Evaluating the feasibility and acceptability of an adapted fencing intervention in breast cancer surgery post-operative care: the RIPOSTE pilot randomized trial.

Background: Adapted physical activity programs have shown promising results in reducing the physical, social and psychological side effects associated with breast cancer, but the extent to which they can be effectively adopted, implemented and maintained is unclear. The aim of this study is to use the framework to guide the planning and evaluation of programs according to the 5 following keys: Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework to evaluate a fencing program under the French acronym RIPOSTE (Reconstruction, Image de soi, Posture, Oncologie, Santé, Thérapie, Escrime) literally in English (Reconstruction, Self-Image, Posture, Oncology, Health, Therapy, Fencing). This program is an innovative intervention focused on improving the quality of life (QoL) of breast cancer surgery patients through fencing. Methods: A convergent mixed methods pilot study was conducted to preliminary evaluate the different RE-AIM dimension of the pilot program. Twenty-four participants who have just undergone surgery for invasive breast cancer were randomly allocated in two groups: one group started immediately after their inclusion (Early RIPOSTE group) and the other started 3 months following their inclusion (Delayed RIPOSTE group). Participants answered a questionnaire at inclusion and at the end of the program on QoL, shoulder functional capacity, fatigue, anxiety-depression and physical activity. Results: RIPOSTE program was able to reach mainly young and dynamic participants, attracted by the originality of fencing and keen to improve their physical condition. Regarding effectiveness, our results suggest a trend to the improvement of QoL, shoulder functional capacity, fatigue and anxiety-depression state, even without any significant differences between the Early RIPOSTE group and the Delayed RIPOSTE group. Discussions: The cooperation, exchanges and cohesion within the group greatly facilitated the adoption of the program, whereas interruptions during school vacations were the main barriers. The intervention was moderately well implemented and adherence to the protocol was suitable. Conclusion: RIPOSTE is an acceptable and effective program for involving breast cancer survivors in physical activity, that needs to be tested at a larger scale to investigate its effectiveness, but has the potential to be transferred and scaled up worldwide.

Spouses of patients treated for colon cancer: identification of key caregiver skills using the Delphi method.

PURPOSE: Spouses are often the front-line caregivers for colon cancer patients. Providing this support requires a particular set of coping skills. Our objective was to identify key skills that healthcare and medico-social sector professionals could assess in routine practice that would allow them to propose appropriate support to spouses who are accompanying colon cancer patients in their care pathway. METHODS: An online two-round Delphi study was conducted among French colon cancer patients, spouses and professionals. The content of the Delphi study was developed from a previously published qualitative study. RESULTS: In the first round of the study, 63% of the participants were professionals (n = 40), 19% spouses (n = 12) and 17% patients (n = 11). In the second round, they were respectively 55% (n = 22), 22% (n = 9) and 22% (n = 9). Twenty-seven of the 75 proposed skills were consensually identified as key skills. Nine were related to emotional and psychological well-being, six to social relations, four to organisation, five to health and three to domestic domains. The three most consensual skills (≥ 90% agreement) for spouses were (1) helping the tired patient in everyday life, (2) stimulating the patient to prevent him/her from giving up and (3) limiting one's amount of personal time to care for the patient. CONCLUSION: The study identified the key skills needed by spouses of patients being treated for colon cancer. Better awareness of these skills among professionals would enable them to offer tailored support to help patients and spouses maintain their physical and emotional well-being.

Behavioural risk patterns in adolescents with excess weight participating in the PRALIMAP-INÈS trial.

OBJECTIVE: To investigate clustering of risk behaviours in adolescents with excess weight. DESIGN: Cross-sectional analysis of baseline data from the PRALIMAP-INÈS trial. Information on food frequency consumption (fruit, vegetables, sugary products and beverages), physical activity, sedentary behaviour (week and weekend days), smoking and alcohol consumption (current frequency and intoxication episodes) and socio-demographic data was collected using self-reported questionnaires. Behavioural risk factors were entered as categorical variables in a two-step clustering procedure: multiple correspondence analysis followed by hierarchical clustering. Associations between cluster membership and socio-demographic variables were investigated using multivariable multinomial logistic regression. SETTING: French PRALIMAP-INÈS trial. PARTICIPANTS: Adolescents with excess weight. RESULTS: A total of 1391 participants (13-18 years old, 58·2 % female) were included in the analysis, which resulted in the identification of four groups of participants, including, respectively, 543 (39·0 %), 373 (26·8 %), 246 (17·7 %) and 229 (16·5 %) participants. Clusters 1 and 4 showed associations of rather healthy behaviours (high physical activity and low consumption of sugary products; high consumption of fruit and vegetables, respectively), while clusters 2 and 3 showed associations of rather unhealthy behaviours (high sedentary behaviour and low consumption of fruit and vegetables; smoking and alcohol consumption, respectively). Both social status and family structure were associated with cluster membership. CONCLUSIONS: Risk behaviour patterns in adolescents with excess weight were clustered in both healthier and less healthy ways, with a complex interplay with socio-demographic factors.

