Experiences, adherence and satisfaction with a combined exercise and dietary intervention for patients with ovarian cancer undergoing chemotherapy: A mixed-methods study.

OBJECTIVE: This study examined experiences, adherence and satisfaction with a combined exercise and dietary intervention in patients with ovarian cancer and their healthcare professionals (HCPs) as part of the randomized PADOVA trial. METHODS: A mixed-methods approach was used in 24 patients with ovarian cancer receiving first-line chemotherapy who were randomly allocated to a combined exercise and dietary intervention or usual care with counseling sessions post-treatment. Qualitative data on intervention experiences, adherence and satisfaction was collected using semi-structured interviews with patients and their HCPs (n = 18 physical therapists; n = 5 dietitians). Quantitative data on adherence and satisfaction was collected to provide context to qualitative data. RESULTS: Exercise relative dose intensity ranged from 36 to 100% (median 72%) and patients attended 33-133% (median 100%) of the prescribed dietary counseling sessions. Patients appreciated guidance on exercise and nutrition and perceived benefits including improved physical fitness, quality of life, peer support and recovery after surgery and/or chemotherapy cycles. Both patients and HCPs were satisfied with the intervention and perceived that participation exceeded prior expectations. Median patient satisfaction score with the intervention was 8.5 out of 10. Suggestions for improving the intervention included further personalization of the number, content and scheduling of the sessions to preferences of patients and HCPs. Patients in the usual care group reported counseling sessions post-chemotherapy to be too little too late. CONCLUSIONS: Patients with ovarian cancer adhered well to the intervention. Numerous perceived benefits of the intervention were reported by patients and HCPs. Good adherence and positive experiences support successful implementation in clinical practice.

Increasing awareness and knowledge of lifestyle recommendations for cancer prevention in Lynch syndrome carriers: Randomized controlled trial.

Lynch syndrome (LS) mutation carriers may reduce their cancer risk by adhering to lifestyle recommendations for cancer prevention. This study tested the effect of providing LS mutation carriers with World Cancer Research Fund-the Netherlands (WCRF-NL) health promotion materials on awareness and knowledge of and adherence to these recommendations. In this randomized controlled trial (n = 226), the intervention group (n = 114) received WCRF-NL health promotion materials. All LS mutation carriers were asked to fill out questionnaires at 2 weeks before (baseline, T0) and at 2 weeks (T1) and 6 months (T2) after the intervention. Linear mixed models were performed on awareness (0-7) and knowledge (0-7) of the recommendations, and on the secondary outcomes, that is adherence, distress, cancer worry, and risk perception. Compared with the control group, the intervention group became significantly more aware (overall mean difference = 1.24; 95%CI = 0.82-1.67) and obtained significantly improved knowledge of the recommendations (overall mean difference = 1.65; 95%CI = 1.27-2.03). Differences were significantly larger for T1 (Pinteraction = .003 and ≤.001, respectively) but remained significant for T2. No effect on secondary outcomes was found. In conclusion, provision of WCRF-NL health promotion materials increases awareness and knowledge of lifestyle recommendations for cancer prevention among LS mutation carriers without causing additional distress, but does not affect adherence.

Risk of cardiovascular disease after pre-eclampsia and the effect of lifestyle interventions: a literature-based study.

OBJECTIVE: This study addresses the following questions. Do cardiovascular risk factors fully explain the odds ratio of cardiovascular risk after pre-eclampsia? What is the effect of lifestyle interventions (exercise, diet, and smoking cessation) after pre-eclampsia on the risk of cardiovascular disease? DESIGN: Literature-based study. SETTING: N/A. POPULATION OR SAMPLE: N/A. METHODS: Data for the calculations were taken from studies identified by PubMed searches. First, the differences in cardiovascular risk factors after pre-eclampsia compared with an uncomplicated pregnancy were estimated. Second, the effects of lifestyle interventions on cardiovascular risk were estimated. Validated risk prediction models were used to translate these results into cardiovascular risk. RESULTS: After correction for known cardiovascular risk factors, the odds ratios of pre-eclampsia for ischaemic heart disease and for stroke are 1.89 (IQR 1.76-1.98) and 1.55 (IQR 1.40-1.71), respectively. After pre-eclampsia, lifestyle interventions on exercise, dietary habits, and smoking cessation decrease cardiovascular risk, with an odds ratio of 0.91 (IQR 0.87-0.96). CONCLUSIONS: Cardiovascular risk factors do not fully explain the risk of cardiovascular disease after pre-eclampsia. The gap between estimated and observed odds ratios may be explained by an additive risk of cardiovascular disease by pre-eclampsia. Furthermore, lifestyle interventions after pre-eclampsia seem to be effective in decreasing cardiovascular risk. Future research is needed to overcome the numerous assumptions we had to make in our calculations.

