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Harden SM, Brow K, Zoellner J, Armbruster SD. Identification of weight loss interventions for translation among endometrial cancer survivors: A RE-AIM analysis. Transl Behav Med 2024:ibae030. [PMID: 38907663 DOI: 10.1093/tbm/ibae030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2024] Open
Abstract
Interventions for obesity-related cancers that combine nutrition and physical activity for weight loss exist; however, their application to survivors of endometrial cancer is unknown. Furthermore, little is known about pre-implementation perceptions of existing programs from a variety of interested persons (physicians, researchers) who may be part of the implementation team. Adapting an existing intervention rather than developing a new intervention may speed the translational lag time as long as intervention characteristics and fit within the delivery system are considered during the planning phase. To describe the process of determining the core elements of obesity-related interventions for cancer survivors and determine which one might be best delivered by an urban healthcare system that predominantly serves individuals who live in rural areas of Virginia and West Virginia. A pragmatic review of the literature was conducted via PubMed and Google Scholar with broad search terms of cancer survivor AND weight loss AND health intervention. Identified interventions were scored related to the Practical, Robust Implementation and Sustainability Model-which is an extension of RE-AIM framework to guide the understanding of who, what, where, when, and how the intervention was conducted. Intervention characteristics are reported. In addition, ratings from three independent reviewers on the validated 5-point Likert scale of an intervention's acceptability, appropriateness, and feasibility in the intended delivery system were collected and summarized. Twelve interventions were identified with an average sample size of 241(±195) and a range of 48-683 participants. Target populations included survivors of colorectal, breast, and endometrial cancers as well as general cancer survivors and included both men and women or only women. Most participants (74%) identified as white/Caucasian and average age ranged from 47.1 to 65.9 years. Program duration ranged from 4 weeks to 18 months, with an average duration of 32 weeks. Intervention dosage ranged from three times a week to once a month. Intervention acceptability, appropriateness, and feasibility had average and standard deviation ratings of 3.52(±0.46), 3.41(±0.45), and 3.21(±0.46), respectively, out of 5. The four interventions with the highest combined acceptable, appropriate, and feasible scores are being considered for potential use as an obesity-related intervention for survivors of endometrial cancer. Future work is needed to determine relevant adaptations and efficacy among survivors of endometrial cancer with obesity. Our approach may be beneficial for other interventionists aiming to speed intervention development and implementation.
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Affiliation(s)
- Samantha M Harden
- Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, USA
- Obstetrics and Gynecology, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Katie Brow
- Obstetrics and Gynecology, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Jamie Zoellner
- Public Health Sciences, University of Virginia, Christiansburg, VA, USA
| | - Shannon D Armbruster
- Obstetrics and Gynecology, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
- Obstetrics and Gynecology, Carilion Clinic, Roanoke, VA, USA
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Howe L, Husband A, Robinson‐Barella A. Prescribing pre- and post-operative physical activity interventions for people undergoing breast cancer surgery: A qualitative systematic review. Cancer Med 2024; 13:e7063. [PMID: 38457236 PMCID: PMC10923032 DOI: 10.1002/cam4.7063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 11/26/2023] [Accepted: 02/18/2024] [Indexed: 03/09/2024] Open
Abstract
INTRODUCTION Undertaking physical activity, pre- and post-operatively, can benefit recovery time and improve post-surgical outcomes. One cohort of patients that have reported these benefits are those undergoing surgery for breast cancer. Yet, what remains unclear is the level to which physical activity interventions are implemented into standard surgical care for patients with breast cancer. AIMS This systematic review aimed to examine existing qualitative evidence focusing on pre- and post-operative physical activity interventions to better understand the benefits and shortcomings of physical activity within the surgical journey. METHODS A systematic literature search was undertaken in November 2022, across five databases: MEDLINE, PsycINFO, Embase, CINAHL, and Scopus. Qualitative studies involving people with breast cancer who had undertaken a physical activity intervention, either pre- and/or post-operatively, were included for analysis. The review was registered on PROSPERO: CRD42022372466 and performed according to PRISMA guidelines. The Critical Appraisal Skills Programme qualitative study checklist was used to assess study quality. RESULTS Fourteen studies were included, comprising the perspectives of 418 people receiving surgery for breast cancer. One study implemented preoperative physical activity interventions; the remaining studies focused on post-operative interventions. A narrative systematic review was undertaken due to heterogeneity in reported results. Four themes were developed by thematic analysis, centring on: (1) factors promoting engagement with physical activity interventions; (2) factors preventing engagement with physical activity interventions; (3) the impact of pre- and post-operative interventions on physical and psychological health; and (4) participant recommendations for pre- and post-operative interventions. CONCLUSION Pre- and post-operative physical activity interventions were well-accepted. Patients recognised factors which promoted or prevented engagement with interventions, as well as pre- and post-operative physical and psychological benefits that arose as a result. Evidence based co-design studies may further inform successful implementation of prescribed physical activity into standard care for surgical breast cancer patients.
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Affiliation(s)
- Lauren Howe
- School of Pharmacy, King George VI BuildingNewcastle UniversityNewcastle upon TyneUK
| | - Andy Husband
- School of Pharmacy, King George VI BuildingNewcastle UniversityNewcastle upon TyneUK
- Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Anna Robinson‐Barella
- School of Pharmacy, King George VI BuildingNewcastle UniversityNewcastle upon TyneUK
- Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUK
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Tjon A Joe S, Verschure-Dorsman S, Wilthagen EA, Stuiver M. Barriers and facilitators for weight management interventions in breast cancer patients: a systematic review of qualitative studies. Int J Qual Stud Health Well-being 2023; 18:2259290. [PMID: 37840321 PMCID: PMC10580791 DOI: 10.1080/17482631.2023.2259290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 09/12/2023] [Indexed: 10/17/2023] Open
Abstract
INTRODUCTION This systematic review and meta-synthesis of qualitative studies provides an overview of barriers and facilitators that breast cancer patients experience in weight management interventions. METHODS We included qualitative studies describing barriers and facilitators for weight management interventions as experienced by adult breast cancer patients after the completion of initial treatment . The data was extracted and using thematic analysis. RESULTS After analysis, eleven themes were determined. Six of those themes could be linked to the Attitude, Social Influence and self Efficacy (ASE)-model. Physical and mental benefits, anticipated regret and a lack of motivation were linked to attitude. Integrating a weight management programme in daily life, stigma and fears were linked to self-efficacy. With regard to the social influence determinant, encouragement and discouragement by family members were developed as a theme. Four additional themes were conducted related to weight management behaviour; external barriers, economic barriers, cultural barriers and physical barriers. In addition, integrating weight management in cancer care was described as a separate theme. CONCLUSIONS Several disease specific issues, including feeling stigmatized after cancer treatment and treatment-related side effects and peer-support should be given specific attention to maximize adherence of weight management programmes.
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Affiliation(s)
- Sheena Tjon A Joe
- clinical dietitian, The Netherlands Cancer Institute, Department of dietetics, Amsterdam, The Netherlands
| | - Sara Verschure-Dorsman
- clinical dietitian, The Netherlands Cancer Institute, Department of dietetics, Amsterdam, The Netherlands
| | - Erica A. Wilthagen
- medical information specialist, Scientific Information Service, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Martijn Stuiver
- Department of Epidemiology and Data Science, CCA, AmsterdamUMC, University of Amsterdam, Amsterdam, The Netherlands
- Associate group leader of the Cancer Survivorship group, Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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Werts SJ, Robles-Morales R, Bea JW, Thomson CA. Characterization and efficacy of lifestyle behavior change interventions among adult rural cancer survivors: a systematic review. J Cancer Surviv 2023:10.1007/s11764-023-01464-4. [PMID: 37768420 DOI: 10.1007/s11764-023-01464-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 09/09/2023] [Indexed: 09/29/2023]
Abstract
PURPOSE Little is known about the intersection between age and rurality as characteristics that impact lifestyle behavior change for cancer survivors. This review aims to summarize the current literature on lifestyle behavior change interventions conducted among rural survivors of cancer, with an emphasis on older survivors. METHODS A systematic search of five databases identified randomized controlled trials and controlled clinical trials that targeted diet, physical activity, alcohol consumption, or tobacco use change in adult cancer survivors living in rural areas of the world. RESULTS Eight studies met the inclusion criteria. Most studies were conducted in either Australia or the USA, included survivors at least 6 weeks post-treatment, and half included only breast cancer survivors, while the other four included a mix of cancer types. All but one had a physical activity component. No articles addressed changes in alcohol or tobacco behavior. Seven (87.5%) had a fully remote or hybrid delivery model. Most of the physical activity interventions showed significant changes in physical activity outcomes, while the dietary interventions showed changes of clinical but not statistical significance. CONCLUSIONS Few studies have been conducted to implement and evaluate the effectiveness of lifestyle behavior change interventions among older rural survivors of cancer. Future research should evaluate the acceptability and relevancy of adapted, evidence-based intervention with this population. IMPLICATIONS FOR CANCER SURVIVORS Effective diet and physical activity interventions exist, albeit limited in terms of effective lifestyle behavior change intervention tailored to older, rural survivors of cancer, particularly in relation to alcohol and tobacco behaviors.
