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Ma X, Cheung YB. Novel 3-arm wait-list controlled trial designs together with mixed-effects analysis improve precision of treatment effect estimators. J Biopharm Stat 2023:1-15. [PMID: 37929703 DOI: 10.1080/10543406.2023.2275755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 10/20/2023] [Indexed: 11/07/2023]
Abstract
Clinical trialists have long been searching for approaches to increase statistical power without increasing sample size. Conventional wait-list controlled (WLC) trials are limited to two trial arms and two or three repeated measurements per person. These features limit statistical power. Furthermore, their analysis is usually based on analysis of covariance or mixed effects modelling, with a focus on estimating treatment effect at one time-period after initiation of therapy. We propose two 3-arm WLC trial designs together with a mixed-effects analysis framework. The designs require three or four repeated measurements per person. The analytic framework defines up to three treatment effect estimands, representing the effects at one to three time-periods after initiation of therapy. The precision (inverse of variance) of the treatment effect estimators in the new and conventional trial designs are analytically derived and evaluated in simulations. The results are interpreted in the context of a cognitive training trial in older people. The proposed designs and analysis methods increase the precision level of treatment effect estimators as compared to conventional designs and analyses. Given a target level of statistical power, the proposed methods require a smaller number of participants per trial than the conventional methods, without necessarily increasing the number of measurements per trial. Furthermore, the proposed analytic framework sheds light on the treatment effects at different times after initiation of therapy, which is not usually considered in conventional WLC trial analysis. In situations that a WLC trial is appropriate, the 3-arm designs are useful alternatives to existing 2-arm designs.
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Affiliation(s)
- Xiangmei Ma
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore
| | - Yin Bun Cheung
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore
- Programme in Health Services & Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Tampere Center for Child, Adolescent and Maternal Health Research, Tampere University, Tampere, Finland
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2
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de Vries-Ten Have J, Winkels RM, Kampman E, Winkens LHH. Behaviour change techniques used in lifestyle interventions that aim to reduce cancer-related fatigue in cancer survivors: a systematic review. Int J Behav Nutr Phys Act 2023; 20:126. [PMID: 37833784 PMCID: PMC10576285 DOI: 10.1186/s12966-023-01524-z] [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: 07/20/2022] [Accepted: 09/29/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Lifestyle interventions that target dietary and/or physical activity behaviours may impact cancer-related fatigue in cancer survivors. Changing lifestyle may be especially difficult for cancer survivors suffering from cancer-related fatigue. To increase effectiveness of lifestyle interventions, behaviour change techniques (BCTs) can be applied. The aim of this review is to systematically describe which BCTs are applied in lifestyle interventions targeting cancer-related fatigue among cancer survivors who finished primary treatment. METHODS PubMed, Scopus, PsycINFO, Cochrane Library and Web of Science were searched to identify randomised controlled trials (RCTs) of dietary and/or physical activity interventions targeting cancer-related fatigue in cancer survivors. The BCT taxonomy was used to code the BCTs that were applied in those interventions. BCTs that were reported in at least 25% of effective interventions were indicated as 'promising BCT', but only retained this classification when these BCTs were present in less than 25% of ineffective interventions. RESULTS Twenty-nine RCTs were identified, of which 17 were effective in reducing cancer-related fatigue. The most frequently applied BCTs were Goal setting (behaviour), Instruction on how to perform the behaviour, Demonstration of the behaviour, Behavioural practice/rehearsal, and Credible Source. The BCT 'Generalisation of the target behaviour' was identified as promising. These results should be interpreted with caution as only three studies screened their participants on level of cancer-related fatigue and most studies focused only on physical activity. Furthermore, many studies did not include a measure for actual behaviour change and had no follow-up period after the intervention ended. CONCLUSIONS There is a need for studies that screen their participants on level of cancer-related fatigue and a need for studies that focus more on dietary behaviours as a possible intervention to reduce fatigue. Also, studies should include follow-up timepoints after the interventions ends to examine long-term behaviour change. Future lifestyle interventions should describe interventions in detail to allow for easier coding of BCTs, and report on actual behaviour change following the intervention. Interventions may apply the BCT 'Generalisation of the target behaviour' to incorporate lifestyle behaviours in daily life. This may increase the chance that interventions will effectively reduce cancer-related fatigue.
