adherence to lifestyle recommendations. DISCUSSION This cross-sectional study assessed the prevalence and correlates of five lifestyle behaviors in early cancer survivors. Additionally, contributing factors to explain the extent of adherence to lifestyle recommendations were assessed, from which only little evidence is available up to date. The special feature of this study is that for the first time both, distal and proximal factors, derived from social cognitive theories, were assessed. In all analyses, the required number of participants, in terms of power, has been achieved. Valuable information was gained about important factors that may explain engagement in lifestyle behaviors and the extent of adherence to recommendations. The highest prevalence in followed recommendations have been detected in PA (87.4%), refrain from smoking (82%), and alcohol consumption (75.4%). Low prevalence was found in adherence to the fruit recommendation (54.8%) and, in particular in adherence to the vegetable recommendation (27.4%). Physical activity The proportion of participants meeting the PA recommendations (87.4%) were much higher than results earlier reported (Blanchard et al., 2008; LeMasters et al., 2014; Stevinson et al., 2014). In these studies, however, a different measurement instrument was used, which might explain the discrepancy. Our results are rather consistent with results from studies, which also used the IPAQ Short form; however, over-reporting might have been occurred (Bertheussen, Oldervoll, Kaasa, Sandmael, & Helbostad, 2013; Craig et al., 2003; Cuevas et al., 2014). An additional explanation for the fairly high level of PA might be the relatively good health of the participants. The sample characteristics (Table 2.1) showed rather high scores on the functioning scales as well as low scores on the symptom scales of the EORTC QLQ-C30, and low scores on the HADS. In addition, more than half of the sample used some formof cancer aftercare, which often had a strong emphasis on PA. From the individuals who were engaged in aftercare, almost 50% were supported by an oncology physiotherapist or participated in a rehabilitation program including physical exercises. This might also partly explain the high level of PA among our sample of survivors.