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Affiliation(s)
- Samantha J Werts
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA.
- University of Arizona Cancer Center, University of Arizona, Tucson, AZ, USA.
| | - Rogelio Robles-Morales
- University of Arizona Cancer Center, University of Arizona, Tucson, AZ, USA
- Department of Clinical Translational Sciences, College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Jennifer W Bea
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
- University of Arizona Cancer Center, University of Arizona, Tucson, AZ, USA
| | - Cynthia A Thomson
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
- University of Arizona Cancer Center, University of Arizona, Tucson, AZ, USA
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Naz S, Haider KA, Jaffar A, Khan U, Azam I, Siddiqui AR, Iqbal R. Feasibility of a peer-supported, WhatsApp-assisted, lifestyle modification intervention for weight reduction among adults in an urban slum of Karachi, Pakistan: a mixed-methods, single-group, pretest-post-test, quasi-experimental study. BMJ Open 2023; 13:e070913. [PMID: 37527890 PMCID: PMC10394542 DOI: 10.1136/bmjopen-2022-070913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 07/24/2023] [Indexed: 08/03/2023] Open
Abstract
OBJECTIVES This pilot study assessed whether a peer-supported, WhatsApp-assisted lifestyle modification intervention for weight reduction is feasible to execute a definitive trial. DESIGN A mixed-methods, single group, pretest and post-test, quasi-experimental study. SETTING Azam Basti, an urban slum in Karachi, Pakistan. PARTICIPANTS Fifty participants (males and females aged 20-60) with a body mass index of >23 kg/m2, along with their nominated peers from the same family. INTERVENTION Using motivational interviewing techniques, a trained nutritionist delivered the lifestyle modification intervention to the participants and peers for 3 days after the baseline assessment and then once monthly for 1 year. The intervention was delivered in groups using WhatsApp voice calls. The education sessions mainly focused on dietary modifications, physical activity advice and peer-support assignments to achieve a 5% wt loss from the participant's initial body weight. OUTCOMES The feasibility measures included screening, recruitment, retention and monthly interview response rates. At 1 year, in-depth interviews (IDIs) with participants and peers were conducted to explore the facilitators, barriers, acceptability and experiences of the intervention. Changes in weight, calorie intake/day and calorie expenditure/day were also assessed. RESULTS The recruitment and retention rates were 32% (n=50/156) and 78% (n=39/50), respectively, while the response rate for monthly interviews ranged between 66% (n=33) and 94% (n=47). The mean weight loss at 1 year was 2.2 kg, and the reduction in mean calorie intake was 386 kcal/day. There were no changes in the mean calorie expenditure. During the IDIs, participants and peers reported intervention via WhatsApp and peer support as convenient, flexible and supportive. CONCLUSIONS The quantitative and qualitative findings of the current pilot study support the scale-up of this work with minor modifications to the screening method as well as close monitoring and motivational interviewing to improve adherence in terms of physical activity. TRIAL REGISTRATION NUMBER NCT05928338.
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Affiliation(s)
- Sabahat Naz
- Community Health Sciences Department, The Aga Khan University, Karachi, Pakistan
| | - Kaniz Amna Haider
- Pediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Ali Jaffar
- Pediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Umber Khan
- Community Health Sciences Department, The Aga Khan University, Karachi, Pakistan
| | - Iqbal Azam
- Community Health Sciences Department, The Aga Khan University, Karachi, Pakistan
| | - Amna Rehana Siddiqui
- Community Health Sciences Department, The Aga Khan University, Karachi, Pakistan
| | - Romaina Iqbal
- Department of Community Health Sciences and Medicine, The Aga Khan University, Karachi, Pakistan
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Davis AM, Befort CA, Lancaster BD, Tuck C, Polivka BJ, Carlson JA, Fleming K, Romine RS, Dean K, Murray M. Rationale and design of integrating a parents first obesity intervention with a pediatric weight management intervention for rural families - Evaluating the ripple effect. Contemp Clin Trials 2023; 128:107140. [PMID: 36893988 DOI: 10.1016/j.cct.2023.107140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 02/21/2023] [Accepted: 02/27/2023] [Indexed: 03/09/2023]
Abstract
Rural families are disproportionately affected by obesity. Obesity often runs in families and is impacted by hereditary components, the shared home environment, and parent modeling/child observational learning. Moreover, parent changes in weight predict child changes in weight. Thus, targeting the family unit has the potential to enhance outcomes for adults and children simultaneously. Additionally, engaging rural nurses in medical clinics and schools may be important in determining whether rural telehealth programs are successfully implemented and sustained. This paper describes the rationale and design of a randomized control trial (RCT) evaluating the effectiveness of an integrated adult- and child-focused obesity treatment tailored for rural participants. Outcomes of this study include participant weight loss from baseline to 9-months, device-measured physical activity, and dietary intake. This project will additionally compare reach between clinic and school settings and evaluate the impact of nurse engagement. This study will include 240 participants from eight rural communities who will be randomized to either a Parent +Family-based group or a Newsletter +Family-based group. Parents in the Parent +Family-based group will receive a 3-month adult obesity treatment designed for adult behavior change as a first step. Then, parents and children together will enter the family-based program (iAmHealthy), allowing for potential enhancement of a theorized ripple effect. Parents in the Newsletter +Family-based group will receive 3 monthly newsletters and then participate in the 6-month family-based intervention designed for child behavior change. This study is the first RCT to examine the effectiveness of an integrated adult- and child-focused obesity treatment program. Registered with ClinicalTrials.gov NCT ID NCT05612971.
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Affiliation(s)
- Ann M Davis
- Center for Children's Healthy Lifestyles & Nutrition, 610 E 22nd St, Kansas City, MO 64108, United States; Department of Pediatrics, University of Kansas Medical Center, 3901 Rainbow Boulevard, MS 4004, Kansas City, KS 66160, United States.
| | - Christie A Befort
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS 66160, United States
| | - Brittany D Lancaster
- Center for Children's Healthy Lifestyles & Nutrition, 610 E 22nd St, Kansas City, MO 64108, United States; Department of Pediatrics, University of Kansas Medical Center, 3901 Rainbow Boulevard, MS 4004, Kansas City, KS 66160, United States
| | - Chris Tuck
- Center for Children's Healthy Lifestyles & Nutrition, 610 E 22nd St, Kansas City, MO 64108, United States
| | - Barbara J Polivka
- School of Nursing, University of Kansas Medical Center, Kansas City, KS 66160, United States
| | - Jordan A Carlson
- Center for Children's Healthy Lifestyles & Nutrition, 610 E 22nd St, Kansas City, MO 64108, United States; Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO 64108, United States
| | - Kandace Fleming
- Lifespan Institute, University of Kansas, Lawrence, KS 66045, United States
| | | | - Kelsey Dean
- Center for Children's Healthy Lifestyles & Nutrition, 610 E 22nd St, Kansas City, MO 64108, United States; Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO 64108, United States
| | - Megan Murray
- Center for Children's Healthy Lifestyles & Nutrition, 610 E 22nd St, Kansas City, MO 64108, United States; Department of Pediatrics, University of Kansas Medical Center, 3901 Rainbow Boulevard, MS 4004, Kansas City, KS 66160, United States
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Uncovering Barriers and Facilitators of Weight Loss and Weight Loss Maintenance: Insights from Qualitative Research. Nutrients 2023; 15:nu15051297. [PMID: 36904294 PMCID: PMC10005538 DOI: 10.3390/nu15051297] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 03/02/2023] [Accepted: 03/04/2023] [Indexed: 03/08/2023] Open
Abstract
Long-term weight loss maintenance is often difficult to achieve. This review analysed qualitative data on self-perceived barriers and facilitators of weight loss and weight loss maintenance among weight loss intervention participants. A literature search was conducted using electronic databases. Qualitative studies written in English and published between 2011-2021 were eligible for inclusion if they explored the perspectives and experiences of individuals who received standardised dietary and behavioural support for weight loss. Studies were excluded if weight loss was achieved through self-directed methods, only increasing physical activity, or surgical or pharmacological interventions. Fourteen studies were included, totaling 501 participants from six countries. Thematic analysis was used to identify four aggregate themes: internal factors (i.e., motivation and self-efficacy), programme-specific factors (i.e., the intervention diet), social factors (i.e., supporters and saboteurs), and environmental factors (i.e., an obesogenic environment). Our findings demonstrate that internal, social, and environmental factors all influence weight loss success, as well as the acceptability of the weight loss intervention. Future interventions may be more successful if they prioritise participant acceptability and engagement by, for example, providing tailored interventions, a structured relapse management plan, strategies to enhance autonomous motivation and emotional self-regulation, and extended contact during weight loss maintenance.
