Perceptions of a comprehensive physical activity behavior intervention among endometrial cancer survivors with obesity. A qualitative study.

Purpose: Evaluate perceptions of a 12-week in-person physical activity intervention for endometrial cancer survivors with obesity. Methods: Sixteen endometrial cancer survivors (Age: 64 ± 8 yrs) with obesity (BMI: 34 ± 8 kg·m-2) who completed a 12-week comprehensive physical activity program completed semi-structured interviews regarding perceptions of physical activity participation. Transcripts were analyzed using thematic analysis and were confirmed by multiple authors. Results: Emergent themes (and subthemes) were: 1) Routine physical activity (Walking, Chores), 2) Motivations for physical activity (Social, Independence, Health, Family, Weight), 3) Barriers to physical activity (Weather, Pain, Fatigue, Family Stress), 4) Motivation to 12-week program adherence (Social, Fun, Caring, Structure, Shared Experiences), 5) Perceived benefits of the program (Social, Self-efficacy, Activities of Daily Living, Body Composition, Well-being, Health), and 6) Feedback about the 12-week program (Timing, Setting, Exercise Modes, Incentives, Instructor, Learning). Conclusions: Socioculturally diverse cancer survivors with obesity who were able to complete a 12-week physical activity program emphasized the importance of maintaining independence, and being part of a fun, caring, and social environment for their ability to overcome fatigue, pain, and family stresses to adhere to the program. Participants discussed myriad health and wellness benefits, and wished the program were more robust. Implications for Cancer Survivors: Low-burden exercise programs can confer meaningful health and wellness benefits for cancer survivors. To maintain adherence, programs should emphasize social cohesion and exercises to help maintain independence. Instructors should express caring support while also making classes fun, while emphasizing body composition instead of weight loss.

Exploring the Association Between the Healthcare Design Elements and Physician Well-Being: A Scoping Review.

PURPOSE: To evaluate the association between elements of the built environment and physician well-being using a scoping review. BACKGROUND: Physicians currently report low work satisfaction, high burnout and depression. The built environment has been shown to affect well-being in the general population, but its relationship to physician well-being is not well understood. Gaining a better understanding of this relationship will allow for better evidence-based design for physician well-being. METHODS: A scoping review of the literature was conducted of Scopus and PubMed databases using key words for (1) environmental variables such as "environmental design"; (2) physician terms, such as "doctor"; and (3) outcome measures of well-being, such as "burnout." Studies were included if they had at least one measure of the built environment and one measure of physician well-being. Of 1,723 abstracts screened, 146 full-text articles were reviewed, leaving 16 articles to be included for data extraction. RESULTS: Included studies were from all around the world, except for, notably, the United States. Robust interpretation of the data was challenging because of the lack of standardization in the assessment of environmental factors and physician well-being. Excessive noise was the variable most linked to well-being. Suitable surroundings, including lighting, furniture, and art, were also linked with satisfaction, but it was unclear whether there was an association with well-being. CONCLUSION: Understanding how environmental factors affect physician well-being is paramount but considerably understudied. Standardization of research approach should be developed in order to produce more robust research to create evidence-based designs for physician well-being.

Parkinson's Disease: Exploring Motives for Long-Term Adherence to a Group Exercise Program.

PURPOSE: The aim of this study was to explore why people with Parkinson's disease maintained attendance at a community group exercise program. DESIGN: Qualitative design was used for this study. METHODS: A purposive sample was used to recruit participants. Interviews with individual and focus groups collected narrative data that were interpreted using content analysis. FINDINGS: Eighteen participants enrolled in the study. Four themes emerged: (1) changing and challenging workout; (2) gaining strength, inspiration, and knowledge and doing it among friends; (3) professionals, not amateurs; and (4) holistic lasting benefit. CONCLUSIONS: For the participants in this study, exercising in a group among peers in an enjoyable, varied, and challenging program that was structured, socially supportive, and supervised provided incentive for maintaining attendance. CLINICAL RELEVANCE: Exercise is a life-long recommendation for everyone, including people with Parkinson's disease, for whom maintaining attendance is more challenging. The words of these participants encourage healthcare providers to consider the relevance of socialization, supervision, and structure when developing exercise programs for this population.

The effects of a novel bicarbonate loading protocol on serum bicarbonate concentration: a randomized controlled trial.

