br Finally the follow up of participants could have been
Finally, the follow-up of participants could have been extended to a longer time frame, for example 12 months; however, this research was conducted as part of a PhD thesis and an extended time frame was unfortunately not possible in this research study.
Despite these limitations, it can be said with some confi-dence that the findings are generalisable to those engaging with Macmillan but generalisability to the broader UK cancer E-64-c cannot be confirmed. To date, this study offers the best available evidence to support a print-based intervention supported by Internet tools to potentially increase physical activity in UK cancer survivors.
Implications for future research
This study suggests that print-based interventions supported by Internet tools offer a potentially promising means to improve physical activity, over 24 weeks, in UK cancer survi-vors who are able to become physically active without prior medical approval and who have Internet and email capability. This area warrants further investigation. It is acknowledged that not all cancer survivors will have Internet and email capability and therefore alternative interventions to support this population should also be investigated. Research and evaluation should continue, using the best available designs, to understand the impact of print-based interventions sup-ported by Internet tools on the physical activity, self-efficacy and HRQOL of cancer survivors over 12 months or more with larger sample sizes to identify small changes.
The Move More Pack significantly increases physical activity over a standard letter recommendation at 12 weeks but not self-efficacy or HRQOL. Prediagnosis physical activity levels and baseline self-efficacy do not predict physical activity improvement from use of the Move More Pack. Print-based interventions supported by Internet tools offers a poten-tially promising low-cost means to intervene to improve physical activity in cancer survivors and warrant further investigation.
The contribution of Clare Lait and Catherine Neck in support of intervention delivery is acknowledged.
The study was registered with the ISRCTN (registration number: 66418871), and ethical approval was received from the University of Surrey (reference: UEC/2017/023/FHMS).
This research formed part of a self-funded PhD and did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors. However, Macmillan supported recruitment, as outlined in the Methods section, and provided the Move More Packs. The University of Surrey paid postage costs.
The principal investigator is a former member of staff of Macmillan and led the design and redevelopment of the Move More Pack in 2016. The principal investigator ceased employment with the charity in April 2017. The relationship between the principal investigator and Macmillan after April 2017 has continued in relation to lateral roots research project only. No other conflicts of interest are reported.
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