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Knowledge, Attitudes and Behaviors toward Healthy Eating among Chinese Cancer Patients Treated with Chemotherapy: A Systematic Review. Asia Pac J Oncol Nurs 2022; 10:100163. [DOI: 10.1016/j.apjon.2022.100163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 10/30/2022] [Indexed: 11/08/2022] Open
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Price J, Brunet J. Understanding rural-living young adult cancer survivors' motivation during a telehealth behavior change intervention within a single-arm feasibility trial. Health Informatics J 2022; 28:14604582221075560. [PMID: 35176882 DOI: 10.1177/14604582221075560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A single-arm feasibility trial was conducted to explore rural-living young adult cancer survivors' physical activity, fruit and vegetable consumption, and motivational processes underlying any behavior changes during a telehealth behavior change intervention grounded in self-determination theory. Participants (n = 7; 85.7% female; Mage = 33.9, range = 28-37) met with a health coach once a week for 60 min for 12 weeks. Participants completed pre- and post-intervention surveys that assessed their behaviors, basic psychological needs satisfaction, and behavioral regulations. Participants also completed a semi-structured interview post-intervention. Quantitative results indicate behavioral outcomes, basic psychological needs satisfaction, and behavioral regulations increased from pre- to post-intervention. Five themes provide context for the observed increases. Results provide preliminary evidence that motivation for physical activity and fruit and vegetable consumption may be facilitated by a one-on-one telehealth intervention among rural-living young adult cancer survivors. Large scale studies are needed to determine effectiveness of the intervention and identify mechanisms underpinning behavioral outcomes.
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Affiliation(s)
- Jenson Price
- School of Human Kinetics, 6363University of Ottawa, Ottawa, ON, Canada
| | - Jennifer Brunet
- School of Human Kinetics, 6363University of Ottawa, Ottawa, ON, Canada; Cancer Therapeutic Program, Ottawa Hospital Research Institute, the Ottawa Hospital, Ottawa, ON, Canada; Institut du savoir Montfort, Hôpital Montfort, Ottawa, ON, Canada
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Delahanty LM, Wadden TA, Goodwin PJ, Alfano CM, Thomson CA, Irwin ML, Neuhouser ML, Crane TE, Frank E, Spears PA, Gillis BP, Hershman DL, Paskett ED, Hopkins J, Bernstein V, Stearns V, White J, Hudis C, Winer EP, Carey LA, Partridge AH, Ligibel JA. The Breast Cancer Weight Loss trial (Alliance A011401): A description and evidence for the lifestyle intervention. Obesity (Silver Spring) 2022; 30:28-38. [PMID: 34932888 PMCID: PMC9186690 DOI: 10.1002/oby.23287] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/06/2021] [Accepted: 08/09/2021] [Indexed: 01/03/2023]
Abstract
The Breast Cancer Weight Loss (BWEL) trial is a randomized controlled trial designed to determine whether weight loss after a breast cancer diagnosis can reduce the risk of cancer recurrence in women with overweight or obesity. The BWEL trial will compare the efficacy of a telephone-based weight-loss intervention plus health education materials versus health education materials alone on invasive disease-free survival in 3,181 women with stage II or III breast cancer and BMI > 27 kg/m2 . This report provides a detailed description of the goals and methods of the lifestyle intervention and the evidence supporting the intervention used in the BWEL trial. The intervention's primary goal for participants is to achieve and maintain a weight loss ≥ 10% of baseline weight through increased physical activity and caloric restriction. The evidence supporting the diet, physical activity, and behavioral components of this telephone-based weight-loss intervention, as well as strategies to promote participant engagement and retention, is described. The intervention is provided through 42 sessions delivered by trained health coaches over a 2-year period. If the BWEL lifestyle intervention is successful in improving cancer outcomes, then weight loss will be incorporated into the care of thousands of breast cancer patients.
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Affiliation(s)
- Linda M. Delahanty
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Thomas A. Wadden
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Pamela J. Goodwin
- Mount Sinai Hospital/Lunenfeld Tanenbaum Research Institute, University of Toronto. Toronto, Ontario, Canada
| | - Catherine M. Alfano
- Northwell Health Cancer Institute; and Institute of Health System Science, Feinstein Institutes, for Medical Research; New York, NY, USA
| | - Cynthia A. Thomson
- Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Melinda L. Irwin
- Yale School of Public Health,Yale University, New Haven, CT, USA
| | - Marian L. Neuhouser
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Tracy E. Crane
- Biobehavioral Health Sciences Division, College of Nursing, University of Arizona, Tucson, AZ, USA
| | - Elizabeth Frank
- Department of Medical Oncology, Dana-Farber/Partners CancerCare, Boston, MA, USA
| | - Patricia A. Spears
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel, Hill, NC, USA
| | - Bonnie P. Gillis
- University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Dawn L. Hershman
- Division of Medical Oncology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Electra D. Paskett
- Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Judith Hopkins
- Novant Health Cancer Institute/SCOR NCORP, Novant Health Oncology Specialists, Winston-Salem, NC, USA
| | - Vanessa Bernstein
- Division of Medical Oncology, Department of Medicine, University of British Columbia, Vancouver, Victoria BC, Canada
| | - Vered Stearns
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Julia White
- Department of Radiation Oncology, the Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Clifford Hudis
- American Society of Clinical Oncology, Alexandria, VA, USA and Department of Medicine Memorial Sloan Kettering Cancer Center, New York, NY, NY, USA
| | - Eric P. Winer
- Department of Medical Oncology, Dana-Farber/Partners CancerCare, Boston, MA, USA
| | - Lisa A. Carey
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel, Hill, NC, USA
| | - Ann H. Partridge
- Department of Medical Oncology, Dana-Farber/Partners CancerCare, Boston, MA, USA
| | - Jennifer A. Ligibel
- Department of Medical Oncology, Dana-Farber/Partners CancerCare, Boston, MA, USA
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Morris BB, Rossi B, Fuemmeler B. The role of digital health technology in rural cancer care delivery: A systematic review. J Rural Health 2021; 38:493-511. [PMID: 34480506 DOI: 10.1111/jrh.12619] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE Rural residents face higher cancer incidence rates and mortality rates, disparities that could be mitigated with health technology interventions, yet a digital divide is also apparent. This paper systematically and critically examines existing literature to understand how digital technologies have been used to support rural oncology care. METHODS PubMed, CINAHL Complete, PsycINFO, and Embase were searched using Medical Subject Headings terms and keywords. Studies were eligible if they presented empirical data investigating the use of technology in rural oncology and were published in English in a peer-reviewed journal within the last decade. The Mixed Methods Appraisal Tool was used to assess methodological quality. FINDINGS Digital health has been less extensively utilized in rural oncology compared with the general cancer population and other chronic diseases. We identified 54 studies that used technology in rural cancer care delivery, a comparatively small number, representing a significant gap in the literature. Studies were classified into 4 categories: Telemedicine (n = 32), phone calls (n = 11), Internet (n = 9), and mobile phone (n = 2). Of the 54 articles, 12 were RCTs, 17 were quasi-experimental, 3 were descriptive, 12 were mixed methods, and 10 were qualitative. Most of the studies involved patients only (n = 31) and were not specific to a cancer type (n = 41). CONCLUSIONS Further implementation and expansion of telemedicine and phone-based strategies in rural cancer care delivery are warranted. Rural cancer survivors value digital approaches to their care. However, social and behavioral determinants of health and access to technology must be considered.
