Associations of dietary patterns with kidney cancer risk, kidney cancer-specific mortality and all-cause mortality among postmenopausal women.

BACKGROUND: The empirical dietary index for hyperinsulinemia (EDIH) and empirical dietary inflammatory pattern (EDIP) are novel measures of dietary quality associated with insulin hypersecretion or chronic inflammation, respectively, whereas the Healthy Eating Index (HEI-2015) measures adherence to the Dietary Guidelines for Americans (DGA). We evaluated associations of EDIH, EDIP and HEI-2015 on the risk of both kidney cancer development and mortality. METHODS: We calculated the dietary scores from baseline food frequency questionnaires among 115,830 participants aged 50-79 years in the Women's Health Initiative. Multivariable-adjusted Cox regression was used to estimate hazard ratios (HR) and 95% confidence intervals (95%CI) for kidney cancer risk, kidney cancer-specific mortality and all-cause mortality, per 1-standard deviation increment in dietary pattern scores. RESULTS: Higher EDIH was associated with greater risk of kidney cancer development [HR, 1.12; 95%CI, (1.01,1.23)], kidney cancer-specific death [1.22(0.99,1.48)], and all-cause mortality, [1.05(1.02,1.08)]. Higher HEI-2015 was associated with lower risk of kidney cancer development, [0.85(0.77, 0.94)], kidney cancer-specific death, [0.84(0.69,1.03)] and all-cause mortality, [0.97(0.95,1.00)]. However, EDIP was not significantly associated with outcomes. Associations did not differ by BMI categories. CONCLUSIONS: Low-insulinemic dietary patterns and higher quality diets, are worthy of testing in dietary pattern intervention trials for kidney cancer prevention and improved survivorship.

Differences in obesity-related health behaviors and health outcomes by rural and Appalachian residency.

PURPOSE: Obesity and health behaviors are the major modifiable contributors to cancer and health disparities. We examined the differences in obesity-related health behaviors, and health outcomes by rural and Appalachian residency in Ohio. METHODS: Cross-sectional survey data from the 2011-2019 Behavioral Risk Factor Surveillance System were obtained from the Ohio Department of Health. County-level identifiers were used to classify urban non-Appalachian, urban Appalachian, rural non-Appalachian, and rural Appalachian residency. Self-reported weight, height, health behaviors, and health conditions were used. Logistic regression was used to assess the difference in health behaviors and health outcomes by rural and Appalachian residency. All analyses incorporated with sample weights. RESULTS: Among Ohio residents, compared to urban non-Appalachian residents, urban Appalachian and rural Appalachian residents had a higher prevalence of obesity, hypertension, high cholesterol, and cardiovascular diseases, as well as lower rates of healthy diet and physical activity. No difference was found in trends of obesity and obesity-related health outcomes in 2011-2019 by rural and Appalachian residency. However, rural Appalachian residents had a greater increase in obesity, hypertension, and diabetes, whereas rural non-Appalachian had favorable changes in obesity-related health behaviors. Additionally, associations between health behaviors and obesity-related health outcomes differed by rural and Appalachian residency. CONCLUSIONS: Findings underscore the importance of distinguishing between urban non-Appalachian, urban Appalachian, rural non-Appalachian, and rural Appalachian populations when assessing health disparities. While the trends of obesity and obesity-related health outcomes did not differ, the association between health behaviors and obesity-related outcomes differed by rural and Appalachian residency.

Impact of an augmented intervention on self-regulatory, dietary and physical activity outcomes in a diabetes prevention trial among adults with prediabetes.

Self-regulation can facilitate modifications in lifestyle to promote behavioral change. However, little is known about whether adaptive interventions promote improvement in self-regulatory, dietary, and physical activity outcomes among slow treatment responders. A stratified design with an adaptive intervention for slow responders was implemented and evaluated. Adults ≥ 21 years old with prediabetes were stratified to the standard Group Lifestyle Balance intervention (GLB; n = 79) or the adaptive GLB Plus intervention (GLB + ; n = 105) based on first-month treatment response. Intake of total fat was the only study measure that significantly differed between groups at baseline (P = 0.0071). GLB reported greater improvement in self-efficacy for lifestyle behaviors, goal satisfaction with weight loss, and very active minutes of activity than GLB + (all P < 0.01) at 4-months. Both groups reported significant improvement in self-regulatory outcomes and reduction in energy and fat intake (all P < 0.01). An adaptive intervention can improve self-regulation and dietary intake when tailored to early slow treatment responders.