BACKGROUND: Previous studies have shown that sodium bicarbonate ingestion may enhance intense exercise performance, but may also cause severe gastrointestinal distress. The purpose of this study was to determine whether a modified sodium bicarbonate (SB) ingestion protocol would elevate serum bicarbonate concentration more than previous methods without causing gastrointestinal distress. METHODS: In randomized order, seven (5 men, 2 women) elite middle-distance runners ingested either placebo, Modified SB (600 mg·kg- 1 over 19.5 h), or Acute SB (300 mg·kg- 1) in opaque gelatin capsules. Baseline and post-ingestion blood samples were analyzed for bicarbonate, pH, sodium, hematocrit, and lactate. Repeated measures ANOVA (2 time points × 3 conditions) were analyzed to determine differences in serum bicarbonate, lactate, sodium, blood pH, and hematocrit. Gastrointestinal distress was assessed via self-report on a Likert scale of 1-10. Simple (condition) and repeated (time) within-participant contrasts were used to determine the location of any statistically significant main and interaction effects (p ≤ 0.05). RESULTS: Both Modified SB (7.6 mmol·L- 1, p < 0.01) and Acute SB (5.8 mmol·L- 1, p < 0.01) increased serum bicarbonate concentration compared to the placebo (p ≤ 0.05). Post-ingestion serum bicarbonate concentration was significantly higher for the Modified SB (34.7 ± 2.2 mmol·L- 1, 28.0% increase) trials than the Acute SB (33.5 ± 2.0 mmol·L- 1, 20.9% increase) trials (p = 0.05). There was no reported severe GI distress in the Modified SB trials, but two cases in the Acute SB trials. CONCLUSIONS: Modified SB elevated serum bicarbonate concentration more than Acute SB, without any severe gastrointestinal side effects. Consequently, it is recommended that future experimentation involving SB by researchers and athletes use the novel ingestion protocol described in this study due to its potential for improved effectiveness and reduced gastrointestinal impact. TRIAL REGISTRATION: ClinicalTrials.gov , NCT03813329 . Registered 23 January 2019 - Retrospectively registered.

What makes a group fitness program for people with Parkinson's disease endure? A mixed-methods study of multiple stakeholders.

OBJECTIVE: Identify key features of an enduring group exercise program for people with Parkinson's disease (PD) by exploring experiences of participants, student assistants and the exercise instructor through a convergent mixed methods design. METHODS: Fourteen people with PD (modified Hoehn & Yahr: 1-3.5) who regularly participated in a group exercise program (≥ 50% of classes for ≥ 1 year) were interviewed to explore their perceptions of the program. The exercise instructor was also interviewed and weekly written reflections were collected from 18 undergraduate student assistants. Using a grounded theory approach, interviews and written reflections were thematically analyzed via qualitative content analysis. Quantitative data from the Physical Fitness and Exercise Activity Levels of Older Adults Scale were used as part of a convergent mixed-methods design to move towards theory formation. RESULTS: Thematic analysis of the PD participant interviews revealed 4 themes: 1) Quality of the program, 2) Social interactions, 3) Facilitators to exercise, 4) Barriers to exercise. The exercise instructor interview revealed 2 themes: individualization and functionality of exercises, and creating a nurturing atmosphere. Themes from students' data included student learning, and positive in-class experiences. Means (sd) were 1.6 (0.5) for facilitators and 3.0 (0.5) for barriers subscales (1=strongly agree to 4=strongly disagree). CONCLUSION: These varied sources of data converge to identify and characterize key features of an enduring group exercise program for people with PD: a positive and nurturing environment, varied and individually tailored exercise content, and the importance of social cohesion. These findings also highlight the critical role of multiple stakeholders in fostering an environment that facilitates long-term adherence to group exercise.

Acceptability and feasibility of a Fitbit physical activity monitor for endometrial cancer survivors.