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Affiliation(s)
- Bonny B Morris
- School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Brianna Rossi
- School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Bernard Fuemmeler
- School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
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12
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Baillot A, Chenail S, Barros Polita N, Simoneau M, Libourel M, Nazon E, Riesco E, Bond DS, Romain AJ. Physical activity motives, barriers, and preferences in people with obesity: A systematic review. PLoS One 2021; 16:e0253114. [PMID: 34161372 PMCID: PMC8221526 DOI: 10.1371/journal.pone.0253114] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 05/30/2021] [Indexed: 12/28/2022] Open
Abstract
Background Although the benefits of physical activity (PA) are well known, physical inactivity is highly prevalent among people with obesity. The objective of this systematic review was to i) appraise knowledge on PA motives, barriers, and preferences in individuals with obesity, and ii) quantify the most frequently reported PA motives, barriers and preferences in this population. Methods Six databases (Pubmed, CINAHL, Psyarticle, SportDiscus, Web of science and Proquest) were searched by independent reviewers to identify relevant quantitative or qualitative articles reporting PA motives, barriers or preferences in adults with body mass index ≥ 30 kg/m2 (last searched in June 2020). Risk of bias for each study was assessed by two independent reviewers with the Mixed Methods Appraisal Tool (MMAT). Results From 5,899 papers identified, a total of 27 studies, 14 quantitative, 10 qualitative and 3 mixed studies were included. About 30% of studies have a MMAT score below 50% (k = 8). The three most reported PA motives in people with obesity were weight management, energy/physical fitness, and social support. The three most common PA barriers were lack of self-discipline/motivation, pain or physical discomfort, and lack of time. Based on the only 4 studies available, walking seems to be the preferred mode of PA in people with obesity. Conclusions Weight management, lack of motivation and pain are key PA motives and barriers in people with obesity, and should be addressed in future interventions to facilitate PA initiation and maintenance. Further research is needed to investigate the PA preferences of people with obesity.
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Affiliation(s)
- Aurélie Baillot
- Department of Nursing, University of Québec en Outaouais, Gatineau, QC, Canada
- Institut du savoir Montfort-Recherche, Ottawa, ON, Canada
- Centre de recherche du Centre Intégré de Santé et Services Sociaux de l’Outaouais, Gatineau, QC, Canada
- * E-mail:
| | | | - Naiara Barros Polita
- Department of Nursing, State University of Northern Paraná, Bandeirantes, PR, Brazil
| | - Mylène Simoneau
- Faculty of Health Sciences, School of Human Kinetics, University of Ottawa, Ottawa, ON, Canada
| | - Mathilde Libourel
- Faculty of Physical Activity Sciences, University of Sherbrooke and Research Center on Aging, CIUSSS de l’Estrie–CHUS, Sherbrooke, QC, Canada
- Institut des Sciences et Industries du vivant et de l’environnement, AgroParisTech, Paris, France
| | - Evy Nazon
- Department of Nursing, University of Québec en Outaouais, Gatineau, QC, Canada
| | - Eléonor Riesco
- Faculty of Physical Activity Sciences, University of Sherbrooke and Research Center on Aging, CIUSSS de l’Estrie–CHUS, Sherbrooke, QC, Canada
| | - Dale S. Bond
- Department of Psychiatry and Human Behavior, Weight Control and Diabetes Research Center, The Miriam Hospital/Brown Alpert Medical School, Providence, RI, United States of America
| | - Ahmed J. Romain
- Faculty of Medicine, School of Kinesiology and Physical Activity Sciences, Université de Montréal, Montréal, QC, Canada
- Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, Montréal, QC, Canada
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13
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Chih MY, McCowan A, Whittaker S, Krakow M, Ahern DK, Aronoff-Spencer E, Hesse BW, Mullett TW, Vanderpool RC. The Landscape of Connected Cancer Symptom Management in Rural America: A Narrative Review of Opportunities for Launching Connected Health Interventions. JOURNAL OF APPALACHIAN HEALTH 2020; 2:64-81. [PMID: 35769642 PMCID: PMC9159365 DOI: 10.13023/jah.0204.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Background The 2016 President's Cancer Panel called for projects focusing on improving cancer symptom management using connected health technologies (broadband and telecommunications). However, rural communities, like those in Appalachia, may experience a "double burden" of high cancer rates and lower rates of broadband access and adoption necessary for connected health solutions. Purpose To better understand the current landscape of connected health in the management of cancer symptoms in rural America. Methods A literature search was conducted using four academic databases (PubMed, CINAHL, MEDLINE, and PsycINFO) to locate articles published from 2010 to 2019 relevant to connected cancer symptom management in rural America. Text screening was conducted to identify relevant publications. Results Among 17 reviewed studies, four were conducted using a randomized controlled trial; the remainder were formative in design or small pilot projects. Five studies engaged stakeholders from rural communities in designing solutions. Most commonly studied symptoms were psychological/emotional symptoms, followed by physical symptoms, particularly pain. Technologies used were primarily telephone-based; few were Internet-enabled video conferencing or web-based. Advanced mobile and Internet-based approaches were generally in the development phase. Overall, both rural patients and healthcare providers reported high acceptance, usage, and satisfaction of connected health technologies. Ten of the 17 studies reported improved symptom management outcomes. Methodological challenges that limited the interpretation of the findings were summarized. Implications The review identified a need to engage rural stakeholders to develop and test connected cancer symptom management solutions that are based on advanced mobile and broadband Internet technologies.
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14
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Maxwell-Smith C, Cohen PA, Platell C, Tan J, Saunders C, Nightingale S, Lynch C, Sardelic F, McCormick J, Hardcastle SJ. "To be there for my family" and "Keep my independence": Metropolitan and Non-Metropolitan Cancer Survivors' Health Behaviour Motives. Support Care Cancer 2020; 29:1969-1976. [PMID: 32827055 DOI: 10.1007/s00520-020-05690-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 08/14/2020] [Indexed: 01/07/2023]
Abstract
PURPOSE Cancer survivors are at risk of comorbidities and mortality, and those living outside of metropolitan areas are particularly susceptible given poorer socioeconomic, health and support resources. As engagement in health behaviours is affected by participants' autonomous motives, investigation of the motives of cancer survivors in metropolitan and non-metropolitan areas could elucidate the values and reasons for practising health behaviours, allowing programs to be tailored to these motives. METHODS Metropolitan (n = 103) and non-metropolitan (n = 80) Australian cancer survivors completed a survey item by describing their motives for physical activity and healthy diet change. Inductive thematic analysis of responses was performed to establish themes across health behaviour motives. RESULTS Analyses revealed four themes: to be able to, longevity, psychological health and appearance. Survivors primarily referred to being able to enjoy family, leisure activities, travel and staying independent, with these motives often linked to longevity. Motives were similar across locations; however, those in non-metropolitan locations reported continuation of work and pain relief more frequently. Female survivors more often reported weight loss. CONCLUSIONS A predominant motive for health behaviour change in cancer survivors across geographical location was the ability to enjoy family and engage in leisure and work activities. Programs aiming to promote health behaviours in cancer survivors might consider framing interventions accordingly by emphasizing benefits of longevity and maintaining independence.
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Affiliation(s)
- Chloé Maxwell-Smith
- School of Psychology, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia. .,Institute for Health Research, University of Notre Dame, Fremantle, Western Australia, Australia.
| | - Paul A Cohen
- St John of God Hospital, Subiaco, Western Australia, Australia.,Division of Obstetrics and Gynaecology, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Cameron Platell
- St John of God Hospital, Subiaco, Western Australia, Australia.,University of Western Australia Medical School, University of Western Australia, Crawley, Western Australia, Australia
| | - Jason Tan
- Women Centre, West Leederville, Western Australia, Australia
| | - Christobel Saunders
- St John of God Hospital, Subiaco, Western Australia, Australia.,University of Western Australia Medical School, University of Western Australia, Crawley, Western Australia, Australia
| | | | - Craig Lynch
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Frank Sardelic
- Tamara Private Hospital, Tamworth, New South Wales, Australia
| | | | - Sarah J Hardcastle
- Institute for Health Research, University of Notre Dame, Fremantle, Western Australia, Australia.,School of Health and Human Performance, Dublin City University, Dublin, Ireland
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15
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Ratcliff CG, Torres D, Tullos EA, Geng Y, Lu Q. A systematic review of behavioral interventions for rural breast cancer survivors. J Behav Med 2020; 44:467-483. [PMID: 32813192 DOI: 10.1007/s10865-020-00174-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 08/06/2020] [Indexed: 12/21/2022]
Abstract
Rural breast cancer survivors (RBCS) are at greater risk for poorer health outcomes and face greater treatment barriers compared to their urban counterparts, necessitating behavioral interventions tailored for the unique needs of RBCS. A systematic review of studies examining behavioral interventions delivered to RBCS living in the United States from 2000 to 2020 was conducted following PRIMSA guidelines. Nineteen unique studies were included: eight randomized controlled trials, two matched-control studies, six pre-post intervention feasibility studies, and three post-intervention satisfaction studies. Thirteen interventions aimed to improve psychosocial support, three to improve weight management, and three to improve education. Results indicate interventions' feasibility and acceptability. Six out of eight intervention conditions reported favorable outcomes compared to control conditions, suggesting promise for efficacy. However, variability in intervention objective, duration, delivery, and follow-up timing, and small sample sizes prevent overarching conclusions. Research involving larger sample sizes, higher quality control groups, and longer follow-up data is needed.
