Relationships between Obesity, Exercise Preferences, and Related Social Cognitive Theory Variables among Breast Cancer Survivors.

Breast cancer survivors with obesity have an increased risk of cancer recurrence, second malignancy, and comorbidities. Though physical activity (PA) interventions are needed, investigation of the relationships between obesity and factors influencing PA program aspects among cancer survivors remain understudied. Thus, we conducted a cross-sectional study examining associations amongst baseline body mass index (BMI), PA program preferences, PA, cardiorespiratory fitness, and related social cognitive theory variables (self-efficacy, exercise barriers interference, social support, positive and negative outcome expectations) from a randomized controlled PA trial with 320 post-treatment breast cancer survivors. BMI was significantly correlated with exercise barriers interference (r = 0.131, p = 0.019). Higher BMI was significantly associated with preference to exercise at a facility (p = 0.038), lower cardiorespiratory fitness (p < 0.001), lower walking self-efficacy (p < 0.001), and higher negative outcome expectations (p = 0.024), independent of covariates (comorbidity score, Western Ontario and McMaster Universities osteoarthritis index score, income, race, education). Those with class I/II obesity reported a higher negative outcome expectations score compared with class III. Location, walking self-efficacy, barriers, negative outcome expectations, and fitness should be considered when designing future PA programs among breast cancer survivors with obesity.

A qualitative evaluation of a clinic versus home exercise rehabilitation program for adults with multiple sclerosis: The tele-exercise and multiple sclerosis (TEAMS) study.

BACKGROUND: Substantial evidence supports therapeutic exercise for improving health and function in people with multiple sclerosis (MS). However, few studies have considered the patients' perspective. OBJECTIVE: This study explored perspectives of adults with MS following participation in a 3-month clinic- and home-based exercise rehabilitation program. METHODS: Twenty participants with MS were interviewed using a semi-structured interview guide on the design and implementation processes of the exercise programs as well as any perceived facilitators or barriers to exercise. Data analysis was conducted using a thematic analysis approach to generate themes from the transcribed interviews. RESULTS: Key facilitators of exercise for people with MS included perceived improvements in physical health and function, activity participation, and psychosocial health. Mismatched level of exercise with their stage of post-diagnosis and/or functional ability and limited human interaction emerged as barriers to exercise. CONCLUSIONS: Participation in the exercise program was a positive experience for people with MS. Despite the provision of a high level of adaptation and tailored exercise plan and delivery, self-directed exercise continued to present challenges for people with MS. Additionally, the importance of seeking cost-effective ways to maintain motivational support was implicit in participant responses. The findings provided an improved understanding of personal experiences and exercise perspectives that can inform future intervention strategies aimed at promoting sustained exercise participation.

Correction: Pekmezi et al. Rationale and Methods for a Randomized Controlled Trial of a Dyadic, Web-Based, Weight Loss Intervention among Cancer Survivors and Partners: The DUET Study. Nutrients 2021, 13, 3472.

The authors would like to correct errors in their prior publication [...].

Test/Retest Reliability and Validity of Remote vs. In-Person Anthropometric and Physical Performance Assessments in Cancer Survivors and Supportive Partners.

(1) Background: Anthropometric and physical performance testing is commonly done in lifestyle research and is traditionally performed in-person. To expand the scalability of lifestyle interventions among cancer survivors, in-person assessments were adapted to remote means and evaluated for feasibility, safety, validity, and reliability. (2) Methods: Cancer survivors and supportive partners were approached to participate in three anthropometric and physical performance testing sessions (two remote/one in-person). Correlations, concordance, and differences between testing modes were evaluated. (3) Results: 110-of-112 individuals approached for testing participated (98% uptake); the sample was 78% female, 64% non-Hispanic White, of mean age 58 years and body mass index = 32.4 kg/m2. ICCs for remote assessments ranged from moderate (8' walk = 0.47), to strong (8' get-up-and-go = 0.74), to very strong (30 s chair stand = 0.80; sit-and-reach = 0.86; 2 min step test = 0.87; back scratch = 0.90; weight = 0.93; waist circumference = 0.98) (p-values < 0.001). Perfect concordance (100%) was found for side-by-side and semi-tandem balance, and 87.5-90.3% for tandem balance. No significant differences between remote and in-person assessments were found for weight, 8' walk, and 8' get-up-and-go. No adverse events occurred and 75% indicated no preference or preferred virtual testing to in-person. (4) Conclusions: Remote anthropometric and physical performance assessments are reliable, valid, acceptable, and safe among cancer survivors and supportive partners.

Rationale and Methods for a Randomized Controlled Trial of a Dyadic, Web-Based, Weight Loss Intervention among Cancer Survivors and Partners: The DUET Study.