Lessons Learned for Training a Research Team and Teaching Kidney Transplant Recipients How to Use a Mobile Health Technology for Dietary Intake and Physical Activity via a Virtual Platform.

Kidney transplant centers and other health care organizations historically have struggled to merge lifestyle management for diet and physical activity into clinical practice. The use of mobile health (mHealth) applications has the potential for kidney transplant recipients to track calorie intake and physical activity in real time. Few studies have reported how they trained their research team and participants how to use mHealth technology in real time. The purpose of this study was to describe lessons learned for training a research team and teaching kidney transplant recipients how to use mHealth technology utilizing a virtual format. Findings suggest that time and educational materials, and using verbal, written, and visual information are critical when conducting a research study using a virtual format.

Maintenance phase of a physical activity intervention in older kidney transplant recipients: A 12-month follow-up.

Daily walking activities are associated with improving cardiovascular outcomes in older kidney transplant recipients. However, little is known regarding physical activity adherence outcomes in older kidney recipients. The purpose of this randomized controlled trial 12-month follow-up study was to evaluate the feasibility of the intervention (SystemCHANGE™ + activity tracker) during the maintenance period (7-12 months), compared to an attention-control group (activity tracker only) in older kidney recipients (age 60 and older). The sample included 60 participants (n = 30 IG; n = 30 ACG). Adherence rates for wearing the activity tracker daily were 96.5% in the IG and 80.8% in the ACG. The IG demonstrated within-group improvements for blood pressure at 12 months. Overall, there was a decrease in the average daily steps observed in both groups. These data suggest this intervention is feasible and additional boosters should be considered during the maintenance period to encourage physical activity.

Hepatitis E seroprevalence in the United States: Results for immunoglobulins IGG and IGM.

BACKGROUND: Previous research identified a decline in hepatitis E virus (HEV) seroprevalence in US in 1988-1994 and 2009-2010. We investigated most recent HEV epidemiology. METHOD: Using a nationally representative sample (7656 persons in the National Health and Nutrition Examination Survey [NHANES] 2013-2014 and 7124 persons in NHANES 2015-2016), we compared the weighted seroprevalence of HEV (immunoglobulin G [IgG]/immunoglobulin M [IgM]) among people from the US (aged ≧ 6 years) between these two time periods. Sampling-weighted multivariate logistic regression models were used to identify factors associated with HEV seropositivity. RESULTS: The median participant age was 37 years (interquartile range = 17-58 years); 51.17% of them were female. Among US-born individuals, HEV seropositivity (IgG/IgM) increased from 4.5% (95% confidence interval [CI] = 3.5%-5.5%) in 2013-2014 to 8.1% (95%CI = 6.5%-9.7%) in 2015-2016. Recent HEV infection (IgM) has nearly doubled in all US-born people. For participants born in and outside of the US, the overall weighted HEV (IgG/IgM) seropositivity increased from 5% (95%CI = 3.9%-6.1%) during 2013-2014 to 7.7% (95%CI = 7.2%-10.5%) during 2015-2016. In "non-Hispanic Asian" females, HEV seropositivity (IgG/IgM) rose from 8.4% (95%CI = 5.6%-11.1%) during 2013-2014 to 20.7% (95%CI = 15.8%-25.7%) during 2015-2016. In "non-Hispanic Asian" males, HEV seropositivity (IgG/IgM) increased from 9.3% (95%CI = 6.9%-11.8%) during 2013-2014 to 16.8% (95%CI = 12.5%-21.2%) during 2015-2016. HEV (IgG/IgM) seropositivity was significantly associated with "non-Hispanic Asian" ethnicity (odds ratio [OR] = 1.69; CI = 1.12-2.56), female (OR = 1.2, CI = 1.06-1.38), and age (OR = 1.058, CI = 1.05-1.06). No clear etiologic agent was found. CONCLUSION: The combined and strata-specific HEV weighted seroprevalence increased from 2013-2014 to 2015-2016. Although prior studies had found increasing age as the only significant factor associated with HEV, the attribute of "non-Hispanic Asian" had a stronger association with HEV seropositivity than the age factor alone.