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Affiliation(s)
- Chelsea G Ratcliff
- Department of Psychology, Sam Houston State University, Campus Box 2447, Huntsville, TX, 77341-2447, USA. .,Baylor College of Medicine, Houston, TX, USA.
| | - Debbie Torres
- Department of Psychology, Sam Houston State University, Campus Box 2447, Huntsville, TX, 77341-2447, USA
| | - Emily A Tullos
- Department of Psychology, Sam Houston State University, Campus Box 2447, Huntsville, TX, 77341-2447, USA
| | - Yimin Geng
- Research Medical Library, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Qian Lu
- Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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16
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Exercise Interventions for Survivors of Cancer Living in Rural or Remote Settings: A Scoping Review. REHABILITATION ONCOLOGY 2020. [DOI: 10.1097/01.reo.0000000000000208] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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17
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Alston L, Partridge SR. Limited dietary interventions in rural Australian communities: A systematic review. Nutr Diet 2020; 78:57-68. [PMID: 32160401 DOI: 10.1111/1747-0080.12612] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 02/14/2020] [Accepted: 02/17/2020] [Indexed: 01/13/2023]
Abstract
AIM This review aimed to synthesise the evidence on the effectiveness of dietary interventions targeting adolescents (>13 years) and adults living in rural or remote Australia. METHODS Six electronic databases were searched to identify dietary interventions undertaken in rural or remote communities. Studies were included if they utilised intervention and control comparisons or pre and post assessment of diet-related outcomes. If studies included metropolitan populations, dietary outcome measures had to be provided separately for rural data. RESULTS In total, 14 articles from 12 unique studies met the criteria for inclusion and together provided incomplete coverage across all states of Australia, included intervention studies targeted diet to address obesity, cardiovascular disease, and high blood pressure or diabetes. No studies were focussed on reducing community malnutrition. All studies, with one exception, focussed specifically on rural adults, no interventions specifically targeted adolescents in rural areas. Only two studies documented the involvement of a dietitian in intervention development or delivery. All studies produced a significant outcome for either dietary intake, body mass index, waist circumference, or diet related biomedical risk factors for individuals located in rural or remote areas of Australia. CONCLUSION Dietary interventions in rural Australia are under-studied, especially among the adolescent population. This is despite the high level of preventable diet-related disease burden in rural and remote Australia. Existing evidence shows promise in improving dietary intakes, but further, large scale intervention research, with the involvement of dietitians, is urgently needed to improve the health of rural communities.
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Affiliation(s)
- Laura Alston
- The Global Obesity Centre, Deakin University, Institute for Health Transformation, Geelong, Victoria, Australia.,Faculty of Health, Deakin Rural Health, Deakin University, Warrnambool, Victoria, Australia.,Research Department, Colac Area Health, Colac, Victoria, Australia
| | - Stephanie R Partridge
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Prevention Research Collaboration, Charles Perkins Centre, Sydney School Public Health, The University of Sydney, Sydney, New South Wales, Australia
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18
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Anbari AB, Wanchai A, Graves R. Breast cancer survivorship in rural settings: a systematic review. Support Care Cancer 2020; 28:3517-3531. [DOI: 10.1007/s00520-020-05308-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 01/14/2020] [Indexed: 01/20/2023]
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19
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Hardcastle SJ, Galliott M, Lynch BM, Nguyen NH, Cohen PA, Mohan GR, Johansen NJ, Saunders C. 'If I Had Someone Looking Over My Shoulder…': Exploration of Advice Received and Factors Influencing Physical Activity Among Non-metropolitan Cancer Survivors. Int J Behav Med 2019; 26:551-561. [PMID: 31364038 DOI: 10.1007/s12529-019-09808-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND There are significant geographic inequalities in cancer survival with poorer survival rates in non-metropolitan areas compared to major cities. Physical activity (PA) can reduce cancer recurrence and prevent cardiovascular disease. However, few survivors participate in sufficient PA and the prevalence of inactivity is significantly higher in non-metropolitan survivors. The study investigated non-metropolitan survivors' recollections regarding PA advice received following cessation of active treatment, their knowledge of PA guidelines, and the factors that impact on PA behaviour change. METHOD Sixteen individuals (14 women and 2 men) with breast (n = 8), endometrial (n = 4) or colorectal cancer (n = 4), with a mean age of 60 years (SD = 12) completed semi-structured interviews as part of a larger study to examine the acceptability and utility of wearable trackers to increase PA. Interviews explored survivors' recollections regarding the advice they received concerning PA following active treatment, knowledge of PA guidelines for cancer survivors and the influences on PA behaviour change. Interview transcripts were analysed using thematic analysis. RESULTS Four main themes emerged: (i) insufficient knowledge of guidelines, (ii) support from the treating oncology team, (iii) external accountability, and (iv) barriers to PA. CONCLUSIONS Survivors' knowledge of PA guidelines was limited and they did not often recall their oncologists making specific recommendations concerning PA. Survivors' referred to the desire for accountability and monitoring in order to successfully change PA. Lack of motivation was the main barrier to PA participation. Other barriers included age, health status, and lack of facilities or exercise programs.
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Affiliation(s)
- Sarah J Hardcastle
- School of Psychology, Curtin University, Perth, WA, Australia. .,School of Medicine, University of Western Australia, Crawley, WA, Australia.
| | | | - Brigid M Lynch
- Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, VIC, Australia
| | - Nga H Nguyen
- Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, VIC, Australia
| | - Paul A Cohen
- School of Medicine, University of Western Australia, Crawley, WA, Australia.,St John of God Hospital, Subiaco, Subiaco, WA, Australia
| | | | | | - Christobel Saunders
- School of Medicine, University of Western Australia, Crawley, WA, Australia.,St John of God Hospital, Subiaco, Subiaco, WA, Australia
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20
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Outcomes of a text message, Fitbit, and coaching intervention on physical activity maintenance among cancer survivors: a randomized control pilot trial. J Cancer Surviv 2019; 14:80-88. [PMID: 31776849 DOI: 10.1007/s11764-019-00831-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 10/26/2019] [Indexed: 12/20/2022]
Abstract
PURPOSE We aimed to determine the effect of a health coach, text message, and Fitbit intervention on moderate-to-vigorous physical activity (MVPA) maintenance in cancer survivors following a supervised exercise program compared to provision of a Fitbit alone. METHODS Participants were recruited during the last month of an exercise-based oncology rehabilitation program and randomly assigned to the full intervention (n = 34) or Fitbit-only control groups (n = 32). In total, 59 cancer survivors completed the program (81% female; mean age 61.4 ± 9.0). Group by time differences in accelerometer-measured MVPA was assessed using linear mixed models. Additionally, we examined mean weekly Fitbit-derived MVPA levels. RESULTS Intervention participants maintained weekly MVPA from pre- (295.7 ± 139.6) to post-intervention (322.0 ± 199.4; p = 0.37), whereas those in the Fitbit-only group had a significant decrease in MVPA (305.5 ± 181.1 pre vs 250.7 ± 166.5 post; p = 0.03, effect size 0.57). The intervention participants maintained recommended levels of MPVA for health benefits during the 8-week intervention, whereas the Fitbit-only control group did not. CONCLUSIONS The findings demonstrate that a remote intervention delivered through health coaching, text messages, and Fitbit can promote maintenance of MVPA after a structured program for cancer survivors. However, use of a Fitbit alone was not sufficient to prevent expected decline in MVPA. Additional research is warranted to examine long-term impacts and efficacy in a more diverse population of cancer survivors. IMPLICATIONS FOR CANCER SURVIVORS Use of a wearable tracker alone may not be sufficient for exercise maintenance among cancer survivors after transition to an independent program. Additional planning for relapse prevention is recommended.