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Affiliation(s)
- Judith de Vries-Ten Have
- Division of Human Nutrition and Health, Nutrition and Disease Chair Group, Wageningen University and Research, Stippeneng 4, 6708 WE, Wageningen, The Netherlands.
- Consumption and Healthy Lifestyles Chair Group, Wageningen University and Research, Hollandseweg 1, 6706 KN, Wageningen, The Netherlands.
| | - Renate M Winkels
- Division of Human Nutrition and Health, Nutrition and Disease Chair Group, Wageningen University and Research, Stippeneng 4, 6708 WE, Wageningen, The Netherlands
| | - Ellen Kampman
- Division of Human Nutrition and Health, Nutrition and Disease Chair Group, Wageningen University and Research, Stippeneng 4, 6708 WE, Wageningen, The Netherlands
| | - Laura H H Winkens
- Consumption and Healthy Lifestyles Chair Group, Wageningen University and Research, Hollandseweg 1, 6706 KN, Wageningen, The Netherlands
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3
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Wang TC, Chen PL, Liao WC, Tsai IC. Differential Impact of Exercises on Quality-of-Life Improvement in Breast Cancer Survivors: A Network Meta-Analysis of Randomized Controlled Trials. Cancers (Basel) 2023; 15:3380. [PMID: 37444490 DOI: 10.3390/cancers15133380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 05/22/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
This study aimed to assess the effectiveness of various exercise interventions in enhancing the quality of life for breast cancer survivors. To achieve this, randomized controlled trials were identified from major electronic databases, focusing on the relationship between exercise and quality of life in breast cancer survivors. The primary outcome was the impact of exercise on quality of life 12 weeks after the intervention, with a secondary outcome comparing dropout rates between intervention groups and a regular care control group. The study protocol was registered with INPLASY (INPLASY202340007). A network meta-analysis of nine randomized controlled trials involving 725 participants was conducted, examining aerobic and strength training, aerobic activity, yoga, and strength exercise. Results showed that aerobic and strength training was the most effective intervention, significantly improving the quality of life of breast cancer survivors (1.31; 95% confidence interval: 0.49 to 2.12). Aerobic activity had a borderline effect (0.83; 0.03 to 1.63), while no exercise interventions were associated with an increased dropout risk compared to the control group (regular care). The study concluded that concurrent aerobic and strength training can improve breast cancer survivors' quality of life after 12 weeks of intervention without increasing dropout risk compared to regular care.
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Affiliation(s)
- Tzu-Chieh Wang
- Doctoral Program, Department of Nursing, College of Nursing, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
- Department of Nursing, Taichung Veterans General Hospital, Taichung 407219, Taiwan
| | | | | | - I-Chen Tsai
- InnovaRad, Taichung 407217, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
- Congenital Heart Disease Study Group, Asian Society of Cardiovascular Imaging, Seoul 13572, Republic of Korea
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Effect of Wearable Technology-Based Physical Activity Interventions on Breast Cancer Survivors' Physiological, Cognitive, and Emotional Outcomes: A Systematic Review. J Clin Med 2021; 10:jcm10092015. [PMID: 34066752 PMCID: PMC8125804 DOI: 10.3390/jcm10092015] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/09/2021] [Accepted: 05/05/2021] [Indexed: 12/12/2022] Open
Abstract
This systematic review synthesized all randomized controlled trials (RCTs) and controlled trials examining the effects of wearable health technology-based physical activity interventions on physiological, cognitive, and emotional outcomes in breast cancer survivors (BCS). We searched NCBI, Academic Search Premier, EMBASE, Web of Science, PubMed, and Medline from inception to March 2021. We included studies which: (1) were RCTs or controlled trials ≥8 weeks in duration; (2) were peer-reviewed and published in English; (3) sampled BCS in full remission and had not received treatment for at least six months; (4) utilized wearable health technology (e.g., Fitbit, Garmin xGC30); and (5) examined physiological, emotional, and/or cognitive outcomes. Sixty-six studies were identified and 14 were included in the review. Most of the observed effects were statistically significant and those which employed multi-component interventions generally yielded greater effects. Overall, the use of wearable health technology reduced sedentary behavior and increased moderate-to-vigorous intensity physical activity. Further, increased moderate-to-vigorous intensity physical activity was observed to be associated with increased perceived cognition and higher cognitive performance. Multiple studies also observed significant improvements in attitude, worry, and anxiety. Overall, findings suggested wearable health technology-based physical activity interventions to be effective for improving physical activity, attitude, and cognitive functions and for reducing sedentary behavior, anxiety, and worry in BCS.
