Innovative approach for increasing physical activity among breast cancer survivors: protocol for Project MOVE, a quasi-experimental study

Cross-sector co-creation of a community-based physical activity program for breast cancer survivors in Colombia

Benefits of physical activity (PA) in breast cancer survivors (BCS) are well established. However, programs to promote PA among BCS tailored to real-world contexts within low- to middle-income countries are limited. Cross-sector co-creation can be key to effective and scalable programs for BCS in these countries. This study aimed to evaluate the networking process to engage multisector stakeholders in the co-creation of a PA program for Colombian BCS called My Body. We employed a mixed-methods design including semistructured interviews, workshops and a social network analysis of centrality measures to assess stakeholders' engagement, resources and skills enabling the collaborative work, challenges, outcomes and lessons learned. The descriptive analysis and the centrality measures of the network revealed that 19 cross-sector stakeholders engaged in the My Body collaborative network. Through ongoing communication and cooperation, My Body built relationships between the academic lead institutions (local and international), and local and national public, private and academic institutions working in public health, sports and recreation, social sciences and engineering fields. The outcomes included the co-creation of the community-based PA program for BCS, its implementation through cross-sector synergies, increased relationships and communications among stakeholders, and successful dissemination of evidence and project results to the collaboration partners and other relevant stakeholders and community members. The mixed-methods assessment enabled understanding of ways to advance cross-sector co-creation of health promotion programs. The findings can help to enable continued development of sustainable cross-sector co-creation processes aimed at advancing PA promotion.

The influence of a supervised group exercise intervention combined with active lifestyle recommendations on breast cancer survivors' health, physical functioning, and quality of life indices: study protocol for a randomized and controlled trial

Background

Most cancer patients, under active treatment or not, are sedentary, despite increasing scientific and clinical understanding of the benefits of exercise and physical activity, such as improving quality of life, limiting disease symptoms, decreasing cancer recurrence, and increasing overall survival. Studies have shown that both supervised exercise and unsupervised physical activity programs have low adherence and limited long-term benefits among cancer survivors. Therefore, interventions focused on increasing physical activity levels have clinical and psychological relevance. The present study will examine the feasibility and efficacy of an intervention that combines supervised group exercise with active lifestyle recommendations, analyzing its clinical, psychological, physiological, functional, and immunological effects in breast cancer survivors.

Methods

Women aged 35–75 years who have completed chemotherapy, radiotherapy, and surgery for breast cancer will be recruited from the Cancer Institute of the State of Sao Paulo (ICESP) and take part in a 16-week, parallel-group, randomized, and controlled trial. They will receive a booklet with recommendations for achieving a physically active lifestyle by increasing overall daily movement and undertaking at least 150 min/week of structured exercise. Then, they will be randomized into two groups: the supervised group will take part in two canoeing group exercise sessions every week, and the unsupervised group will increase their overall physical activity level by any means, such as active commuting, daily activities, or home-based exercise. Primary outcome includes aerobic capacity. Secondary outcomes are physical activity, physical functioning, self-reported quality of life, fatigue, presence of lymphedema, body composition, immune function, adherence to physical activity guidelines, and perceptions of self-image.

Discussion

Results should contribute to advance knowledge on the impact of a supervised group exercise intervention to improve aspects related to health, physical functioning, and quality of life in female breast cancer survivors.

Trial registration

Brazilian Registry of Clinical Trials Number: RBR-3fw9xf. Retrospectively Registered on 27 December 2018. Items from the World Health Organization Trial Registration Data Set can be accessed on http://www.ensaiosclinicos.gov.br/rg/RBR-3fw9xf/.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13063-021-05843-z.

Facilitators of peer coaching/support engagement and dissemination among women at risk for and surviving with breast cancer

One-on-one peer coaching/support programs hold promise in promoting healthy outcomes among women at risk for and surviving with breast cancer, with the potential to bridge gaps in "whole person care." Although popularly cited for their benefits, emerging evidence is mixed and suggests that peer support program impacts may be attenuated by individual- and community-specific factors. We evaluated a national not-for-profit breast cancer organization's peer support program outcomes (2015-2018) serving women from predominantly Jewish backgrounds to examine program engagement, facilitation, and satisfaction. Of the N = 392 women sampled, 37% utilized the peer support program: the majority were referred by a family member/friend (40%) or had connected with the program online (34%). Logistic regression modeling revealed that mothers (odds ratio [OR] = 1.82; 95% confidence interval [CI] = 1.04 to 3.19), women at increased genetic risk for breast cancer (OR = 2.07; 95% CI = 1.08 to 3.94), and those who connected with the organization through a family member/friend (OR = 1.97; 95% CI = 1.23 to 3.15) were significantly more likely to utilize peer support (all p's < .05). Satisfaction with peer support was high and reliably measured (M = 42.8 out of possible 50; α = .95). These findings emphasize opportunities for peer support programs to serve a range of needs among breast cancer previvors and survivors and increase health care's organizational capacity to reach and impact this community through trusted and well-trained lay coaches.