Effects of a Group-Mediated Exercise and Dietary Intervention in the Treatment of Prostate Cancer Patients Undergoing Androgen Deprivation Therapy: Results From the IDEA-P Trial.

Background: Although androgen-deprivation therapy (ADT) is the foundation of treatment for prostate cancer, the physiological impacts of ADT result in functional decline and enhanced risk of chronic disease and metabolic syndrome. Purpose: The Individualized Diet and Exercise Adherence Pilot Trial (IDEA-P) is a single-blind, randomized, pilot trial comparing the effects of a group-mediated, cognitive-behavioral (GMCB) exercise and dietary intervention (EX+D) with those of a standard-of-care (SC) control during the treatment of prostate cancer patients undergoing ADT. Methods: A total of 32 prostate cancer patients (M age = 66.28, SD = 7.79) undergoing ADT were randomly assigned to the 12-week EX+D intervention (n = 16) or control (n = 16). The primary outcome in IDEA-P was change in mobility performance with secondary outcomes including body composition and muscular strength. Blinded assessment of outcomes were obtained at baseline and at 2- and 3-month follow-ups. Results: Favorable adherence and retention rates were observed, and no serious intervention-related adverse events were documented. Intent-to-treat ANCOVA controlling for baseline value and ADT duration demonstrated that EX+D resulted in significantly greater improvements in mobility performance (p < .02), muscular strength (p < .01), body fat percentage (p < .05), and fat mass (p < .03) at 3-month follow-up, relative to control. Conclusion: Findings from the IDEA-P trial suggest that a GMCB-based EX+D intervention resulted in significant, clinically meaningful improvements in mobility performance, muscular strength, and body composition, relative to controls. Collectively, these results suggest that the EX+D was a safe and well-tolerated intervention for prostate cancer patients on ADT. The utility of implementing this approach in the treatment of prostate cancer patients on ADT should be evaluated in future large-scale efficacy trials. Clinical Trial information: NCT02050906.

Monitoring Resistance Exercise Intensity Using Ratings of Perceived Exertion in Previously Untrained Patients With Prostate Cancer Undergoing Androgen Deprivation Therapy.

Fairman, CM, LaFountain, RL, Lucas, AR, and Focht, BC. Monitoring resistance exercise intensity using ratings of perceived exertion (RPE) in previously untrained patients with prostate cancer undergoing androgen deprivation therapy. J Strength Cond Res 32(5): 1360-1365, 2018-Exercise has been shown to be safe and effective for patients with prostate cancer (PrCa). The monitoring of resistance exercise (RE) intensity is an emerging area of interest in RE prescription. Rating of perceived exertion (RPE) is one of the most commonly used methods but has not yet been validated in this population. Thus, the purpose of this study was to examine the relationship between RPE and RE intensity in PrCa. Data for this study were abstracted from baseline upper- and lower-body strength assessments from 2 previous trials (Individual Diet and Exercise Adherence Pilot Trial; Livestrong, Austin, TX, USA) in our laboratory investigating functional outcomes in patients with PrCa undergoing androgen deprivation therapy (ADT). A total of 75 participants from both trials were included in this study. Ratings of perceived exertion corresponding to 50, 70, and 90% 1 repetition maximum (1RM) were extracted from the results of participants' upper- and lower-body 1RM strength tests. The changes in RPE across increasing intensities were assessed using separate univariate analysis of variance (ANOVA). For each ANOVA, RPE was used as the dependent variable and intensity (50, 70, and 90%) used as the fixed factor. A univariate ANOVA revealed a significant difference (p ≤ 0.05) among the RPE values for each intensity for both upper- and lower-body lifts. The results of our analyses suggest that RPE values rise linearly in response to increases in exercise intensity. Our study supports the concept that RPE may be a practical training tool to accurately estimate RE intensity in PrCa survivors undergoing ADT. Practitioners may consider using RPE to monitor and adjust RE intensity in this population.