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Blount DS, McDonough DJ, Gao Z. Effect of Wearable Technology-Based Physical Activity Interventions on Breast Cancer Survivors' Physiological, Cognitive, and Emotional Outcomes: A Systematic Review. J Clin Med 2021. [PMID: 34066752 DOI: 10.3390/jcm10092015.4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023] Open
Abstract
This systematic review synthesized all randomized controlled trials (RCTs) and controlled trials examining the effects of wearable health technology-based physical activity interventions on physiological, cognitive, and emotional outcomes in breast cancer survivors (BCS). We searched NCBI, Academic Search Premier, EMBASE, Web of Science, PubMed, and Medline from inception to March 2021. We included studies which: (1) were RCTs or controlled trials ≥8 weeks in duration; (2) were peer-reviewed and published in English; (3) sampled BCS in full remission and had not received treatment for at least six months; (4) utilized wearable health technology (e.g., Fitbit, Garmin xGC30); and (5) examined physiological, emotional, and/or cognitive outcomes. Sixty-six studies were identified and 14 were included in the review. Most of the observed effects were statistically significant and those which employed multi-component interventions generally yielded greater effects. Overall, the use of wearable health technology reduced sedentary behavior and increased moderate-to-vigorous intensity physical activity. Further, increased moderate-to-vigorous intensity physical activity was observed to be associated with increased perceived cognition and higher cognitive performance. Multiple studies also observed significant improvements in attitude, worry, and anxiety. Overall, findings suggested wearable health technology-based physical activity interventions to be effective for improving physical activity, attitude, and cognitive functions and for reducing sedentary behavior, anxiety, and worry in BCS.
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Affiliation(s)
- Daphne S Blount
- College of Biological Science, University of Minnesota-Twin Cities, 1445 Gortner Ave, Saint Paul, MN 55108, USA
| | - Daniel J McDonough
- School of Kinesiology, University of Minnesota-Twin Cities, 208 Cooke Hall, 1900 University Ave SE, Minneapolis, MN 55455, USA
| | - Zan Gao
- School of Kinesiology, University of Minnesota-Twin Cities, 208 Cooke Hall, 1900 University Ave SE, Minneapolis, MN 55455, USA
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Allicock M, Kendzor D, Sedory A, Gabriel KP, Swartz MD, Thomas P, Yudkin JS, Rivers A. A Pilot and Feasibility Mobile Health Intervention to Support Healthy Behaviors in African American Breast Cancer Survivors. J Racial Ethn Health Disparities 2021; 8:157-165. [PMID: 32385847 DOI: 10.1007/s40615-020-00767-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 04/13/2020] [Accepted: 04/22/2020] [Indexed: 12/13/2022]
Abstract
African American breast cancer (AA BC) survivors are more likely to have cancer-related comorbidities compared with other women, ultimately putting them at higher risk for overall mortality and breast cancer-specific mortality. Survivorship care guidelines emphasize the importance of attention to obesity, weight management, and physical activity. Mobile technologies have been effective for improving health behaviors among cancer survivors, though few studies have focused on AA BC survivors. Creating Healthy Actions through Technology (CHAT) was a 4-week pilot intervention that employed an ecological momentary assessment (EMA) to improve survivors' physical activity and diet behaviors. We evaluated the acceptability, feasibility, and impact of a mHealth intervention for AA BC survivors. Participants (N = 22) were randomized to intervention (n = 13) or control (n = 9). All participants completed daily EMAs via smartphone for 4 weeks and wore accelerometers for seven consecutive days at baseline, 4, and 8 weeks. Intervention participants additionally received tailored health messages. Diet was measured using a self-reported questionnaire and physical activity with accelerometers. Participant engagement was high. Of 84 EMA assessments, the average response was 63 (SD 16.1). Participant accelerometer wear was at least 6 of the 7 days (SD 1.7) for each assessment. Eighty-five percent of participants reported the intervention helped change behaviors. Intervention participants reduced their sedentary time by 4.37 (SD = 7.14) hours/day versus controls (p = .05), reduced fast food intake by 1.5 servings (p = 0.008), and increased vigorous activity by 0.56 (SD = 28.10) minutes, which was non-significant (p = 0.959). Findings show feasibility and acceptability and potential of the intervention to positively impact physical activity among AA BC survivors.