Scalable, effective interventions are needed to address poor diet, insufficient physical activity, and obesity amongst rising numbers of cancer survivors. Interventions targeting survivors and their friends and family may promote both tertiary and primary prevention. The design, rationale, and enrollment of an ongoing randomized controlled trial (RCT) (NCT04132219) to test a web-based lifestyle intervention for cancer survivors and their supportive partners are described, along with the characteristics of the sample recruited. This two-arm, single-blinded RCT randomly assigns 56 dyads (cancer survivor and partner, both with obesity, poor diets, and physical inactivity) to the six-month DUET intervention vs. wait-list control. Intervention delivery and assessment are remotely performed with 0-6 month, between-arm tests comparing body weight status (primary outcome), and secondary outcomes (waist circumference, health indices, and biomarkers of glucose homeostasis, lipid regulation and inflammation). Despite COVID-19, targeted accrual was achieved within 9 months. Not having Internet access was a rare exclusion (<2%). Inability to identify a support partner precluded enrollment of 42% of interested/eligible survivors. The enrolled sample is diverse: ages 23-81 and 38% racial/ethnic minorities. Results support the accessibility and appeal of web-based lifestyle interventions for cancer survivors, though some cancer survivors struggled to enlist support partners and may require alternative strategies.

Moderating Effects of Health Literacy on Change in Physical Activity Among Latinas in a Randomized Trial.

INTRODUCTION: Latinas report low rates of physical activity (PA) and are at risk for poor health outcomes. Language and literacy barriers impede access and utilization of PA-related resources. This study examined health literacy as a moderator on changes in moderate-to-vigorous physical activity (MVPA) in 196 Latinas enrolled in Seamos Saludables, a randomized-controlled trial of a 6-month culturally and linguistically adapted PA print intervention METHODS: Secondary analyses were conducted on demographics, acculturation and generation status, and health literacy (Newest Vital Sign). MVPA was determined by 7 day physical activity recall, assessed at baseline and 6 months. General linear models examined interaction effects between health literacy (HL), experimental condition (treatment vs. control), and generation status. RESULTS: Health literacy moderated change in MVPA from baseline to 6 months. The intervention effect was greater among first-generation Latinas with limited health literacy. DISCUSSION: Differences in health literacy level appear to influence MVPA outcomes. Formative research is recommended to ensure that materials are appropriate when developing print-based PA interventions, particularly among first-generation Latinas who are more likely to have limited health literacy.

Internet-Based Physical Activity Interventions.

This article provides a comprehensive review of Internet- and Website-based physical activity interventions targeting adult populations. Search procedures identified 72 unique Internet-based physical activity interventions published in peer-reviewed journals. Participants of the studies were predominately White, middle-aged (mean age = 43.3 years), and female (65.9%). Intervention durations ranged from 2 weeks to 13 months (median = 12 weeks). Forty-six of the studies were randomized controlled trials, 21 were randomized trials without a control condition, 2 were non-randomized controlled trials, and 3 used a single-group design. The majority of studies (n = 68) assessed outcomes immediately following the end of the intervention period, and 16 studies provided delayed postintervention assessments. Forty-four of the 72 studies (61.1%) reported significant increases in physical activity. Future directions for Internet-based physical activity interventions include increasing representation of minority and male populations in Internet-based efforts, conducting delayed postintervention follow-up assessments, and incorporating emerging technologies (ie, cellular and Smartphones) into Internet-based physical activity efforts.

Physical activity and quality of life among university students: exploring self-efficacy, self-esteem, and affect as potential mediators.

PURPOSE: Physical activity (PA) has been shown to enhance quality of life (QOL) in older adults. Findings from these studies indicate that the relationship between PA and QOL is indirect and likely mediated by variables such as physical self-esteem, exercise self-efficacy, and affect. As PA varies greatly by age, the purpose of the current study is to extend this area of research to young adults and explore the complex relationship between PA and QOL in this target population. METHODS: Data were collected via anonymous questionnaire from N = 590 undergraduate students. PA was assessed with the Godin Leisure Time Exercise Questionnaire, and QOL was assessed by the Satisfaction with Life Scale. Path analysis was used to test the relationship between PA and QOL, with mediators of exercise self-efficacy, physical self-esteem, and affect. RESULTS: The PA model (RMSEA = .03, CFI = .99) accounted for 25 % of the variance in QOL. PA had positive direct effects on exercise self-efficacy (ß = .28, P < .001), physical self-esteem (ß = .10, P < .001), positive affect (ß = .10, P < .05), and negative affect (ß = .08, P < .05). Physical self-esteem was found to be the most powerful mediating variable on QOL (ß = .30, P < .001), followed by positive affect (ß = .27, P < .001) and negative affect (ß = .14, P < .001). CONCLUSION: Physical self-esteem and, to a lesser extent, positive affect emerged as integral components in the link between PA and QOL. Findings suggest that health education programs designed to promote regular PA and increase physical self-esteem may be effective in improving QOL in young adults.