OBJECTIVE: Endometrial cancer survivors are the least physically active of all cancer survivor groups and exhibit up to 70% obesity. While studies suggest lifestyle interventions result in improved health outcomes, recruitment and availability of these programs are limited. The purpose was to evaluate the acceptability and validity of the Fitbit Alta™ physical activity monitor (Fitbit) for socioculturally diverse endometrial cancer survivors. METHODS: Thirty endometrial cancer survivors were given wrist-worn Fitbits to wear for 30 days. Participants then returned the Fitbits, completed the Godin Leisure-Time Exercise Questionnaire (GLTEQ), Technology Acceptance Questionnaire, and answered qualitative prompts. Correlations between daily Fitbit step counts, demographic factors, body mass index (BMI), and GLTEQ Index, were analyzed using Stata 13.0. Concordance Correlation Coefficient using U statistics was used to examine convergent validity. RESULTS: Twenty-five participants completed the study. Mean age was 62 ±â€¯9 years. Mean BMI was 32 ±â€¯9 kg·m-2. Self-identified race/ethnicity was 36% Hispanic, 36% non-Hispanic white, 16% non-Hispanic black and 12% Asian. Participants wore the Fitbits a median of 93% of possible days. Median daily Fitbit step count was 5325 (IQR: 3761-8753). Mean Technology Acceptance score was 2.8 ±â€¯0.5 out of 4.0. Younger (<65 years) and employed participants were more likely to achieve at least 6000 daily steps (p < 0.05). There was no correlation (CCC = 0.00, p = 0.99) between step count and GLTEQ Index. Most free responses reflected positive experiences. CONCLUSIONS: The Fitbits were well accepted in this sample. Self-reported physical activity was not associated with steps recorded. The physical activity data indicate an insufficiently active population.

Effects of Theory-Based Behavioral Interventions on Physical Activity Among Overweight and Obese Female Cancer Survivors: A Systematic Review of Randomized Controlled Trials.

PURPOSE: To determine whether theory-based physical activity (PA) interventions for overweight and obese female cancer survivors lead to increased PA and improved health. METHODS: This systematic review examined randomized controlled trials analyzing the impact of theory-based PA interventions on overweight and obese female cancer survivors through December 2016. Searches of 5 electronic databases revealed 10 articles that included 1351 participants who met the inclusion criteria. RESULTS: Participants were primarily non-Hispanic white (74%-100%) breast or endometrial cancer survivors. Intervention characteristics and PA assessment tools varied greatly. Adherence (68%-99%) and retention (79%-100%) were relatively high. Social cognitive theory was utilized as the theoretical construct in 9 of the 10 studies. Home-based interventions led to small improvements in PA (Cohen's d range = 0.25-0.31), whereas home-based plus center-based interventions led to moderate to large improvements (Cohen's d range = 0.45-1.02). Only three of the studies assessed psychosocial behavioral processes associated with PA, and the results were mixed. Health-related outcomes included improvements in aerobic fitness (Cohen's d = 0.32-1.1 in 5 studies), large absolute decreases in waist circumferences (>6 cm in 3 of 5 studies; Cohen's d = -0.31 to -1.02), and no change in inflammatory biomarkers (in 2 studies). Only one serious adverse event (pelvic stress fracture) was attributed to the interventions. CONCLUSIONS: Theory-based PA interventions are safe and feasible for overweight and obese female cancer survivors. Interventions that include a center-based component showed moderate to large effect sizes for PA. Future studies should evaluate behavioral variables and more health-related clinical outcomes.

Physical activity-related differences in body mass index and patient-reported quality of life in socioculturally diverse endometrial cancer survivors.

PURPOSE: The purpose of this study was to describe physical activity-related differences in body composition, quality of life, and behavioral variables among a socioculturally diverse sample of endometrial cancer survivors. METHODS: Ambulatory, English-speaking endometrial cancer survivors (6 months to 5 years post-treatment), who were residents of Bronx, NY, were recruited to complete questionnaires about physical activity (PA), quality of life (QoL), and psychosocial characteristics. Body weight and height were obtained from medical records to determine body mass index (BMI). ANOVA and independent sample t tests were used to determine differences between racial/ethnic groups and active versus insufficiently active, respectively. RESULTS: Sixty-two participants enrolled in the study. Recruitment rate was 7% for mailed questionnaires and 92% in clinic. Mean age was 63 ± 10 years. Sixty-five percent of the sample was obese (mean BMI: 34.2 ± 8.6 kg·m-2). BMI was significantly higher in non-Hispanic black women (37.8 ± 10.2 kg·m-2) than non-Hispanic white women (31.2 ± 7.8 kg·m-2; d = 0.73, p = 0.05). Forty-seven percent reported being physically active, with no differences by race/ethnicity. Physically active endometrial cancer survivors had higher QoL scores (d = 0.57, p = 0.02). There was a moderate effect size for BMI for the active (32.4 ± 5.6 kg·m-2) compared to the insufficiently active group (35.7 ± 10.2 kg·m-2; d = 0.40, p = 0.06). Walking self-efficacy was a significant predictor of physical activity (χ2 = 13.5, p = 0.02). CONCLUSIONS: Physically active endometrial cancer survivors reported higher QoL, lower BMI, and more positive walking self-efficacy. These data suggest that a physically active lifestyle has a benefit in socioculturally diverse endometrial cancer survivors.