A RE-AIM Evaluation of a Workplace Physical Activity Microgrant Initiative: The 10,000 Steps Workplace Challenge

OBJECTIVE

This study examines the reach, effectiveness, adoption, implementation, and maintenance of the 10,000 Steps Pedometer Microgrant Scheme using the RE-AIM framework.

METHODS

The study used a mixed methods pre-post design. RE-AIM indicators were examined using employee surveys and workplace reports of microgrant implementation, adoption, and maintenance.

RESULTS

A total of 259 microgrants and 21,211 pedometers were awarded (reach). Significant increases in physical activity were observed (P < 0.05) (effectiveness). Many (78%) workplaces reported using at least one challenge resource (adoption). Barriers were higher (26.5%) or lower (20.5%) than anticipated participation rates (implementation). Fifty percent of workplaces would continue to promote physical activity (maintenance).

CONCLUSIONS

The microgrant reached a large number of employees and workplaces, increased physical activity, and achieved good levels of adoption and implementation. Employee and workplace levels of maintenance were mixed and need to be improved.

Utilizing RE-AIM to examine the translational potential of Project MOVE, a novel intervention for increasing physical activity levels in breast cancer survivors

Translating effective research into community practice is critical for improving breast cancer (BC) survivor health. The purpose of this study is to utilize the RE-AIM framework to evaluate the translational potential of Project MOVE, an innovative intervention focused on increasing physical activity (PA) in BC survivors. A mixed-methods design, including a self-report questionnaire, accelerometry, focus groups, and interviews, was used to inform each RE-AIM dimension. Reach was evaluated by the representativeness of participants. Effectiveness was reflected by change in PA levels and perceptions of satisfaction and acceptability. Adoption was examined using participants' perceived barriers/facilitators to program uptake. Implementation was examined by participants' perceived barriers/facilitators to implementing the program. Maintenance was assessed by participant retention. Assessments occurred at baseline and 6-months. Mixed analysis of variance and content analysis were used to analyze the data. A total of 87 participants participated in Project MOVE and were demographically comparable to similar studies (Reach). Participants indicated high levels of program satisfaction (88%) and previously inactive survivors' significantly increased PA levels from baseline to 6-month follow-up (Effectiveness). Participants reported that a program focused on PA rather than disease helped them overcome barriers to PA (Adoption) and having leaders with BC and exercise expertise was essential to accommodate population specific barriers (Implementation). At 6-months, participant retention was 83% (Maintenance). Project MOVE is an acceptable, practical, and effective program for engaging BC survivors in PA and has the potential to be highly transferable to other populations and regions.

Qualitative Exploration of the Feasibility and Acceptability of Workplace-Based Microgrants to Improve Physical Activity: The 10,000 Steps Pedometer Microgrant Scheme

OBJECTIVE

Despite the benefits associated with workplace health programs, many organizations are unable to offer them due to financial constraints. To address this barrier, the existing 10,000 Steps program trialed the 10,000 Steps Pedometer Microgrant Scheme. This study assessed the feasibility and acceptability of the Microgrant Scheme.

METHODS

Semi-structured interviews with employee representatives (n = 19) were used to explore perceptions of the Microgrant Scheme. Thematic inductive analysis was conducted.

RESULTS

Three main themes emerged: 1) the need for workplace initiatives to address health promotion issues (The Need); 2) the factors associated with the application and implementation process (The Process); and 3) employee and employer benefits associated with the Microgrant Scheme (The Outcomes).

CONCLUSION

These findings highlight the potential utility of a Microgrant Scheme to extend the reach and long-term sustainability of workplace health promotion activities.

Evaluability assessment of "growing healthy communities," a mini-grant program to improve access to healthy foods and places for physical activity

Background

Mini-grants have been used to stimulate multisector collaboration in support of public health initiatives by funding non-traditional partners, such as economic development organizations. Such mini-grants have the potential to increase access to healthy foods and places for physical activity through built environment change, especially in small and rural towns in the United States. Although a promising practice, few mini-grant evaluations have been done. Therefore, our purpose was to conduct an Evaluability Assessment (EA), which is a process that can help promising programs that lack evidence advance toward full-scale evaluation. Specifically, we conducted an Evaluability Assessment of a statewide mini-grant program, called “Growing Healthy Communities” (GHC), to determine if this program was ready for evaluation and identify any changes needed for future implementation and evaluation that could also inform similar programs.