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Affiliation(s)
- Marlyn Allicock
- School of Public Health, University of Texas Health Sciences Center at Houston, Houston, TX, USA.
- Department of Health Promotion & Behavioral Sciences, 5323 Harry Hines Blvd., V8.112, Dallas, TX, 75390-9128, USA.
| | - Darla Kendzor
- The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Tobacco Intervention Research Clinic, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Abigail Sedory
- School of Public Health, University of Texas Health Sciences Center at Houston, Houston, TX, USA
| | - Kelley Pettee Gabriel
- School of Public Health, University of Texas Health Sciences Center at Houston, Houston, TX, USA
| | - Michael D Swartz
- School of Public Health, University of Texas Health Sciences Center at Houston, Houston, TX, USA
| | - Priya Thomas
- School of Public Health, University of Texas Health Sciences Center at Houston, Houston, TX, USA
| | - Joshua S Yudkin
- School of Public Health, University of Texas Health Sciences Center at Houston, Houston, TX, USA
| | - Aeisha Rivers
- Memorial Breast Cancer Center, Memorial Regional Hospital, Memorial Hospital West, Hollywood, FL, USA
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Markert C, Sasangohar F, Mortazavi BJ, Fields S. The Use of Telehealth Technology to Support Health Coaching for Older Adults: Literature Review. JMIR Hum Factors 2021; 8:e23796. [PMID: 33512322 PMCID: PMC7880804 DOI: 10.2196/23796] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 12/17/2020] [Accepted: 12/23/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Health coaching is an intervention process for driving behavior change through goal-setting, education, encouragement, and feedback on health-related behaviors. Telehealth systems that include health coaching and remote monitoring are making inroads in managing chronic conditions and may be especially suited for older populations. OBJECTIVE This literature review aimed to investigate the current status of health coaching interventions incorporating telehealth technology and the associated effectiveness of this intervention to deliver health care with an emphasis on older adults (aged 65 and older). METHODS A literature review was conducted to identify the research conducted on health coaching combined with remote monitoring for delivering health care to older adults. The Ovid MEDLINE and CINAHL databases were queried using a combination of relevant search terms (including middle aged, aged, older adult, elderly, health coaching, and wellness coaching). The search retrieved 196 papers published from January 2010 to September 2019 in English. Following a systematic review process, the titles and abstracts of the papers retrieved were screened for applicability to health coaching for older adults to define a subset for further review. Papers were excluded if the studied population did not include older adults. The full text of the 42 papers in this subset was then reviewed, and 13 papers related to health coaching combined with remote monitoring for older adults were included in this review. RESULTS Of the 13 studies reviewed, 10 found coaching supported by telehealth technology to provide effective outcomes. Effectiveness outcomes assessed in the studies included hospital admissions/re-admissions, mortality, hemoglobin A1c (HbA1c) level, body weight, blood pressure, physical activity level, fatigue, quality of life, and user acceptance of the coaching program and technology. CONCLUSIONS Telehealth systems that include health coaching have been implemented in older populations as a viable intervention method for managing chronic conditions with mixed results. Health coaching combined with telehealth may be an effective solution for providing health care to older adults. However, health coaching is predominantly performed by human coaches with limited use of technology to augment or replace the human coach. The opportunity exists to expand health coaching to include automated coaching.