The Seamos Saludables study: A randomized controlled physical activity trial of Latinas.

BACKGROUND: Latinas in the U.S. are less physically active than non-Latino white women and also report higher levels of diabetes, obesity, and other conditions related to inactivity. Interventions are needed to address disparities in this high-risk group. PURPOSE: To evaluate the efficacy of a culturally adapted, Spanish-language, individually tailored, computer expert system-driven physical activity print-based intervention for adult Latinas. DESIGN: RCT. SETTING/PARTICIPANTS: Participants were 266 inactive adult Latinas who participated between 2009 and 2012. INTERVENTION: Participants were randomized to one of two treatment arms: a 6-month tailored physical activity intervention condition or wellness contact control. For both conditions, print materials were delivered by mail. MAIN OUTCOME MEASURES: The main outcome measure was change in weekly moderate-to-vigorous physical activity (MVPA) measured by the 7-Day Physical Activity Recall interview, which was administered at baseline and post-intervention (6 months). Participants also wore accelerometers for a week at baseline and follow-up. Analyses were conducted in 2013. RESULTS: Increases in minutes/week of MVPA measured by the 7-Day PAR were significantly greater in the intervention group compared to the control group (mean difference=41.36, SE=7.93, p<0.01). This difference was corroborated by accelerometer readings (rho=0.44, p<0.01). Further, results indicate that intervention participants had greater increases in self-efficacy, cognitive processes, and behavioral processes at 3 months compared to control paricipants (p's<0.05). CONCLUSIONS: The tailored Spanish-language intervention was effective in increasing MVPA among predominantly low-income, less-acculturated Latinas. Such print-based interventions are poised for widespread dissemination, and thus may help address health disparities.

Health literacy predicts change in physical activity self-efficacy among sedentary Latinas.

Health literacy (HL) is associated with preventive health behaviors. Self-efficacy is a predictor of health behavior, including physical activity (PA); however, causal pathways between HL and self-efficacy for PA are unknown, especially among Latinas who are at risk for chronic disease. To explore this potential relationship, secondary analyses were conducted on data [Shortened Test of Functional Health Literacy in Adults (STOFHLA), PA self-efficacy, and socio-demographics] from a 6-month, randomized controlled trial of a print-based PA intervention (n = 89 Spanish-speaking Latinas). Linear regression models revealed associations between HL and baseline self-efficacy in addition to changes in self-efficacy at 6-months. After controlling for significant covariates, higher HL scores were associated with lower baseline PA self-efficacy. Regardless of treatment assignment, higher HL scores at baseline predicted greater changes in PA self-efficacy at 6-months. HL may contribute to Latinas' improved PA self-efficacy, though further research is warranted.

Physical Activity and Social Cognitive Theory Outcomes of an Internet-Enhanced Physical Activity Intervention for African American Female College Students.

BACKGROUND: African American women report low levels of physical activity (PA) and are disproportionately burdened by related chronic diseases. This pilot study tested a 6-month theory-based (Social Cognitive Theory, SCT) culturally-relevant website intervention to promote PA among African American female college students. MATERIALS AND METHODS: A single group pre-post test design (n=34) was used. PA and associated SCT constructs (outcome expectations, enjoyment, self-regulation, social support) were assessed at baseline, 3 months and 6 months. RESULTS: The sample was comprised of mostly obese (M BMI= 35.4, SD=6.82) young adults (M age= 21.21 years, SD=2.31). Fifty percent of the sample completed all assessments. Intent-to-treat analyses showed that participants reported a significant median improvement in moderate-to-vigorous physical activity from 82.5 minutes/week (M=81.76, SD=76.23) at baseline to 115.0 minutes/week (M=122.44, SD=97.93) at 3 months (Wilcoxon z=2.39, p=.02). However these gains appear to have attenuated by 6 months (Median= 82.5 minutes/week, M=96.73, SD=84.20; Wilcoxon z=1.02, p=.31). Significant increases from baseline to 6 months were found in self-regulation for PA (p=.02) and social support for PA from friends (p=.02). Changes in the SCT variables were not significantly associated with changes in PA; however, this may have been due to small sample size. CONCLUSIONS: Future studies with larger samples and more aggressive retention strategies (e.g., more frequent incentives, prompts for website use) are needed to further explore the applicability of web-based approaches to promote PA in this at-risk population.

Updated evidence in support of diet and exercise interventions in cancer survivors.

