Due to earlier detection and advances in treatment, more and more women are surviving breast cancer each year
. Whilst improved survival is duly welcomed, breast cancer survivors are faced with both short and long-term health and psychosocial sequelae
, including fatigue, reductions in physical and cognitive functioning, reductions in bone health, lymphedema, weight gain and mood disturbances
[3–6]. Compared to the general (non-cancer) population, breast cancer survivors are at an increased risk of co-morbid chronic conditions and death from both cancer and non-cancer causes
. As such, there is a growing need for effective cancer recovery services that can help to improve the quality of life of breast cancer survivors and negate the associated health burdens and risks
One promising cancer recovery strategy is the promotion of regular physical activity (PA)
[9, 10]. Evidence from health outcome trials suggests that regular PA can address both the psychological and physiological burdens presented after breast cancer diagnosis and treatment
[11, 12]. Furthermore, observational research suggests that regular PA may also have an impact on survival, with breast cancer survivors who are active after treatment having a lower risk of cancer recurrence, co-morbidities and death from all causes compared to those who are less active, regardless of cancer stage
[13–15]. In recognition of these benefits, detailed exercise prescription guidelines for cancer survivors have been published by professional bodies in both Australia and North America
[9, 10, 16].
There is also new evidence that addressing the pattern of activity is important, with unique metabolic consequences associated with prolonged sedentary behaviour, regardless of total activity time
[15, 17]. Despite this evidence, the majority of breast cancer survivors are not sufficiently active for health
[17, 18] and efforts to encourage regular PA and reductions in sitting time are not a routine part of the cancer treatment or rehabilitation process
Whilst over 70 PA intervention studies have been conducted with cancer survivors, the majority have been atheoretical face-to-face programs conducted during the treatment phase
[23–26]. Whilst these interventions have been efficacious in improving important outcomes for cancer survivors, there is a need for more sustainable, less resource intensive approaches that can support survivors beyond the initial treatment phase
[27–29]. Such programs should be grounded in behaviour change theory, and address the unique determinants of PA adoption and maintenance in the post-treatment breast cancer population
The purpose of this study is to evaluate the relative efficacy of two promising distance-based approaches (targeted and tailored print interventions) for promoting PA among post-treatment breast cancer survivors compared to a standard recommendation control group. In targeted-print interventions, irrelevant information is reduced by providing individuals with materials targeted to a particular subgroup they belong to (e.g., breast cancer survivors)
. In tailored-print interventions, computer technology is utilised to provide individuals with personalised advice based on information specific to them (derived from individual assessment)
. Both approaches have been put forth as low-cost, evidence-based alternatives to resource intensive face-to-face programs
[32, 33], but little information exists about the relative efficacy and the cost/benefit of these approaches in the physical activity domain.
Some theories of information processing, such as The Elaboration Likelihood Model
, suggest that people are more likely to process information in a way that is conducive to behaviour change, if it is personally relevant to them. Based on this model, we hypothesise that individuals randomised into either the targeted or tailored print groups will experience significantly greater improvements at each timepoint on all primary and secondary outcomes compared to the standard recommendation control group. Furthermore, given the greater level of personalisation of materials in the tailored-print condition, we expect participants in the tailored-print group to experience greater improvements across PA outcomes compared to participants in the targeted-print group. This hypothesis relies on the assumption that breast cancer survivors are a somewhat heterogeneous group in terms of determinants (i.e., demographics, social-cognitive and ecological factors) of PA behaviour change.