Physical Activity and Eating Behavior Inequalities Mediating the Effects of Socioeconomic Status and Sex on Adolescent Quality of Life: Insights of the PRALIMAP Trial.

BACKGROUND: This study aimed to quantify the 2-year mediating effects of physical activity (PA) and eating behavior (EB) on socioeconomic and sex inequalities in quality of life (QoL) among French adolescents. METHODS: Adolescents from a 2-year school-based trial were included. PA and EB were assessed at baseline, 1 year, and 2 years using the International Physical Activity Questionnaire and an eating habits questionnaire, respectively. QoL was measured at 2 years using the Duke Health Profile questionnaire. The mediating effect of adherence to PA and EB guidelines in the associations between socioeconomic status or sex and QoL was analyzed with a counterfactual method. RESULTS: Among the 3562 included adolescents (mean age, 15.2 [0.6] y), being a boy and having a high socioeconomic status was associated with high QoL. Differences in QoL by socioeconomic status were mediated by adherence to guidelines for PA (up to 10.2%) and EB (up to 8.8%), and differences in QoL by sex were predominantly mediated by adherence to guidelines for PA (up to 163.8%). CONCLUSIONS: Policies, programs, and interventions designed to reduce socioeconomic and sex inequalities in QoL among adolescents could use PA and EB as leverage.

Adapted Fencing for Patients With Invasive Breast Cancer: The RIPOSTE Pilot Randomized Controlled Trial.

Introduction: Even if indications for mastectomy have been progressively reduced in loco-regional breast cancer (BC) treatment, the harmful effects of surgery are still numerous and can impact physical and psychological wellbeing of women. The RIPOSTE (Reconstruction, self-Image, Posture, Oncology, "Santé"-Health, Therapy, "Escrime"-Fencing) program aimed to propose adapted fencing to patients with BC. This study aims to investigate the effect and conditions of effectiveness of the RIPOSTE program. Methods and analysis: This is a prospective randomized controlled trial including 24 patients with invasive BC who have just undergone surgery. The study will be proposed to the patient and if interested, the patient will be referred to a sports physician for a medico-sportive evaluation. At the end the evaluation, if the patient meets the inclusion criteria, she will be randomly assigned to one of the 2 groups based on a 1:1 principle: Early RIPOSTE group (receive one fencing session per week for 3 months immediately after their inclusion), Delayed RIPOSTE group (receive one fencing session per week for 3 months but within the 3 months following their inclusion). Patients will be included for 6 months with 3 follow-up times (0, 3, and 6 months) by a sport physician. The primary outcome is the evolution of quality of life score. Secondary outcomes are disability score, fatigue, anxiety-depression, cost-effectiveness and process evaluation. Ethics and dissemination: The study protocol has been approved by a French ethics committee (CPP Sud Méditerranée IV, N°ID-RCB: 2020-A01916-33). Results will be submitted for publication, at scientific conferences and through press releases. Trial Registration: NCT04627714.

Longitudinal patterns of lifestyle behaviours in adolescence: a latent transition analysis.