Determinants of adherence to recommendations on physical activity, red and processed meat intake, and body weight among lynch syndrome patients.

This study aimed to identify determinants of adherence to lifestyle and body weight recommendations for cancer prevention among Lynch Syndrome (LS) patients. Cross-sectional baseline data of LS patients participating in the Lifestyle & Lynch (LiLy) study was used to assess determinants of adherence to the World Cancer Research Fund cancer prevention recommendations on body weight, physical activity, and red and processed meat intake. Adherence and potential determinants of adherence were assessed using questionnaires. Multivariable logistic regression analyses were conducted to identify determinants of adherence. Of the 211 participants, 50.2% adhered to the body weight recommendation, 78.7% adhered to the physical activity recommendation, and 33.6% adhered to the red and processed meat recommendation. Being younger and having a higher level of education were associated with adherence to the recommendation on body weight. Having knowledge about the recommendation was associated with adherence to the recommendations on physical activity and red and processed meat. Results confirm that knowledge about recommendations for cancer prevention is an important determinant for adherence and suggest that strategies to increase knowledge should be included in lifestyle promotion targeted at LS patients, along with behavior change techniques influencing other modifiable determinants.

Feasibility and effectiveness of a lifestyle intervention after complicated pregnancies to improve risk factors for future cardiometabolic disease.

OBJECTIVES: To evaluate the feasibility and effectiveness of a postpartum lifestyle intervention after pregnancies complicated by preeclampsia, fetal growth restriction (FGR) and/or gestational diabetes mellitus (GDM) to improve maternal risk factors for future cardiometabolic disease. METHODS: Women following a complicated pregnancy were included six months postpartum in this specific pre-post controlled designed study. It has been conducted in one tertiary and three secondary care hospitals (intervention group) and one secondary care hospital (control group). The program consisted of a computer-tailored health education program combined with three individual counselling sessions during seven months. Primary outcome measures were the proportion of eligible women and weight change during the intervention. RESULTS: Two hundred and six women were willing to participate. The proportion of eligible women who complied with the intervention was 23%. Major barrier was lack of time. Adjusted weight change attributed to lifestyle intervention was -1.9 kg (95%-CI -4.3 to -0.3). Further changes were BMI (-0.9 kg/m2 (95%-CI -1.4 to -0.3)), waist-to-hip ratio (-0.04 cm/cm (95%-CI -0.06 to -0.03)), blood pressure medication use (19% (95%-CI 9% to 28%)), HOMA2-score (59 %S (95%-CI 18 to 99)) and total fat intake (-2.9 gr (95%-CI -4.6 to -1.2)). CONCLUSIONS: The results support feasibility and effectiveness of a lifestyle intervention after complicated pregnancies to improve maternal cardiometabolic risk factors. Further randomized controlled studies are needed with longer follow-up to evaluate durability. In the meantime, we suggest health care professionals to offer lifestyle interventions to women after complicated pregnancies.

OS031. Lifestyle intervention after complicated pregnancy successfully improves cardiovascular and metabolic health: Results of the pro-active study.