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Affiliation(s)
- Carl Markert
- Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, United States
| | - Farzan Sasangohar
- Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, United States.,Center for Outcome Research, Houston Methodist, Houston, TX, United States
| | - Bobak J Mortazavi
- Department of Computer Science and Engineering, Texas A&M University, College Station, TX, United States
| | - Sherecce Fields
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, United States
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8
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Effects of a wearable technology-based physical activity intervention on sleep quality in breast cancer survivors: the ACTIVATE Trial. J Cancer Surviv 2020; 15:273-280. [PMID: 32875536 DOI: 10.1007/s11764-020-00930-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 08/20/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Physical activity interventions can improve sleep quality in breast cancer survivors. This paper examines the effects of the ACTIVATE Trial, a wearable-based physical activity intervention (Garmin Vivofit2® coupled with behavioral feedback, goal setting, and health coaching) on sleep outcomes. METHODS Post-primary treatment, inactive, postmenopausal breast cancer survivors were recruited and randomized to primary intervention or waitlist. Wrist-worn actigraphy (sleep onset latency, SOL; total sleep time, TST; sleep efficiency, SE; wake after sleep onset, WASO; and number of awakenings, NWAKE) and questionnaire-derived sleep measures (Pittsburgh Sleep Quality Index) were assessed at baseline (T1), 12 weeks (end of primary intervention and start of waitlist intervention, T2), and at 24 weeks (T3). RESULTS Eighty-three women (mean age = 62 years) were randomized; trial retention was 94% at T2 and 87% at T3. At T2, primary intervention participants had greater improvements in WASO (- 5.7 min, 95% CI - 11.7 to - 0.2) and NWAKE compared with the waitlist arm (- 2.0, 95% CI - 3.6 to - 0.4). At T3, within-group improvements were observed for SE (both groups), WASO (both groups), NWAKE (primary intervention group only), total PSQI score (primary intervention group), and sleep efficacy (primary intervention group). CONCLUSIONS The intervention reduced actigraphy-measured sleep disturbances. Within-group analyses suggest that improvements in sleep quality are sustained over a longer duration, and there may be similar benefits from an abridged intervention (wearable device only). Actigraphy-measured effects appeared stronger in participants who were poor sleepers at study entry. IMPLICATIONS FOR CANCER SURVIVORS Wearable technology can increase physical activity and improve sleep for breast cancer survivors.
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Vallance JK, Nguyen NH, Moore MM, Reeves MM, Rosenberg DE, Boyle T, Milton S, Friedenreich CM, English DR, Lynch BM. Effects of the ACTIVity And TEchnology (ACTIVATE) intervention on health-related quality of life and fatigue outcomes in breast cancer survivors. Psychooncology 2019; 29:204-211. [PMID: 31763746 DOI: 10.1002/pon.5298] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 11/14/2019] [Accepted: 11/15/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND The ACTIVATE Trial examined the efficacy of a wearable-based intervention to increase physical activity and reduce sedentary behavior in breast cancer survivors. This paper examines the effects of the intervention on health-related quality of life (HRQoL) and fatigue at 12 weeks (T2; end of intervention) and 24 weeks (T3; follow-up). METHODS Inactive and postmenopausal women who had completed primary treatment for stage I-III breast cancer were randomized to intervention or waitlist control. Physical activity and sedentary behavior were measured by Actigraph and activPAL accelerometers at baseline (T1), end of the intervention (T2), and 12 weeks follow-up (T3). HRQoL and fatigue were measured using the Functional Assessment of Cancer Therapy-Breast (FACT-B) and the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-Fatigue). Primary intervention effects were evaluated comparing intervention and waitlist group at T2 using repeated measures mixed effects models. RESULTS Overall, 83 women were randomized and trial retention was high (94%). A 4.6-point difference in fatigue score was observed between groups at T2 (95% CI: 1.3, 7.8) indicating improvement in fatigue profiles in the intervention group. In within groups analyses, the intervention group reported a 5.1-point increase in fatigue from baseline to T2 (95% CI: 2.0, 8.2) and a 3.3-point increase from baseline to T3 (95% CI: 0.1, 6.41). CONCLUSIONS Despite small improvements in fatigue profiles, no effects on HRQoL were observed. While the ACTIVATE Trial was associated with improvements in physical activity and sedentary behavior, more intensive or longer duration interventions may be needed to facilitate changes in HRQoL.
