User-centered development of a smartphone application (Fit2Thrive) to promote physical activity in breast cancer survivors.

Increased moderate and vigorous physical activity (MVPA) is associated with better health outcomes in breast cancer survivors; yet, most are insufficiently active. Smartphone applications (apps) to promote MVPA have high scalability potential, but few evidence-based apps exist. The purpose is to describe the testing and usability of Fit2Thrive, a MVPA promotion app for breast cancer survivors. A user-centered, iterative design process was utilized on three independent groups of participants. Two groups of breast cancer survivors (group 1 n = 8; group 2: n = 14) performed app usability field testing by interacting with the app for ≥3 days in a free-living environment. App refinements occurred following each field test. The Post-Study System Usability Questionnaire (PSSUQ) and the User Version Mobile Application Rating Scale (uMARS) assessed app usability and quality on a 7- and 5-point scale, respectively, and women provided qualitative written feedback. A third group (n = 15) rated potential app notification content. Quantitative data were analyzed using descriptive statistics. Qualitative data were analyzed using a directed content analysis. The PSSUQ app usability score (M1= 3.8; SD = 1.4 vs. M2= 3.2; SD = 1.1; lower scores are better) and uMARS app quality score (M1 = 3.4; SD = 1.3 vs. M2= 3.4; SD = 0.6; higher scores are better) appeared to improve in Field Test 2. Group 1 participants identified app "clunkiness," whereas group 2 participants identified issues with error messaging/functionality. Group 3 "liked" 53% of the self-monitoring, 71% of the entry reminder, 60% of the motivational, and 70% of the goal accomplishment notifications. Breast cancer survivors indicated that the Fit2Thrive app was acceptable and participants were able to use the app. Future work will test the efficacy of this app to increase MVPA.

Social cognitive variables and physical activity during chemotherapy for breast cancer: An intensive longitudinal examination.

OBJECTIVE: Although physical activity is associated with better health outcomes in breast cancer survivors (BCS), activity often declines during cancer treatment. Social cognitive theory (SCT) constructs have been associated with physical activity in post-treatment BCS, but little is known about the relation between these constructs and physical activity during chemotherapy. METHODS: BCS (n = 67; Mage  = 48.6 [SD = 10.3]) undergoing chemotherapy wore accelerometers and completed prompts in the morning and at night assessing same-day and next-day exercise self-efficacy, physical and psychological outcome expectations, and goal-setting for 10 consecutive days (3 days pre-, day of, and 6 days post-chemotherapy dose) at three time points (beginning, middle, and end of chemotherapy). Separate mixed models assessed between- and within-person associations of each of the SCT constructs associations with same- and next-day moderate to vigorous physical activity (MVPA) and light physical activity (LPA), independently. RESULTS: Within-person differences in all SCT variables were statistically significantly related to same-day MVPA (p's < 0.001) and LPA (p's < 0.001). Every one-point increase in SCT construct related to an increase in MVPA ranging from (a) 3.70 (self-efficacy) to 8.02 (physical outcome expectations) minute increase in MVPA and (b) 12.72 (self-efficacy) to 20.38 (physical outcome expectations) increase in LPA that day. No same-day between-person effects nor any next-day effects were significant. CONCLUSION: MVPA and LPA were related to same-day within-person differences in SCT variables. Interventions targeted at increasing or mitigating chemotherapy-related declines in daily within-person changes in SCT constructs could help to increase physical activity among BCS during chemotherapy.

Behavioural interventions for CVD risk reduction for blue-collar workers: a systematic review.

OBJECTIVES: Individuals working in blue-collar occupations experience high rates of cardiovascular disease (CVD). The purpose of this systematic review is to describe the characteristics and efficacy of behavioural interventions that have targeted CVD risk factors in this high-risk group. METHODS: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we searched seven databases to find interventions focused on changing the following: blood pressure, cholesterol, diet, physical activity, smoking or weight. Eligible studies tested a behavioural intervention (not exclusively policy, environmental, or pharmaceutical), in individuals working in blue-collar occupations using a randomised study design. Study quality was evaluated using the National Heart, Lung, and Blood Institute's study quality assessment tool. RESULTS: 22 studies evaluating 31 interventions were included: 11 were rated as 'good' or 'fair' quality. Intervention intensity ranged from a single contact via a mailed letter to studies that included individual-level contacts at multiple time points between staff and participants. Studies that included at least some individual contact generally yielded the greatest effects. Interventions had the greatest observed effects on self-report changes in diet, regardless of intervention intensity. Four of the five higher quality studies that explicitly tailored the intervention to the occupational group were successful at reducing at least one risk factor. CONCLUSIONS: Interventions that used individual contact and tailored the intervention to the occupational setting yielded the greatest effects on CVD risk-factor reduction in individuals working in blue-collar occupations. Generally, studies were low quality but showed promising effects for reaching this high-risk population. Future work should incorporate these promising findings in higher quality studies. PROSPERO REGISTRATION NUMBER: CRD42019136183.