Physical Functioning After 1, 3, and 5 Years of Exercise Among People With Parkinson's Disease: A Longitudinal Observational Study.

BACKGROUND AND PURPOSE: Regular physical activity is thought to be crucial to maintaining optimal physical function in people with Parkinson's disease (PWP), and it may have neuroprotective effects. As with many medical treatments, exercise is most effective when performed consistently over a period of years. The primary aim of this study was to examine multiyear adherence to a community-based group exercise program for PWP. A secondary aim was to document how physical functioning progressed after 1, 3, and 5 years for participants who consistently attended a community-based, group, exercise program. METHODS: Forty-six individuals with idiopathic Parkinson's disease, who were at modified Hoehn and Yahr stage I, II, or III and were community ambulators, were recruited on a rolling basis between 2008 and 2013. Each provided yearly medical clearance to exercise. Participants engaged in a free, community-based, group exercise program offered 2 days per week, 1 hour per day, for three 10-week sessions per year. The program included supervised floor exercises for balance, coordination, strength, and flexibility along with resistance training on dual-action exercise machines. Participants who attended more than half the classes for 1, 3, or 5 years (n = 27, n = 14, n = 7, respectively) were considered to have completed the fitness program (consistent exercisers) and were included in the longitudinal data analysis; participants who either dropped out or attended less than half the classes (n = 19) were not included. Physical functioning was evaluated at baseline for all participants and yearly thereafter for consistent exercisers. Wilcoxon signed rank tests were used to compare baseline data with data collected after 1, 3, and 5 years of consistent exercise. RESULTS AND DISCUSSION: Over half of the participants initially evaluated completed at least 1 year of the fitness program (27 of the 46 = 59%) and a proportion completed 3 years (14 of the 39 = 39%), and 5 years (7 of the 24 = 29%). At baseline, consistent exercisers were younger than those who dropped out (63.9 vs 69.9 years, P < .05), but had similar modified Hoehn and Yahr medians (2.0 vs 2.3), and similar time since diagnosis (8.0 vs 5.6 years). Consistent exercisers showed small statistically significant improvements in grip strength (8.9% change), Berg Balance scores (5.1% change), and 6-minute walk test (11% change) from baseline to year 1. No significant differences were found in these variables after 3 or 5 years, or for gait speed and timed up and go after 1, 3, or 5 years. CONCLUSION: Despite the progressive nature of Parkinson's disease, many PWP can sustain a regular program of varied modes of community-based, group exercise over a period of years. Participants who did so maintained initial performance levels on key measures of physical functioning. By working with an interprofessional team in a supportive community-based exercise program, physical therapists can help many PWP engage in consistent and sustained exercise activity over multiyear periods.

Feasibility of a physical activity intervention for obese, socioculturally diverse endometrial cancer survivors.

PURPOSE: Determine the feasibility of a 12-week physical activity intervention for obese, socioculturally diverse endometrial cancer survivors and to evaluate whether the intervention improves physical activity behavior, physical function, waist circumference, and quality of life. METHODS: Obese endometrial cancer survivors from Bronx, NY were assigned to either a 12-week physical activity intervention of behavioral counseling, physical activity and home-based walking (n=25), or wait-list control group (n=15). Mixed-design ANOVA (2 groups×2 time points) were analyzed to determine differences between the intervention and the control for the Yale Physical Activity Survey, six-minute walk test, 30-second chair stand test, waist circumference, and Functional Assessment of Cancer Therapy-Endometrial questionnaire. Data are presented as mean±standard deviation. RESULTS: The sample was diverse (38% non-Hispanic black, 38% Hispanic, 19% non-Hispanic white). Mean Body Mass Index was 37.3±6.5kg·m(-2). Although recruitment rate was low (20% of 140 contacted), 15 of 25 participants in the intervention group attended 75-100% of scheduled sessions. Participants reported walking 118±79min/week at home. There were large effect sizes for the improvements in the six-minute walk test (22±17m vs. 1±22m, d=1.10), waist circumference (-5.3±5.3cm vs. 2.6±6.7cm, d=-1.32), quality of life (10±12 vs. -1±11, d=0.86) and walking self-efficacy (24±30% vs. 1±55%, d=0.87) compared to the control group. CONCLUSIONS: The intervention appeared feasible in this population. The results show promising effects on several outcomes that should be confirmed in a larger randomized control trial, with more robust recruitment strategies.