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21
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Female cancer survivor perspectives on remote intervention components to support physical activity maintenance. Support Care Cancer 2019; 28:2185-2194. [PMID: 31422476 DOI: 10.1007/s00520-019-05038-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 08/08/2019] [Indexed: 01/31/2023]
Abstract
PURPOSE Physical activity minimizes the side effects of cancer; yet, participation rates among cancer survivors are low. Technological innovations are promoted as efficient means for communication and remote monitoring, but little is known about acceptability among female cancer survivors. The purpose of this study was to examine female cancer survivor perspectives on remote monitoring and communication to support independent, physical activity maintenance after completing a structured, facility-based program. METHODS Participants were 19 female cancer survivors (mean age 56.3) recruited after completing a 12-week exercise-based oncology rehabilitation program. Semi-structured interviews were conducted with participants following a 4-week pilot trial of a tailored text message, FitBit®, and health coach intervention to support independent physical activity maintenance. All interviews were audio-recorded and transcribed. Transcripts from the interviews were iteratively coded by two team members using a thematic analysis. RESULTS Participants reported acceptance and satisfaction with remote monitoring and communication. Emergent themes related to technology-based support for physical activity maintenance included the following: (1) accountability to a remote partner; (2) plan Bs, planning for barriers; (3) the habit cycle; (4) convenience through technology; and (5) reclaiming health ownership following a cancer diagnosis. CONCLUSIONS Participants attributed physical activity maintenance to accountability enabled by technology. Communication based on remote monitoring was perceived as encouraging and not intrusive, during the transition to a home program. IMPLICATIONS FOR CANCER SURVIVORS This study highlights the importance of accountability and support for physical activity adherence and the positive role that technology can provide for female cancer survivors to regain control of health management.
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22
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Porter GC, Laumb K, Michaud T, Brito F, Petreca D, Schwieger G, Bartee T, Yeary KHK, Estabrooks PA. Understanding the impact of rural weight loss interventions: A systematic review and meta-analysis. Obes Rev 2019; 20:713-724. [PMID: 30633845 PMCID: PMC7565480 DOI: 10.1111/obr.12825] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 11/28/2018] [Accepted: 11/28/2018] [Indexed: 02/06/2023]
Abstract
Rural adults have a higher risk of developing obesity than urban adults. Several evidence-based interventions have targeted rural regions, but their impact, defined as reach (number and representativeness of participants) by effectiveness, has not been examined. The purpose of this review was to determine the impact of rural weight loss interventions and the availability of data across dimensions of the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework. A systematic review was conducted to identify rural weight loss interventions that targeted adults. RE-AIM-related data were abstracted from each article. We performed a meta-analysis to examine effectiveness. Sixty-four articles reported on rural weight loss interventions, describing 50 unique interventions. The median number of participants was 107. Median participation rate differed between values reported by the authors (62%) and values computed using a standard method (32%). Two studies reported on sample representativeness; none reported comparisons made between target and actual delivery settings. Median weight loss per participant was 3.64 kg. Meta-analyses revealed the interventions achieved a significant weight reduction, and longer-duration interventions resulted in greater weight loss. Rural weight loss interventions appear to be effective in supporting clinically meaningful weight loss but reach and cost outcomes are still difficult to determine.
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Affiliation(s)
- Gwenndolyn C Porter
- Department of Health Promotion, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Karen Laumb
- Laumb Consulting, LLC, Minneapolis, Minnesota, USA
| | - Tzeyu Michaud
- Department of Health Promotion, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Fabiana Brito
- Department of Health Promotion, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Daniel Petreca
- Nucleus of Research in Collective Health & Environment, University of Contestado, Mafra-SC, Brazil
| | - Gina Schwieger
- Department of Health Promotion, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Todd Bartee
- Department of Kinesiology and Sport Sciences, University of Nebraska at Kearney, Kearney, Nebraska, USA
| | - Karen H K Yeary
- Department of Health Behavior and Health Education, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Paul A Estabrooks
- Department of Health Promotion, University of Nebraska Medical Center, Omaha, Nebraska, USA
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23
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Jongerius C, Russo S, Mazzocco K, Pravettoni G. Research-Tested Mobile Apps for Breast Cancer Care: Systematic Review. JMIR Mhealth Uhealth 2019; 7:e10930. [PMID: 30741644 PMCID: PMC6388100 DOI: 10.2196/10930] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 10/20/2018] [Accepted: 10/30/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The use of mobile health (mHealth) apps in clinical settings is increasing widely. mHealth has been used to promote prevention, improve early detection, manage care, and support survivors and chronic patients. However, data on the efficacy and utility of mHealth apps are limited. OBJECTIVE The main objective of this review was to provide an overview of the available research-tested interventions using mHealth apps and their impact on breast cancer care. METHODS A systematic search of Medline, PsycINFO, Embase, and Scopus was performed to identify relevant studies. From the selected studies, the following information was extracted: authors, publication date, study objectives, study population, study design, interventions' features, outcome measures, and results. RESULTS We identified 29 empirical studies that described a health care intervention using an mHealth app in breast cancer care. Of these, 7 studies were about the use of an mHealth application in an intervention for breast cancer prevention and early detection, 12 targeted care management, and 10 focused on breast cancer survivors. CONCLUSIONS Our results indicate consistent and promising findings of interventions using mHealth apps that target care management in breast cancer. Among the categories of mHealth apps focusing on survivorship, mHealth-based interventions showed a positive effect by promoting weight loss, improving the quality of life, and decreasing stress. There is conflicting and less conclusive data on the effect of mHealth apps on psychological dimensions. We advocate further investigation to confirm and strengthen these findings. No consistent evidence for the impact of interventions using mHealth apps in breast cancer prevention and early detection was identified due to the limited number of studies identified by our search. Future research should continue to explore the impact of mHealth apps on breast cancer care to build on these initial recommendations.
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Affiliation(s)
- Chiara Jongerius
- Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Selena Russo
- Kids Cancer Centre, Sydney Children's Hospital, University of New South Wales, Sydney, Australia
| | - Ketti Mazzocco
- Department of Oncology and Hemato-oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Gabriella Pravettoni
- Department of Oncology and Hemato-oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
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24
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Gavin KL, Sherwood NE, Wolfson J, Pereira MA, Linde JA. Characterizing Self-Monitoring Behavior and Its Association With Physical Activity and Weight Loss Maintenance. Am J Lifestyle Med 2018; 15:173-183. [PMID: 33786033 PMCID: PMC7958215 DOI: 10.1177/1559827618790556] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 06/21/2018] [Accepted: 07/03/2018] [Indexed: 11/17/2022] Open
Abstract
Introduction: Reviewing gaps in self-monitoring during weight loss interventions may help identify individuals demonstrating signs of disengagement in behaviors, including moderate to vigorous physical activity (MVPA), associated with weight loss maintenance. This study examined the associations of different aspects of self-monitoring during a weight loss intervention with 24-month MVPA and weight. Methods: Secondary data analysis from the Tracking Study, a trial comparing weight-tracking frequency during a lifestyle weight loss program, was conducted. Self-monitoring logs from n =339 participants were used to define 4 characteristics and 4 specific gap lengths: short (1-4 weeks), medium (5-8 weeks), long (9-12 weeks), and extra long (>12 weeks). Self-reported MVPA and staff-measured weight were measured at baseline, 6, 12, 18, and 24 months. Generalized estimating equation modeling examined the association between self-monitoring characteristics and reported MVPA and weight. Results: Participants with gaps in self-monitoring as early as the second week of the intervention reported less MVPA and weighed more at 24 months. Furthermore, consistent tracking of MVPA was associated with higher reported MVPA and lower weight. Conclusions: Behavior tracking provides important information about behavioral disengagement early in the intervention process. Future work should test intervention augmentations to improve behavior change when disengagement is detected.