Recruiting Endometrial Cancer Survivors to Studies Examining Lifestyle Behaviors and Quality of Life: Challenges Faced and Lessons Learned.

There are a growing number of cancer survivors in the USA. Despite lifestyle behaviors being strongly associated with morbidity and mortality following primary treatment, recruitment to clinical research studies that aim to improve such behaviors remains a significant challenge. Furthermore, pilot and feasibility studies are critical for the refinement of research methods and form an important training opportunity for early career scientists. This report details the challenges faced and lessons learned in the process of recruiting a population of overweight/obese endometrial cancer survivors (ECS) to two separate studies focused on lifestyle behaviors: a survey study and a randomized behavioral intervention study that aimed to improve diet, physical activity, and quality of life. We used in-clinic and mail-based approaches to reach eligible patients identified from clinic records. Surveys were offered via paper or online. To evaluate the recruitment process, we compared clinic records and enrollment data over time and location. Chi-squared tests were also used to compare recruitment strategies. We address specific challenges at the patient level, the clinic/provider level, and the organizational level. Overall response rate was 13.9% to the survey and 4% to the intervention. Responses to in-clinic offers were greater than to mail-based approaches for the survey with no difference for the intervention. Identifying the unique characteristics of each survivorship population, adequate planning, resource allocation, and involvement of key staff are essential to supporting recruitment efforts to research studies. Having the support of physicians and nurses is especially critical to the success of recruitment.

The presence of symptoms of testosterone deficiency in the exercise-hypogonadal male condition and the role of nutrition.

PURPOSE: High volumes of aerobic exercise have been associated with reduced testosterone (T), known as the exercise-hypogonadal male condition (EHMC). Although the presence of low T has been identified, few studies have assessed the presence of androgen-deficient symptoms. The purpose of this investigation is to assess men exhibiting EHMC and evaluate their hypothalamic-pituitary-gonadal axis, the presence of hypogonadal symptoms, and also investigate a possible contribution of inadequate nutrition to the condition. METHODS: A cross-sectional design compared 9 long-distance runners exhibiting EHMC to 8 non-active controls. Comparisons included serum T, luteinizing hormone (LH), follicle-stimulating hormone, and cortisol, the Aging Male Symptoms (AMS) questionnaire score, bone mineral density (BMD), and a food frequency questionnaire. RESULTS: Mean T was significantly reduced in the EHMC group (EHMC 9.2 nmol L-1 vs. CONT 16.2 nmol L-1). The EHMC group demonstrated significantly higher AMS scores (EHMC 27.1 ± 7.3 vs. CONT 19.7 ± 2.5). There were no differences in bone density, although 3 cases of osteopenia were noted for EHMC in the lumbar spine, 1 in the right femur, and 1 in the radius. Energy availability was significantly reduced in EHMC (EHMC 27.2 ± 12.7 vs. CONT 45.4 ± 18.2 kcal d FFM-1). CONCLUSIONS: Men exhibiting EHMC do appear to present with symptoms associated with androgen deficiency. For the most part, these symptoms are limited to those reported on the AMS questionnaire, although there are also some cases of clinically low BMD. It is possible that inadequate energy intake is contributing to this condition.

A group-mediated physical activity intervention in older knee osteoarthritis patients: effects on social cognitive outcomes.

The objective of the present study was to compare a group-mediated cognitive behavioral (GMCB) physical activity intervention with traditional exercise therapy (TRAD) upon select social cognitive outcomes in sedentary knee osteoarthritis (knee OA) patients. A total of 80 patients (mean age = 63.5 years; 84% women) were recruited using clinic and community-based strategies to a 12-month, single-blind, two-arm, randomized controlled trial. Mobility-related self-efficacy, self-regulatory self-efficacy (SRSE), and satisfaction with physical function (SPF) were assessed at baseline, 3, and 12 months. Results of intent-to-treat 2 (Treatment: GMCB and TRAD) × 2 (Time: 3 and 12 month) analyses of covariance yielded significantly greater increases in SRSE and SPF (P < 0.01) relative to TRAD. Partial correlations revealed that changes in SRSE and SPF were significantly related (P < 0.05) to improvements in physical activity and mobility at 3 and 12-months. The GMCB intervention yielded more favorable effects on important social cognitive outcomes than TRAD; these effects were related to improvements in physical activity and mobility.