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Affiliation(s)
- Jeff K Vallance
- Faculty of Health Disciplines, Athabasca University, Athabasca, Alberta, Canada
| | - Nga H Nguyen
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Melissa M Moore
- Medical Oncology, St Vincent's Hospital, Melbourne, Victoria, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Marina M Reeves
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Dori E Rosenberg
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Terry Boyle
- Australian Centre for Precision Health, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Shakira Milton
- Department of General Practice, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Christine M Friedenreich
- Department of Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, Alberta, Canada.,Departments of Oncology and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Dallas R English
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Brigid M Lynch
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.,Physical Activity Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
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10
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Lynch BM, Nguyen NH, Moore MM, Reeves MM, Rosenberg DE, Boyle T, Milton S, Friedenreich CM, Vallance JK, English DR. Maintenance of physical activity and sedentary behavior change, and physical activity and sedentary behavior change after an abridged intervention: Secondary outcomes from the ACTIVATE Trial. Cancer 2019; 125:2856-2860. [PMID: 31012968 DOI: 10.1002/cncr.32142] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 02/10/2019] [Accepted: 03/12/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND This brief report examines the maintenance of moderate to vigorous physical activity (MVPA) and sedentary behavior changes approximately 12 weeks after the delivery of the ACTIVATE Trial primary intervention (use of the Garmin Vivofit 2 activity tracker coupled with a behavioral feedback and goal-setting session and 5 telephone-delivered health coaching sessions). We also examine the efficacy of an abridged intervention (use of the Garmin Vivofit 2 only) in the waitlist control group. METHODS A pre-post design was employed to examine the secondary aims of the ACTIVATE Trial (n = 80; mean age = 62 years). MVPA and sedentary behavior were measured using Actigraph and activPAL accelerometers after delivery of the primary intervention (T2), and again 12 weeks later (T3). Linear mixed models with random effects were used to examine within-group changes in MVPA and sitting time variables. RESULTS After the 12-week follow-up period, women in the primary intervention group had maintained their higher levels of MVPA (change from T2 to T3 = 14 min/wk; 95% CI = -18 to 46; P = .37). However, their sitting time increased slightly, by 7 min/d (95% CI = -20 to 34; P = .58), but it did not return to its preintervention level. After receiving the Garmin Vivofit 2, the waitlist control group increased their MVPA by 33 min/wk (95% CI = 3-64; P = .03) and reduced their sitting time by 38 min/d (95% CI = -69 to -7; P = .02) over the same 12-week period. CONCLUSION The secondary outcomes from the ACTIVATE Trial suggest that wearable technology may generate sustainable changes in MVPA and sitting time. Wearable technology alone may be sufficient to change behavior, at least in the short term.
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Affiliation(s)
- Brigid M Lynch
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.,Physical Activity Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Nga H Nguyen
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Melissa M Moore
- Medical Oncology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - Marina M Reeves
- Cancer Prevention Research Centre, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Dori E Rosenberg
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Terry Boyle
- Australian Centre for Precision Health, School of Health Sciences, University of South Australia Cancer Research Institute, Adelaide, South Australia, Australia
| | - Shakira Milton
- Department of General Practice, Melbourne Medical School, The University of Melbourne, Victoria, Australia
| | - Christine M Friedenreich
- Department of Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, Alberta, Canada.,Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jeff K Vallance
- Faculty of Health Disciplines, Athabasca University, Athabasca, Alberta, Canada
| | - Dallas R English
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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11
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Lynch BM, Nguyen NH, Moore MM, Reeves MM, Rosenberg DE, Boyle T, Vallance JK, Milton S, Friedenreich CM, English DR. A randomized controlled trial of a wearable technology-based intervention for increasing moderate to vigorous physical activity and reducing sedentary behavior in breast cancer survivors: The ACTIVATE Trial. Cancer 2019; 125:2846-2855. [PMID: 31012970 DOI: 10.1002/cncr.32143] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 02/10/2019] [Accepted: 02/15/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND The benefits of an active lifestyle after a breast cancer diagnosis are well recognized, but the majority of survivors are insufficiently active. The ACTIVATE Trial examined the efficacy of an intervention (use of the Garmin Vivofit 2 activity monitor coupled with a behavioral feedback and goal-setting session and 5 telephone-delivered health coaching sessions) to increase moderate to vigorous physical activity (MVPA) and reduce sedentary behavior in breast cancer survivors. METHODS This randomized controlled trial recruited 83 inactive, postmenopausal women diagnosed with stage I-III breast cancer who had completed primary treatment. Participants were randomly assigned to the intervention group or to the control group, and the intervention was delivered over a 12-week period. MVPA and sedentary behavior were measured with Actigraph and activPAL accelerometers at baseline (T1) and at the end of the intervention (T2). RESULTS Retention in the trial was high, with 80 (96%) of participants completing T2 data collection. At T2, there was a significant between-group difference in MVPA (69 min/wk; 95% CI = 22-116) favoring the intervention group. The trial resulted in a statistically significant decrease in both total sitting time and prolonged bouts (≥20 min) of sitting, with between-group reductions of 37 min/d (95% CI = -72 to -2) and 42 min/d (95% CI = -83 to -2), respectively, favoring the intervention group. CONCLUSION Results from the ACTIVATE Trial suggest that the use of wearable technology presents an inexpensive and scalable opportunity to facilitate more active lifestyles for cancer survivors. Whether or not such wearable technology-based interventions can create sustainable behavioral change should be the subject of future research.
