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.

A Mindfulness-Based Lifestyle Intervention for Obese, Inactive Endometrial Cancer Survivors: A Feasibility Study.

BACKGROUND: Mindfulness-based interventions (MBIs) to address self-regulation and lifestyle behaviors (diet, physical activity) may benefit endometrial cancer survivors (ECS), who are at increased risk for morbidity and mortality associated with obesity. However, the acceptability of mindfulness training and whether it can augment behavior change in ECS is unknown. We aimed to examine; 1) the feasibility of the Mindfulness in Motion + Diet (MIM+D) intervention and 2) the preliminary efficacy of MIM+D for improving mindfulness, diet, PA and health-related quality of life (HRQL). METHODS: ECS (Mage=62.4, ±5yrs from diagnosis) completed assessments at baseline, 8 and 14 weeks. Feasibility was determined by intervention completion surveys, attendance and adherence data. We used repeated measures ANOVA's (SPSS 22.0) and effect size estimates (Cohen's d) to examine changes in mindfulness, diet, PA, and HRQL over time. RESULTS: Thirteen ECS (76%) completed the MIM+D program and attendance (≥6/8 sessions) was 90%. Women reported favorably on the overall quality (mean of 4.75/5) and benefits of the MIM+D program; however, would have preferred receiving MIM+D closer to diagnosis. Intention to treat analyses found MIM+D did not significantly improve any outcomes. However, an intervention completers analysis showed significant change in mindfulness (p=.0039) and small to moderate estimates for change in fruits and vegetable intake (d=.23), MVPA (d=.45), RAND SF-36: MCS (d=.46), and sleep quality (d=.68). CONCLUSIONS: Integrating mindfulness training into behavioral interventions is feasible and ECS that adhere to these lifestyle programs may benefit. However, to future research should examine the-long term effects of mindfulness-based behavioral lifestyle interventions.

Sex Differences in Time Perception during Self-paced Running.

Time perception during exercise may be affected by chosen intensity, and may also affect enjoyment of exercise and subsequent long-term adherence. However, little is known about how individuals perceive the passage of time during exercise, or if factors such as sex are influential. The purpose of this study was to determine if there are sex related differences in perception of time during a bout of exercise in experienced runners. Twenty-two recreational runners (11 men, 11 women) participated in a bout of treadmill running where they were allowed to select their intensity. Sixty second prospective time estimations were taken before, during (at 33%, 66% and 90% of the completed distance), and after the run. Heart rate (HR) was also recorded throughout. The women (M = 91.9, SD = 3.3) ran at a significantly higher percentage of their maximum HR than the men (M = 86.5, SD = 6.4; p = 0.022), choosing to run at a higher relative intensity than the men when given the opportunity to self-pace. The women had relatively lower time estimations overall, showing that they perceived time to be passing by more slowly compared to the men. These results may help to explain sex related differences in exercise adherence.

Prospective evaluation of C-reactive protein, smoking and lung cancer death in the Third National Health and Nutrition Examination Survey.

Chronic inflammation plays an important role in lung carcinogenesis. Few prospective studies have examined associations between lung cancer, serum C-reactive protein (CRP), a measure of systemic inflammation, and inflammatory lifestyle factors, such as smoking and obesity. This study prospectively examined the relationship between CRP and lung cancer death and its interrelationships with several lifestyle factors. Baseline data on smoking and other lifestyle variables were collected for 8,950 participants in the Third National Health and Nutrition Examination Survey (NHANES III: 1988-1994). Baseline CRP levels were measured in serum samples by nephelometry. Mortality status was ascertained through probabilistic record matching using the National Death Index through 2006. Cox proportional hazard regression models were used to estimate hazard ratios (HRs) for CRP and lung cancer death, with adjustment for smoking and other variables. During 18 years of follow-up, 219 individuals died from lung cancer. Multivariate regression models revealed a dose-response effect for elevated CRP and risk of lung cancer death when adjusting for age, gender, BMI and smoking. Compared to individuals with CRP <3 mg/l, lung cancer death was significantly associated with elevated levels of CRP: HR=1.63 (95% CI=1.15-2.26) for 3-7 mg/l and HR=2.44 (95% CI=1.81­3.45) for CRP >7 mg/l, P-trend <0.0001). The risk of lung cancer death for smokers increased 9-fold in adjusted models (P<0.0001). When stratified by gender and smoking status the effects of CRP were similar for smokers and males but did not reach statistical significance for females and non-smokers. This study supports a dose-dependent relationship between lung cancer death and CRP for males and smokers, but additional efforts are needed to better elucidate these relationships in women and non-smokers. The results suggest that CRP may emerge as a valuable tool in identifying high-risk subgroups of smokers for lung cancer prevention strategies.