Ratings of Perceived Exertion During Acute Resistance Exercise Performed at Imposed and Self-Selected Loads in Recreationally Trained Women.

Cotter, JA, Garver, MJ, Dinyer, TK, Fairman, CM, and Focht, BC. Ratings of perceived exertion during acute resistance exercise performed at imposed and self-selected loads in recreationally trained women. J Strength Cond Res 31(8): 2313-2318, 2017-Resistance exercise (RE) is commonly used to elicit skeletal muscle adaptation. Relative intensity of a training load links closely with the outcomes of regular RE. This study examined the rating of perceived exertion (RPE) responses to acute bouts of RE using imposed (40% and 70% of 1 repetition maximum [1RM]) and self-selected (SS) loads in recreationally trained women. Twenty physically active women (23.15 ± 2.92 years), who reported regular RE training of at least 3 weekly sessions for the past year, volunteered to participate. During the initial visit, participants completed 1RM testing on 4 exercises in the following order: leg extension, chest press, leg curl, and lat pull-down. On subsequent visits, the same exercises were completed at the SS or imposed loads. The RPE was assessed after the completion of each set of exercises during the 3 RE conditions using the Borg-15 category scale. Self-selected loads corresponded to an average of approximately 57%1RM (±7.62). Overall, RPE increased with load (40%1RM = 11.26 [±1.95]; SS 57%1RM = 13.94 [±1.58]; and, 70%1RM = 15.52 [±2.05]). Reflecting the linear pattern found between load and perceived effort, the present data provide evidence that RPE levels less than 15 likely equate to loads which are not consistent with contemporary American College of Sports Medicine (ACSM) guidelines for enhancing musculoskeletal health which includes strength and hypertrophy. Women desiring increases in strength and lean mass likely need to train at an exertion level at or surpassing a rating of 15 on the Borg-15 category. This article examined the modification of training load on perceived exertion, but other variables, such as the number of repetitions completed, may also be targeted to achieve a desired RPE. The primary understanding is that women who engage in RE may not self-select loads that are consistent with the ACSM recommendations for musculoskeletal health.

Effect of a behavioral intervention on dimensions of self-regulation and physical activity among overweight and obese adults with type 2 diabetes: a pilot study.

The purpose of this pilot study was to determine the preliminary effect of a behavioral intervention on the use of self-regulation strategies and moderate-to-vigorous physical activity (MVPA) in overweight and obese adults with type 2 diabetes. 23 individuals recruited from ResearchMatc.org and campus advertisements were randomized into an intervention (n = 12) and control (n = 11) group. The intervention group received a behavioral intervention that used goal setting, time management, and self-monitoring to target dimensions of self-regulation and MVPA. The control received information regarding their PA habits. MVPA was measured via BodyMedia Armbands at pre- and post-test. The use of self-regulatory strategies for MVPA was assessed at pretest and posttest using the Self-Regulation for Exercise Scale. Cohen's d effect sizes were calculated to determine the practical impact of the intervention. The intervention had a large effect on all dimensions of self-regulation across time: including total self-regulation (3.15), self-monitoring (4.63), goal setting (3.17), social support (1.29), self-reward (1.98), time management (4.41), and overcoming barriers (2.25). The intervention had no impact on dimensions of MVPA across time. This pilot study demonstrated the ability of a behavioral intervention to improve the use of self-regulation strategies for MVPA in a sample of adults with type 2 diabetes. These findings can further inform the development of health promotion programs to promote self-regulation. Future research should focus on determining ability of improvements in self-regulation to stimulate behavior change.

A Randomized Controlled Trial Translating the Diabetes Prevention Program to a University Worksite, Ohio, 2012-2014.