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Affiliation(s)
- Brigid M Lynch
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.,Physical Activity Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Nga H Nguyen
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Melissa M Moore
- Medical Oncology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - Marina M Reeves
- Cancer Prevention Research Centre, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Dori E Rosenberg
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Terry Boyle
- Australian Centre for Precision Health, School of Health Sciences, University of South Australia Cancer Research Institute, Adelaide, South Australia, Australia
| | - Jeff K Vallance
- Faculty of Health Disciplines, Athabasca University, Athabasca, Alberta, Canada
| | - Shakira Milton
- Department of General Practice, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Christine M Friedenreich
- Department of Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, Alberta, Canada.,Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Dallas R English
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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12
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Phillips SM, Courneya KS, Welch WA, Gavin KL, Cottrell A, Nielsen A, Solk P, Blanch-Hartigan D, Cella D, Ackermann RT, Spring B, Penedo F. Breast cancer survivors' preferences for mHealth physical activity interventions: findings from a mixed methods study. J Cancer Surviv 2019; 13:292-305. [PMID: 30912011 PMCID: PMC6499383 DOI: 10.1007/s11764-019-00751-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 03/13/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE Despite the benefits of physical activity for breast cancer survivors, the majority remain insufficiently active. Mobile health (mHealth) physical activity interventions may be a more scalable strategy to increase activity among survivors. However, little is known about their preferences for mHealth intervention features. This study explored survivors' preferences for these features. METHODS Survivors (N = 96; Mage = 55.8 (SD = 10.2)) self-reported demographic and disease characteristics, physical activity. A subset (n = 28) completed a semi-structured phone interview. Transcribed interviews were evaluated using a thematic content analysis approach and consensus review. Following interviews, the full sample self-reported interests and preferences for intervention features via online questionnaires. Quantitative data were analyzed using descriptive statistics. RESULTS Five themes emerged from interview data: (1) importance of relevance to breast cancer survivors; (2) easy to use; (3) integration with wearable activity trackers; (4) provide sense of accomplishment; and (5) variability in desired level of structure and personalization. The highest ranked intervention features were: daily and weekly progress feedback (87.5%), newsfeed (86.6%), activity challenges (81.3%), and scheduling tool (79.2%). Survivors were interested in receiving progress feedback (80.2%) and motivational (78.1%) and reminder (75.0%) messages. CONCLUSIONS Breast cancer survivors are interested in mHealth physical activity promotion interventions, but preferences varied around themes of relevance, ease of use, and enhancing personal motivation. IMPLICATIONS FOR CANCER SURVIVORS Engaging survivors in developing and implementing remotely delivered mHealth activity promotion interventions may enhance their effectiveness.
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Affiliation(s)
- Siobhan M Phillips
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Kerry S Courneya
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Whitney A Welch
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kara L Gavin
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Alison Cottrell
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Anne Nielsen
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Payton Solk
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ronald T Ackermann
- Department of Medicine, Feinberg School of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Bonnie Spring
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Frank Penedo
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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13
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Gavin KL, Welch WA, Conroy DE, Kozey-Keadle S, Pellegrini C, Cottrell A, Nielsen A, Solk P, Siddique J, Phillips SM. Sedentary behavior after breast cancer: motivational, demographic, disease, and health status correlates of sitting time in breast cancer survivors. Cancer Causes Control 2019; 30:569-580. [PMID: 30919252 DOI: 10.1007/s10552-019-01153-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 02/22/2019] [Indexed: 12/24/2022]
Abstract
PURPOSE Sedentary behavior is associated with poor health outcomes including obesity, lower quality of life, and mortality in breast cancer survivors. This study sought to identify motivational, demographic, and disease characteristics of breast cancer survivors who engage in greater amounts of sedentary behavior. METHODS Multivariate linear regression models estimated associations between demographic, disease, and health characteristics with reported sitting in breast cancer survivors (n = 279; Mage = 60.7 (± 9.7) years). Regression models estimated associations between motivational factors and reported sitting adjusted for demographic and disease and health covariates. RESULTS Working at least part-time and marital status were associated various sitting domains including weekday and non-leisure sitting. Higher BMI was associated with more average daily, weekend, and weekday sitting. High income was additionally associated with less non-leisure sitting. The belief that sedentary behavior is bad for health, physical function, and self-evaluative OE, and lifestyle self-efficacy were associated with multiple sitting domains in both univariate and covariate-adjusted models. CONCLUSIONS Future work should examine the relationships between motivational, demographic, and disease predictors and objectively measured sedentary behavior over time and across different sedentary behavior domains. Understanding activity changes during and after treatment is needed to identify intervention targets and develop effective interventions.
