Methodological considerations when monitoring and promoting physical activity in cancer populations: Towards translation of evidence into broader application and impact

The prevalence of cancer is rising in accordance with the expanding global population of increasingly older individuals. Lifestyle factors and behaviours of modern-day life, such as inactivity and more sedentary time, are also associated with an increasing risk of cancer. Today, individuals diagnosed with cancer often live long lives after being treated or on long-term treatment. Yet, life beyond cancer can come with its own set of challenges, including the presence of health impairments emerging after cancer treatment. Physical activity and exercise have been associated with significant improvements in several of these health impairments. Thus, cancer survivors are generally recommended to engage in physical activities at moderate-to-vigorous intensity for 150 minutes or more each week, and to perform muscle strengthening exercises twice a week. However, few cancer survivors comply with these recommendations. Despite the numerous benefits of physical activity, widespread implementation and accessibility of exercise programs and self-management support in the cancer care are lacking. One reason for this may be the limited proportion of research dedicated to conducting pragmatic research directly relevant for realworld settings. Most research have been carried out in ideal, well-resourced settings that may not be applicable to practice. Consequently, cancer survivors are deprived of potential benefits while the burden on the health care system is increasing. As the population of cancer survivors continues to expand, the promotion of long-term health should be a central goal of the cancer survivorship care. The cancer care should provide a follow-up regime that enables and equips cancer survivors to self-manage their health including performance of behaviours such as physical activity, that can positively affect their health and wellbeing long-term. This will require translation of current evidence and knowledge into broader application and impact, which can further inform pragmatic trials and implementation. The overarching aim of the present thesis was to explore unaddressed areas in the literature and close research gaps related to methodological components of studies measuring and promoting physical activity and exercise in cancer populations. Accurate measures…