INTRODUCTION: Working adults spend much time at the workplace, an ideal setting for wellness programs targeting weight loss and disease prevention. Few randomized trials have evaluated the efficacy of worksite diabetes prevention programs. This study evaluated the efficacy of a worksite lifestyle intervention on metabolic and behavioral risk factors compared with usual care. METHODS: A pretest-posttest control group design with 3-month follow-up was used. Participants with prediabetes were recruited from a university worksite and randomized to receive a 16-week lifestyle intervention (n = 35) or usual care (n = 34). Participants were evaluated at baseline, postintervention, and 3-month follow-up. Dietary intake was measured by a food frequency questionnaire and level of physical activity by accelerometers. Repeated measures analysis of variance compared the change in outcomes between and within groups. RESULTS: Mean (standard error [SE]) weight loss was greater in the intervention (-5.5% [0.6%]) than in the control (-0.4% [0.5%]) group (P < .001) postintervention and was sustained at 3-month follow-up (P < .001). Mean (SE) reductions in fasting glucose were greater in the intervention (-8.6 [1.6] mg/dL) than in the control (-3.7 [1.6] mg/dL) group (P = .02) postintervention; both groups had significant glucose reductions at 3-month follow-up (P < .001). In the intervention group, the intake of total energy and the percentage of energy from all fats, saturated fats, and trans fats decreased, and the intake of dietary fiber increased (all P < .01) postintervention. CONCLUSION: The worksite intervention improved metabolic and behavioral risk factors among employees with prediabetes. The long-term impact on diabetes prevention and program sustainability warrant further investigation.

Affective Responses to Acute Resistance Exercise Performed at Self-Selected and Imposed Loads in Trained Women.

The purpose of this study was to examine the affective responses to acute resistance exercise (RE) performed at self-selected (SS) and imposed loads in recreationally trained women. Secondary purposes were to (a) examine differences in correlates of motivation for future participation in RE and (b) determine whether affective responses to RE were related to these select motivational correlates of RE participation. Twenty recreationally trained young women (mean age = 23 years) completed 3 RE sessions involving 3 sets of 10 repetitions using loads of 40% of 1 repetition maximum (1RM), 70% 1RM, and an SS load. Affective responses were assessed before, during, and after each RE session using the Feeling Scale. Self-efficacy and intention for using the imposed and SS loads for their regular RE participation during the next month were also assessed postexercise. Results revealed that although the SS and imposed load RE sessions yielded different trajectories of change in affect during exercise (p < 0.01), comparable improvements in affect emerged after RE. Additionally, the SS condition was associated with the highest ratings of self-efficacy and intention for future RE participation (p < 0.01), but affective responses to acute RE were unrelated to self-efficacy or intention. It is concluded that acute bouts of SS and imposed load RE resulted in comparable improvements in affect; recreationally trained women reported the highest self-efficacy and intention to use the load chosen in SS condition in their own resistance training; and affective responses were unrelated to motivational correlates of resistance training.

Transportation Factors and Postoperative Attendance and Weight Loss Through 24 Months.

PURPOSE: Transportation, access to follow-up care, and association with weight loss are understudied in the bariatric population. The objective of this study was to determine how transportation variables associate with postoperative attendance and weight loss through 24 months. MATERIALS AND METHODS: Seven hundred eighty-seven patients (81.3% female; 59.1% White) who had primary surgery (48.6% gastric bypass) from 2015 to 2019 were included. Sidewalk coverage and number of bus stops from patients' homes, driving distance in miles and minutes from patients' homes to the nearest bus stop and the clinic were measured. Bivariate analyses were conducted with the transportation variables and attendance and %TWL at 2 or 3, 6, 12, and 24 months. One mixed multilevel model was conducted with dependent variable %TWL over 24 months with visits as the between-subjects factor and covariates: race, insurance, surgical procedure, and driving distance to the clinic in minutes, attendance, and %TWL over 24 months; an interaction between distance, attendance, and visits. RESULTS: There were no significant differences between the majority of the transportation variables and postoperative attendance or %TWL. Patients who had perfect attendance had improved %TWL at 12 months [t(534)=-1.92, p=0.056] and 24 months [t(393)=-2.69, p=0.008] compared to those who missed at least one appointment. Patients with perfect attendance and who had shorter driving times (under 20 min) to the clinic had greater weight loss through 24 months [F(10, 1607.50)=2.19, p=0.016)]. CONCLUSIONS: Overall, transportation factors were not associated with attendance and weight loss, with the exception of the interaction between shorter driving minutes to follow-up and perfect attendance.