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Affiliation(s)
- Kara L Gavin
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois (KLG).,Division of Epidemiology and Community Health (NES, MAP, JAL), University of Minnesota School of Public Health, Minneapolis, Minnesota.,Division of Biostatistics (JW), University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - Nancy E Sherwood
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois (KLG).,Division of Epidemiology and Community Health (NES, MAP, JAL), University of Minnesota School of Public Health, Minneapolis, Minnesota.,Division of Biostatistics (JW), University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - Julian Wolfson
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois (KLG).,Division of Epidemiology and Community Health (NES, MAP, JAL), University of Minnesota School of Public Health, Minneapolis, Minnesota.,Division of Biostatistics (JW), University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - Mark A Pereira
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois (KLG).,Division of Epidemiology and Community Health (NES, MAP, JAL), University of Minnesota School of Public Health, Minneapolis, Minnesota.,Division of Biostatistics (JW), University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - Jennifer A Linde
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois (KLG).,Division of Epidemiology and Community Health (NES, MAP, JAL), University of Minnesota School of Public Health, Minneapolis, Minnesota.,Division of Biostatistics (JW), University of Minnesota School of Public Health, Minneapolis, Minnesota
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25
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Cox-Martin E, Song J, Demark-Wahnefried W, Lyons EJ, Basen-Engquist K. Predictors of enrollment in individual- and couple-based lifestyle intervention trials for cancer survivors. Support Care Cancer 2018; 26:2387-2395. [PMID: 29423679 DOI: 10.1007/s00520-018-4084-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 01/29/2018] [Indexed: 01/14/2023]
Abstract
PURPOSE To utilize data from lifestyle intervention pilot studies for cancer survivors to elucidate demographic, disease-related, and health behavior factors that might predict enrollment in this type of research. Additionally, factors were differentially compared based on intervention design (i.e., individual versus couple-based). METHODS Secondary data analysis was conducted regarding predictors of enrollment into lifestyle intervention studies, including Healthy Moves Weight Loss (individual participants, screened n = 89, enrolled n = 30) and Healthy Moves Couples (survivors and their partners, screened n = 197, enrolled n = 23). Due to small sample sizes, common in pilot studies, random forest analyses were used to maximize information yielded by the data. RESULTS Results identified numerous important predictors of enrollment in individual and couple-based lifestyle interventions. Percent energy from fat and physical activity minutes were identified as important predictors for both recruitment methods. Age, cancer site, and marital status were important predictors of enrollment in the individual-based intervention. Weight, fiber consumption, and disease-related symptom severity and interference were important predictors of enrollment in the couple-based intervention. CONCLUSION Although there was some overlap in predictors for enrollment between studies, many differential predictors were identified between individual versus couple-based study designs for lifestyle intervention in cancer survivors. Future lifestyle intervention studies for cancer survivors may benefit from targeting different predictors of enrollment based on study design to optimize recruitment. Additionally, understanding predictors may allow certain barriers to enrollment (i.e., symptom burden) to be directly addressed, making lifestyle intervention research more feasible and acceptable to difficult-to-recruit survivors.
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Affiliation(s)
- Emily Cox-Martin
- Division of Medical Oncology, School of Medicine, University of Colorado Anschutz Medical Campus, 12801 E 17th Ave, Aurora, CO, 80045, USA.
| | - Jaejoon Song
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, P.O. Box 301402, Houston, TX, 77230-1402, USA
| | - Wendy Demark-Wahnefried
- Department of Nutrition Sciences, University of Alabama at Birmingham, 1675 University Blvd, Birmingham, AL, 35233, USA
| | - Elizabeth J Lyons
- Department of Nutrition and Metabolism, The University of Texas Medical Branch, 301 University Boulevard, Galveston, TX, 77555-1124, USA
| | - Karen Basen-Engquist
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Unit 1330, P.O. Box 301439, Houston, TX, 77230-1439, USA
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26
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Braun A, Portner J, Grainger EM, Hill EB, Young GS, Clinton SK, Spees CK. Tele-Motivational Interviewing for Cancer Survivors: Feasibility, Preliminary Efficacy, and Lessons Learned. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2018; 50:19-32.e1. [PMID: 29325658 PMCID: PMC7333356 DOI: 10.1016/j.jneb.2017.05.352] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 05/07/2017] [Accepted: 05/14/2017] [Indexed: 05/06/2023]
Abstract
OBJECTIVE Determine the feasibility, acceptability, and efficacy of tele-Motivational Interviewing (MI) for overweight cancer survivors. DESIGN Six-month nonrandomized phase 2 clinical trial. SETTING Urban garden and remote platforms. PARTICIPANTS Overweight and obese cancer survivors post active treatment. INTERVENTION Remote tele-MI from a trained registered dietitian nutritionist (RDN). MAIN OUTCOME MEASURES Feasibility, acceptability, and preliminary efficacy. ANALYSIS Groups were stratified as users and nonusers based on tele-MI use. Qualitative survey data and remote MI interaction logs were analyzed for trends. Two-sample t tests were performed to assess pre-post intervention changes in physical activity and dietary behaviors, quality of life, self-efficacy, and clinical biomarkers. RESULTS A total of 29 participants completed the intervention. There were 17 tele-MI users (59%) and 12 nonusers (41%). Users were primarily female (88%), breast cancer survivors (59%), college educated (82%), with a mean age of 58 years. Users set 50% more goals, lost more weight (4.8 vs 2.6 kg), significantly improved quality of life (P = .03), and trended more positively in clinical biomarkers (eg, cholesterol, blood pressure) than did nonusers. CONCLUSIONS AND IMPLICATIONS Findings from this study indicate that tele-MI is a feasible and acceptable intervention for overweight cancer survivors after active therapy. Larger randomized trials are needed to establish efficacy and generalizability to a variety of demographic populations.
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Affiliation(s)
- Ashlea Braun
- Medical Dietetics and Health Sciences, School of Health and Rehabilitation Sciences, Ohio State University College of Medicine, Columbus, OH
| | - James Portner
- Ohio State University College of Social Work, Columbus, OH
| | - Elizabeth M Grainger
- Comprehensive Cancer Center, Ohio State University College of Medicine, Columbus, OH
| | - Emily B Hill
- Medical Dietetics and Health Sciences, School of Health and Rehabilitation Sciences, Ohio State University College of Medicine, Columbus, OH
| | - Gregory S Young
- Center for Biostatistics, Ohio State University College of Medicine, Columbus, OH
| | - Steven K Clinton
- Comprehensive Cancer Center, Ohio State University College of Medicine, Columbus, OH; Department of Internal Medicine, Division of Medical Oncology, Ohio State University College of Medicine, Columbus, OH
| | - Colleen K Spees
- Medical Dietetics and Health Sciences, School of Health and Rehabilitation Sciences, Ohio State University College of Medicine, Columbus, OH; Comprehensive Cancer Center, Ohio State University College of Medicine, Columbus, OH.
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27
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Demark-Wahnefried W, Schmitz KH, Alfano CM, Bail JR, Goodwin PJ, Thomson CA, Bradley DW, Courneya KS, Befort CA, Denlinger CS, Ligibel JA, Dietz WH, Stolley MR, Irwin ML, Bamman MM, Apovian CM, Pinto BM, Wolin KY, Ballard RM, Dannenberg AJ, Eakin EG, Longjohn MM, Raffa SD, Adams-Campbell LL, Buzaglo JS, Nass SJ, Massetti GM, Balogh EP, Kraft ES, Parekh AK, Sanghavi DM, Morris GS, Basen-Engquist K. Weight management and physical activity throughout the cancer care continuum. CA Cancer J Clin 2018; 68:64-89. [PMID: 29165798 PMCID: PMC5766382 DOI: 10.3322/caac.21441] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 10/10/2017] [Accepted: 10/11/2017] [Indexed: 12/20/2022] Open
Abstract
Mounting evidence suggests that weight management and physical activity (PA) improve overall health and well being, and reduce the risk of morbidity and mortality among cancer survivors. Although many opportunities exist to include weight management and PA in routine cancer care, several barriers remain. This review summarizes key topics addressed in a recent National Academies of Science, Engineering, and Medicine workshop entitled, "Incorporating Weight Management and Physical Activity Throughout the Cancer Care Continuum." Discussions related to body weight and PA among cancer survivors included: 1) current knowledge and gaps related to health outcomes; 2) effective intervention approaches; 3) addressing the needs of diverse populations of cancer survivors; 4) opportunities and challenges of workforce, care coordination, and technologies for program implementation; 5) models of care; and 6) program coverage. While more discoveries are still needed for the provision of optimal weight-management and PA programs for cancer survivors, obesity and inactivity currently jeopardize their overall health and quality of life. Actionable future directions are presented for research; practice and policy changes required to assure the availability of effective, affordable, and feasible weight management; and PA services for all cancer survivors as a part of their routine cancer care. CA Cancer J Clin 2018;68:64-89. © 2017 American Cancer Society.
