Effects of tandem cognitive behavioral therapy and healthy lifestyle interventions on health-related outcomes in cancer survivors: a systematic review.

PURPOSE: Healthy lifestyle (HL) behaviors and cognitive behavioral therapy (CBT) have been individually shown to improve adverse effects of cancer treatment. Little is known about how such programs in tandem affect health-related outcomes. This review evaluates extant literature on tandem CBT/HL interventions on health-related outcomes in cancer survivors. METHODS: A comprehensive search of PubMed, PsychINFO, CINAHL, and Embase databases revealed numerous studies involving CBT and HL tandem interventions in cancer survivors in the last 20 years. Studies meeting the inclusion criteria were examined and assessed by the authors. RESULTS: The 36 studies included 5199 participants. Interventions involved the use of CBT in combination with a HL condition (stress reduction, increasing physical activity, etc.). These tandem conditions were compared against no intervention, usual care, and/or CBT alone or HL alone. Interventions were delivered by a variety of interventionists, and over different durations. The most common HL target outcomes were stress, and insomnia. Most studies (31 of 36) reported a reduction in adverse treatment and/or cancer-related effects. CONCLUSION: Findings were biased with the overrepresentation of breast cancer survivors, and underrepresentation of minority groups, and those with advanced cancer. Thus, this review highlights the need for further research to test tandem interventions against CBT alone and HL alone, and toward identifying the most efficacious interventions for dissemination and implementation across diverse groups of cancer survivors. Implications for cancer survivors Tandem CBT/HL interventions can improve health-related outcomes for cancer survivors when compared to usual care, but there is a paucity of knowledge to suggest differential outcomes when compared to CBT or HL alone.

Community-engaged and community-based participatory research to promote American Heart Association Life's Simple 7 among African American adults: A systematic review.

BACKGROUND: Cardiovascular disease (CVD) is the leading cause of death in the United States and African Americans (AA) have a disproportionately greater burden of CVD as compared to Whites. The American Heart Association (AHA) Life's Simple 7 (LS7) framework outlines goals for attaining ideal cardiovascular health. Yet, there is a lack of evidence summarizing best practices to maximize LS7 attainment. The objective of the present study was to systematically review the extant peer-reviewed literature on community-engaged and community-based participatory research (CBPR) aimed at improving one or more LS7 metrics among AA. METHODS: PubMed, CINAHL, and Embase databases were searched. We included articles that reported quantitative results for one or more of the following LS7 metrics: physical activity, diet, cholesterol, blood pressure, body mass index, smoking, and glycemia. We included analyses with a greater than 50% AA study population focused on adults (≥18 years of age). RESULTS: Of the 1008 unique studies identified, 54 met inclusion criteria; 27 of which were randomized controlled trials. 50% of studies assessed more than one LS7 metric but only two studies evaluated all seven of the LS7 metrics. No studies had a high proportion of AA males. 40 studies improved at least one LS7 metric at the study end-point. Formative research was used in many studies to guide intervention design. Studies were of varying quality, but overall rated "fair" using a modified approach to the National Institute of Health quality assessment tool. CONCLUSION: There is insufficient data to recommend a specific community-engaged or CBPR intervention to improve attainment of LS7 metrics among AA. Future studies using rigorous methodology with increased gender diversity and utilizing the AHA LS7 framework are required to establish a validated program to improve LS7 in AAs.

The association of ideal cardiovascular health with self-reported health, diabetes, and adiposity in African American males.

African American (AA) men have the highest age-adjusted all-cause mortality rate in the United States of America (US) and a high burden of cardiovascular risk factors. The African American Male Wellness Walk (AAMWW) seeks to reduce such health disparities among AA males. The association of a combination of ideal cardiovascular health (ICH) metrics (blood pressure, glucose, cholesterol, body mass index (BMI), physical activity, and smoking) with self-reported health, diabetes, and body fat percentage was examined among 729 AA male participants from the 2017 and 2018 AAMWWs. Six metrics of ICH were categorized into a three-tiered ICH score 0-2, 3-4, 5-6. Linear and logistic regression modeling was performed with adjustment for age and insurance. Seven percent of men attained 5-6 ICH metrics at baseline. Participants with 5-6 ICH metrics versus 0-2 had 256% higher odds of excellent self-reported health compared to good, fair or poor (p < 0.0001). After exclusion of glucose from the ideal cardiovascular health score, participants with 3-4 versus 0-2 ICH metrics had a 48% lower odds of diabetes (p < 0.0031). After exclusion of BMI from the ICH score, participants with 5 ICH metrics had a 14.1% lower body fat percentage versus participants with 0-2 ICH metrics (p = 0.0057). Attainment of higher ideal cardiovascular health scores is associated with higher odds of self-reported health, lower odds of diabetes and lower body fat percentage among AA men. Future strategies leading to greater attainment of cardiovascular health in AA males will be important to advance health equity.