E-PROOF: E-intervention for protein intake and resistance training to optimize function: A study protocol.

BACKGROUND: Accounting for more than 60% of cancer survivors, older (≥65 years) cancer survivors have a 2- to 5-fold risk of physical function impairment, compared to cancer-free peers. One strategy to improve physical function is dietary and resistance training interventions, which improve muscle strength and mass by stimulating muscle protein synthesis. The E-PROOF (E-intervention for Protein Intake and Resistance Training to Optimize Function) study will examine the feasibility, acceptability, and preliminary efficacy of a 12-week randomized controlled trial of an online, tailored nutritional and resistance training education and counseling intervention to improve physical function and associated health outcomes (muscle strength, health-related quality of life (HRQoL), self-efficacy, and weight management). METHODS: In this study, 70 older cancer survivors will be randomized to one of two groups: experimental (receiving remote behavioral counseling and evidence-based education and resources), and control (general survivorship education). We will examine the intervention effects on physical function, muscle strength, HRQoL, self-efficacy, weight, and waist circumference during a 12-week period between the experimental and control groups. Three months following the end of the intervention, we will conduct a follow-up assessment to measure physical function, muscle strength, and HRQoL. SIGNIFICANCE AND IMPACT: This study is the first synchronous, online protein-focused diet and resistance training intervention among older cancer survivors. This novel study advances science by promoting independent health behaviors among older cancer survivors to improve health outcomes, and provide foundational knowledge to further address this growing problem on a wider scale through online platforms.

Resistance exercise interventions during and following cancer treatment: a systematic review.

Findings from prior systematic reviews suggest that exercise results in meaningful improvements in many clinically relevant physiologic and quality of life (QOL) outcomes during and following cancer treatment. However, the majority of exercise-cancer studies have focused upon the benefits of aerobic exercise (AE) and knowledge of the efficacy of resistance exercise (RE) alone as a supportive care intervention for cancer patients and survivors remains limited. Consequently, the purpose of this review was to provide the first systematic evaluation of the effects of RE alone upon clinically relevant physiologic and QOL outcomes during and following cancer treatment. Literature searches were conducted to identify studies examining RE interventions in cancer patients and survivors. Data were extracted on physiologic (fitness, physical function, and body composition) and QOL (fatigue, psychological well-being, and cancer-specific and global QOL outcomes. Cohen's d effect sizes were calculated for each outcome. A total of 15 studies (6 in samples undergoing active cancer treatment and 9 in samples having completed cancer treatment) involving 1,077 participants met the inclusion criteria. Findings revealed that, on average, RE resulted in large effect-size improvements in muscular strength (d = 0.86), moderate effect-size improvements in physical function (d = 0.66), and small effect-size improvements in body composition (d = 0.28) and QOL (d = 0.25) outcomes. The effect sizes observed following RE are comparable in magnitude to the effects of exercise interventions reported in prior comprehensive reviews of the exercise-cancer literature which primarily focused upon AE. Additionally, the methodologic quality of the studies was generally strong. Taken collectively, results of this systematic review suggest that RE is a promising supportive care intervention that results in meaningful improvements in clinically relevant physiologic and QOL outcomes during and following cancer treatment.

Feelings of energy, exercise-related self-efficacy, and voluntary exercise participation.

This study used a path analysis approach to examine the relationship between feelings of energy, exercise-related self-efficacy beliefs, and exercise participation. A cross-sectional mailing survey design was used to measure feelings of physical and mental energy, task and scheduling self-efficacy beliefs, and voluntary moderate and vigorous exercise participation in 368 healthy, full-time undergraduate students (mean age = 21.43 ± 2.32 years). The path analysis revealed that the hypothesized path model had a strong fit to the study data. The path model showed that feelings of physical energy had significant direct effects on task and scheduling self-efficacy beliefs as well as exercise behaviors. In addition, scheduling self-efficacy had direct effects on moderate and vigorous exercise participation. However, there was no significant direct relationship between task self-efficacy and exercise participation. The path model also revealed that scheduling self-efficacy partially mediated the relationship between feelings of physical energy and exercise participation.