The effect of endpoint knowledge on perceived exertion, affect, and attentional focus during self-paced running.

The purpose of this study was to determine the effect of endpoint knowledge on psychophysiological variables. Twenty-two runners (11 men and 11 women) participated in 2 conditions: a run with an unknown endpoint and a run to the same distance with knowledge of the endpoint. Rating of perceived exertion (RPE), affect, heart rate, and attentional focus were assessed during testing. Subjects ran faster when the endpoint was known (p < 0.01) but no differences in RPE, affect, or heart rate between conditions were present (p > 0.05). There were differences in attentional focus between conditions (p = 0.034) and subjects reported more associative thoughts in the known endpoint condition. Cardiorespiratory fitness was a significant predictor of attentional focus in the known endpoint condition. In sum, when the endpoint was known, subjects used more associative strategies as RPE increased, and those with higher fitness levels used more associative strategies overall.

How are previous physical activity and self-efficacy related to future physical activity and self-efficacy?

Self-efficacy (SE) has been found to be a robust predictor of success in achieving physical activity (PA) goals. While much of the current research has focused on SE as a trait, SE as a state has received less attention. Using day-to-day measurements obtained over 84 days, we examined the relationship between state SE and PA. Postmenopausal women (n = 71) participated in a 12-week PA intervention administered via cell phone and monitored their daily PA using a pedometer. At the end of each day, they reported their state SE and number of steps. Using a longitudinal model, state SE was found to be a robust predictor of PA even after accounting for trait SE and other covariates. The findings offer insights about the temporal relationship between SE and PA over the course of an intervention, which can be of interest to researchers and intervention designers.

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.

A walking intervention for postmenopausal women using mobile phones and Interactive Voice Response.

We conducted a feasibility study of a 12-week walking intervention administered through an Interactive Voice Response (IVR) system and mobile phones. We also examined the added benefit of a human coach. Post-menopausal women (n = 71) were given a daily-steps goal, which they monitored using a pedometer. Each day, they answered an automated call from the IVR system to their mobile phone and provided assessments of walking goals and mood. Every evening, they called the IVR system to report their steps, answered a brief questionnaire and received a message with a helpful hint. Participants took less time to complete a one-mile walk after the intervention, compared to baseline (0.77 min, SE = 0.22, P < 0.001). In addition, a significant loss in body weight (0.93 kg, SE = 0.31) and body-mass index (0.28 kg/m(2), SE = 0.11) were observed. The key psychometric measures of exercise goal setting (0.67 units, SE = 0.12) and exercise planning (0.48 units, SE = 0.09) also improved from baseline (both P < 0.001). However, results in the coach and no-coach conditions were not significantly different. The study suggests that mobile phones can be used to deliver an effective, low-cost walking intervention, irrespective of the addition of a human coach.

Social support and companionship among active African American women.

OBJECTIVE: To examine the role of physical activity (PA) companions in supporting PA participation among African American women. METHODS: Data were collected through in-depth interviews and focus groups. Fifteen physically active African American women participated in the study. Grounded theory data analysis techniques were used to develop a taxonomy depicting roles of PA companions for African American women. RESULTS: PA companions functioned in 4 different roles: motivational, social, facilitative, and instructional. Supportive behaviors associated with each role were also elucidated. CONCLUSIONS: These findings provide an understanding for the function of companions in sustaining active lifestyle that can be used to inform intervention development.