Physical activity for an ethnically diverse sample of endometrial cancer survivors: a needs assessment and pilot intervention.

OBJECTIVE: To determine the physical activity (PA) behavior, needs and preferences for underserved, ethnically diverse women with a history of endometrial cancer (EC). METHODS: Women with a history of EC (41 non-Hispanic black, 40 non-Hispanic white, and 18 Hispanic) completed a needs assessment during their regular follow-up appointments at Montefiore Medical Center in Bronx, NY, USA. An 8-week pilot PA intervention based on the results of the needs assessment was conducted with 5 EC survivors. RESULTS: Mean body mass index (BMI) among the 99 respondents was 34.1±7.6 kg/m², and 66% did not exercise regularly. Self-described weight status was significantly lower than actual BMI category (p<0.001). Of the 86% who were interested in joining an exercise program, 95% were willing to attend at least once weekly. The primary motivations were improving health, losing weight, and feeling better physically. Despite the high interest in participation, volunteer rate was very low (8%). However, adherence to the 8-week pilot PA intervention was high (83%), and there were no adverse events. Body weight decreased in all pilot participants. CONCLUSION: These data show that ethnically diverse EC survivors have a great need for, and are highly interested in, PA interventions. However, greater care needs to be taken to assess and identify barriers to increase participation in such programs.

Development and Evaluation of the Curriculum for BOLD (Bronx Oncology Living Daily) Healthy Living: a Diabetes Prevention and Control Program for Underserved Cancer Survivors.

Underserved minority communities have few resources for addressing comorbidity risk reduction among long-term cancer survivors. To address this community need, we developed and piloted the Bronx Oncology Living Daily (BOLD) Healthy Living program, the first known diabetes prevention and control program to target cancer survivors and co-survivors in Bronx County, NY. The program aimed to facilitate lifestyle change and improve health-related quality of life (HRQoL) through weekly group nutrition education (60-90 min) and exercise (60 min) classes. We examined baseline characteristics of participants using simple descriptive statistics and evaluated program implementation and impact using the Reach, Efficacy, Adoption, Implementation and Maintenance (RE-AIM) framework. The curriculum, which drew from the social-ecological framework and motivational and cognitive behavioral strategies, consisted of 12 culturally and medically tailored modules with options for implementation as a 12- or 4-week program. Seven programs (four 12 weeks and three 4 weeks in length, respectively) were implemented at five community site locations. Sixty-six cancer survivors and 17 cancer co-survivors (mean age 60.5 ± 10.2 years) enrolled in one of the programs. Most participants were female (95.2 %) minority (55.4 % black, 26.5 % Hispanic/Latino) breast cancer survivors (75.7 %). Median program attendance was 62.5 % and did not significantly differ by program length; however, 67.3 % of participants achieved ≥60 % attendance among the 12-week programs, compared to 41.9 % among the 4-week programs, and this difference was statistically significant (p = 0.02). Overall, participants reported significant pre/post improvements in perceived health as good/excellent (66.0 to 75.5 %; p = 0.001) and borderline significant decreases in perceived pain as moderate/severe (45.5 to 38.2 %; p = 0.05). More than 90 % of participants reported that the program helped them to achieve their short-term goals, motivated them to engage in healthier behaviors, and felt that the nutrition and exercise classes were relevant to their needs. These results indicate that a short-term lifestyle intervention program for adult cancer survivors was acceptable in our community and motivated cancer survivors to improve their HRQoL. The curriculum can be used as a tool to facilitate development of similar programs in the future.