Methods

Telephone interviews with directors of six past mini-grant recipient organizations were conducted to assess implementation and evaluability. The six interviews were split equally among agencies receiving funding for food-oriented projects and physical activity-oriented projects. Within- and cross-case thematic analyses of interview transcripts were conducted.

Results

Organizational capacity was a universal theme, reflecting other key themes (described in detail in the manuscript) that affected program implementation and evaluation, including collaboration, limited time and measurement integration. Conclusions. The EA process provided pilot data that suggest that other state, regional, and national funders should provide centralized assistance for data collection and evaluation from the outset of a mini-grant award program.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-7156-8) contains supplementary material, which is available to authorized users.

A preliminary trial examining a 'real world' approach for increasing physical activity among breast cancer survivors: findings from project MOVE

Background

Physical activity (PA) is a safe and effective strategy to help mitigate health challenges associated with breast cancer (BC) survivorship. However, the majority of BC survivors are not meeting the minimum recommended PA (≥150 min of moderate to vigorous intensity). Project MOVE was developed as a model for increasing PA that combined a) Microgrants: funds ($2000) awarded to applicant groups to develop and implement a PA initiative and b) Financial incentives: a reward ($500) for increasing group PA. The purpose of this paper was to provide an exploratory analysis of effectiveness of Project MOVE on PA behavior, PA motivation, and quality of life (QoL) in female BC survivors. The differential outcomes between women meeting and not meeting PA guidelines were also investigated.

Methods

This pre-post test, preliminary trial included groups of adult (18+ years) self-identified female BC survivors, who were post-surgery and primary systemic chemo- and radiation therapy, and living in British Columbia, Canada. PA was assessed by accelerometry. PA motivation and QoL were assessed by self-report. Data were collected at baseline, 6-months, and 12-month time points. Repeated measures mixed ANOVAs were used to test changes in the main outcomes.

Results

A total of 10 groups were awarded microgrants between May 2015 and January 2016. Groups comprised of 8 to 12 women with a total of 87 participants. A statistically significant increase was found between time points on weekly moderate to vigorous PA (p = .012). This was mediated by a significant interaction between those meeting PA guidelines and those not meeting guidelines at baseline by time points (p = .004), with those not meeting guidelines at baseline showing the greatest increase in MVPA. A statistically significant difference across time points was found for intrinsic motivation (p = .02), physical functioning (p < .001), physical health limitations (p = .001), emotional health limitations (p = .023), social functioning (p = .001) and general health (p = .004).

Conclusion

These results provide promising support for a unique approach to increasing PA among BC survivors by empowering women and optimizing PA experiences through the use of microgrants and financial incentives.

Trial registration

ClinicalTrials.gov NCT03548636, Retrospectively registered June 7, 2018.

Acceptability and satisfaction of project MOVE: A pragmatic feasibility trial aimed at increasing physical activity in female breast cancer survivors

Objective

Despite the physical and psychological health benefits associated with physical activity (PA) for breast cancer (BC) survivors, up to 70% of female BC survivors are not meeting minimum recommended PA guidelines. The objective of this study was to evaluate acceptability and satisfaction with Project MOVE, an innovative approach to increase PA among BC survivors through the combination of microgrants and financial incentives.

Methods

A mixed‐methods design was used. Participants were BC survivors and support individuals with a mean age of 58.5 years. At 6‐month follow‐up, participants completed a program evaluation questionnaire (n = 72) and participated in focus groups (n = 52) to explore their experience with Project MOVE.

Results

Participants reported that they were satisfied with Project MOVE (86.6%) and that the program was appropriate for BC survivors (96.3%). Four main themes emerged from focus groups: (1) acceptability and satisfaction of Project MOVE, detailing the value of the model in developing tailored group‐base PA programs; (2) the importance of Project MOVE leaders, highlighting the value of a leader that was organized and a good communicator; (3) breaking down barriers with Project MOVE, describing how the program helped to address common BC related barriers; and (4) motivation to MOVE, outlining how the microgrants enabled survivors to be active, while the financial incentive motivated them to increase and maintain their PA.

Conclusion

The findings provide support for the acceptability of Project MOVE as a strategy for increasing PA among BC survivors.