RESUMO
Breast cancer (BC) is the most common neoplasm in women globally. Healthy eating, a characteristic of the Mediterranean diet (MD), has been associated with a lower risk of developing BC, although this relationship remains inconclusive. This study aimed to analyse the relationship between MD adherence and the risk of BC development. A case-control study was carried out with 181 women divided into two groups: with BC (n= 90) and without breast cancer (WBC) (n= 91). Clinical and reproductive aspects were investigated through interviews, and food consumption was assessed through a food frequency questionnaire (FFQ). Adherence to the MD was evaluated using the MD score. Statistical analysis was performed using SPSS® software, with p<0.05. The results showed that the main type of breast carcinoma was invasive ductal carcinoma, positive for oestrogen or progesterone receptors. The mean MD score was 4.08 ± 1.61 and 4.22 ± 1.69 among women with BC and without BC, respectively, with no difference between the groups. The risk assessment of BC with respect to adherence to MD showed no significant difference after adjustments were made in the logistic regression models. In conclusion, this study showed that women with and without breast cancer had "medium adherence" to MD, with no difference between the groups. In the group of women investigated, adherence to MD did not affect the risk of developing the disease.
El cáncer de mama (CM) es la neoplasia más frecuente entre las mujeres del mundo, y la alimentación saludable, característica del patrón de la dieta mediterránea (DM), se ha asociado con un menor riesgo de desarrollar CM, aunque esta relación sigue sin ser concluyente. El objetivo del estudio fue analizar la relación entre la adherencia a la DM y el riesgo para el desarrollo de CM. Estudio de casos y controles realizados con 181 mujeres divididas en dos grupos: con cáncer de mama (n=90) y sin cáncer de mama (SCM; n= 91). Los aspectos clínicos y reproductivos se evaluaron a través de una entrevista; consumo de alimentos a través del cuestionario de frecuencia alimentaria (FFQ) y adherencia a la dieta mediterránea evaluada según la puntuación de DM. El análisis estadístico se realizó mediante el software SPSS®, considerando valores significativos de p<0,05. Los resultados mostraron que el principal tipo de carcinoma de mama fue el carcinoma ductal invasivo, positivo para el receptor de estrógenos y progesterona. La puntuación media de DM fue de 4,08 ± 1,61 entre las mujeres con CM y de 4,22 ± 1,69 entre las que no tenían la enfermedad, sin diferencia entre los grupos. La evaluación del riesgo de CM en relación con la adherencia a la DM mostró que, después de ajustes en los modelos de regresión logística, no hubo diferencia significativa. En conclusión, el estudio muestra que las mujeres con y sin CM tuvieron "adherencia media" a la DM, sin diferencia entre los grupos. También mostró que, en el grupo de mujeres investigadas, la adherencia a la DM no influyó en el riesgo para el desarrollo de la enfermedad.
RESUMO
OBJECTIVE: The purpose of this study was to investigate the effects of adding virtual reality (VR) to maintenance cardiac rehabilitation (CR); it was hypothesized VR would increase adherence, motivation, and engagement. METHODS: This study was a randomized, 1:1 concealed-allocation, single-blinded, 2 parallel-arm, crossover trial. Blinded assessments were undertaken at baseline (midprogram), 12 weeks, and 24 weeks after baseline. The setting was a single CR program of unlimited duration in Brazil. Participants were patients with cardiovascular diseases or risk factors who had been in the program for 3 months or longer. The CR program consisted of 3 supervised exercise sessions per week. In the VR arm, participants had 1 VR session of the 3 per week during the initial 12 weeks of the trial; this was withdrawn the subsequent 12 weeks. Measures were program adherence (% of 3 sessions/week over 12 weeks, ascertained in all participants), motivation (Behavioral Regulation in Exercise Questionnaire 3), and engagement (User Engagement Scale, adapted; vigor, dedication, and absorption subscales); all 3 were primary outcomes. RESULTS: Sixty-one (83.6%) patients were randomly assigned (n = 30 to CR + VR); 54 (88.5%) were retained at 12 and 24 weeks. At baseline, participants had been in CR on average 7 years and had high engagement and motivation. CR + VR resulted in a significant increase in adherence at 12 weeks (baseline = 72.87%; 12 weeks = 82.80%), with significant reductions at 24 weeks when VR was withdrawn (65.48%); in the usual CR care arm, there were no changes over time. There was a significant effect for arm, with significantly higher adherence in the CR + VR arm than usual CR at 12 weeks (73.51%). Motivation decreased significantly from baseline to 12 weeks (4.32 [SD = 0.37] vs 4.02 [SD = 0.76]) and significantly increased from 12 to 24 weeks in the CR + VR arm (4.37 [SD = 0.36]). Absorption was significantly lower at 12 weeks in the CR + VR arm (6.79 [SD = 0.37] vs 6.20 [SD = 1.01]). CONCLUSION: Although VR increased program adherence, interspersing it with usual CR sessions actually decreased patient motivation and absorption. IMPACT: Supplementing a maintenance CR program with VR using "exergames" resulted in significantly greater adherence (8% increase or 3 of 36 sessions), and this was quite a robust effect given it was extinguished with the removal of VR. However, contrary to the hypotheses, offering 1 session of VR per week and 2 of usual CR exercise was related to lower motivation and absorption, which has implications for how clinicians design programs for this patient population.