INTRODUCTION: Women with a pregnancy complicated by preeclampsia, intra-uterine growth restriction and/or gestational diabetes are at increased risk of future cardiovascular and metabolic disease. Lifestyle intervention may help these women to effectively lower these risks. OBJECTIVES: To test if offering lifestyle intervention after a complicated pregnancy significantly reduces weight (primary objective) and/or other cardiovascular and metabolic risk factors (secondary objective). METHODS: The Pro-Active study (Postpartum Rotterdam Appraisal of Cardiovascular health and Tailored Intervention) is a feasibility study to develop and evaluate a postpartum lifestyle intervention program. In a prospective case-control setting we tested the effect of the lifestyle intervention. Women were included between April 2007 and August 2009. They were eligible if ⩾18 years old at time of inclusion, being able to understand and speak the Dutch language and not having pre-existing conditions that could interfere with the lifestyle intervention. Cases were offered lifestyle intervention by a trained counsellor between 6 and 10 months postpartum. During 3 private sessions, mainly exercise and fat-intake and to some extend smoking habits were discussed and aims were made to improve lifestyle. Controls did not receive these sessions, but were not restricted to improve lifestyle on their own. Anthropometric and laboratory measurements were taken at 6 and 10 months postpartum and again at 13 months postpartum to test for durability of the effects. RESULTS: During our study 1121 women gave birth after a complicated pregnancy. Four hundred and ninety Women were eligible for the study of which 240 women (49%) gave informed consent to participate. 56 Women (23%) were lost-to-follow-up, leaving 186 women for the analysis. Between 6 and 13 months postpartum weight was significantly reduced in cases compared to controls by 2.1kg (95%>CI 0.4-3.7), resulting in a 0.7kg/m(2) (0.1-1.3) lower BMI. Also systolic blood pressure (5.0mmHg(0.3-9.7)), waist circumference (4.6cm(2.6-6.6)) and waist-to-hip ratio (0.03(0.01-0.04)) were significantly improved in cases compared to controls. Heart rate, hip circumference and total cholesterol were significantly improved within cases, but not compared to controls. Diastolic blood pressure and fasting glucose were not improved. CONCLUSION: Lifestyle intervention after complicated pregnancy may be effective in lowering weight and improving other cardiovascular and metabolic risk factors. It suggests that now is prudent and justified to start a large-scale randomised controlled trial to validate our results.

OS109. Lifestyle intervention after complicated pregnancy successfully improves saturated fat-intake, but not exercise and smoking habits: results of the pro-active study.

INTRODUCTION: Women with a pregnancy complicated by preeclampsia, intra-uterine growth restriction and/or gestational diabetes are at increased risk of future cardiovascular and metabolic disease. Lifestyle intervention may help these women to effectively lower these risks. OBJECTIVES: To test if offering lifestyle intervention after a complicated pregnancy significantly improves saturated fat-intake and exercise (primary objectives) and/or smoking habits (secondary objective). METHODS: The Pro-Active study (Postpartum Rotterdam Appraisal of Cardiovascular health and Tailored Intervention) is a feasibility study to develop and evaluate a postpartum lifestyle intervention program. In a prospective case-control setting we tested the effect of the lifestyle intervention. Women were included between April 2007 and August 2009. They were eligible if ⩾18 years old at time of inclusion, being able to understand and speak the Dutch language and not having pre-existing conditions that could interfere with the lifestyle intervention. Cases were offered lifestyle intervention by a trained counsellor between 6 and 10 months postpartum. During 3 private sessions, mainly exercise and fat-intake and to some extend smoking habits were discussed and aims were made to improve lifestyle. Controls did not receive these sessions, but were not restricted to improve lifestyle on their own. Lifestyle habits were scored at 6 and 13 months postpartum. For saturated fat-intake we used the Maastricht Fatlist. For exercise we used the International Physical Activity Questionnaire (IPAQ). For smoking habits we used a short version of the questionnaire of STIVORO (the Dutch anti-smoking association). We also performed a formative evaluation of the intervention program. RESULTS: During our study 1121 women gave birth after a complicated pregnancy. 490 Women were eligible for the study of which 240 women (49%) gave informed consent to participate. 56 Women (23%) were lost-to-follow-up, leaving 186 women for the analysis. Between 6 and 13 months postpartum saturated fat-intake was significantly reduced by 3.6g/day (95%>CI 1.8-5.4) in cases compared to controls. Exercise was improved in cases compared to controls, but it did not reach significance (277 MET's (-2699-3254)). Although smoking decreased from 14.5% to 10.4% in cases, it was not significant and comparable to the decrease in controls (15.0% to 8.4%). The formative evaluation showed that the most important motivator to improve lifestyle was the increased risk of future cardiovascular and metabolic disease (70%) and the increased risk for recurrence in a next pregnancy (57%). Main barriers were an already busy life (40%), distance (35%) and duration (38%) of travelling to the hospital and to early postpartum to pay attention to lifestyle (26%). CONCLUSION: Lifestyle intervention after complicated pregnancy may be effective in improving saturated fat-intake. Other interventions, specially aimed at postpartum women, are needed to improve exercise and smoking habits. More research is needed to develop lifestyle intervention program specifically aimed at these women. New possibilities of multimedia are promising.