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Affiliation(s)
| | - Kathryn H Schmitz
- Professor of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Catherine M Alfano
- Vice President, Survivorship, American Cancer Society, Inc., Washington, DC
| | - Jennifer R Bail
- Post-Doctoral Fellow, Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL
| | - Pamela J Goodwin
- Professor of Medicine, Mount Sinai Hospital, Lunenfeld-Tanenbaum Research Institute at the University of Toronto, Toronto, Ontario, Canada
| | - Cynthia A Thomson
- Professor of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ
| | - Don W Bradley
- Associate Consulting Professor, Community and Family Medicine, Duke School of Medicine, Durham, NC
| | - Kerry S Courneya
- Professor of Physical Education and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Christie A Befort
- Associate Professor of Preventive Medicine, University of Kansas Medical Center, Kansas City, KS
| | - Crystal S Denlinger
- Associate Professor of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | | | - William H Dietz
- Chair, Redstone Global Center for Prevention and Wellness, George Washington University, Washington, DC
| | | | - Melinda L Irwin
- Professor of Epidemiology, Yale School of Public Health, New Haven, CT
| | - Marcas M Bamman
- Professor of Cell Developmental and Integrative Biology, University of Alabama at Birmingham, Birmingham, AL
| | | | | | | | - Rachel M Ballard
- Director, Prevention Research Coordination, Office of Disease Prevention, Office of the Director, National Institutes of Health, Bethesda, MD
| | | | - Elizabeth G Eakin
- Professor and Director, Cancer Prevention Research Centre, School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Matt M Longjohn
- Vice President and National Health Officer, YMCA of the USA, Chicago, IL
| | - Susan D Raffa
- National Program Director for Weight Management, Veterans Health Administration, Durham, NC
| | | | - Joanne S Buzaglo
- Senior Vice President, Research and Training Institute, Cancer Support Community, Philadelphia, PA
| | - Sharyl J Nass
- Director, National Cancer Policy Forum and Board on Health Care Services, Health and Medicine Division, National Academies of Science, Engineering, and Medicine, Washington, DC
| | - Greta M Massetti
- Associate Director for Science, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
| | - Erin P Balogh
- Senior Program Officer, National Cancer Policy Forum, Health and Medicine Division, National Academies of Science, Engineering, and Medicine, Washington, DC
| | | | - Anand K Parekh
- Chief Medical Advisor, Bipartisan Policy Center, Washington, DC
| | - Darshak M Sanghavi
- Chief Medical Officer, Senior Vice President, Translation, Optum Labs, Cambridge, MA
| | | | - Karen Basen-Engquist
- Professor of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX
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28
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Fazzino TL, Fabian C, Befort CA. Change in Physical Activity During a Weight Management Intervention for Breast Cancer Survivors: Association with Weight Outcomes. Obesity (Silver Spring) 2017; 25 Suppl 2:S109-S115. [PMID: 29086523 PMCID: PMC5679351 DOI: 10.1002/oby.22007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 08/18/2017] [Accepted: 08/21/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE This study examined the effects of a group phone-based weight management intervention on change in physical activity as measured via accelerometer and self-report in rural breast cancer survivors. The study also evaluated the role of physical activity on clinically meaningful cut points for weight loss (baseline to 6 months) and weight loss maintenance (6 to 18 months). METHODS Participants were breast cancer survivors in a weight management intervention who provided valid weight and accelerometer data (N = 142). Participants were categorized into four groups based on weight loss ≥10% and weight regain ≥5% at 18 months. RESULTS Accelerometer-measured moderate-to-vigorous physical activity (MVPA) significantly increased from baseline to 6 months (+46.9 minutes). MVPA declined during maintenance but remained significantly greater than baseline. Self-reported MVPA followed a similar pattern as accelerometer MVPA, but estimates were significantly higher. Participants in the high loss, low regain group had significantly higher MVPA at all points. CONCLUSIONS A distance-based weight management intervention for survivors improved physical activity outcomes over 18 months. Self-reported physical activity was substantially higher than accelerometer measured. Findings highlight the importance of device-based measurement for characterizing the magnitude of physical activity change as well as the role of physical activity in weight management outcomes.
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Affiliation(s)
- Tera L Fazzino
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Carol Fabian
- Department of Internal Medicine, Division of Medical Oncology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Christie A Befort
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, Kansas, USA
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29
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Breast cancer survivors' experience of making weight, dietary and physical activity changes during participation in a weight loss intervention. Support Care Cancer 2016; 25:1455-1463. [PMID: 27988868 DOI: 10.1007/s00520-016-3542-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 12/12/2016] [Indexed: 12/21/2022]
Abstract
PURPOSE The aim of this study is to explore breast cancer survivors' experience of a weight loss intervention and identify potential facilitators and barriers of initiating and maintaining weight, dietary or physical activity changes. METHOD Fourteen women randomised to and completing the 12-month weight loss intervention completed semi-structured interviews 7.5 ± 0.5 months after intervention completion. An inductive thematic analysis was conducted whereby interviews were independently coded and themes identified. RESULTS Women were (mean ± SD) 55.6 ± 8.5 years, 30.2 ± 4.6 kg/m2 and 17.1 ± 3.4 months post-diagnosis at study baseline. Four themes emerged: (1) perceived motivation to participate in the intervention, (2) facilitators, (3) challenges and (4) maintenance of weight loss and behaviour changes. All women noted the impact of social/family environments, either to facilitate (e.g., support from family members) or impede (e.g., major family event) changes. The structure and support of the intervention, particularly accountability to their coach, was also seen as facilitating. Formation of habitual physical activity facilitated dietary changes. Dietary change strategies most perceived to facilitate weight loss were reducing energy intake by dietary self-monitoring, increasing vegetable intake and portion control. Challenges included breast cancer-specific issues such as post-diagnosis weight gain, treatment-related side effects and psychological issues around readiness to change and self-regulation. Diminished accountability following intervention completion impacted the maintenance of weight loss and behaviour changes, notably dietary self-monitoring. CONCLUSIONS Results suggest that formal involvement of a support person (e.g. family member/friend) and referring women to ongoing, community-based services to maintain patient-perceived accountability may be particularly useful strategies for future weight loss intervention trials targeting women with breast cancer.
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30
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Ford ME, Magwood G, Brown ET, Cannady K, Gregoski M, Knight KD, Peterson LL, Kramer R, Evans-Knowell A, Turner DP. Disparities in Obesity, Physical Activity Rates, and Breast Cancer Survival. Adv Cancer Res 2016; 133:23-50. [PMID: 28052820 PMCID: PMC6598680 DOI: 10.1016/bs.acr.2016.08.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The significantly higher breast cancer (BCa) mortality rates of African-American (AA) women compared to non-Hispanic (NHW) white women constitute a major US health disparity. Investigations have primarily focused on biological differences in tumors to explain more aggressive forms of BCa in AA women. The biology of tumors cannot be modified, yet lifestyle changes can mitigate their progression and recurrence. AA communities have higher percentages of obesity than NHWs and exhibit inefficient access to care, low socioeconomic status, and reduced education levels. Such factors are associated with limited healthy food options and sedentary activity. AA women have the highest prevalence of obesity than any other racial/ethnic/gender group in the United States. The social ecological model (SEM) is a conceptual framework on which interventions could be developed to reduce obesity. The SEM includes intrapersonal factors, interpersonal factors, organizational relationships, and community/institutional policies that are more effective in behavior modification than isolation from the participants' environmental context. Implementation of SEM-based interventions in AA communities could positively modify lifestyle behaviors, which could also serve as a powerful tool in reducing risk of BCa, BCa progression, and BCa recurrence in populations of AA women.
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Affiliation(s)
- M E Ford
- Medical University of South Carolina, Charleston, SC, United States; Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States.
| | - G Magwood
- Medical University of South Carolina, Charleston, SC, United States
| | - E T Brown
- Morehouse School of Medicine, Atlanta, GA, United States
| | - K Cannady
- Medical University of South Carolina, Charleston, SC, United States; Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States
| | - M Gregoski
- Campbell University, Buies Creek, NC, United States
| | - K D Knight
- Medical University of South Carolina, Charleston, SC, United States; Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States
| | - L L Peterson
- Washington University School of Medicine, St. Louis, MO, United States
| | - R Kramer
- Medical University of South Carolina, Charleston, SC, United States
| | - A Evans-Knowell
- South Carolina State University, Orangeburg, SC, United States
| | - D P Turner
- Medical University of South Carolina, Charleston, SC, United States; Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States
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