BRIEF REPORTS Negative Affect and Barriers to Exercise Among Early Stage Breast Cancer Patients Frank M. Perna and Lynette Craft Boston University School of Medicine Charles S. Carver and Michael H. Antoni University of Miami Objective: To assess the relative frequency of and barriers to exercise among women with breast cancer while controlling for cancer-relevant and demographic factors. Design: The present study employed concurrent samples, correlational research design. Main Outcome Measures: Exercise frequency and its association with negative affect and barriers to exercise, independent of cancer treatment, among women (N =176) with Stage I or II breast cancer who were 3, 6, and 12 months postsurgery. Results: After accounting for cancer-relevant and control variables, degree of negative affect and frequency of perceived barriers were significantly inversely associated with exercise. Conclusion: These findings suggest that attention to both emotional factors and psychosocial barriers to exercise may be warranted to further understand exercise among women with early stage breast cancer. Keywords: exercise, breast cancer, physical activity, barriers Exercise has been shown to increase functional capacity, de- crease side effects associated with cancer treatment, and improve negative affect and overall quality of life during and after treat- ment among women living with breast cancer (Burnham & Wilcox, 2002; Courneya & Friedenreich, 1997; Courneya et al., 2003; Graydon, Bubela, Irvine, & Vincent, 1995; MacVicar, Winningham, & Nickel, 1989; Mock et al., 1994; Winningham & MacVicar, 1988; Winningham, MacVicar, Bonduc, Anderson, & Minton, 1989; Young-McCaughan & Sexton, 1991). Moreover, exercise following cancer diagnosis has been associated with de- creased mortality (Holmes, Chen, Feskanich, Kroenke, & Colditz, 2005). Despite endorsement of exercise for cancer patients by the American Cancer Society and the National Cancer Institute (Winningham, 1991), little is known about exercise frequency among breast cancer patients at various stages of treatment. Cancer treatment, barriers to exercise, and negative affect have been cited as potential moderators of exercise involvement among women with breast cancer. The largest study to date reported that breast cancer patients’ level of exercise decreased from prediagnosis to active adjuvant treatment but then increased following cessation of chemotherapy and radiation treatment (Courneya & Friedenreich, 1997). Breast cancer patients have been found to perceive more barriers to exercise than age-matched controls, and women with relatively more barriers and less perceived behavioral control were less likely to exercise than breast cancer patients with fewer perceived barriers and greater perceived behavioral control (Courneya & Friedenreich, 1997; Leddy, 1997; Nelson, 1991). However, in most large-scale studies, exercise behavior and barriers were as- sessed retrospectively among women who were 18 months or more postdiagnosis and the effect of cancer treatment was not specifi- cally analyzed. Retrospective recall may be inaccurate, and omit- ting cancer treatment factors when assessing perceived barrier associations with exercise is conceptually problematic. That is, cancer treatment can alter emotional and physical states (e.g., feeling depressed or tired), and these states are commonly listed as reasons or barriers for not exercising independent of cancer treat- ment. Practically, determining whether perceived affective and physical barriers to exercise exist independently of cancer treat- ment may inform exercise intervention (Brawley, Martin, & Gyurcsik, 1998). It is possible that perceived barriers and cancer treatment have their effect on exercise behavior by their association with a com- mon factor: negative affect. Negative affect varies by cancer site and is experienced by approximately a third of breast cancer patients (Zabora, BrintzenhofeSzoc, Curbow, Hooker, & Piantadosi, 2001). Negative affect, an emotional state, is concep- tually distinct from perceived barriers, which are beliefs; yet, negative affect may function as a barrier to health behaviors, including exercise (Andersen, Kiecolt-Glaser, & Glaser, 1994; Brawley et al., 1998; Heatherton & Renn, 1995). Similarly, fatigue is a common physical symptom of cancer therapy that is associated with negative affect and may be stated as a reason for inactivity (Andersen et al., 1994; Brawley et al., 1998). Frank M. Perna and Lynette Craft, Division of Psychiatry, Boston University School of Medicine; Charles S. Carver and Michael H. Antoni, Department of Psychology, University of Miami. Frank M. Perna is now at the National Cancer Institute. Preparation of this article was supported by National Cancer Institute Grants R01-CA78801 and CA-64710, National Institute of Mental Health Research Training Grant T32MH18917, Department of Defense Training Grant J4236-DAMD1794, and National Institutes of Health General Clin- ical Research Center Grant M01RR005333 to Boston University School of Medicine. Correspondence concerning this article should be addressed to Frank M. Perna, Division of Cancer Control and Population Sciences, National Cancer Institute, 6130 Executive Blvd., EPN 4060, Bethesda, MD 20892. E-mail: pernafm@@mail.nih.gov Health Psychology Copyright 2008 by the American Psychological Association 2008, Vol. 27, No. 2, 275–279 0278-6133/08/$12.00 DOI: 10.1037/0278-6133.27.2.275 275 This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.