Developing long-term physical activity participation: a grounded theory study with African American women.

Regular physical activity is linked to a reduced risk of obesity and chronic disease. African American women bear a disproportionate burden from these conditions and many do not get the recommended amount of physical activity. Long-term success of interventions to initiate and maintain a physically active lifestyle among African American women has not been realized. By clearly elucidating the process of physical activity adoption and maintenance, effective programming could be implemented to reduce African American women's burden from chronic conditions. In-depth interviews were conducted with physically active African American women. Grounded theory, a rigorous qualitative research method used to develop theoretical explanation of human behavior grounded in data collected from those exhibiting that behavior, was used to guide the data collection and analysis process. Data derived inductively from the interviews and focus groups guided the development of a behavioral framework explaining the process of physical activity evolution.

Effects of low-dose mindfulness-based stress reduction (MBSR-ld) on working adults.

Mindfulness-based stress reduction (MBSR) has produced behavioral, psychological, and physiological benefits, but these programs typically require a substantial time commitment from the participants. This study assessed the effects of a shortened (low-dose [ld]) work-site MBSR intervention (MBSR-ld) on indicators of stress in healthy working adults to determine if results similar to those obtained in traditional MBSR could be demonstrated. Participants were randomized into MBSR-ld and wait-list control groups. Self-reported perceived stress, sleep quality, and mindfulness were measured at the beginning and end of the 6-week intervention. Salivary cortisol was assessed weekly. Significant reductions in perceived stress (p = .0025) and increases in mindfulness (p = .0149) were obtained for only the MBSR-ld group (n = 22). Scores on the global measure of sleep improved for the MBSR-ld group (p = .0018) as well as for the control group (p = .0072; n = 20). Implications and future research are discussed.

Aerobic exercise improves cardiorespiratory fitness but does not reduce blood pressure in prehypertensive African American women.

OBJECTIVE: To determine the effectiveness of a 10-week aerobic exercise training intervention on blood pressure, cardiorespiratory fitness, and workload in African American women with prehypertension. DESIGN: After we obtained informed consent and medical clearance, each participant underwent baseline measurements, an aerobic exercise-training regimen, and postintervention assessments. SETTING: This investigation took place in Columbus, Ohio, on the campus of The Ohio State University. PARTICIPANTS: Twelve sedentary African American women with prehypertension volunteered to participate. INTERVENTIONS: Study participants trained three days per week for 30 minutes per session at an intensity of 70% maximal oxygen consumption (VO2 peak) for 10 weeks. MAIN OUTCOME MEASURES: Blood pressure, cardiorespiratory fitness, and workload achieved. RESULTS: Exercise training resulted in a significant improvement in cardiorespiratory fitness and workload capacity. However, no significant reductions in blood pressure were seen after the 10-week aerobic exercise period. CONCLUSIONS: Ten weeks of 30 minutes of aerobic exercise, three times a week at 70% VO2 peak, is a sufficient stimulus to improve cardiorespiratory fitness and workload achieved. However, this exercise regimen was not adequate in eliciting a simultaneous reduction in systolic, diastolic, or mean arterial blood pressure in this cohort of prehypertensive African American women. Additional studies are needed to determine specific exercise protocols that would be effective in lowering blood pressure in various populations. These exercise protocols may vary across ethnicity, sex, and disease status.

Physical activity, exercise, and sedentary behavior in college students.