Obesity Status on associations between cancer-related beliefs and health behaviors in cancer survivors: Implications for patient-clinician communication.

OBJECTIVE: Associations between cancer beliefs and health behavior engagement are largely unexplored in cancer survivors, particularly among those with overweight and obesity. We investigated belief-behavior associations for cancer survivors, and whether obesity altered these associations. METHODS: Cancer survivors were identified from the National Cancer Institute HINTS Survey 5 data and classified as having had an obesity-related cancer or not. Linear and multiple logistic regression analyses examined whether cancer risk beliefs and self-efficacy predicted dining out behaviors and physical activity (PA). Restricted analyses were conducted in those with overweight or obesity. RESULTS: Low self-efficacy to take care of one's health was associated with longer sitting time in the overall sample (p = 0.04). In cancer survivors with overweight or obesity, engagement in healthier behaviors was associated with 1) feeling less overwhelmed by cancer risk recommendations and 2) believing that PA or obesity influences cancer development (both p < 0.05). Among those with overweight and obesity, associations between cancer beliefs and health behaviors were not significantly different by cancer type (obesity-related vs. not). CONCLUSIONS: Obesity altered associations between cancer risk beliefs and health behavior engagement from the overall sample. PRACTICE IMPLICATIONS: Weight status may be a useful tailoring factor when delivering health-promoting interventions for cancer survivors.

Daily Physical Activity and Symptom Reporting in Breast Cancer Patients Undergoing Chemotherapy: An Intensive Longitudinal Examination.

BACKGROUND: Increased activity is beneficial during chemotherapy, but treatment-related symptoms may be a barrier. This study examines the relationship between daily fluctuations in symptoms and activity during chemotherapy. METHODS: Women undergoing chemotherapy for breast cancer [n = 67; M age = 48.6 (SD = 10.3)] wore an accelerometer 24 hours/day and received four text prompts/day to rate symptoms for 10 consecutive days at the beginning, middle, and end of chemotherapy. Mixed-effects models were used to examine the between and within-person relationships between symptom ratings on a given day and moderate to vigorous physical activity (MVPA) and light physical activity (LPA) on that day and the following day controlling for relevant covariates and using the Bonferroni correction for multiple comparisons. RESULTS: For MVPA and LPA, within-person associations were statistically significant for same day affect, fatigue, pain, walking, activities of daily living (ADL) physical function, and cognitive function. Previous day anxiety was associated with next day LPA. Every one point worse symptom rating than an individual's overall average was associated with: (i) between 1.49 (pain) and 4.94 (fatigue) minutes less MVPA and between 4.48 (pain) and 24.72 (ADL physical function) minutes less LPA that day, and (ii) 11.28 minutes less LPA the next day. No between-person effects were significant for MVPA or LPA. CONCLUSIONS: Daily within-person variations in symptoms were associated with MVPA and LPA during chemotherapy for breast cancer. IMPACT: Future work should explore relationships between symptoms and activity further and identify whether tailoring to symptoms enhances efficacy of physical activity promotion interventions during chemotherapy.

Preferences for mHealth physical activity interventions during chemotherapy for breast cancer: a qualitative evaluation.