BACKGROUND: A growing body of evidence suggests that diet and exercise behaviors and body weight status influence health-related outcomes after a cancer diagnosis. This review synthesizes the recent progress in lifestyle interventions in light of current guidelines put forth by the American Cancer Society (ACS), the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) and the American College of Sports Medicine (ACSM). METHODS: The PubMed database was searched for terms of cancer survivor(s) or neoplasms/survivor, cross-referenced with MeSH terms of lifestyle, health behavior, physical activity, exercise, body weight, obesity, weight loss, diet, nutrition, and intervention studies and limited to randomized controlled trials (RCTs) that had retention rates exceeding 75%. RESULTS: There has been an increase in the number and methodological rigor of the studies in this area, with 21 RCTs identified in the past three years. Results suggest that physical activity interventions are safe for cancer survivors and produce improvements in fitness, strength, physical function, and cancer-related psychosocial variables, whereas dietary interventions improve diet quality, nutrition-related biomarkers and body weight. Preliminary evidence also suggests that diet and exercise may positively influence biomarkers associated with progressive disease and overall survival (e.g., insulin levels, oxidative DNA damage, tumor proliferation rates). DISCUSSION: The evidence base regarding health-related benefits of increased physical activity, an improved diet, and weight control continues to expand. Due to the large (and increasing) number of cancer survivors, more research is needed that tests the impact of lifestyle change on health-related outcomes in this population, especially research that focuses on high-reach, sustainable interventions that recruit diverse, representative samples to help increase the generalizability of findings to the population at large. Concurrent research also needs to address relative benefit in relation to various subpopulations as defined by phenotype, genotype, and/or exposures to treatment, and other lifestyle and environmental factors.

Feasibility of using computer-tailored and internet-based interventions to promote physical activity in underserved populations.

OBJECTIVE: Computer-tailored and Internet-based interventions to promote physical activity behavior have shown some promise, but only few have been tested among African Americans. We examined the feasibility and efficacy of three 1-year, multiple contact physical activity interventions (Tailored Internet, Tailored Print, Standard Internet) in a subsample of African American participants (n = 38) enrolled in a randomized controlled trial. MATERIALS AND METHODS: Participants randomly assigned to Tailored Internet and Print programs received individually tailored computer expert system feedback delivered via Internet or print. Participants in the Standard Internet program received access to six currently available physical activity Web sites. Self-reported physical activity was assessed at baseline and 6 and 12 months with the 7-Day Physical Activity Recall. RESULTS: Across all participants, physical activity changed from 17.24 min/week (standard deviation [SD] = 20.72) at baseline to 139.44 min/week (SD = 99.20) at 6 months, to 104.26 min/week (SD = 129.14) at 12 months. According to available consumer satisfaction data (n = 30), 70% reported reading most or all of the physical activity information received by Internet or mail. Most participants described the Internet- and print-based physical activity programs as "somewhat" or "very" helpful (80%) and enjoyable (87%). CONCLUSIONS: These findings suggest that computer-tailored and Internet-based interventions are able to produce long-term increases in physical activity and associated process variables among African American participants. Future studies with larger numbers of African American participants are needed to determine which of the programs (Tailored Print, Tailored Internet, Standard Internet) are more effective and what program modifications might be helpful in assisting this population in becoming more active.

A culturally adapted physical activity intervention for Latinas: a randomized controlled trial.

BACKGROUND: In the U.S., Latinos report particularly high levels of inactivity and related chronic illnesses and are in need of intervention. Thus, the purpose of the current study was to culturally and linguistically adapt an empirically supported, individually tailored physical activity print intervention for Latinos and then conduct an RCT of the modified program. DESIGN: An RCT was conducted. SETTING/PARTICIPANTS: The sample included 93 overweight/obese (80%) Latinas with low income and acculturation. INTERVENTION: Data were collected in 2007-2008 and analyzed by intent-to-treat in 2009. Participants were randomly assigned to either (1) a culturally and linguistically adapted physical activity intervention (Seamos Activas) or (2) a wellness contact control condition. MAIN OUTCOME MEASURES: Self-report physical activity, as measured pre- and post-intervention (6 months, 87% retention) by the 7-Day Physical Activity Recall. RESULTS: Moderate-intensity (or greater) physical activity increased from an average of 16.56 minutes/week (SD=25.76) at baseline to 147.27 (SD=241.55) at 6 months in the intervention arm (n=45), and from 11.88 minutes/week (SD=21.99) to 96.79 (SD=118.49) in the wellness contact control arm (n=48). No between-group differences were seen in overall physical activity. Intervention participants reported significantly greater increases in cognitive (F[1, 91]=9.53, p=0.003) and behavioral processes of change (F[1, 91]=8.37, p=0.005) and available physical activity supplies and equipment at home (F[1, 91]=4.17, p=0.04) than control participants. CONCLUSIONS: Results supported the hypothesized feasibility, acceptability, and preliminary efficacy of individually tailored physical activity print interventions among Latinas. Although more research is needed to corroborate these findings, such high-reach, low-cost approaches have great potential to positively affect public health. TRIAL REGISTRATION: NCT00724165.