The authors examined the relationship between physical activity, exercise, and sedentary behaviors in 493 college students who were enrolled in 10 conditioning activity classes and had completed questionnaires at the beginning of the course. They analyzed sedentary activities and indicators of participation in exercise and physical activity by demographic variables. Surveyed men reported greater participation in physical activity and exercise than did women, and they also spent more time watching television/videos and using the computer. Older students were more likely to report more computer use, whereas younger students scored higher on several physical activity indicators. Of the sedentary behaviors, only computer use for men and television watching for women were negatively correlated with exercise and physical activity. In addition to accessibility and reinforcing properties of sedentary activities, the gender-related relationships between sedentary and active behaviors should be considered in designing interventions to promote exercise in this population.

The effects of land vs. aquatic plyometrics on power, torque, velocity, and muscle soreness in women.

The purpose of this study was to compare changes in performance indicators (power, torque, and velocity) and muscle soreness between plyometric training on land and in water. Thirty-two college age women were randomly assigned to 8 weeks of an identical plyometric training program on land or in an aquatic setting. Performance indicators were assessed pretraining, midtraining, and posttraining. Muscle soreness (ordinal scale) and pain sensitivity (palpation) were assessed after a training bout (0, 48, and 96 hours) during the first week of training and when training intensity was increased (weeks 3 and 6). Performance indictors increased for both groups (pretraining < midtraining < posttraining, p < or = 0.001). Muscle soreness was significantly greater in the land compared to the aquatic plyometric training group at baseline and each time training intensity was increased, p = 0.01. Aquatic plyometrics provided the same performance enhancement benefits as land plyometrics with significantly less muscle soreness.

Ratings of perceived exertion are not influenced by exercise stage of change in physically active college students.

Comparisons of ratings of perceived exertion based on fitness have been equivocal but have not accounted for recent exercise history. The purpose of this study was to test mean differences in ratings of perceived exertion among individuals of differing exercise histories as measured by exercise stage of change. Participants completed questionnaires to measure exercise stage of change and physical activity [preparation stage (n=32), action stage (n=31), and maintenance stage (n=41)]. Ratings of perceived exertion were measured during a graded maximal exercise test. Individual regression equations were computed to estimate the ratings for 50%, 60%, 70%, and 80% of VO2 max. There were no significant differences in the ratings across the preparation, action, and maintenance stages. Therefore, the hypothesis that recent exercise history would influence ratings of perceived exertion during an aerobic fitness test was rejected.

A Prospective Evaluation of the Effects of a 12-Week Outpatient Exercise Program on Clinical and Behavioral Outcomes in Patients with Epilepsy.

Purpose. We hypothesized that patients randomized to an exercise program would demonstrate a measurable improvement in behavioral outcomes with no adverse clinical outcomes, as compared with control patients.Methods. This randomized, prospective, parallel, and controlled study spanned 12 weeks. Twenty-eight patients were randomized either to participate in a supervised exercise program (Exercise) or to continue their current level of activity with no planned intervention (Control). The Exercise group worked with an exercise physiologist three times per week. At specific intervals, behavioral (QOLIE-89, POMS, PSDQ, Self-Esteem) and clinical (seizure activity, antiepileptic drug (AED) concentrations) outcomes were measured.Results. Twenty-three patients completed the study (Exercise n = 14, Control n = 9). Of the four patients in the Exercise group with active seizures, two had no change, one had an increase, and one had a decrease in seizure activity. Of the three patients in the Control group with active seizures, one had no change, one had an increase, and one had a decrease in seizure activity. In all patients, there was <26% coefficient of variation in AED concentrations over the 12-week study, suggesting little or no impact of the exercise intervention. The overall quality of life and two domain scores improved from baseline to Week 12 in the Exercise group (P = 0.031), while the Control group score did not change (P = 0.943). In the Exercise group, there were several measures of physical self-concept and vigor that improved and total mood disturbance decreased from the beginning to the end of the program.Conclusion. This is the first randomized, controlled study of exercise in patients with epilepsy. Behavioral outcomes are positively influenced by moderate exercise and there is no impact on seizure frequency. This suggests that exercise should not be discouraged in the care of epilepsy patients. The ability to offer an exercise program adds a health promotion component to the current plan of care provided by our comprehensive epilepsy program.