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Affiliation(s)
- Kara L Gavin
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N Lake Shore Dr. Suite 1400, Chicago, IL, 60611, USA.
| | - Whitney A Welch
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N Lake Shore Dr. Suite 1400, Chicago, IL, 60611, USA
| | - David E Conroy
- The Pennsylvania State University, State College, PA, USA
| | | | - Christine Pellegrini
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Alison Cottrell
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N Lake Shore Dr. Suite 1400, Chicago, IL, 60611, USA
| | - Anne Nielsen
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N Lake Shore Dr. Suite 1400, Chicago, IL, 60611, USA
| | - Payton Solk
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N Lake Shore Dr. Suite 1400, Chicago, IL, 60611, USA
| | - Juned Siddique
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N Lake Shore Dr. Suite 1400, Chicago, IL, 60611, USA
| | - Siobhan M Phillips
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N Lake Shore Dr. Suite 1400, Chicago, IL, 60611, USA
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14
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Paxton RJ, Garner W, Dean LT, Logan G, Allen-Watts K. Health Behaviors and Lifestyle Interventions in African American Breast Cancer Survivors: A Review. Front Oncol 2019; 9:3. [PMID: 30723698 PMCID: PMC6349825 DOI: 10.3389/fonc.2019.00003] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 01/02/2019] [Indexed: 11/13/2022] Open
Abstract
Background: African American breast cancer survivors have a higher incidence of estrogen receptor negative and basal-like (e.g., triple negative) tumors, placing them at greater risk for poorer survival when compared to women of other racial and ethnic groups. While access to equitable care, late disease stage at diagnosis, tumor biology, and sociodemographic characteristics contribute to health disparities, poor lifestyle characteristics (i.e., inactivity, obesity, and poor diet) contribute equally to these disparities. Lifestyle interventions hold promise in shielding African American survivors from second cancers, comorbidities, and premature mortality, but they are often underrepresented in studies promoting positive behaviors. This review examined the available literature to document health behaviors and lifestyle intervention (i.e., obesity, physical activity, and sedentary behavior) studies in African American breast cancer survivors. Methods: We used PubMed, Academic Search Premier, and Scopus to identify cross-sectional and intervention studies examining the lifestyle behaviors of African American breast cancer survivors. Identified intervention studies were assessed for risk of bias. Other articles were identified and described to provide context for the review. Results: Our systematic review identified 226 relevant articles. The cross-sectional articles indicated poor adherence to physical activity and dietary intake and high rates of overweight and obesity. The 16 identified intervention studies indicated reasonable to modest study adherence rates (>70%), significant reductions in weight (range -1.9 to -3.6%), sedentary behavior (-18%), and dietary fat intake (range -13 to -33%) and improvements in fruit and vegetable intake (range +25 to +55%) and physical activity (range +13 to +544%). The risk of bias for most studies were rated as high (44%) or moderate (44%). Conclusions: The available literature suggests that African American breast cancer survivors adhere to interventions of various modalities and are capable of making modest to significant changes. Future studies should consider examining (a) mediators and moderators of lifestyle behaviors and interventions, (b) biological outcomes, and (c) determinants of enhanced survival in this population.
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Affiliation(s)
- Raheem J Paxton
- Department of Community Medicine and Population Health, The University of Alabama, Tuscaloosa, AL, United States
| | - William Garner
- Department of Life and Health Sciences, University of North Texas at Dallas, Dallas, TX, United States
| | - Lorraine T Dean
- Department of Epidemiology, John Hopkins School of Public Health, Baltimore, MD, United States
| | - Georgiana Logan
- Department of Community Medicine and Population Health, The University of Alabama, Tuscaloosa, AL, United States
| | - Kristen Allen-Watts
- Department of Community Medicine and Population Health, The University of Alabama, Tuscaloosa, AL, United States
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