The interdependence among eating behaviour (EB), physical activity (PA) and sedentary time (ST) suggests simultaneously identifying homogeneous profiles and describing their changes. This study aimed to (1) identify cross-sectional lifestyle behaviour profiles and their 2-year changes among French school-age adolescents and (2) identify factors associated with these profiles and changes. Longitudinal data from adolescents who participated in the PRomotion de l'ALIMentation et de l'Activité Physique trial were used. PA and ST were assessed with the International Physical Activity Questionnaire and EB with a FFQ. Profiles at baseline and their changes were identified by latent transition analysis. Multinomial logistic regression models were used to identify factors associated with profiles and their changes. Among 2390 adolescents included (14-18 years), five baseline profiles that differed mainly in EB were identified: 'healthy diet and high PA (7·9 %)', 'big eater and moderate to high PA (23·8 %)', 'healthy diet and low PA (31·2 %)', 'restrictive diet and moderate PA (20·6 %)' and 'sugar products, nibbling and moderate PA (16·5 %)'. Young adolescents, those who were overweight or obese and socially advantaged, were more in the 'healthy diet and low PA' than others. Boys, older and socially less advantaged adolescents exhibited more 'unfavourable' than 'mixed' changes, while adolescents with overweight or obesity had less 'unfavourable' than 'mixed' changes. In conclusion, adolescents were twice the number in the least than the most favourable profile. Findings highlighted the importance of EB among adolescents and suggest taking adolescents' sociodemographic and weight characteristics into account in interventions aimed at acting on adolescents' behaviours.

Five-year Evolution Patterns of Physical Activity and Sedentary Behavior in Patients with Lower-limb Osteoarthritis and Their Sociodemographic and Clinical Correlates.

OBJECTIVE: The present study aimed to identify trajectories of physical activity (PA) components (frequency, duration, intensity, and type) and screen-based sedentary behavior (SB) as well as baseline predictors of each trajectory in patients with hip and/or knee osteoarthritis (OA). METHODS: We included 878 patients with a 5-year follow-up from the KHOALA cohort. PA and SB were measured by the Modifiable Activity Questionnaire. We used group-based trajectory analysis to identify the trajectories of PA components and screen-based SB, and multivariable logistic regression to determine predictors of the identified trajectories. RESULTS: Two groups of trajectories were identified for each PA component and 3 for SB. High and decreasing PA duration was associated with female sex (OR 0.3, 95% CI 0.1-0.5) as was low and stable, more so than high and decreasing prevalence of weight-bearing activities (OR 0.6, 95% CI 0.4-0.9). Patients with impaired patient-reported outcome measures and obese patients often featured low versus high and decreasing prevalence of weight-bearing activities. Predictors of moderate and high versus low and slightly increasing screen-based SB trajectories were male sex, age < 60 years, single status (OR 1.5, 95% CI 1.1-2.1), obesity (OR 2.1, 95% CI 1.4-3.1), smoking (OR 2.0, 95% CI 1.1-3.7), and less physical jobs. Predictors of moderate and high versus low screen-based SB trajectories were all sociodemographic: male sex, age < 60 years, single status, obesity, smoking, and less physical jobs. CONCLUSION: Sociodemographic and clinical predictors of trajectories vary between PA components; they are associated mainly with PA frequency and type. No clinical characteristics were associated with screen-based SB.

The impact of physical activity on fatigue and quality of life during and after adjuvant treatment for breast cancer.

BACKGROUND: Although physical activity (PA) can alleviate fatigue and improve quality of life (QoL) in patients with breast cancer (BC), not all domains of PA may have equal impact. The objective of the current study was to examine the longitudinal impact of PA components on the evolution of fatigue and QoL during and after adjuvant treatment for BC. METHODS: The women included in the study were participants in the 2-year longitudinal FATSEIN ("Fatigue dans le cancer du Sein") study. Fatigue and QoL were measured using the Multidimensional Fatigue Inventory and the European Organization for Research and Treatment of Cancer 30-item QoL questionnaire, respectively. Group-based trajectory analysis was used to determine patterns of PA evolution (frequency, duration, and intensity). Cross-sectional and longitudinal associations between PA patterns and fatigue and QoL were analyzed by using multivariable linear regression and a mixed model. RESULTS: Among the 424 women who were included (mean ± standard deviation age, 57.1 ± 10.4 years), 2 trajectories were identified for each of the 3 PA components: low and insufficient frequency (51.2%) or regular and moderate frequency (48.8%), low and insufficient duration (47.6%) or regular and moderate duration (52.4%), and low intensity (47.2%) or low to moderate intensity (52.8%). Overall, during treatment, fatigue was increased and QoL was decreased, and the reverse was observed after treatment. During treatment, increased fatigue and decreased QoL were limited by regular PA frequency (ß = -8.71 for total fatigue; ß = 14.59 for emotional function), but the results were less significant after treatment. CONCLUSIONS: PA, especially its frequency, is an important determinant of fatigue and QoL during adjuvant treatment for BC. The promotion of regular PA among women who are receiving treatment for BC may be an effective way to reduce fatigue and improve QoL. Cancer 2018;124:797-806. © 2017 American Cancer Society.