PURPOSE: Physical activity has been shown to decline over the course of chemotherapy in breast cancer survivors; yet it may reduce treatment-related side effects and emerging evidence indicates it may improve disease outcomes. Mobile health (mHealth) interventions may be an effective, scalable strategy to increase physical activity during treatment. However, little is known about breast cancer patients' interests and preferences for these interventions. It is important to understand patients' interests and preferences prior to development of mHealth physical activity interventions to increase their relevance and efficacy. METHODS: Breast cancer survivors (n = 30) participated in a semi-structured phone interview and were asked about barriers and facilitators to physical activity during chemotherapy as well as their preferences on a range of potential mHealth intervention features. Transcribed interviews were coded and key themes were analyzed using an iterative, inductive approach. RESULTS: Five key themes were extracted from the interviews: (1) need for education about physical activity during chemotherapy; (2) treatment side effects inhibit physical activity; (3) a structured, home-based, tech-supported program with in-person elements is most feasible; (4) need for a personalized, highly tailored intervention; and (5) importance of social support from other breast cancer survivors, friends, and family. CONCLUSIONS: Breast cancer survivors are interested in mHealth physical activity interventions during chemotherapy, but preferences for intervention content and delivery varied. Future work should engage patients and survivors in intervention development and testing.

Breast cancer survivors' preferences for social support features in technology-supported physical activity interventions: findings from a mixed methods evaluation.

Incorporating peer and professional social support features into remotely delivered, technology-supported physical activity interventions may increase their effectiveness. However, very little is known about survivors' preferences for potential social features. This study explored breast cancer survivors' preferences for both traditional (e.g., coaching calls and peer support) and innovative (i.e., message boards and competitions) social support features within remotely delivered, technology-supported physical activity interventions. Survivors [N = 96; Mage = 55.8 (SD = 10.2)] self-reported demographic and disease characteristics and physical activity. A subset (n = 28) completed semistructured phone interviews. Transcribed interviews were evaluated using a thematic content analysis approach and consensus review. Following interviews, the full sample self-reported preferences for social features for remotely delivered physical activity interventions via online questionnaires. Questionnaire data were analyzed using descriptive statistics. Four themes emerged from interview data: (a) technology increases social connectedness; (b) interest in professional involvement/support; (c) connecting with similar survivors; and (d) apprehension regarding competitive social features. Quantitative data indicated that most survivors were interested in social features including a coach (77.1 per cent), team (66.7 per cent), and exercise buddy (57.3 per cent). Survivors endorsed sharing their activity data with their team (80.0 per cent) and buddy (76.6 per cent), but opinions were mixed regarding a progress board ranking their activity in relation to other participants' progress. Survivors were interested in using a message board to share strategies to increase activity (74.5 per cent) and motivational comments (73.4 per cent). Social features are of overall interest to breast cancer survivors, yet preferences for specific social support features varied. Engaging survivors in developing and implementing remotely delivered, technology-supported social features may enhance their effectiveness.

Effects of reallocating sedentary time with physical activity on quality of life indicators in breast cancer survivors.

OBJECTIVES: Physical activity is associated with better quality of life (QOL) among breast cancer survivors. However, it is unknown the extent to which time spent sedentary or replacing this time with active behaviors may affect QOL. Our aim was to determine the effect of substituting time between sedentary and active behaviors on QOL indicators in breast cancer survivors. METHODS: An isotemporal substitution approach was used to examine the associations of reallocating time to sedentary and active behaviors measured by accelerometry with Functional Assessment of Cancer Treatment-Breast (FACT-B; total, physical, social, emotional, functional well-being, and breast cancer-specific concerns) and the Hospital Anxiety and Depression Scale (HADS) scores in a pooled analysis of breast cancer survivors (n = 753; Mage  = 56.9 ± 9.5 y) from two observational studies. RESULTS: Reallocating 30 minutes of sedentary time to 30 minutes of moderate-to-vigorous intensity physical activity (MVPA) was associated with improved FACT-B total (B = 3.0; 95% CI, 0.6-4.5), physical well-being (B = 0.8; 95% CI, 0.33-1.2), and functional well-being (B = 0.6; 95% CI, 0.03-1.2) scores. Reallocating 30 minutes of light activity to 30 minutes of MVPA was associated with improved FACT-B total (B = 2.4; 95% CI, 0.3-6.0) and physical well-being (B = 0.72; 95% CI, 0.27-1.2) scores. There was no significant substitution of time effects on HADS scores. CONCLUSIONS: Substituting sedentary time with MVPA showed the greatest range of effects across QOL indicators. These results can inform intervention development interventions and more comprehensive activity recommendations for breast cancer survivors.

Breast cancer survivors' preferences for mHealth physical activity interventions: findings from a mixed methods study.

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.

Sedentary behavior after breast cancer: motivational, demographic, disease, and health status correlates of sitting time in breast cancer survivors.

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.