Predictors of adherence to an exercise program for shoulder pain and dysfunction in head and neck cancer survivors

Abstract

Purpose: Achieving acceptable levels of adherence to exercise may be a challenge with head and neck cancer (HNC) survivors given the high morbidity associated with treatment. The purpose of the present trial was to identify the key predictors of adherence during our shoulder exercise rehabilitation trial.

Methods: Fifty-two HNC survivors were randomly assigned to a 12-week progressive resistance exercise training protocol (n = 27) or a standardized therapeutic exercise protocol (n = 25) that was prescribed to address shoulder pain and dysfunction. Baseline data were collected on standard demographic, medical, behavioral, symptom, psychosocial, and motivational variables from the theory of planned behavior.

Results: The exercise adherence rate for the trial was 91%. In multivariate analysis, the independent predictors of reduced adherence were undergoing a more extensive neck dissection procedure (β = -0.361; P = 0.007) and reporting daily alcohol consumption (β = -0.298; P = 0.031). Higher exercise adherence was achieved by HNC participants who had undergone nerve sparing neck dissection procedures and who were not regular drinkers.

Conclusion: Excellent adherence to exercise was achieved in the trial despite high morbidity associated with HNC treatment. The high adherence achieved was likely due to the select and highly motivated sample of HNC survivors as well as to factors associated with trial design such as the support offered to participants. The findings of this trial need to be further explored and confirmed in a larger study that includes a more diverse sample of HNC survivors.